Care Home: Ashleigh Manor

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What the care home does well The information available for prospective people using the service is detailed and comprehensive and gives sufficient detail for people to know what to expect from the service. People using the service were complementary about the kindness and caring attitude of the staff. They told us,`They take care of all my needs. Thanks to all the staff`. One relative told us ` They are very professional and have been very good in all they have done and always myself and other visitors are made most welcome and they have been open and honest with us`. People were complementary about the standard and choice of meals. People using the service told us the home provides `Very good meals with different meals each day` another told us that the home `Organise meals very well`. People using the service expressed confidence that any concerns would be addressed in an appropriate manner. Staff were able to tell us the procedure to follow should a concern be raised. This means that people using the service and staff have confidence in the procedures in place to protect people using the service. The management of the home and staff members have shown an ongoing commitment to staff training and undertaking National Vocational Qualifications to improve staff knowledge and improve standards of care. Quality Assurance audits have been undertaken and the responses audited to make changes to the home as identified. What has improved since the last inspection? Documents for recording pre admission assessments have been developed to include more detail. Prospective people using the service all receive a detailed pre admission assessment to establish that the home can meet their needs prior to inspection. Activity provision has been developed to encompass the majority of people using the service. The activity provision is person centered and addresses peoples social, cultural, religious and recreational interests. The writing of personal histories has been started, this is well written and provides staff with further insight into peoples choices and preferences. There has been an increase in the size of the home to include a total of 66 beds. The home has been refurbished to a good standard in most areas. The ongoing maintenance plan includes the areas identified as needing further upgrade. What the care home could do better: The registered manager is required to ensure that care plans are developed to include the detail of care to be provided. This will ensure that clear directions are available for staff and the care provided will be person centered. The care plans also need to be developed to include the input of people using the service or their relatives/representatives. This will ensure that people are in agreement with the plan of care in place. Further development is recommended for care plans to include a record of visiting health professionals to ensure a means to audit visits and easily access the information.It is also needed that all areas of risk are transfered to the care plan to enable a plan to be put in place to support staff to manage the risk safely and effectively. The management of recruitment was identified as having significant shortfalls. These shortfalls included procedures not being followed that should be undertaken to ensure the safety of people using the service. It was also identified that when staff start work at the home, a more prompt and robust induction should be developed. This will provide staff with a more formalised training when starting work at the home. We have also identified that supervison of new staff should also be recorded and further development of ongoing supervision should also be recorded. The management of hot water needs to be addressed to ensure that temperatures of water delivery are routinely monitored and recorded. This is required to ensure that there is no risk of burns and scalds to people using the service.The registered manager is recommended to audit all accidents monthly for trends which could be used to promote accident prevention. Key inspection report Care homes for older people Name: Address: Ashleigh Manor 1 & 3 Vicarage Road Plympton Plymouth Devon PL7 4JU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gail Richardson     Date: 2 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Ashleigh Manor 1 & 3 Vicarage Road Plympton Plymouth Devon PL7 4JU 01752346662 01752336233 loretta_severn@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Maureen Lawley,Miss Loretta Maher-Lawley Name of registered manager (if applicable) Mrs Maureen Lawley Type of registration: Number of places registered: care home 66 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 66. The registered person may provide the following category of service: Care home only Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category (Code OP) Dementia (Code DE) - maximum of 38 places, Physical disability (Code PD) - maximum of 38 places Date of last inspection 0 5 1 0 2 0 0 9 38 0 38 Over 65 0 66 0 Care Homes for Older People Page 4 of 36 Brief description of the care home Ashleigh Manor is a care home and was Registered for thirty eight people, however the new extension is now complete and the home is Registered for sixty-six people who may have dementia and/or physical disabilities. The home does provide a small number of short-term respite care. Mrs Maureen Lawley, who is the Registered Manager, and Ms Loretta Maher-Lawley currently own the home. The home is a large detached house set within its own grounds in the residential area of Plympton. It is close to local shops and amenities and public transport is easily available. All bedrooms except for seven are en-suite. The home has access for wheelchair users including three passenger lifts and two stair lifts and ramps to the garden. There is parking space available at the front and rear of the home and has a large garden to the rear of the property. The current fees range from 355.76 pounds to 505.95 pounds. However this may vary depending on individual need. Additional charges are made for personal items