Care Home: Ashley Grange Nursing Home

Similar services:

• The Vicarage
• Fairfields Country Rest Home
• 7 Hyde Road
• 5 Seafield Road
• Queensmount
• Poldhu
• Trevaylor Manor
• Didsbury Court Rest Home

What the care home does well Ashley Grange offers high standards of accommodation. The owners, Mr and Mrs Ashley, are closely involved in service provision, are keen to develop service provision and are open to new ideas. The home is managed by an experienced manager and registered nurse, who is supported by an established team of staff. Staff we spoke with showed a good knowledge of individual residents’ needs and were keen to offer residents the care and support which they needed. The management ethos of the home respect the diversity of the residents and the staff group working in the home. During one of the days of the inspection, a medical emergency occurred, it was dealt with correctly and first aid was promptly and competently carried out, until the emergency services arrived. Despite this emergency the atmosphere in the home remained calm and the situation was dealt with professionally, so that other residents would not have been aware of the situation and so not been alarmed. People commented about the home. One person reported on the “friendly atmosphere”, another that “the home is clean, cheerful and bright”, another that the home “seems to do everything well” and another “I cannot think of anything that is not done exceptionally well in my experience”. People commented about the staff. One person reported on the “very caring staff – always helpful and happy”, another “staff patient and caring”, another “staff are very nice, my [relative] always smiles when they enter the room” and another “senior staff come and chat with me when I am without visitors”. One relative summed up their response by stating “I would happily apply for a placement should I need one”. Staff also commented on the home. One person reported “the home providing a safe, homely and friendly environment where our resident are encouraged to maintain their independence and given whatever they need supports and 24 hour care” and another that they felt “proud” of the home and that external professionals had commented to them that it “never smells” like other homes. Our expert by experience commented “to sum up Ashley Grange Nursing Home is a place where I would be happy to reside”. What has improved since the last inspection? At the last inspection, no requirements and two recommendations were made. The home has ensured that care and fluid charts are completed throughout the 24 hour period. Systems to ensure that staff supervisions are taking place have been developed. Two home supervisors have been appointed recently, their role is to support the manager by taking charge of the management of activities and ancillary staff. Plans have been developed for activities provision to residents and these are being progressed. The home supervisors also manage staff induction and training programmes. The home’s induction has been revised and the supervisors have ensured that all newly employed staff have received a full induction. The home supervisors have audited staff training needs and developed an action plan to ensure this plan is progressed. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.2 The maintenance man has regularly attended relevant courses and, with Mr Ashley, is in the process of further developing the home’s fire risk assessment. What the care home could do better: The home needs to further develop information given to people before admission to ensure that they are informed of the home’s response to inspection and also to provide more detail on staffing to prospective residents and their supporters. The home needs to ensure that all assessment of residents’ needs and risk are always performed in writing and a copy maintained on the resident’s file. Assessments need to be completed promptly after admission and always revised when a person’s condition changes. Care plans and care plan evaluations must always be completed in writing. Care plans need development, to ensure that clear, measurable language is always used and clinical guidelines followed in all areas, including the use of thickening agents and urinary catheters. A key worker system should be developed with key carers being given responsibility for completion of care plans for their key residents. Individual resident fire evacuation plans should be developed. The home needs to modernise its approach to activities provision, including development of care plans on how to meet residents’ needs, taking into account their past lives and preferences. Staff need to use residents’ own preferred names when addressing people and avoid generic terms of endearment. This is particularly the case where residents have dementia care needs. To reduce risks of cross-infection associated with the communal use of host slings, the home must ensure that hoist slings are not used communally and used slings are not stored in contact with each other. Systems need to be put in place to ensure that all residents’ clothing, particularly underclothing is named and returned to them. All parts of the laundry floor should be kept dust-free at all times. The home must complete its review of staff files to ensure that all files have required information on them. They need to ensure that all staff are trained in all mandatory areas, following the action plans for this. They also need to further develop training programmes in meeting residents needs. Documentation of induction and training, including informal training should be further developed. Staff who supervise others should be trained in this role. Systems for supervision of registered nurses should be further developed. All supervision records need to be dated and signed. Systems for audit of quality of care would benefit from audits of complaints received and responses when call bells are used.Ashley Grange Nursing HomeDS0000015887.V377906.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Ashley Grange Nursing Home Lode Hill Downton Salisbury Wiltshire SP5 3PP Lead Inspector Susie Stratton Key Unannounced Inspection 6th October 2009 09:25 DS0000015887.V377906.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley Grange Nursing Home Address Lode Hill Downton Salisbury Wiltshire SP5 3PP 01725 512811 01202 875088 marilyn.hallett@ashleycarehomes.co.uk Other names known Trevor Ashley Mr Trevor Abrahams Mrs Mary Abrahams (aka Ashley) Mrs Alexandra Mary Dempster Care Home 55 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (14), Old age, not falling within any other of places category (55), Physical disability (10), Terminally ill over 65 years of age (2) Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than a total of 14 service users with dementia may be accommodated at any one time whether in the category DE or DE(E). Service users in the categories DE and PD may not be less than 55 years of age and no more than 10 persons in total may be admitted over these two categories. The Mezzanine Room must only be used by able bodied service users because there is no level floor access. The Staffing Levels set out in the Notice of Decision issued on 17 March 2003 must be met at all times. 25th October 2006 3. 4. Date of last inspection Brief Description of the Service: Ashley Grange nursing home is registered to provide nursing care for 55 older people, 10 of which may be under the age of 65 but over 55 years old. The home is also registered to provide care for 14 people with Dementia. The home is situated in the village of Downton, which is seven miles from the city of Salisbury in Wiltshire. The accommodation is provided over two floors with a passenger lift in-between. All areas of the home and external facilities are wheelchair accessible. The home is situated in a rural area with extensive views over the surrounding countryside. A large parking area is to the front of the home. The home is privately owned with the providers remaining involved with the day-to-day management of the home. The manager of the home is Mrs Alex Dempster. The fee range is £650 to £900 pounds a week. Items not included in fees include hairdressing, chiropody and toiletries, for the convenience of residents, the home operates a small shop. All new residents and or their supporters are given a copy of the service users’ guide. