Care Home: Ashleigh

What the care home does well Ashleigh provides support to people with dementia. The staff are very familiar with each persons care needs and this means that their approach is personalised. The people living at the home appear to be settled and contented. The atmosphere is calm and homely. The owner is actively involved in the management of the care home and is supported by a manager and two deputy managers. The staff group are well trained and skilled and many staff have worked at Ashleigh for a number of years. The surveys received were positive about all aspects of the care and practice at Ashleigh. Comments included: `There are only 11 residents and I feel that we get quality time with each individual. I feel that we get quality time with each individual. I feel that we do have enough staff and all residents needs are met.` `My manager and an assistant manager are on call and we ring them anytime, they also work on care and are very approachable as are all the staff.` `The induction was very thorough and covered everything I needed to know. I have been asked what courses I would like to attend and my name has been put forward.` `Ashleigh helps to support people, but still gives them independence and makes sure they are safe.` The staff carry out all duties and this can cause frustration for some staff. One comment made was: `Sometimes I find more time is spent on day to day chores in the home rather than giving the residents quality time.` The owner recognises the impact of staff shortages and has employed a number of staff who can work at times to cover any staff absences. The staff have regular opportunities to meet as a team and have one to one supervision and this provides opportunities to discuss any issues. What has improved since the last inspection? The admission and care planning procedures have been improved by the use of the Deprivation Of Liberty Safeguards, this is a way of ensure that people who may lack the capacity to make decisions for themselves have their rights protected. The inclusion of relatives in the care planning process and the gathering of social histories, has provided a good opportunity to involve relatives and friends in the process of making sure that the persons individual needs and life experiences are understood. All care plans were up to date and have been reviewed regularly. The health needs of people at the home continue to be promoted. The recording of important information for hospital staff should an admission occur is a good idea, and the regular review and update of this information is part of this process.The arrangements for the storage and administration of medication have been improved. The owner and manager are active in securing good outcomes for people who live at Ashleigh and enabling them to continue to be active both in and outside of the home. All staff have current Criminal Record Bureau disclosure checks. The staff handbook has been revised to include key policies. The introduction of a questionnaire for relatives of people at the home has provided some good ideas and an opportunity to involve people in the development of the care home. What the care home could do better: The home was found to be meeting or exceeding the National Minimum Standards, which are good practice guidelines which are underpinned by legal requirements, assessed during this key inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashleigh 17 Beech Grove Ashton Preston Lancashire PR2 1DX     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: Felicity Lacey     Date: 1 2 0 5 2 0 0 9 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. 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. 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 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Ashleigh 17 Beech Grove Ashton Preston Lancashire PR2 1DX 01772723380 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Gillian Wilcock care home 11 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 11 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 11 Date of last inspection Brief description of the care home Ashleigh is a care home that specialises in providing personal care services for people with dementia who can be over or under the age of 65. The home is registered for eleven persons of either sex. The proprietor of the home is involved in daily management activities and is supported in her duties by a manager and two deputies. Ashleigh is situated on a quiet road, within easy reach of all local services and amenities. The home is arranged over two floors and is served by a passenger lift. Accommodation comprises of eleven single rooms, two lounge areas and a dining area. There is a pleasant enclosed garden at the side and rear of the premises and a car parking area for visitors. The home has established links with health support and social services. The proprietor and staff are experienced and skilled in providing specialist care for older people with dementia, and are committed to involving the residents and Care Homes for Older People Page 4 of 25 Brief description of the care home their representatives in the planning and delivery of care. Information about current fee levels can be obtained from the manager of the home. Care Homes for Older People Page 5 of 25 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: This inspection included an unannounced visit to Ashleigh. Prior to the visit information was provided by the owner and manager of the home in an Annual Quality Assurance Assessment (AQAA), this is a record of how the service provided at Ashleigh meets the standards set out in law and good practice guidance. Surveys were sent out to people living at the home and staff. During the visit people who live at Ashleigh, staff, the manager and the owner were spoken with. Ashleigh was last inspected on 15 May 2007 and an Annual Service Review was completed on 15 May 2008. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? The admission and care planning procedures have been improved by the use of the Deprivation Of Liberty Safeguards, this is a way of ensure that people who may lack the capacity to make decisions for themselves have their rights protected. The inclusion of relatives in the care planning process and the gathering of social histories, has provided a good opportunity to involve relatives and friends in the process of making sure that the persons individual needs and life experiences are understood. All care plans were up to date and have been reviewed regularly. The health needs of people at the home continue to be promoted. The recording of important information for hospital staff should an admission occur is a good idea, and the regular review and update of this information is part of this process. Care Homes for Older People Page 8 of 25 The arrangements for the storage and administration of medication have been improved. The owner and manager are active in securing good outcomes for people who live at Ashleigh and enabling them to continue to be active both in and outside of the home. All staff have current Criminal Record Bureau disclosure checks. The staff handbook has been revised to include key policies. The introduction of a questionnaire for relatives of people at the home has provided some good ideas and an opportunity to involve people in the development of the care home. 