should as hairdressing. Care Homes for Older People Page 5 of 36 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: one star adequate 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 was an unannounced inspection, which took place over 2 days ( 14 hours ) on the 24th and 29th March 2010 by Regulation Inspector Gail Richardson. As part of this inspection, the term we will be used when referring to the Care Quality Commission). The home uses the term Clients when referring to people using the service. For the purposes of this report we refer to people living at Ashleigh Manor and Lodge as People using the service. The last key inspection was undertaken on the 8th April 2009 when a quality rating of 1 star adequate was made. A further random inspection was undertaken on the 5th October 2009. At this inspection there were 53 people currently residing at the home receiving personal care and dementia care. 36 people are in Ashleigh Manor and 17 people are in Care Homes for Older People Page 6 of 36 Ashleigh Lodge. The home has provided the Care Quality Commission with a completed AQAA ( Annual Quality Assurance Audit ) which was completed by the Registered Provider/ Manager and gives details of all aspects of the home. A tour of the home took place and all of the bedrooms and communal areas were seen. An Expert by Experience was also available for part of the inspection. An Expert by Experience is a person who, because of shared experience of using services and/or ways of communicating, visits the service with an inspector to help them get a picture of what it is like to live in the service. The Expert by Experience spoke with 8 people using the service and 3 visitors and spent time looking around the home and had lunch with people using the service. Also assisting the inspector was the Commissions Pharmacist Inspector who spent time looking at medication systems at the home and speaking with some staff. We spent time observing the care being provided. We spoke to 5 people using the service, 1 visiting health professional and 12 members of staff.The Registered Manager / provider was available throughout the inspection. As part of this inspection we surveyed the opinions of a random selection of people using the service and their representatives, GPs, District Nurses and Care Workers. The responses received are used in the body of this report. Records relating to care including 8 care plans, 6 staff files, finances and health and safety were examined The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: The registered manager is required to ensure that care plans are developed to include the detail of care to be provided. This will ensure that clear directions are available for staff and the care provided will be person centered. The care plans also need to be developed to include the input of people using the service or their relatives/representatives. This will ensure that people are in agreement with the plan of care in place. Further development is recommended for care plans to include a Care Homes for Older People Page 8 of 36 record of visiting health professionals to ensure a means to audit visits and easily access the information.It is also needed that all areas of risk are transfered to the care plan to enable a plan to be put in place to support staff to manage the risk safely and effectively. The management of recruitment was identified as having significant shortfalls. These shortfalls included procedures not being followed that should be undertaken to ensure the safety of people using the service. It was also identified that when staff start work at the home, a more prompt and robust induction should be developed. This will provide staff with a more formalised training when starting work at the home. We have also identified that supervison of new staff should also be recorded and further development of ongoing supervision should also be recorded. The management of hot water needs to be addressed to ensure that temperatures of water delivery are routinely monitored and recorded. This is required to ensure that there is no risk of burns and scalds to people using the service.The registered manager is recommended to audit all accidents monthly for trends which could be used to promote accident prevention. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 36 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 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider and manager ensure that prospective people using the service receive sufficient information prior to admission. An assessment is undertaken to ensure that each person admitted will be able to have their needs met at Ashleigh Manor. Evidence: The registered provider / manager provides each person and their representative, with a copy of the homes Warm Welcome Pack. This is a shorter document than the statement of purpose but gives an insight into the services provided by the home. This also includes a questionaire called Getting to know you.The home also provides an individual Statement of Terms and Conditions and contract that specifies the fees to be paid and the room to be occupied. The manager undertakes a pre admission assessment and includes the involvement of appropriate health professionals. Prospective people and their relatives may visit to Care Homes for Older People Page 11 of 36 Evidence: test run the service. We saw records of pre admission assessments undertaken and these showed that effort is made to establish the needs of each person prior to admission. The pre admission assessment forms have been developed and improved to enable more detailed information to be gathered. The homes Annual Quality Assurance Audit (AQAA) told us We encourage clients to visit and if possible stay for a meal.We encourage families to leave prospective clients with us to see if they really like us and would like to live here. The AQAA also tells us that the manager plans to develop the service by sending out letters of acceptance to people who are to move into the home. The Expert by Experience noted The people I spoke with about the information given, choices of lifestyle and routine appeared to be