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. As part of the inspection, questionnaires were sent out to residents and staff. Forty Seven were returned. Comments made by people in the questionnaires and to us during the inspection process have been included when drawing up the report. The homes file was also reviewed and information provided since the homes last inspection considered. We also received an Annual Quality Assurance Assessment (AQAA) from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the past year. We looked at the AQAA, the surveys and reviewed all the other information that we have received about the home. This enabled us to decide what to focus on during the inspection. As Ashley Grange is a larger home, two site visits were made. One inspector performed both the site visits. This inspector was supported by an expert by experience on the first day of the inspection. An expert by experience is a person who by experience is in a position to make an independent assessment of the services provided by a care home. The inspector is referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). The first site visit took place on Tuesday 6th October 2009, between 9:25am and 4:35pm. The second site visit took place on Tuesday 13th October 2009 between 9:10am and 3:55pm. Both visits were unannounced. Mrs Dempster, the registered manager was on duty for both the site visits. Mrs Dempster and Mr Ashley were available for feedback at the end of the site visits. During the site visits, we met with nine residents and four relatives. We also observed care for eight residents for whom communication was difficult. We toured all of the home and observed care provided at different times of day and in different areas of the home. We reviewed care provision and documentation in detail for five residents and specific matters relating to a further four residents, across all parts of the home. As well as meeting with residents, we met with three registered nurses, ten carers, both home supervisors, the laundress, two cleaners, the cook, a kitchen assistant and the maintenance man. We observed a lunchtime meal and services provided in the main sitting room. We reviewed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including staff training records, staff employment records, accident records, complaints records and records of residents’ financial transactions. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.2 Page 6 What the service does well: Ashley Grange offers high standards of accommodation. The owners, Mr and Mrs Ashley, are closely involved in service provision, are keen to develop service provision and are open to new ideas. The home is managed by an experienced manager and registered nurse, who is supported by an established team of staff. Staff we spoke with showed a good knowledge of individual residents’ needs and were keen to offer residents the care and support which they needed. The management ethos of the home respect the diversity of the residents and the staff group working in the home. During one of the days of the inspection, a medical emergency occurred, it was dealt with correctly and first aid was promptly and competently carried out, until the emergency services arrived. Despite this emergency the atmosphere in the home remained calm and the situation was dealt with professionally, so that other residents would not have been aware of the situation and so not been alarmed. People commented about the home. One person reported on the “friendly atmosphere”, another that “the home is clean, cheerful and bright”, another that the home “seems to do everything well” and another “I cannot think of anything that is not done exceptionally well in my experience”. People commented about the staff. One person reported on the “very caring staff – always helpful and happy”, another “staff patient and caring”, another “staff are very nice, my [relative] always smiles when they enter the room” and another “senior staff come and chat with me when I am without visitors”. One relative summed up their response by stating “I would happily apply for a placement should I need one”. Staff also commented on the home. One person reported “the home providing a safe, homely and friendly environment where our resident are encouraged to maintain their independence and given whatever they need supports and 24 hour care” and another that they felt “proud” of the home and that external professionals had commented to them that it “never smells” like other homes. Our expert by experience commented “to sum up Ashley Grange Nursing Home is a place where I would be happy to reside”. What has improved since the last inspection? At the last inspection, no requirements and two recommendations were made. The home has ensured that care and fluid charts are completed throughout the 24 hour period. Systems to ensure that staff supervisions are taking place have been developed. Two home supervisors have been appointed recently, their role is to support the manager by taking charge of the management of activities and ancillary staff. Plans have been developed for activities provision to residents and these are being progressed. The home supervisors also manage staff induction and training programmes. The home’s induction has been revised and the supervisors have ensured that all newly employed staff have received a full induction. The home supervisors have audited staff training needs and developed an action plan to ensure this plan is progressed. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.2 Page 7 The maintenance man has regularly attended relevant courses and, with Mr Ashley, is in the process of further developing the home’s fire risk assessment. What they could do better: The home needs to further develop information given to people before admission to ensure that they are informed of the home’s response to inspection and also to provide more detail on staffing to prospective residents and their supporters. The home needs to ensure that all assessment of residents’ needs and risk are always performed in writing and a copy maintained on the resident’s file. Assessments need to be completed promptly after admission and always revised when a person’s condition changes. Care plans and care plan evaluations must always be completed in writing. Care plans need development, to ensure that clear, measurable language is always used and clinical guidelines followed in all areas, including the use of thickening agents and urinary catheters. A key worker system should be developed with key carers being given responsibility for completion of care plans for their key residents. Individual resident fire evacuation plans should be developed. The home needs to modernise its approach to activities provision, including development of care plans on how to meet residents’ needs, taking into account their past lives and preferences. Staff need to use residents’ own preferred names when addressing people and avoid generic terms of endearment. This is particularly the case where residents have dementia care needs. To reduce risks of cross-infection associated with the communal use of host slings, the home must ensure that hoist slings are not used communally and used slings are not stored in contact with each other. Systems need to be put in place to ensure that all residents’ clothing, particularly underclothing is named and returned to them. All parts of the laundry floor should be kept dust-free at all times. The home must complete its review of staff files to ensure that all files have required information on them. They need to ensure that all staff are trained in all mandatory areas, following the action plans for this. They also need to further develop training programmes in meeting residents needs. Documentation of induction and training, including informal training should be further developed. Staff who supervise others should be trained in this role. Systems for supervision of registered nurses should be further developed. All supervision records need to be dated and signed. Systems for audit of quality of care would benefit from audits of complaints received and responses when call bells are used. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.2 Page 8 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. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including visits to this service. People will largely be fully informed about services provided and staff will be aware of residents’ needs, however not all documentation relating to nursing and care is completed in full. EVIDENCE: In their AQAA the home reported that all residents are admitted on the basis of a four week trial either way and that this can be extended if relevant. They reported on their assessment processes and how they continually reviewed these. For example they have recently reviewed nutritional pre-admission assessments to facilitate improvements in communication between all parties. People commented to us in questionnaires about information provided by the home and 33 out of the 35 people who responded to us reported that they had Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 11 received sufficient information about services offered to enable them to make a decision about whether Ashley Grange could meet their needs. One person did comment that they would like to see “fee transparency and the requirement to publish the range of fees”. A relative commented that they would like more information provided to them about the records that are maintained on their relatives. Mrs Dempster reported that all prospective residents and/or their supporters are given a copy of the service users’ guide. During the inspection, we reviewed the home’s statement of purpose and service user’s guide. We noted as good practice that the service users’ guide includes the home’s gender policy and equal opportunities policy. The guide also included the home’s standard contract, which includes full details on fees payable in the event of a resident’s death. We noted that the service users’ guide does not include a copy of the summary of our most recent inspection report, together with information how the full report can be obtained. This is required so that people can have access to their own copy of our findings. We reviewed both the home’s statement of purpose and service users’ guide and noted that otherwise they complied with our regulations and standards. We did recommend that the section on staffing be expanded, to fully inform people of how many staff and grades of staff who would be on duty during different parts of the day. We met with a resident who had recently been admitted and reviewed their records. They reported about staff “I think that they are kind as far as I can tell”. We discussed the newly admitted person’s needs with a carer, who was able to inform us about the person’s needs and the ways in which they were meeting them. The carer also knew significant details about the newly admitted person’s preferences for spending their day and other factors which were currently affecting them, such as experience of pain and how it was being managed by the home. When we looked at the person’s records we observed that some bruising, which had been visible when we met with the resident, was fully documented in their records and that it was clear that they had been admitted to the home with this bruising. What was documented reflected what the member of staff informed us. The home had information from the local hospital on file about the person’s needs on admission. Their records showed that the home had ensured that they had consulted the person about preference of sex of carer. The home had assessed the residents’ needs, for example there was clear information on their past life experience, it also documented their communication needs clearly. However, some areas needed further development. The person was observed to be using bed rails. Whilst consent had been obtained for their use, there was no risk assessment for their use completed. It was noted that the person Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 12 had “pink” skin discoloration on one of their pressure points, five days after their admission but the home’s risk assessment for pressure damage had still not been completed. The National Centre for Health Care and Excellence (NICE) guidelines state that risk assessments for pressure ulceration in health care settings need to be completed promptly after admission. The resident, as the carer reported, experienced pain and there was reference in their daily record to provision of pain relief. However a care plan had not been drawn up about meeting this need. We discussed these findings with Mrs Dempster who reported that they had recently experienced a shortage of registered nurses which meant that not all assessments and care plans had been drawn up promptly. We advised that we were aware that staff understood how to meet individual residents’ needs, but without appropriate assessment and care plans there remained a risk that a resident might not have their needs met during the admissions process. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including visits to this service. Residents will have their personal and health care needs met, although systems for documentation would benefit from improvement. EVIDENCE: In their AQAA, the home comment that they “provide high quality care to each resident ensuring their personal and medical needs are met in accordance with their individual care plan, which takes into account the views of the resident, relatives and other health care professionals”. They also report on their “excellent working relationships with our local GP, Community Mental Health Team, Community Palliative Care and Department of Adult and Community Services” and that they are “supported well by our local Pharmacy”. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 14 People commented to us on nursing and care provision. All of the 36 people who responded to this section of the questionnaire reported that they always or usually received the care and support that they needed. One person commented that the home “always gives excellent care and attention”, another “everyone is well looked after and needs catered for” and another “the home has always displayed a high level of care and compassion to residents with dementia.” Staff reported that they were informed about how to meet individual resident’s needs. Of the ten people who responded to this section of the questionnaire, seven reported that the ways of sharing information about people was always, one usually and two sometimes worked well. We spoke to a wide range of staff about how they found out about residents’ needs. Two carers reported that they always had a full report and were always told if someone’s condition had changed. They reported on the good rapport with the registered nurses, who would listen to them if they noted any changes in residents’ conditions. We discussed three residents’ needs in detail with another carer and they understood these residents’ needs and were able to report fully on why certain interventions were important for the resident. We discussed supporting residents’ dietary needs with another care assistant who again had a clear understanding of different residents’ needs and how they were to support them. A cleaner informed us that if any of the residents were unwell or if they had any other changed needs, that they were always informed so that they could properly support the resident. We met with a range of residents in different areas of their home, discussed their needs with staff and reviewed their records. We observed that there was a variability in completion of assessments and care plans. One person who had highly complex needs had very clear care plans about their behaviours and how their safety was to be ensured, which were written in a non-judgemental style. They also had clear assessments relating to key areas such as risk of pressure ulceration, manual handling and risk of falls. Where risks were identified, clear care plans had been developed to direct staff on how needs were to be met and risk reduced. These were regularly evaluated. This person also had a very clear care plan relating to their experience of pain and how their pain relief was to be managed. These clear assessments and care plans were not reflected across other residents. For example one person clearly had complex needs in relation to dementia care. Their care plan did not document interventions such as the use of a mood altering drug to manage their behaviours and also did not document the detail of what a carer reported to us about how they managed the person’s behaviours to support them in accepting care. The person was assessed as being at high risk of falls but they did not have a care plan to direct staff on how risk was to be reduced for them. The person was noted to have a sore area on one of their pressure points six days before the inspection, but it had not led to a review of their assessment of risk of pressure ulceration or of their Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 15 care plan. However a carer informed us of what the home were doing and why, to manage the person’s increased risk of pressure ulceration. This variability in care plans was reflected across a range of areas. For example one person was being fed by an artificial method. Their care plan documented clearly the amount and type of fluids they were to have and when but did not document how the tube site was to be cared for, although staff we spoke with were aware of the importance of caring for the tube site. Another person had a clear care plans about management of their diabetic condition, which was