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.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 9 of 25 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 25 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. People are admitted to the home following a full assessment of their needs and capacity to make informed decisions, in this way staff can provide appropriate support and the rights of people at the home are promoted and protected. Evidence: Case files showed that people were visited before deciding to move to the home, and had their needs assessed. The manager explained that people may be assessed at home or at hospital. There were assessments from health and social services. The owner explained that in some cases after initial assessments it is decided that Ashleigh cannot meet the persons long term needs and a place is not then offered. Those people who completed questionnaires thought they had enough information to help decide if the home was the right place for them before they decided to move in. Staff spoken with were aware of the needs of the people living at the home and Care Homes for Older People Page 11 of 25 Evidence: explained that time is taken to get to know any new person. A key worker system is in place and part of the key worker role would be to work closely with the person and their family during the time of admission. The admission process has been improved by the implementation of the Deprivation of Liberty safeguards. All the people at Ashleigh have a diagnosis of dementia, some people will have limited capacity to make independent decisions, this is a way in which a persons rights can be protected and decisions can be shown to be made in a persons best interest. Care Homes for Older People Page 12 of 25 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 care planning arrangements in place are thorough and inclusive, this ensures that everyone involved agrees on how the identified care needs of the individual can be met. Evidence: All care plans at Ashleigh have recently been fully reviewed and considered in line with new legislation designed to safeguard the rights of people who may not be able to make their own decisions. The staff have worked hard to ensure that peoples care plans are accurate and show how the person is to be supported and care to be provided. the care plans have been devised in consultation with the person themselves if possible or most usually with their relative or representative. The new approach has allowed relatives to be fully involved in the process. Any changes to the care plan are highlighted in red, giving a clear message that this important information is new. Relatives have been consulted with about how often they wish to be part of the care plan review. In response to their answers they will Care Homes for Older People Page 13 of 25 Evidence: meet with the management team and the key worker every three months to review the plan. If there are any changes in between times a note is left for the relative to look at the updated plan. The plans seen were helpful and accurately reflected the personality and needs of the people at the home. The staff were seen to be following the care plans in place, for example when one person was trying to touch a light fitting staff successfully diverted her attention to another safer activity. The care plans contain a useful hospital admission information sheet. This sheet contains relevant details that would be required by hospital staff, there was evidence that these sheets were regularly reviewed to ensure that all information was kept up to date. The records seen at the home showed that peoples health needs were met. Medical advice and consultations are arranged when needed. People who completed surveys felt that medical support was always provided when needed. Particular attention is paid to the mobility needs of people who live at Ashleigh, an example of this is a recent request for an assessment for a wheelchair to allow a person to go out of the home, the person currently uses a frame within the home but is not able to use this safely outdoors. In other cases where falls have occurred there has been very prompt action to try and find the cause and any required treatment. The medication storage and administration systems at the home have improved. The introduction of colour coding on the sheet which is used to record medications given, provides an additional prompt to ensure that medication is given correctly. Staff spoken with confirmed they had received training and updates in safe administration of medications.The manager carries out regular audits of the medication records and medications held at the home. The importance of respecting the privacy and dignity of people living at the home was evident in staff practices. The people living at Ashleigh appeared to be comfortable and settled in their surroundings and to enjoy good relationships with staff who support them. Care Homes for Older People Page 14 of 25 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. People are provided with activities based on their individual needs and an understanding of their social history and this helps promote a sense of wellbeing. Evidence: There is a range of activities available in the home. These include arts and crafts, reminiscence sessions, bingo and listening to music. The people at the home have limited verbal communication skills and can find it difficult to settle at an activity. During the visit to Ashleigh some people were listening to music, some people were in another lounge watching a TV programme, one person was having her nails done, and a couple of people were wandering together in between rooms. The care plans include a social history of the person. This information is gathered through family and friends and provides an insight into the life experience of the people who currently live at the home. This is particularly relevant for people who may not be able to tell staff about their past experiences and interests. There was evidence that peoples cultural and religious preferences were respected and followed. The staff have recently re-established regular contact with the local Catholic church following the admission of a person who has been a practising catholic during her life, to enable Care Homes for Older People Page 15 of 25 Evidence: her to continue to follow her faith. The people all showed signs of well being and showed interest in their surroundings. Some people have lost their capacity to communicate verbally but they were relaxed and gave positive facial gestures and responses, others chatted away happily and occasionally sang. Ashleigh does not organise trips out of the home. Relatives take people out and the staff sometimes take people along to the local shops. Most of the people living at the home have a relative or friend, however there are several people who have no visitors and it is important that special efforts are made to ensure these people get the opportunity to go out in the local community. Relatives and friends are able to visit at any reasonable time. There was good evidence of staff supporting people to maintain their family relationships whilst at Ashleigh. The owner and manager have been active in meeting with each persons relatives and representatives when revising the care plans. There has also been