satisfied with these aspects and I received the following responses - Things seem to be going well, mum is settled and we are satisfied with things and The staff are very good they treat me with intelligence. Staff training records show that dementia care training is provided to support the care needs of people using the service. This is required to ensure that staff both individually and collectively have the skills and experience to deliver the services and care the home offers to provide. Where help is needed from visiting health professionals there was clear evidence that this is sought and instruction followed. The home provides respite care but does not provide intermediate care. . Care Homes for Older People Page 12 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need to be further developed to ensure that they provide staff with the detail they need to support person centered care for each person. People are cared for in a respectful and dignified manner. People receive their medicines in a safe way, as their doctor has prescribed for them. There have been improvements in the way medicines are handled in the home, but there are still some areas that need further improvement. Evidence: We looked at 8 care plans for people using the service. Considerable work has been undertaken to make the care plans concise and more accessible for staff. The home has developed a profile for people in some cases. These are very detailed and support the development of person centered care enabling staff to have insight into peoples past lives, preferences and choices. However, it was noted in each care plan we looked at, that more detail is needed to Care Homes for Older People Page 13 of 36 Evidence: ensure that the care plans are both person centered but also have sufficient detail to support staff to give the care needed. Areas such as personal care told the staff if the person needed help but did not give detail of the help needed. Care plans relating to behavior told staff the ranges of behavior but did not detail triggers or means to manage challenging behavior effectively. Care plans for night time give an outline of peoples preferences but did not give detail of how the person preferred their routine and needs to be met. The information in the persons profile was not transfered to the care plan to enable staff to have a reference of each persons specific preferences. Risk assessments have been undertaken. This information was not always transfered to the care plan to enable staff to be aware of how to meet the risks safely and effectively. This was seen in the risk assessments for skin care, with high risks being identified but the management of the risks not being included in the care plan. The input of visiting health professionals was evident, however the care plans did not include the specific instructions or advice provided by the health professionals to ensure a continuity of care provided. The care plans are reviewed monthly by staff and changes monitored. There was no evidence of input by people using the service of their relatives/representatives. This is recommended to ensure that people or their representatives are in agreement with the plan of care. It is recommended that the visits and instructions given by health professionals from outside of the home are recorded in each plan of care to ensure a clear audit trail of visiting health professionals. Specialist equipment was seen to be in place were there was an assessed need but care plans need to reflect why this is in place. The Expert by Experience observed I did have some concerns that many of the women did not have stockings or tights on and some of the footwear was not supportive or well fitting. When the Inspector and I spoke with the manager later and I raised this, she said that it was difficult to ensure people had them to wear, because families did not always provide them and the Home could not provide them. The Expert by Experience noted I feel that this situation was high priority to find a solution. We have been told subsequently by the manager that Many of our ladies do not choose to wear tights or stockings. Some wear slipper socks and, yes, some families do not supply clients with adequate tights and footwear. The Expert by Experience also noted I observed staff carrying out moving and handling and on one occasion the footplates were not raised when staff were helping the person out of the chair which looked very difficult and potentially dangerous for the person as well as the staff. This observation was fed back to the registered Care Homes for Older People Page 14 of 36 Evidence: manager at the inspection. We observed care being provided. We saw that people were treated with dignity and respect. Staff spoke to people respectfully and were seen to knock on doors before entering rooms. Each room has a lockable facility and people using the service can have a key to lock their room should they wish to. Staff training in dignity has been undertaken by a high percentage of staff at the home.People were seen to be supported to make choices and staff helped them to manage the choices. People appeared to be mostly well dressed and groomed. People have the choice of male or female staff to attend to their care needs and this is choice is recorded within their care plan. The Expert by Experience noted The Home appeared to be well staffed and the staff showed respect and concern for people as individuals and gave time to talk and to listen to them in very helpful ways. I observed one or two situations where staff were giving valuable reassurance and support to distressed people who had dementia they showed care and concern when doing this. People using the service told us if I dont know something I can always ask and staff are always very willing to give information or to find out for me. Some people have personal telephones in their rooms and the newer part of the home has Internet facilities in each bedroom. We saw that staff were encouraging and supporting independence with areas such as eating and drinking, mobility and personal care. It was clear that staff knew the people using the service well and