reviewed when their eating habits changed. However another person who had a catheter in place did not have the clinical reason for its use documented and there were no plans relating to how often the bag needed to be changed or care of the site of the tube. Some care plans were clear but others were too simplistic. For example one residents’ care plan stated “wears pad”, with no detail of the type of pad indicated or how often it should be changed. When this was discussed with a registered nurse, they were fully informed of all factors relating to this person’s need but these had not been documented. We were satisfied that carers we spoke to were aware of how they were to meet different residents’ needs and changing needs, however if such matters are not documented, there remains a risk that nursing and care staff will not be providing care in a consistent, planned manner. We discussed how matters might be progressed with the manager. She reported that currently the home did not have a key worker system and that all care plans were completed by registered nurses and that some registered nurses were more competent at documentation than others. Additionally there had recently been some turnover in registered nurses, making record keeping more complex as there were fewer persons able to complete assessments and care plans. We advised that the home develop a key worker system and delegate some responsibilities for assessments and care planning to key workers. Additionally all people who assess needs and draw up care plans need training in the area, so as to ensure that residents’ needs are properly assessed and planned for. Where residents were very frail, we observed that their personal care needs were attended to. A person with complex communication needs, whilst restless, showed no overt signs of distress such as shouting or repetitive behaviours. All frail residents who we visited had clean hair, fingernails and mouths. The home maintains records of when people had their positions changed and were offered fluids and diet. One care assistant was able to explain to us how important correct completion of such records was in ensuring that people on different shifts had full information about residents. We observed that fluid charts were generally not totalled in 24 hours. This is recommended so that such information can be used in evaluation processes to review if a person is receiving adequate fluids. Where people were receiving thickened fluids, care plans did not state how thick each person needed their fluids. It is recommended that the home use terms such as syrup, custard, Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 16 jelly to direct how thick people need their drinks to be. This is needed so that all staff give residents their drinks at the consistency that they need. All personal care was given behind closed doors. One person who had complex behaviours was observed to have their dignity protected and staff regularly visited them to ensure that they remained covered. Several of the resident experienced dementia and carers were observed to respond to people who repeatedly asked the same question or the same remark, in a gently supportive manner. However we did observe that many carers called residents by generic terms of affection such as “my dear”, “my love”, darling”, “good girl” or “sweetheart”, not by their own name. This is not regarded as good practice in dementia care and people should always be called by their own preferred name and any such terms of affection only be used after using the person’s own preferred name. Where residents had complex needs such as wounds, there were clear records relating to care of the wound, additionally the home regularly consulted with external healthcare professionals such as the tissue viability nurse. There was also evidence of close working relationships with continence nurses and the Macmillan nurses. On one of the days of this inspection the community psychiatric nurse was visiting and they clearly had a close working relationship with staff. Of the 37 people who responded to this section of the questionnaire, 32 reported that they always, four that they usually and one sometimes received the medical care that they needed. This is indicates that people are satisfied in this area. Comments included that the home was good at “seeking medical help for me when needed”, another that “medical care is always available” and another that the home did “medical care” well. We observed two medicines administration rounds during the inspection and noted that they were safely performed in accordance with regulations and guidelines. We observed that registered nurses always locked the medicines trolley when they were not with it. Registered nurses carefully checked the medicines administration record, gave the resident their prescribed medication and did not sign the record until the resident had taken their medication. All medicines were safely stored, including Controlled Drugs and drugs requiring cold storage. We observed that there were systems in place for the regular checking of stocks of drugs, including Controlled Drugs. Records of medication were clear. Where medicines administration instructions were completed by hand, they were always signed and counter-signed. Where drugs were prescribed to be given on an intermittent basis, for example once a week, there were safe systems to ensure that the person received their medication as prescribed. Prescribed dietary supplements were signed for providing evidence that people had received such supplements. During the inspection, we observed that one resident showed signs of distress, this was promptly noted by a carer, who asked if they were in pain, the resident initially replied that they were not but after support from the carer they were prepared Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 17 to admit that they were experiencing pain. We observed that the carer then promptly went to the registered nurse to inform them of the circumstances and that the registered nurse quickly attended to the resident, to ensure that they had their prescribed medication, to prevent pain. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including visits to this service. Services to residents while satisfactory in some areas, need further development, to ensure that residents are fully supported in social engagement and able to exercise choice, including at mealtimes. EVIDENCE: In their AQAA, the home reported that they “listen to the individual resident and act on what they tell us, and always remember that they have the right to say no” and that “visitors are welcome at any time provided the resident is pleased to see them”. They reported that they were aware that they needed to continue to develop their range and types of activites to meet the diverse needs of residens, particuarly those residents who have dementia. Responses to questionniares reflected the fact that this was an area which needed develpent. Of the thrity six people who responded to this section of the questionnaire, 13 reported that the home always, 16 usually, five sometimes arranged activites which they could take part in and two did not Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 19 know. Comments included that the home needed to “provide a full time activity coordinator qualified in this field”, another that the home should “consider the value of 1:1 interraction in an attempt to stimulate and enhance resident engagement” and another, that the home should provide “more activities suitable for residents”. Following such comments, we discussed activites with a range of staff and managers. On the first day it was reported that carers were allocated to work with residents in the lounge, providing activities. Carers had not been trained in this role. We discussed this issue with the home supervisor who holds responsibilty for activities. They reported that since they had recently come in post, they had been putting forward the case for a full review of activites provision, including the employment of a dedicated activites person. By the second day of the inspection, it was reported that a person had been appointed to this post. We also observed that equipment to enhance activities was delivered to support activities during our second visit to the home. Since we visited the home, the providers have also written to us about progress and developments in this area. When we reviewed records relating to individual assessments and plans for activities, we noted similar variation as for care plans. Whilst some people had very clear past life histories documented and plans in place to meet individual needs for recreation and stimulation, others had