Care Home: Ashley House

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What the care home does well They carry out a pre-admission assessment to make sure they are able to meet people`s needs. They have an activities organiser. This means that regular activities are planned based on people`s interests. They provide information for people thinking about going to live at the home. This means that people have enough information about the home to make a decision about whether they want to live there. They provide a wide range of training for staff. Staff have received training in safe moving and handling, safeguarding, first aid and basic food hygiene. This means that people can be confident that staff have the knowledge and skills to meet their care needs. People who live at the home were very complimentary about the staff and the care they receive. The home was comfortably furnished. What has improved since the last inspection? Staff have achieved NVQ level two. The manager and staff have received training in relation to the deprivation of Liberty safeguards. What the care home could do better: It was recommended that the monthly reviews be recorded on the risk assessment to show that they were an up to date and accurate assessment of the person`s risk. A recommendation is made that the home contact the General Practitioner and asks that directions show the dose and times that medication is to be administered. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashley House 155 Barlow Moor Road Didsbury Manchester M20 2YA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Jennings     Date: 1 0 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ashley House 155 Barlow Moor Road Didsbury Manchester M20 2YA 01614453776 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Deborah Reynolds,Ms Carmel McHale care home 18 Number of places (if applicable): Under 65 Over 65 17 0 old age, not falling within any other category physical disability Additional conditions: 0 1 That one named service user is accommodated who is under the age of 65. That the category of registration reverts solely to older people (OP) when this service user reaches the age of 65 or leaves the home. The maximum number of service users accommodated is 18. Date of last inspection Brief description of the care home Ashley House is a privately owned residential care home providing personal care and accommodation for 18 older people. The home is located in the Didsbury area of Manchester and is within easy reach of Manchester City Centre. The area is well served by public transport to the neighbouring areas of Stockport and Chorlton. In addition, the home is well positioned for local amenities such as shops, Didsbury shopping centre, hospitals and Manchester airport. The home is a large Victorian detached property that stands in its own grounds. Well-maintained gardens provide pleasant outdoor facilities. Parking is at the side of the building and there is access to a large Care Homes for Older People Page 4 of 27 Brief description of the care home car park to the side of the building. The accommodation comprises of twelve single and three double bedrooms. All rooms have a wash hand basin and are individually furnished with some residents bringing their own furniture into the home. There are two pleasant lounges on the ground floor and these were decorated to a satisfactory standard. A separate dining room is available where seating is arranged in small group settings of four. Accessible toilets and bathrooms are located on both floors near to bedrooms and living rooms. A lift is available to take residents to the first floor. On the day of the site visit the manager said that the weekly charges to residents living at Ashley House are, £358.09 for a shared bedroom and £373.54 for a single bedroom. 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: two star good 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 quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This visit was undertaken as part of a key inspection, which includes an analysis of any information received by us (Care Quality Commission)in relation to this home prior to the site visit. We also looked at other information we had about the home. Before the visit the home manager was asked to complete an Annual Quality Assurance Assessment (AQAA) to provide up to date information. We sent our questionnaires out to people who live in the home, their families and staff in order to find out their views. Care Homes for Older People Page 6 of 27 The visit was carried out by two inspectors and was unannounced and took place over the course of 7 hours on Wednesday 10th June 2009. During the course of the site visit we spent time talking to people who live at the home, the manager, a district nurse and 3 members of staff to find out their views of the home. Time was spent examining maintenance records and the residents and staff files. A tour of the building was also carried out. There was evidence to show that the unit managers and staff continued to work hard to develop and improve the service. Health and Safety checks take place to make sure people are kept safe and good records are kept of these. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 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 9 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. People were given enough information about the home and needs assessments were carried out before admission. Evidence: We saw a sample of four care plans. We saw that each one contained an assessment of the individuals needs. We saw that needs assessments had been carried out by a care manager. We saw that they also carried out a pre-admission assessment to make sure they were able to meet peoples needs. The pre-admission assessment was carried out by a senior member of staff. This means that people were only admitted to the home once they were sure they could meet their needs. Once the assessment was completed admission to the home was arranged. Care Homes for Older People Page 10 of 27 Evidence: People thinking about moving into the home and their relatives are invited to visit so that they can meet other people and see the accommodation for themselves. This means that they have a chance to make sure they like the home and that it is the right place for them. One person told us my daughter wanted somewhere I could stay if they were away she looked all around and she said she liked this one the best, she liked the owner and the animals. Another told us my son found this home and I have been very happy here, he came and looked around they gave him lots of information about it and he thought it was ideal for me. We saw that they had a statement of purpose that gave enough information about the care the home provided. We saw that each person has a contract that detailed the terms and conditions of residence and the cost of living at the home. The Home does not provide intermediate care. Care Homes for Older People Page 11 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. Peoples care plans identified their health and personal care needs and medication practices generally safeguarded people from harm. Evidence: We saw the care plans of four people living at the home. Each one had a copy of the pre-admission assessment completed by the home. We saw that where the local authority had arranged admission a care managers assessment of