despite the shortfalls in the care plans were providing a adequate level of care. We looked at arrangements for storing and giving medicines in the home. We checked the records that are held in the home for medicines given to people, and discussed how medicines are handled with the manager and other staff working in the home. We watched some medicines being given to people as part of the midday medicines round. We spoke to one person who looks after some of their own medicines. We found that there have been improvements to the way medicines are handled in the home since the previous inspection. There are new storage rooms and trolleys. There are more trained staff, and the way the medicines rounds are organised has been improved. A controlled drugs cabinet has been fitted in one of the rooms which means that controlled drugs are stored correctly and safely in this part of the home. However the new part of the home does not have a correctly fitted cabinet. It is a requirement Care Homes for Older People Page 15 of 36 Evidence: that controlled drugs are stored correctly and safely in line with current legislation. There are separate refrigerators for any medicines that need cold storage and the temperatures are monitored daily. It is recommended to record maximum and minimum temperatures to show that these medicines are always stored in the correct temperature range. It is also recommended to monitor room temperatures where medication is stored to help make sure they are stored at the correct temperature recommended by the manufacturers. This helps to ensure that medicines will be safe and effective for people. Clear records are kept of medicines received into the home, those given to people, and any unwanted medicines that are sent for destruction. These records help to show that people receive their medicines as their doctor has prescribed for them. Medicines charts are usually printed by the supplying pharmacy, but a few charts are handwritten. It is recommended to get all handwritten entries on charts double checked and signed by a second member of trained staff. This helps to minimise the risks of any errors. We looked at some peoples care plans to see what information is recorded about their medicines. We found information and risk assessments in some care plans but for others there was not much information recorded on peoples medicines. Detailed medicines policies and procedures are in place to help staff, and since the previous inspection there has been training provided for more staff. This has helped to improve the way medicines are given in the home. Care Homes for Older People Page 16 of 36 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. The home has developed an activity programme which enables peoples social, cultural, religious and recreational interests to be met. People are supported with contact with the community and are encouraged to make choices about their lives. Evidence: The home has an activity coordinator who is qualified in Art Therapy. Twelve hours per week are provided for the coordinator to organise and administer an activity program. Other staff are supported to continue the activities throughout each week. The activity coordinator has started to do a detailed life history for each person. There are very well done and provide staff with a detailed insight into peoples lives.They detail a time line of that persons life experiences and also include what is important to them and why. These histories are then used to develop activities in the home. We could see how peoples previous hobbies and interests are being transfered into activities at the home. There is a notice board which identifies planned activities and people have he opportunity for group or individual one to one time, this is clearly dependent on individual choice. Records are maintained of peoples activities and includes detail of how they enjoyed it ,this is then used to develop the activity further. Activities include Care Homes for Older People Page 17 of 36 Evidence: a regular sherry evening, cooking club,exercise classes , painting classes and further activities are also brought in from outside the home on a weekly basis. People using the service told us We have been planting a few seeds, I like gardening A small group of us have been having a Faith Meeting where we can share aspects of our Christian faith and read passages from the bible together - I find this opportunity very important for me. Another told us I like having my hair done and we have a hairdresser visits regularly, she is good. The Expert by Experience told us I spoke with the Activity Co-ordinator who seemed very committed to her work and enjoyed what she did, she had some very good ideas and told me I always plan activities for groups and for individuals and I focus on providing activities where I know people can achieve as well as enjoy them. She also told me that she alternated her work between the different levels of the Home each day, ensuring that those who had dementia and those who did not, all had the opportunity to engage in activities. By also working on the Care Staff at week-ends, she felt she was able to get to know people well and found this beneficial. I am sure she is a great support to people living in the Home enabling and facilitating people to pursue a range of activities and activities which they can enjoy. The Manager of the Home has a dog which spends time in the Home and we were told how much some of the people living in the Home enjoy this. We observed staff and people using the service chatting as they undertook tasks. The Expert By Experience noted I observed quite a lot of interaction between members of staff and people living in the Home which was good and The Home had a pleasant friendly atmosphere, with lots of space for people to move around in and small diningsitting rooms where they could choose to be. There appeared to be a good number of staff on duty, which would be necessary in order that people could be supervised and supported safely. People using the service told us I stay up late as I like to watch TV and I like to read and there is a selection of books I can choose