little or no information. For example one resident was noted to have been a doctor in their past working life, but there was no written information about what field they had gained their doctorate in and if they were a doctor of medicine, what field they had specialised in. Where people have dementia, information about their past lives is a crucial area, so that recreational interventions can be appropriately targeted to the individual and their wishes respected and preferences up-held. This is an area which needs more attention. In their AQAA, the home commented on the meals, reporting “we provide wholesome nutritious food served in a manner which is appropriate for the individual and we supervise or actively feed any resident who is struggling or unable to physically feed themselves. We also access advice from a Dietitian or Speech and Language Therapist if we have concerns about a residents nutritional status”. We received a range of responses about meals from people in questionnaires. Of the thirty six people who responded to this part of the questionnaire, 13 reported they always, 16 usually and 3 sometimes liked the meals. Comments included that the home could do “food” better, another that the home needed “more variety in the menus”, another “more choice of menu?” and another “choice of menu, more than one daily option”. We asked residents and their relatives about meals during the inspection. One person reported that the food was “very good indeed”, another that the food was “reasonable” and another that the food was “warm and very nicely cooked”. One person commented “I Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 20 don’t think there’s a choice” and another that they would like more “fresh seasonal vegetables”. We discussed these responses with the providers, Mrs Dempster and the cook, on the first day of the inspection. It was reported that the home did not offer a menu choice as such, but that it was clear on information provided to residents that alternatives could be provided if a resident did not like the meal on the menu. It was also reported that they had found that people with dementia could forget the choice they had made by the meal-time and sometimes look at a different resident’s meal and ask for that. We reported that this was a common finding among people with memory loss and that there were a range of supports for residents in making choice which the home might like to consider, including the resident being able to make choice at the time of the meal or photographs of meals provided. By the second inspection day, the home had commenced offering choice for the lunch-time meal. The cook showed a good knowledge of residents and their needs. They are happy to meet with residents to discuss their preferences. One resident reported to us “the lady chef comes and talks to me a lot”. The cook also reported that they went round every day and listened to what residents reported about the meal, keeping a record of their comments and their findings. The cook reported that they had full control over the ordering of foodstuffs and also that they cooked all soups, sauces and gravies up from raw ingredients. The expert by experience reported “I was welcomed into the kitchen and I noticed that both fresh meat and fresh vegetables were being prepared, the kitchen staff were very keen for me to see an award hanging on the wall which they had recently been granted to them for the cleanliness of the kitchen area”. We observed a mealtime. Meals are offered in one of two dining rooms, at tables in the sitting rooms or in resident’s own rooms. One of the dining rooms is large, light and airy. The other one is small and more intimate. It was reported that the smaller dining room was mainly used by residents who found noise difficult to cope with or who wanted a quieter environment. For example at one of the tables there were a couple of residents from an ethnic minority. By sitting in the quieter room, they could converse more easily in their own language, making the mealtime more of a social event for them. Staff were readily available to support residents who needed to be assisted to eat their meals. We observed that a cleaner and a catering assistant also supported residents. Both of these members of the ancillary staff reported that they had been trained on how to do this, were always allocated to assist certain residents and knew these individual residents’ needs for support. We observed that one resident had a difficulty in opening their mouth wide and that the care assistant was feeding them, using a teaspoon, with small Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 21 amounts of food, so that they would not choke, taking their time with the resident and not rushing them. Another carer was sitting with a resident, supporting them in making the meal a social occasion, as well as assisting them to eat. We observed that staff maintained close working links with each other throughout the meal-time, to ensure that residents were assisted when needed and received supports in a timely manner. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 22 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including visits to this service. Residents will have their concerns listened to and will be safeguarded. EVIDENCE: In their AQAA, the home reported that they “have an Open Door Policy which ensures concerns and complaints from residents families and staff are dealt with promptly and sensitively and which in many cases prevents an issue becoming a major concern”. The also report that “within our Employee Handbook a copy of which is provided to eachstaff member, their protection is guaranteed should a situation of Whistle Blowing arise. Staff are encouraged to report to a senior member of staff any concern that they have, be it a minor concern,or a fully protected or qualifying disclosure”. Of the 35 people who responded to this section of the questionnaire, 34 reported that they knew who to speak to if they were not happy and all of the 11 staff who responded to this reaction of the questionnaire reported that they knew what to do if someone had concerns about the home. A resident reported that they had spoken to the home manager and that they had sorted out something they had been concerned about. During the inspection we spoke to a visitor who reported that they had “brought up a few things”, they had gone “straight to Matron” and “she’s sorted it”. The home’s service users’ Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 23 guide includes a very clear complaints procedure, which is written in an approachable style, which clearly documents how people can take matters further if they wish. Our expert by experience commented “I was also able to speak to a number of visitors who were present in the Nursing Home and I found no one had any complaints to make and in fact all complimented the staff on how they carried out their duties and the general running of the Care Home”. We looked at the complaints log and observed that verbal complaints were received and were documented in full as well as formal complaints. We observed that investigations were clear with statements taken from staff if relevant. Mrs Dempster reported on her open door policy, encouraging people to discuss matters with her informally so that issues did not become a complaint. We observed that visitors appeared to feel able to drop in to see her when she was not otherwise engaged. Mrs Dempster reported that she meets relatives regularly if there are any issues, reporting that face-to-face meetings assisted understanding. If relevant, she documented such meetings. Discussions with Mrs Dempster showed that she also took complaints from staff when indicated. Mrs Dempster reported that she regularly reviews systems for management of complaints and is currently re-designing the complaints form to make more functional. Mrs Dempster does not maintain a written analysis of complaints as part of quality audit to identify, if there are any trends and we discussed that she may find it beneficial to do so. In their AQAA, the home reported that “we listen effectively and promptly as soon as we are aware that someone needs to talk. We ensure our staff comprehend and receive training in Understanding Abuse and Whistleblowing and that all our policies and procedures are reviewed regularly”. We discussed a range of scenarios with different staff. All were aware of their responsibilties for supporting vulnerable people given such scenarios. Staff we spoke with were aware of whistleblowing polcies. A review of the home’s files shows that the whistleblowing procedure has worked in an effecive manner in the past. Mrs Dempster was aware of how to report alerts via local procedures and fully understood that if she needed to suspend a member of staff that this was a non-judgemental action, to support both the resident and the member of staff. We discussed training in safeguarding with the home supervisor and reviewed records. The home supervisor, who had only recently come into post, reported that they had needed to audit records to clarify who had been trained in the area and any deficits. As records were not clear, they reported that they had commenced by ensuring that all newly employed staff had received training in abuse awareness. Now that this had been addressed, they were planning to ensure that all permanent staff were trained on a regular basis. They reported that they were using a DVD programme, which had questions for staff to answer which could be marked initially and after that to further develop, using Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 24 group discussion and further training methods to develop staff awareness and skills in this area. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 25 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including visits to this service. Residents will be supported by a pleasing, clean, well-maintained environment. EVIDENCE: In their AQAA, the home reported: “We maintain a clean odour free environment with light and airy rooms both private and communal. We redecorate and deep clean each bedroom as it becomes vacant and as frequently as necessary while occupied. Personal laundry is done on a daily basis”. Of the 36 people who responded to this section of the questionniare, 33 people responded that the home was always and three that it was usually fresh and clean. Comments included “the home is clean, cheerful, bright”, “the hygiene Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 26 and cleanliness of the nursing home is excellent”, “the communal areas are excellent” and “the home is spotlessly clean”. This was also supported by people we met with during the inspection. One visitor commenting “I like it because there are no smells”. A resident commented that the home had supplied them with new pillows the day before and they appreciated the home’s attention to such matters. Our expert by experience commented “I arrived at the premises by car and found that access to the front door was very easy, the car park although not immaculate was tidy but parking spaces were difficult to find probably due to building work taking place at the premises. There were a number of disabled parking spaces but both of these had been taken, these spaces were within easy access of the front door”. They commented about the home “I looked into several resident private rooms and found them to be good or in fact excellent and bathrooms were very clean and tidy. Beds were reported as being very comfortable and all rooms were light and airy. The main dining room was a lovely room and excellent for purpose. The furniture was of a lovely quality and the whole room was light and airy with a most wonderful view out over the countryside. There were lovely pictures around the walls. I also found that the lounge was a lovely room and this also had a beautiful view and gave a lovely relaxed atmosphere. As I moved around the premises I did notice that there may be a need for some hand rails in the passageways. As I have difficulty in walking I did notice that there was nothing for a person with walking difficulties to hold on to as they moved around the public areas”. We observed that the home environment well maintained, range of different sizes of rooms for residents. All areas of the home were attractively presented with high quality of equipment and finishes. All the beds variable height and many were profiling. There was a good supply of disposable gloves, including both latex and vinyl. One male member of staff reported that the home had “got all sorts of gloves”, including large gloves which fitted his hands. A range of air mattresses and chair cushions were available for residents who were at high risk of pressure ulceration. All commode chairs inspected were clean. Where residents shared a room, wash bowls were labelled with their name. Wash bowls were stored clean and dry. A cleaner we spoke to had a good understanding of their responsibility in the prevention of spread of infection. They reported that they changed all mop-heads every day. A range of hoists and other equipment was provided to aid manual handling. Hoist slings were provided in different sizes. We observed that hoist slings were hung up one on top of the other and staff reported that slings were used communally. We advised that this is not regarded as good practice as communal use of hoist slings can lead to a risk of cross-infection. If a resident needs a hoist sling, they need to be allocated their own sling, which is used only for them. Used hoist slings should not be hung up so that they are in contact with each other, as this can also present a risk of cross infection. The Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 27 laundress knew how to safely clean hoist slings and reported that they were laundered frequently. We met with the laundress who showed a good understanding of their role in the prevention of spread of infection. They were able to show us a good supply of disposable gloves and aprons for them to use. We observed that the area behind the dryers was clean and free of dust. Some white-coloured dust was observed behind the washing machines and we advised that such areas needed to be kept dust-free. The laundress reported that staff always put laundry in the correct bags, in accordance with the home’s polices and procedures, so they never needed to re-sort laundry. We observed carers correctly managing laundry, using disposable aprons and gloves to carry the laundry to the laundry skips. The laundry has a “spares” box for items which had not been named. The laundress reported that they asked carers to come and look to see if the owners of such items could be identified, but reported that the issue of un-named clothes did occur, particularly for items such as socks and net underwear. We discussed with Mrs Dempster that this is an area which needed further consideration and that she should look at systems to ensure that all laundry is named and returned to the person they belonged to. We advised that there are a range of systems and equipment available which can facilitate this. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 28 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including visits to this service. Residents will be protected by the numbers and skill mix of staff on duty. Developments are needed to evidence safe recruitment procedure and staff training needs to be progressed this is to avoid risk of unsafe recruitment processes and staff without a sufficient knowledge-base to meet residents’ needs. EVIDENCE: In their AQAA the home reported “we employ sufficient staff both qualified/unqualified to meet the assessed needs of all our residents and to comply with registration standards” and “we employ sufficient non-care staff seven days a week to ensure the environment is always clean nutritional needs are met and laundry is freshly and promptly returned to individual residents. Maintenance personnel are employed from Monday to Friday”. The expert by expereince commented “I spoke with a number of members of staff and found them to be very friendly and helpful and they were clean and tidy in the uniforms”. They also commented that the door to the home was promptly answered when they rang the bell. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 29 Of the 36 people who responded to this section of the questionnaire, 20 replied they always and 16 usually received the care and support that they needed. Comments included “staff are very kind and caring”, “I am always ready on time if I am going out”, a person commented on the good “staff accessibility” and another “plenty of staff on duty”. Of the 10 staff who responded to this section of the questionnaire, five felt there were always, three usually and two sometimes enough staff on duty to meet residents’ needs. One person felt that the home needed “additional staff” commenting that the needs of residents were increasing and another “sometimes you need more staff on because of the clients’ needs”. We observed staffing levels during our visits. We observed that there were enough staff on duty at lunch-time to support residents with different dependency needs. We also observed that when we asked a member of staff for assistance of behalf of a resident, that staff were able to promptly give the resident the assistance they needed. We observed that there was always at last one member of staff and sometimes more, available in sitting rooms and on each floor and area of the home. Recruitment of staff in a rural area such as Ashley Grange can be complex and the home, like many others relies on support from staff from other countries. Some people commented on staff English language skills in questionnaires. Comments included “my [relative] has always found it difficult to understand the overseas workers because of the language barrier”, “many of the care staff have a poor command of English” and “it is very difficult to make foreign staff understand all the time”. Due to these comments we met with nearly all the carers on duty, to assess if they knew how to meet residents’ needs. All of the carers we met with were able to inform us about residents’ needs, some in considerable detail. We did observe that some carers had accents which might be unfamiliar to some residents, but all the carers we met with had sufficient understanding of English to communicate effectively. Some staff who were not involved in a caring role, did not have such good command of English language, however their understanding was sufficient for their role. For example a kitchen assistant who was giving out drinks knew enough English to understand the types of drinks residents wanted. In their AQAA the home reported “new staff are only offered employment subject to two satisfactory references POVA and CRB check being received. All staff must complete a satisfactory three month probationary period”. The home supervisor reported to us that as part of their role, they were relieving staff files to ensue that all files included all required information. We looked at recruitment records and found, as the home supervisor had advised that while all records included two references, a health status declaration and an employment history, not all records were in good order, one did not provide proof of identity in that it included a photocopy of a photograph which was not clear and others did not provide evidence of police checks. This was discussed with the provider and it appeared that for some staff such records were not kept on site and others had not been provided by the agency the home uses to assist in recruitment. Since the inspection, the provider has informed us of Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 30 steps taken to rectify issues identified during the inspection. The home supervisor needs to be enabled to complete their audit of staff files, to ensure that all required documentation is in place. Staff gave a mixed response about induction in questionnaires. Of the ten people who responded to this section of the questionnaire, six reported that their induction has covered all areas that they needed to know very well, three people reported that it mostly covered areas that they needed to know, however one person felt that it had not. We discussed the home’s induction programme with the home supervisor. They reported that when they commenced their role, they had reviewed and revised the home’s induction programme to ensure that it complied with current guidelines. They had then drawn up a schedule and had identified that some staff not had an induction. By the time of the inspection, they were able to show that they had taken action to ensure that all staff employed in the home had had an induction. New staff work four days supernumerary when they commence employment, shadowing, learning and working different shifts. After that, the home supervisor reported and records showed that for six weeks each new employee would look at each induction standard and meet for an hour a week with the home supervisor to discuss the topic and show their understanding. These meetings were not documented and we advised that as they are a key part of the induction programme, they should be. Induction records that we saw had been signed by different people on different dates, indicating that it was a live document. There was also evidence of topic-based training in areas such as shaving, assisting a resident in eating their meals and bed bathing. Ancillary staff have an induction relating to them this is done individually according to the person’s role. For registered nurses inductions take place with Mrs Dempster. We observed a new registered nurse being inducted into their role during the inspection. They reported on how supportive staff at all levels had been to them and that they had been impressed by carers’ knowledge of individual resident’s needs. We observed that the registered nurse was supervised on administration of medication on induction, however this was not documented and it should be as it is a key area in the registered nurses’ role. At the end of the induction period all staff receive supervision. This is documented. In their AQAA, the home reported “we encourage all our staff to undertake NVQ training and we currently have six care staff with NVQ 2 or above. We have sixteen other carers working towards NVQ level 2 and 3”. In questionniareas, some staff commented on training. One person reported that the home needed to “make sure junior staff have training” and another “the staff are not paid for training, except for induction, this makes the training of staff difficult”. The home supervisor reported that the home had not had a Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 31 training matrix when they came in post. They had now drawn one up. In doing this, they had identified a range of deficits in mandatory training such as manual handling, infection control and food hygiene. They had a plan to ensure that all such mandatory training would be up to date by 31st December 2009. Training was observed to be taking place on both days of the inspection. Discussions with staff indicated that informal training in care was also taking place. This was not documented and it is recommended that such training also be documented. The home supervisor reported that they were currently in the process of reviewing all staff individual training files, to ensure that records were up-to-date. The home supervisor was also developing an audit of training, so that they could identify gaps in knowledge or areas where staff needed more development. For example the home supervisor had given a training programme on practice and management of laundry, as it was identified as an issue ensuring supervisions, particularly when night staff were performing laundry. There some was evidence that staff had received training in key areas such as dementia care, palliative care, nutrition and catheter care. However other key areas such as diabetes, stroke care and care of people with swallowing difficulties did not appear to have been covered recently. The home supervisor reported that once they had ensured that mandatory training was up-to-date, they would develop an action plan for development of a training programme in meeting residents’ needs. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 32 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 26 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including visits to this service. Residents will be supported by a management team who are keen to ensure quality of service provision. EVIDENCE: In their AQAA, the home reported that Mrs Dempster “has been employed at Ashley Grange since 1999, first as deputy-matron and then since 2005 as matron.She has had extensive clinical and senior management experience within the NHS”. They also repored that “we operate an open door policy and have an open and transparent approach to management”. During the inspection, we discussed a range of areas with Mrs Dempster, she was open Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 33 and showed an interest in all areas relating to improving service provision to residents. Mrs Dempster also showed a detailed knowledge of her different residents and their needs. The owners of the home Mr and Mrs Ashley are very involved in the home and visit reguarly. They are happy to meet with residents, their visitors and staff members when needed. They also take an active interest in staff welfare. For example, they have provided and ensure that staff use flourescent jackets and never walk alone when walking to and from work, as this involves walking along un-lit country lanes. Mrs Dempster is supported by two deputy managers. She is also supported by two home supervisors, who manage activities, ancilliary staff and staff training and development. The home has systems for regular review of quality of care. They survey newly admitted residents to seek their views. They also regularly survey residents and their supporters. The home does not currently perform a confidential survey