a questionnaire completed by relatives which has then been discussed and acted upon. These are good examples of the involvement of relatives and friends in ensuring the care provided meets the needs and expectations of the people living at Ashleigh. The meals at the home are prepared by staff. Staff spoken with confirmed they had enough time to carry out their duties, including meal preparation. The menus are based on the preferences and dietary requirements of the people who live at the home. Meal times are flexible. Some people require assistance and this is provided discretely. Snacks and drinks are available throughout the day. The weights and dietary intake of people are monitored in line with their care needs. Care Homes for Older People Page 16 of 25 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, which were understood by staff. Evidence: There have been no recorded complaints over the past 12 months. There was evidence on peoples daily records that when issues have been raised these have been listened to and sorted out. Surveys completed by people and their relatives indicate that staff always listen and respond. The owner and manager have been active in gaining the views of relatives and friends. Staff spoken with explained how they would deal with any concerns or complaints. The complaints procedure is included in the written information provided by the home for current and prospective residents. Some staff have completed safeguarding training as part of their National Vocational Qualification (NVQ) studies. The policy of the home is included in the staff handbook as a key policy all staff must be familiar with. This is also covered in the induction of new staff. The Whistle blowing policy is also included in the staff handbook. Care Homes for Older People Page 17 of 25 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. Ashleigh provides a safe and comfortable home that is well maintained and decorated and furnished to a good standard. Evidence: The home is clean and well presented. There is a lounge which has a TV and comfy seating, and a lounge/dining room. People were using both communal seating areas and moved freely around the home. There is a lift between floors. There is a seating area to the rear of the property. There has been ongoing refurbishment and decoration. The surveys received confirmed that the home is always fresh and clean. Staff carry out cleaning duties. There is a schedule in place to make sure that all areas are kept clean and tidy. Staff spoken with confirmed that they had sufficient time to carry out cleaning duties. There are infection control measures in place. Staff have received training in infection control and guidance is given during the induction of new staff. Care Homes for Older People Page 18 of 25 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. A settled, competent and well trained staff team provide a personalised package of support to the people living in the home. Evidence: The staffing levels at the home are good. There are many long standing staff members who know the people living at the home and their relatives and friends well. The small size of the home allows for a high level of individual contact day to day between staff and residents. The surveys completed indicated that staff were available when needed and always listened and acted on what was said. The staff spoken with enjoyed working at the home and felt that it provided a homely and family like atmosphere. The owner has recruited a bank of staff who are able to cover staff absences and provide additional staffing when needed. Staff confirmed they were given encouragement to attend further training and felt supported by the manager and the owner. 90 of staff have achieved a National Vocational Qualification (NVQ) in Care, this is the recommended qualification for people who work in social care. The manager is to conduct an audit to ensure mandatory health and safety training is up to date. NVQs do provide additional qualifications, such as First Aid, but these will need to be renewed periodically. Care Homes for Older People Page 19 of 25 Evidence: The staff recruitment files contained the required references and Criminal Record Bureau Disclosures. Staff spoken with confirmed that they had completed application forms and been interviewed for their current job. Evidence was seen on staff files of thorough induction programme. This includes practical information, health and safety topics and professional guidance. Care Homes for Older People Page 20 of 25 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 service is well run and a high level of consultation with people which means that people using the service can contribute to its development. Evidence: The owner of the home is a qualified social worker, she has also completed a NVQ level 4 in Management and Care. She is actively involved in the operation of the care home. There is a manager who is qualified and she is supported by two deputy managers. The management team is seen as effective and inclusive. Staff feel well supported in their roles. Ashleigh has retained its Investor in People Award which is an independent quality assurance scheme. The owner and manager have also now introduced a questionnaire which asks for peoples views and suggestions. These have been completed by some families and the results discussed. There have been some suggested improvements Care Homes for Older People Page 21 of 25 Evidence: and some decisions made on the feedback received, for example the idea of writing changes to the care plan in red came from a relative, and the frequency of full reviews was part of this questionnaire. People who live at Ashleigh have private arrangements in place for the management of their financial affairs. The home keeps records of small expenses, such as the hairdresser, but does not manage any money on behalf of residents. The was good evidence of support for people to access their funds, in one case these are administered by the Court of Protection and the manager liaises with the Safeguarding Adult Finance Officer of the Local Authority, to ensure the person has the funds required to meet her additional needs, such as for buying new clothes. Staff received regular formal supervisions. This is an opportunity to discuss professional issues and identify training needs. There is also an annual appraisal system in place, this enables staff to recognise their achievements over the past year and plan their continuing professional development. The health and safety of people living and working at the home is promoted by review of policies and procedures, training and regular up dates. The required maintenance and servicing of equipment has been carried out. The accident book was looked at and found to be correctly completed. The manager regularly reviews the accident book to enable any trends to be identified and any preventative action to be taken. Risk assessments are in place to ensure safe working practices. Care Homes for Older People Page 22 of 25 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 23 of 25 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 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 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. Care Homes for Older People Page 25 of 25 - 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!