from but I do get bored at times, really because I cant walk about very well these days. People have access to local churches and clergy also visit the home. All people are registered to vote should they wish to. Anybody who does not have a relative or representative can have access to an independent advocate. The home encourages links with families and have implemented a relative association group which met twice whilst the inspection was taking place. The home also has a staff member allocated to a liaison role with families. The home has further plan to look into dementia care mapping and developing a key worker system to further review the care provided. Care Homes for Older People Page 18 of 36 Evidence: The home has a new kitchen in place and meals are served in both units from hot trolleys. There is a smaller kitchen in the newer unit of the home which is not used for meal preparation at this time. The menus are a set six week menu but the cook told us that peoples preferences are included in the menu planning. There are ten different areas for eating and sitting, these include a designated dining area. We observed that breakfast was ongoing with people eating for most of the morning. Lunch was the main meal of the day with people being supported to eat and drink as needed. People who need more help are seated in a separate area with designated staff to support them. The manager told us that We have a special eaters policy to give poor eaters extra. The cook told us that specialist diets are catered for and that there is a choice for each meal. We looked at the menu and found that there was a main choice and then an alternative of jacket potato, salad or omlette each day. The evening meal is a lighter meal and snacks are available form the kitchen should people want them. The Expert by Experience observed I was unsure as to why drinks at lunchtime were served in plastic beakers as all other plates etc. were pottery. Most people at home would not normally use plastic beakers for their drinks. We have been told that plastic beakers have been used in some areas as people with dementia/confusion do drop them frequently causing smashed glass. Approximately 50 of people using the service have glass drinks glasses. There were several small dining rooms around the Home, allowing people to eat in small groups and where possible, with people of their choosing, which was good. The tables were covered in patterned oil-cloth covers; they looked good and would be easy to clean. Some of the tables had small artificial flower arrangements on them When I arrived at Ashleigh Manor breakfast had had been served much earlier, but there were still one or two people sitting at the table finishing their drinks and toast. Mid morning drinks were served at about 11-30am and people were given a choice of what they would like to drink. In the veranda area of the Home there were posters giving general information about meals and mealtimes on the walls, alongside posters of the menu for the week. This information was easily accessible for people to read although some of the print was rather small. The menus for the week displayed were varied. Some people I spoke with did know what was on the menu for the day, it was roast beef and people said how much they enjoyed this meal. People also told me there was always choice if you did not want the main meal. When I asked people for their opinions on the food and drinks provided most people were very satisfied with the quality, quantity and variety. Two ladies told me that they found difficulty in accessing drinks early in the morning and later in the evening and Care Homes for Older People Page 19 of 36 Evidence: that if something could be done to improve this it would be good. Another comment made was We are always the last to be served our meal at lunchtime and sometimes it is not as warm as it should be . I ate lunch on the veranda sharing a table with a group of five other people who all had varying degrees of dementia and memory loss. There was another similar table in the area and three people were sitting in easy chairs and using small tables to put their lunch on. The meal was served from a heated trolley, by the cook, but the manager was there to supervise along with a good number of staff. The tables were set with place mats cutlery and paper napkins and large plastic beakers for drinks. Staff served Lemonade or Orange juice to people giving them a choice of drink. Staff explained to people what food was available and they were able to choose what they wanted. Condiments, along with mustard and horseradish sauce were on the tables for people to help themselves to. The meals looked appetising and there was a good supply of fresh vegetables. Most people had the roast beef, but some people were having omelettes or jacket potatoes with a range of fillings and salad. I had a jacket potato with salad, when the man sitting next to me saw this, he asked if he could change his mind and have one to, this was not a problem and the man was duly served a jacket potato with cheese and salad. People were given a choice of two puddings and cheese and biscuits, some people had more than one pudding and also had the cheese and biscuits, the cheese and biscuits had a range of cheeses on the plate as well as some grapes. Most people ate a good proportion of their meal and after wards were served a cup of tea or coffee in a cup and saucer with milk and sugar added as they had requested. People were given support according to their need and encouraged to eat their meal, their was some general conversation and the meal did not seem to be hurried, it was pleasant and sociable occasion. Care Homes for Older People Page 20 of 36 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. The Complaints Procedure and Adult Protection Procedures are in place protect people using the service. Evidence: There has been two complaints received by the Care Quality Commission since the last inspection, both were investigated and the manager confirms were unsubstantiated. A complaints procedure is in place, and is included in the Service User Guide and displayed publicly, this details