of staff and they might like to consider this as part of their quality audit. Mrs Dempster reported that she receives verbal feed-back from external professionals. There is a system for regular survey of meals. Mrs Dempster audits accidents regularly, to identify trends. Mrs Dempster was aware of all residents who had infection and tissue viability needs and so could monitor clinical outcomes. There was evidence of regular medication audits and it was clear that if issues were identified, they were fed back to registered nurses. The home does not perform regular audits on response times to call bells, which they may find beneficial as part of their quality audit, to assess if staff consistently respond promptly when call bells are used or if there are any variations. In their AQAA, the home report “we safeguard residents personal money by an effective individualised record showing income and expenditure. A computerised print out is available to relevant personnel upon request”. We reviewed the home’s sytems and observed that there was a monthly invoicing system. All expenses were fully receipted. There was a full audit trail, for additional expenses, including toiletries. Accounts were audited regularly. There was also a system for valuables handed in for safekeeping. All such items were fully receipted and included clear descriptions of the item handed in. Of the eleven staff who responded to this section of the questionnaire, six felt they were regularly, two often, one sometimes but two never given supervision. We discussed this with the home supervisor, who reported that when they came in post, they had found that systems for ensuring that staff received supervision needed development. They reported, and records showed, that most care staff had received at least one supervision since the home supervisor came in post. They reported that they were planning that some supervisions would be observed practice in care, as well as one to ones. They reported that they were currently trying out different formats for supervision, including a supervision observation record. Not all supervisions Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 34 reviewed had been dated and signed. None of the staff had been trained in how to conduct supervisions and this is recommended so that supervisions can be conduced in a way that will support both the home and staff. The home supervisor reported that they were next looking at developing supervision in the catering department. Mrs Dempster is responsible for supervising registered nurses. Records indicated that this was not taking place on a regular basis and there were not clear systems for clinical supervision. It is advisable that registered nurses also be supervised, including clinical supervision. In their AQAA, the home reported “the Proprietors and management take Health and Safety very seriously with regular checks being made on services and equipment by outside contractors”. It was reported that a consultant from a health and safety company had recently visited the home to look at the area and support the providers in developing an action plan. The maintenance man reported that staff were very good at writing in maintenance book and that they also perform a half hour inspection of building every day. There was full evidence of monthly, three monthly, bi-annual and annual maintenance. Records showed that the cleaners checked water temperatures and shower-heads monthly. The maintenance man reported that they informed him of any deficits for him to action. Records showed that all electrical items were tested, this included items brought in by new residents. Wheelchairs, hoists and lifts were regularly maintained. All staff received regular fire safety training. All new staff receive fire safety training on induction. Fire drills are carried out regularly any time of day and some evenings too. Staff have been trained on fire extinguisher use. The home does not yet have individual evacuation plans for residents as is recommended by the fire brigade. We met with two cleaners who reported that they had all chemicals and equipment they needed to perform their role. The reported they had been trained in safety relating to hazardous substances, infection control and use of their equipment. The maintenance man reported that staff managed clinical waste correctly. We observed staff performing manual handling using a Standaid hoist. The two members of staff worked carefully together, reassuring the resident throughout the procedure. We watched two other members of staff moving a person using a hoist and sling and they also performed this procedure safely. We observed that when staff were moving residents using wheelchairs that they made sure the residents had both feet on the footplates. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 2 4 3 X 2 3 X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 4 2 x 3 Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 36 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement The summary of the most recent inspection report must be included in the service users’ guide, together with information on how the full report may be obtained. The home must ensure that all assessments of residents’ needs or risks are always completed in writing and a copy held on the resident’s file. Such assessments must be completed promptly after a resident’s admission. When a resident’s condition changes, revised assessments must be promptly completed. All care plans and care plan evaluations must be completed in writing. The home must develop care plans relating to residents’ needs for activities, taking into account their past lives, interests and preferences. The home must ensure that hoist slings are not used communally and are not stored where they can be in contact with each other. DS0000015887.V377906.R01.S.doc Timescale for action 31/01/10 2. OP7 14 31/12/09 3. 4. OP7 OP12 15 15 31/12/09 31/01/10 5. OP26 13 28/02/10 Ashley Grange Nursing Home Version 5.3 Page 37 6. OP29 19 7. OP30 18 The home must complete its review of staff employment files, and ensure that all required information is available for inspection. The home must ensure that it completes training programmes for all staff in mandatory areas and must then develop training programmes for all staff in specific areas to meet resident needs. 31/12/09 31/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Refer to Standard OP1 OP7 OP7 OP7 OP8 OP8 OP8 OP10 OP16 OP26 Good Practice Recommendations The service users’ guide should include more detail on how many staff, and their grades, on duty at different times of the day. Care plans should use clear, measurable language. The home should develop a key worker system. Key workers should complete the care plans for their key residents. All staff who complete care plans should be trained in their role. The clinical indicator for use of a urinary catheter should always be documented. Fluid balance charts should always be completed every 24 hours and information used in the evaluation process. Where residents need thickening agent in their drinks, precise directions on the thickness needed for drinks should be documented. Residents own preferred names should always be used when addressing them. Generic terms of endearment should always be avoided. The home should perform regular written audits of complaints to identify any trends. The area behind the washing machines in the laundry should be kept dust-free at all times. DS0000015887.V377906.R01.S.doc Version 5.3 Page 38 Ashley Grange Nursing Home 11. 12. 13. 14. 15. 16. 17. 18. 19. OP26 OP30 OP30 OP30 OP33 OP36 OP36 OP36 OP38 The home should develop systems to ensure that residents own clothing is always returned to them and thereby reduce risks of communal use of underclothing. Records should be made of all meetings with new staff as part of the induction processes. Records should be made of medication supervisions for newly employed registered nurses. Written records should be made of informal training given to staff, to evidence all training given. The home should perform regular written audits on response times when call bells are used. All supervisions should be dated and signed by both parties Staff who perform supervisions should be trained in the role. Registered nurses should receive regular supervision, including clinical supervision. The home should develop individual resident fire evacuation plans Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 39 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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. Ashley Grange Nursing Home DS0000015887.V377906.R01.S.doc Version 5.3 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!