Care Home: Ashley Arnewood Manor

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What the care home does well Prospective residents are given information about the home to help them decide if it is the right place for them. The home carries out, and records, assessments of need of those referred for possible admission. This helps the home in deciding to admit only those whose needs it can meet. Residents state that their health and personal care needs are met. This was also echoed by the staff and healthcare professionals. Staff are said to be kind and are available to residents when they need assistance. Residents know how about the home`s complaints procedure and staff are trained in the principles and procedures for protecting vulnerable adults. The home`s environment is clean, homely and generally well maintained. Specialist equipment is provided in bathrooms so that residents can safely access bathing facilities. Equipment is tested and serviced for safety reasons. What has improved since the last inspection? Additional information on prospective residents is obtained and recorded. The assessment and care plan system has been improved so that more detail is recorded on care needs and how staff should meet those needs. The medication system has been changed so that medication is now administered directly from the pharmacist`s containers. The complaints procedure has been updated. The dining room has been redecorated and residents were consulted about this. A number of bedrooms have also been redecorated. Hygiene procedures have been improved by the introduction of paper towels in communal toilets. staff receive training in infection control. What the care home could do better: Staff recruitment procedures have not been improved which was required by the last inspection report. Adequate checks are not carried out before staff start work, which has the potential to place residents at risk. Improvements are needed in the recording of residents` money depositted for safekeeping with the home. Key inspection report Care homes for older people Name: Address: Ashley Arnewood Manor 32 Ashley Road New Milton Hampshire BH25 6BB     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: Ian Craig     Date: 2 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ashley Arnewood Manor 32 Ashley Road New Milton Hampshire BH25 6BB 01425611453 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: SCOFIL Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Ashley Arnewood Manor is a privately owned and run care home is set in a residential area close to local amenities and New Milton town centre. The home residential care for up to 20 elderly residents including persons with dementia. Bedrooms are situated on two floors ground and first floors with a chairlift between floors. A variety of aids and adaptations have been provided which enable residents to move about more independently. Eighteen of the bedrooms are single, two of these having an en suite toilet. There are three communal toilets and a bathroom on the ground floor, and three toilets and two bathrooms on the first floor. There is a garden to the rear of the Care Homes for Older People Page 4 of 27 0 9 0 9 2 0 0 8 20 0 Over 65 0 20 Brief description of the care home building easily accessed by residents. Care Homes for Older People Page 5 of 27 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: The inspection consisted of a site visit of approximately 5 hours. Two staff and three residents were involved with the inspection. Discussions took place with the manager. Surveys were sent by the Commission to residents, health and social care professionals and staff, asking for their views on the service provided by the home. These were returned by 5 staff, 9 residents and 3 health and social care professionals. Information contained in the surveys has been used for this report. Records, documents and policies and procedures were looked at. Care services are required to complete an Annual Quality Assurance Assessment (AQAA). This was completed by the home and returned to the Commission. Care Homes for Older People Page 6 of 27 Information contained in the AQAA has been used for this report. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 27 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 27 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 27 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. Prospective residents are able to make an informed choice about whether or not to move into the home. Steps are taken to ensure that the home accommodates only those whose needs it can meet. Evidence: The home has a Statement of Purpose, which is available in the entrance hall. It gives information about the services provided including the environment, the homes admission policy and the complaints procedure. The manager explained that prospective residents are given a brochure. Surveys from residents and relatives state that they received information about the home, which helped them make a decision about whether or not to move in. The manager told us that prospective residents and their relatives are able to have a look round the home and can spend a whole day at the home to see if it meets their needs. Residents confirmed that they had a look round the home before moving in. Care Homes for Older People Page 11 of 27 Evidence: Records show that the home carries out an assessment of those referred for possible admission. This is carried out by either the manager or deputy manager by visiting the person at their home or at hospital. A pre admission assessment form is completed covering the following needs: mental and physical health, medication, allergies, respiration, emotions, social activities, nutrition, personal care, continence, sleep pattern, risks, end of life preferences, skin integrity, mobility and oral/vision/hearing. Personal details are recorded, such as name of next of kin and general practitioner. If someone is referred by social services for possible admission to the home copies of relevant social services assessments and care plans are obtained, as well as information from hospitals and specialist multi agency meetings. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the residents are met. Residents are treated with dignity and their privacy respected. Evidence: The manager explained that the home has reviewed and improved its care planning system so that staff have more detail of how care needs should be met. Care plans were looked at for 4 people. These record how individuals needs are to be met with instructions for staff to follow. These include details of personal and health care needs as well as mental health needs. Residents and/or their relatives are encouraged to be involved in the assessment and care planning. Designated staff are allocated to a resident with a responsibility for monitoring care. There is a keyworker responsibility list, which gives details of the role of the allocated staff member for the individual resident. Records show that health needs are monitored. Weight is monitored and recorded for each person. Details of nutrition needs are recorded. Assessments and plans are Care Homes for Older People Page 13 of 27 Evidence: recorded for the risk and prevention of pressure sore development and moving and handling needs. Surveys were received from 3 health and social care professionals. These state that residents social and health care needs are properly monitored, reviewed and met. The home is said to always seek advice on health and social care needs and the staff have the right skills and experience to meet health and social care needs. Staff spoken to said that the care needs of the residents are met. Residents appeared well cared for. This was also confirmed from residents spoken to or from the surveys returned. One person said, They keep you so clean. This includes your clothes too. A relative made the following comment: It looks after the physical and emotional well being of the residents and listens to them and their relatives. Another relative said, The home encourages visitors and shows warm hospitality. Communicates well with family. Residents said that they are treated with respect and that the staff are kind and helpful. 2 of the 3 surveys returned from health and social care professionals state that the home always respects residents privacy and dignity. One professional said that this is sometimes the case. Bedroom doors have a privacy lock, which some of the residents use. Residents are also able to have key to their bedroom door for security. The homes medication procedures were looked at. The system of administering medication has been changed as required by the last report, so that medication is administered straight from the pharmacists container. The written procedure for the handling, administering and recording of medication has been revised to reflect these changes. The revised procedure does not contain the controlled drug procedure, which is still held with the previous procedure. The home has a controlled drug cupboard but uses the medication trolley to store a second portable lockable box. At the time of the visit the home did not have any medication that was classified as controlled. The correct storage of controlled medication was discussed with the manager and deputy manager. Records showed that the home had followed the correct guidance for administering controlled medication in the recent past. Staff sign a record to show that residents have taken their medication. The home maintains a record of any incoming medication and any medication that needs to be returned to the pharmacist. It was noted that the stocks of medication did not tally with the records as the home had carried over an excess of medication from previous months. This made it difficult to audit the medication stock and to check if residents had received the correct dose of medication. Care Homes for Older People Page 14 of 27 Evidence: 12 of the 18 staff have completed a Safe Handling of Medicines course. Care Homes for Older People Page 15 of 27 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. There are opportunities for activities and stimulation. Nutritious meals are provided. Evidence: There is an activities programme compiled for each month. Activities for the month of July 2009 include films, walks in the garden, pottery, entertainment from a musician, a visit by the mobile library every 2 weeks, hand massages, bingo and a charity coffee morning. Residents spoken to, or who returned surveys, said that activities are provided. One person said that the activities could be developed further and 2 others said that the provision of outings and making use of the garden could be improved. The manager said that there are occassional outings for the residents. Individual residents social and activity needs are assessed and recorded. Any religious needs are discussed at the time of admission. Holy communion is provided by a visiting priest and one person attends church. Residents said that they are able to choose how they spend their time. It was noted that the individual care plans could be expanded to reflect the preferred routines of Care Homes for Older People Page 16 of 27 Evidence: individual residents. There are regular residents meetings which are recorded. One resident said how he/she is able to contribute to decision making at these meetings, for instance, by making suggestions about the menus. Residents said that they like the meals. One person said that there is fresh fruit every day. The midday meal on the day of the visit consisted of lamb chops with mint sauce, roast potatoes and vegetables. Dessert was fruit strudel with custard. Details of the midday meal were displayed in the dining room on a notice board. Care Homes for Older People Page 17 of 27 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. There is an effective complaints procedure and steps are taken to protect residents from possible harm. Evidence: The homes complaints procedure is held with the Statement of Purpose. Each resident, or their relative, said that there is someone to talk to informally if they have a concern, and, that they know what to do if they have a complaint. The home has not received any complaints. Staff who returned a survey confirm that they know what to do if someone has concerns about the home. The manager, deputy manager and head of care have attended a course on protecting vulnerable adults from possible harm. There are plans for each staff member to also attend this training. Records show that staff have attended a course on abuse awareness. The home has its own policy for dealing with any suspected abuse. It was unclear if the home had a copy of the local authority safeguarding vulnerable adults procedure. The home has literature on the Mental Capacity Act 2005 and restricting peoples liberty. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a generally well maintained and clean environment. Evidence: A number of residents bedrooms were seen. All bedrooms are single apart from one double. Two bedrooms have an en suite toilet. These are clean and brightly decorated in differing colour schemes and with different wallpaper. The rooms contain items of personal possessions such as pictures, ornaments and books. There is a communal lounge and a smaller quiet lounge as well as a dining room. Residents were observed using the communal areas. Surveys say that the home is clean and fresh. This was observed to be the case and there was an absence of any unpleasant odours. Staff are trained in infection control. There are 5 toilets and 3 bathrooms with specialist baths for those with mobility needs. The first floor is accessed by a stairlift but this does not cover all of the staircase, which means those with mobility needs may have difficulty going up and down the stairs. Care Homes for Older People Page 19 of 27 Evidence: Two surveys state that areas of the home would benefit from redecoration. It was noted that the front exterior paintwork is in need of attention. Care Homes for Older People Page 20 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a trained staff team, although staff numbers need to be reviewed for specific times if care needs are to be adequately met. Staff recruitment procedures still do not protect residents even though this was required following the previous inspection. Evidence: The home provides at least 3 staff from 8am to 1pm each day and sometimes 4. From 5pm there are usually 2 staff on duty. The previous report recommended that the staffing levels at the time of the preparation of the early evening meal are reviewed as only 2 staff carry out the catering and care duties. The manager explained that the home intends to deploy a third staff member for the evening shift when the homes occupancy level increases from 16 to 18. Night time staffing consists of one waking and one sleeping staff. Care staff said in surveys and in discussion that there are enough staff to meet the residents needs. Residents say that staff are available when they need them and that there are enough staff on duty. Newly appointed staff have an induction period where they shadow other staff for 2 Care Homes for Older People Page 21 of 27 Evidence: weeks followed by a 6 week trial period. An induction checklist is completed after 3 days which is signed by the manager and the staff member to acknowledge that instruction has been given to carry out the job. Each staff member who returned a survey states that they received an induction, which prepared them for the job. Records of staff training are maintained and the manger uses a training matrix to monitor individual training needs. Staff have attended training in basic food hygiene, health and safety, safe handling of medicines, abuse awareness, fire safety, moving and handling and infection control. The home has training links with a local college and mental health professionals from a local hospital trust provide informal training for staff. The home employs 16 care staff. 6 staff have National Vocational Qualification (NVQ) level 2 in care and 2 staff are to study for this qualification in the near future. 6 staff are studying NVQ level 3 and 2 staff have NVQ level 3. Staff commented that they receive training in relevant areas such as medication procedures, infection control and health and safety. Staff also confirm that regular staff meetings take place, that they work as a team, and, that they are given up to date information about the care needs of the residents. The staff training could be extended to cover dementia. Recruitment procedures were looked at for 4 staff. The required checks had been obtained for 2 of these people before they started work. For another person, the required checks had been carried out but the person had started work before a protection of vulnerable adults (POVA) check had been obtained. For a 4th person 2 references had been obtained but the home was using a criminal record bureau and protection of vulnerable adult check from another employer and had not carried out its own check. The manager stated her commitment to apply for these checks as a matter of priority. Care Homes for Older People Page 22 of 27 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 management has not carried out sufficient checks and monitoring of its staff recruitment procedures despite requirements in a previous report. Some improvement is needed to ensure that residents valuables are fully protecyed. The health and safety of staff and residents is promoted. Evidence: The manager has been in post for several years and has the NVQ level 4 as well as the Registered Managers Award. Staff report that they feel supported in their work. The home obtains the views of residents by the use of surveys which ask for feedback on the service provided by the home. Staff and residents meetings also allow the management to monitor the homes performance. There is an annual development plan with details of how the home intends to develop its service. Monthly visits are made to the home by a representative of the owners and an audit report compiled. Care Homes for Older People Page 23 of 27 Evidence: Copies of these were seen. The home looks after small amounts of money and valuables for residents. Records are kept of a balance of these amounts plus any deposits or withdrawls. It was noted that 2 amounts of cash given to the home for safekeeping had not been checked and recorded in the running totals. Staff have recieved training in first aid, health and safety, moving and handling and infection control. The AQAA gives details to show that the homes equipment and appliances have been tested and serviced by suitably qualified persons. Assessments are carried out and recorded for each person regarding the risk of the environment. Care Homes for Older People Page 24 of 27 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 29 19 The registered person must ensure that all relevent information is recevied, as stated in Schedule 2 of the Care Home Reguations before commencing employment of newly recruited staff. This includes CRB and POVA checks and two written references. You must do this to ensure that service users are protected. 31/12/2008 Care Homes for Older People Page 25 of 27 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 35 17 A record must be made of any money or valuables deposited or received on behalf of residents. So that there are safe systems for managing residents money. 28/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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