the timescale for initial responses people would be expected to have. The home undertakes a regular review of quality in the form of questionnaires and any issues arising from that are dealt with promptly. We saw some comments received which told us that people were confident that any issues raised would be addressed appropriately. Staff have a good understanding of the complaints and whistle blowing procedures and have undertaken adult protection training. They were able to tell us clearly the actions to be taken should an allegation of abuse be made. The homes policy regarding whistle blowing needs to be updated and amended to include external contact numbers should they be needed by staff. Care Homes for Older People Page 21 of 36 Evidence: The home has a copy of the safeguarding local policy and demonstrated a good understanding of the protocol and had been seen to use the process for the protection of people using the service. Care Homes for Older People Page 22 of 36 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. The home has undertaken extensive building and refurbishment work. The newer part of the building is decorated to a higher standard than the older part but maintenance is ongoing. The environment appears safe and appeared clean with infection control measures in place. Evidence: Ashleigh Manor is a large detached building, an extension has recently been opened which takes the total beds available to 66. To manage this number the home is in two units, Ashleigh Lodge and Ashleigh Manor. The Lodge is the newer unit and has been completed to a good standard.This unit is used predominantly for people with a lesser dependency of need. The Manor is the older part of the home and is finished to an adequate standard,ongoing maintenance was seen to be taking place. This unit is used for people who have assessed higher needs and levels of dependency. We have been told by the manager that sixteen bedrooms have been refurbished with new sinks, flooring, decorating and furniture with other bedrooms being decorated as necessary. There is ample communal space with ten small seated or dining areas available. Rooms contained lots of family pictures and evidence of hobbies and interests. Rooms without en suite facilities have a toilet/bathroom nearby. Equipment is supplied where there is an assessed need and stand aids and wheelchairs are accessible due to ramps and lifts allowing access to all areas. Some people had access to hi/lo beds and Care Homes for Older People Page 23 of 36 Evidence: pressure relieving equipment. Most areas are well signposted and some areas had handrails to support mobility. Some corridors appeared to have reduced lighting and appeared a little dark. All areas were warm and furnishings were seen throughout to be of a good standard. The Expert by Experience observed Some refurbishment-redecoration work appeared to be in the final stages of completion, particularly the veranda area, and when completed this should create an improvement to the environment. It would be important to check that the veranda did not get too hot for people in the summer months as there were no blinds at the time of my visit Lockable storage is provided in the rooms of the newer buildings but is not consistently available in the older building. It was noted that the wardrobes were not risk assessed and secured as needed. The manager confirmed that this was undertaken at the inspection. Communal areas were seen to be decorated with items for people to pick up and look at. These included games, ornaments, books, hats , stuffed animals, newspapers. Corridors had seating areas to encourage purposeful walking and all areas of the home are accessible to people using the service. Some bathrooms appear to be worn in places. The manager confirmed that maintenance is ongoing. Showers are available but are not adapted to take disability access easily. Some bedrooms were noted to have an offensive smell of urine, we are advised that these rooms were being refurbished. This was addressed by the carpets being removed. In some instances rooms have a water resistant floor covering to reduce the risk of odours. The systems in place for the risk of cross infection are suitable for people using the service, hand wash and paper towels are available in all bathrooms to prevent the risk of cross infection. The laundry area is large and well organised with peoples clothing and all linen being managed in house. Appropriate infection control measures are in place for contaminated laundry. The gardens are being developed and there are plans for a sensory garden. Smoking is only permitted outside of the home and staff are available to supervise people using the service to smoke should they wish. The home has sufficient parking available in the grounds of the service. Care Homes for Older People Page 24 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are staff in sufficient numbers most of the time to meet the needs of people using the service. There is an evident commitment to staff training . Recruitment procedures are not robust and must be followed to ensure the safety of people using the service. Evidence: The home measures the needs of people using the service and we are advised that the level of dependency is calculated to be reflected in the level of staffing at the service.There are aimed to be 10 staff on duty each morning over both units, 7 each afternoon and three waking staff overnight. There is also a head of care on duty. The registered manager and provider work each day at the home and are on call 24 hours a day. No agency staff are used. Staff told us that they felt there were sufficient numbers of staff each shift to meet the needs of people using the service. We looked at two weeks previous rotas and saw that staffing levels were variable and were affected by staff sickness and absence. People who visit the service told us that they felt that sometimes more staff would be a benefit to people using the service. The home employs nine domestic staff including a housekeeper and 3/4 cooks with 56 staff employed in total. People using the service who spoke with us were all very complimentary about the kindness of the staff. Quality Audits in the home contained several positive comments Care Homes for Older People Page 25 of 36 Evidence: about the staff. Two staff told us that the communication at the home was excellent and that they felt part of a team. One person using the service told us I get lots of help the staff are very good, my legs have gone, and I need help at night and staff are very good at night. Staff training is ongoing and there is evidence of a commitment by the management of the service to an ongoing training program. Staff training records were not up to date but staff told us that they received training in all mandatory areas. Further training in specific areas relevant to the people using the service was also provided. The home has designated trainers for moving and handling and abuse awareness. Staff are encouraged to undertake NVQ training. Currently 22 of the 53 staff employed have achieved an NVQ in Care. We looked at recruitment files of people employed at the service. The recruitment records were well ordered, however, the procedures in place were not consistently followed to ensure safe practice. All staff have a Protection of Vulnerable Adults Check (POVA) and a Criminal Record Bureau Check (CRB). We identified that on several occasions only one reference had been received. On one occasion no references had been received. Two appropriate references must be received prior to staff starting work at the home. The references must be signed and dated and the relationship to the referee clarified to ensure the reference is appropriate. Reasons for leaving previous employment must also be sought if the post was with vulnerable people. Some employment histories for were not fully completed and had gaps between employment which had not been recorded as explored and the reasons provided. Some employment histories were also very limited in timescale and are recommended where possible to be within the previous 10 years. This detail is recommended to provide a clear record of where people have been employed and establish their suitability for the post . When prospective staff are agreed to start work, the manager implements a trial day, this is a visit by the staff member to the home but has been clarified as not a working day. This was recorded as the persons start date and as a result was noted in some instances to have been before the POVA check had been returned. This practice must be reviewed to ensure that staff do not have contact within the service until all appropriate recruitment checks have been received. This is required to ensure that people using the service are not placed at risk. When staff members have received the POVA check but prior to the CRB check having been received, any staff member who starts work must be supervised at all times. The Care Homes for Older People Page 26 of 36 Evidence: home must undertake a system to record who the supervisor was. this will enable a clear audit trail of responsibility until all recruitment checks have been received. We saw induction records for staff at the home. this induction was in the form of a checklist which is signed and dated. The manager is recommended that this induction is completed when staff start work and not later, as the lack of information may place staff and people using the service at risk. The induction did not contain any detail of information provided. The home is recommended to implement the Skills for Care Common Induction Standards to ensure that staff have a robust induction over a sustained and identified period of time. Staff receive regular supervisions and appraisals to promote good practice and provide an opportunity to identify and develop skills. The manager is recommended to implement an overview to ensure that it is evident that all staff receive supervision no less than 6 times per year. Care Homes for Older People Page 27 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes leadership and management is promoting a positive working environment which is being run in the best interests of people using the service. The management of recruitment by the registered manager must be robust to protect people using the service. Health and safety is promoted in the home but requires further development. Evidence: The Registered Manager / Provider is Maureen Lawley. This is a family run business and Maureen is assisted in her management by her two daughters. Maureens role is primarily the business side but is also with hands on daily management. One daughter has the role of managing the day to day details of people using the service and the other daughter takes the administrative responsibility. There are no job descriptions defining clarity for each persons responsibility but a role for each that has evolved. All three people undertake a hands on role if needed. The home also has a Head of Care and a Liaison Manager who undertake a senior role in supporting the management of Care Homes for Older People Page 28 of 36 Evidence: the service. Several staff told us The manager is very approachable, you can talk to her The Expert by Experience said The Manager appeared to be very enthusiastic and concerned about the people in her care she spent time with her staff and was involved in day to day aspects of care. The management of recruitment (See outcome group 6 ) is not robust and may place people using the service at risk. The registered manager must ensure that the management of this area shows a consistent improvement to support and protect people using the service. Annual quality assurance questionnaires are undertaken and the responses are used to monitor the quality of care provided and change practice where needed. Review of the recent audit showed positive responses from both relative and visiting health professionals. The audits are reviewed and any outcomes included in a newsletter to feedback to people using the service and relatives. This monitoring of quality appears to be used to develop service provision. The registered manager only handles a limited amount of money for people using the service. The procedures for this management were seen to be in good order. All records are stored securely in line with the Data Protection Act. The homes policies and procedures are comprehensive and reviewed, and as issues arise for discussion the relevant policy is brought to the attention of staff during supervision sessions and by staff memo. Accidents are recorded appropriately, the information is only reviewed randomly. It is recommended that monthly accident audits take place to review for trends and incidences which may be used to promote accident prevention. The homes maintenance records folder showed that the fabric of the building and the equipment within it are regularly and properly maintained for the safety of all. We identified that some free standing units such as wardrobes were not secure and may have posed a risk of tip/tilt injury to people using the service. The manager had this issue addressed immediately. We also identified that the storage of dental tablets may have placed people using the survive at risk of accidental ingestion of substances which are hazardous to health. The storage was also addressed immediately to ensure the safety of people using the service. Care Homes for Older People Page 29 of 36 Evidence: We noted that whilst all hot water delivery outlets have thermostatic valve controllers in place the temperature is not monitored to ensure that no changes have taken place. The registered manager is required to implement monthly monitoring of all hot water delivery to ensure that it is delivered within the Health and Safetys guidance. Care Homes for Older People Page 30 of 36 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 19 16 All areas of the home must 28/08/2009 be well maintained and meet peoples individual needs. This will protect the health and safety of all that live in the home. Care Homes for Older People Page 31 of 36 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 7 15 The registered manager is required to develop care plans to include the input of people using the service and/or their relatives/representatives. This will ensure that people are in agreement with the plan of care in pace. 30/04/2010 2 7 15 The registered manager is required to ensure that care plans are developed to include the detail of care to be provided. This will ensure that clear directions are available for staff and the care provided will be person centered. 30/04/2010 3 9 13 Controlled drugs must be stored in a controlled drugs cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations 1973 as amended. 31/07/2010 Care Homes for Older People Page 32 of 36 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 This will ensure that they are safely stored and will comply with current legislation. 4 29 19 The registered manager must ensure that two references have been received for all staff members. These references must be from appropriate referees and include the most recent employer. The reference must include the relationship between the staff and former employer and be signed and dated when received. This will ensure the safety of people using the service 5 38 12 The registered manager must ensure that all hot water outlets are monitored to be within the Health and Safety guidelines. This is required to ensure that there is no risk of burns and scalds to people using the service. 30/04/2010 30/04/2010 Care Homes for Older People Page 33 of 36 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 7 The registered manager is recommended to ensure that all areas of risk are transfered to the care plan to enable a plan of care to be put in place to support staff to manage the risk safely and effectively The registered manager is recommended to develop care plans to include a record of visiting health professionals to ensure a means to audit visits and easily access the information. It is recommended to monitor room temperatures in the medicines storage areas, and to monitor the maximum and minimum temperatures in the medicines refrigerator. This will help to show that medicines are always stored at the correct temperature and will be safe and effective for people It is also recommended to get all handwritten entries on medicines charts checked and signed by two members of trained staff. This is ensure that charts are accurate and correct and reduce the risks of any errors occurring 2 7 3 9 4 16 The registered manager is recommended to update the whisteblowing policy to include contact details of an external body should this be needed. It is recommended that any staff memebr who has received a POVA check and has started work prior to the CRB check having been receieved is supervised at all times and the supervisor recorded to ensure an audit trail of accountability. The regiatered manager is recommended toensure that all gaps inemployment history are investigaed and recorded to ensure there is a clar audt trail of previous employment and ensure the safety of people using the service. The registered manager is recommended to ensure that a robust employment history is obtained to go back when possible 10 years.This will ensure the homes recruitment procedures to protect people using the service. The registered manager is recommended to clarify the actual start date of new staff members. Trail days must not include any contact with people using the service until the appropriate recruitment checks have been received. The registered manager is recommended to ensure that Page 34 of 36 5 28 6 29 7 29 8 29 9 30 Care Homes for Older People 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 induction takes place immediately that staff start work. The induction is also recommended to include the Common Induction Standards. 10 30 The registered manager is recommended to provide an overview of staff supervisions planned and undertaken to ensure that supervison is provided no less than 6 times each year for each staff member. This will promote and support best practice. The registered manager is recommended to audit all accidents monthly for trends which could be used to promote accident prevention. 11 38 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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