need was completed. We saw that people had been involved in writing their care plans. Care plans had been signed and dated by the individual or their representatives. We saw that care plans detailed peoples interests, family and friends and their likes and dislikes. Care plans were being reviewed on a monthly basis. We spoke to care staff who knew peoples health and personal care needs. They were able to tell us what help people needed. We spoke to people living at the home. One Care Homes for Older People Page 12 of 27 Evidence: person told us they help me to go to my room in the wheelchair, they know I cant walk there on my own, they are so kind. Another said they know exactly what I need to get through the day. We saw that risk assessments were carried out in relation to falls and fire safety. The risk assessments were dated 2007 and stated that they were ongoing. The manager told us that they were reviewed monthly. It was recommended that the monthly reviews be recorded on the risk assessment to show that they were an up to date and accurate assessment of the persons risk. We spoke to four people living at the home. One person told us I dont think they could look after me any better and they are really good. Another said they are great, it is very homely and they will do anything for us and I couldnt fault them One person told us the staff are lovely they really are and pointing out one member of staff one person told us this one is a real live wire. One person told us I like to spend time in my room and they pop in and out bring me drinks and let me know when the meals are ready. We saw that the care staff treated people with respect and maintained their dignity. We were sat with one person in their room when care staff came to tell them lunch was ready. We saw that they knocked on the door and waited for a response before popping their head in to speak to the person. One person told us I need help to have a shower, but I never feel uncomfortable they are so thoughtful. We saw that they had policies and procedures regarding the ordering, storage and administration of medication. Medication was dispensed into blister packs. We saw that these were stored in a locked cupboard inside a locked room. We saw one persons medication had been prescribed to be taken as directed. There should be clear and detailed instructions available to staff on the dose to be taken and when the medication should be given. This should include any special information like should it be given with, before or after food. A recommendation is made that the home contact the General Practitioner and asks that the directions show the dose and times that medication is to be administered. We also saw one persons medication that did not have a Medication Administration Record (MAR). This indicated that medication was not being signed for as and when it was given to the person. The owner told us that the district nurse had taken the record Care Homes for Older People Page 13 of 27 Evidence: to the GP to be amended and would be returning it later in the day. A recommendation is made that Medication Administration Records should not be removed from the home. Care Homes for Older People Page 14 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. People could choose to whether or not to take part in various activities offered and a balanced and varied menu was provided. Evidence: The home has recorded peoples previous life history. The completed document details religious cultural and recreational interests and is retained in the persons care plan. This helps the carers to better understand peoples needs and is considered to be good practice. It was apparent from speaking to the people living at the home that their relatives were well known and welcome into the home. One person told us she spent time away from the home with her family. We saw that people benefit from relaxed informal contact with the staff. Music was playing in one lounge and a small group of residents were watching the television. There was plenty of lighthearted banter between people living at the home and the staff. We saw that the daily menu was displayed in the hallway. This means that Care Homes for Older People Page 15 of 27 Evidence: people know what the meal is each day. The food provided was all home cooked and they used fresh vegetables and local produce. We spoke to a number of people living at the home. One told us they make lovely, lovely meals. Another said I am awkward as I cant swallow anything lumpy they always make me something else I never have to ask and I never leave anything. The meal on the day of our visit was corned beef hash with vegetables, cauliflower cheese or vegetable lasagne with mixed vegetables. the sweet was mixed fruit or egg custard. We saw the meal being served. It looked appetising and people looked as though they were enjoying their lunch. A choice of hot and cold drinks was available. After lunch people were relaxing in the lounges or watching television. Some people went out for a walk and others went to their rooms for a rest. We spoke to the member of staff responsible for arranging activities. they told us we have themed discussions, we will pick a letter of the alphabet and people have to name a flower or a tune begining with that letter, it makes people think and talk about it. They also told us one of the staff enjoys singing and will come in and do a sing-along. We spoke to people who told us the girl who sings is like a live wire she is really good. Another told us she dances about and makes me laugh, I really enjoy her singing. One person told us I am 100 and can honestly say I think I have laughed for half of my life thats why I love it here they are all happy. This person pointed to a member of staff and told us this one here is a real gem. Staff told us we have a quiz where we ask people what hairstyles they used to have, what their first boyfriends name was and what their wedding dress was like, they all evoke memories and discussions. Care Homes for Older People Page 16 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. Procedures were in place to protect people from abuse and people knew how to make a complaint and were confident their concerns would be taken seriously. Evidence: We saw that they had a complaint policy and procedure. We spoke to people living at the home who told us they knew who to speak to if they had a complaint. One person told us I have not had any concerns but I would initially speak to my daughter and then to the manager. People told us that they felt sure their concerns would be taken seriously. We saw a large number of thank you cards from relatives. These were pinned to the notice board in the hallway. We saw one complaint had been recorded since the last inspection. The complaint log recorded the nature of the complaint, the investigation and the outcome. We spoke to the manager about safeguarding procedures. they told us that if they had an allegation they would report it to the local authority contact centre. The manager and three members of staff had received training in how to recognise abuse and how to report it. Training for two more care staff was planned for the 16th June. Six of the staff and the manager had attended training in relation to the Deprivation Of Liberty Care Homes for Older People Page 17 of 27 Evidence: Safeguards. This means that staff are aware of peoples rights. Every member of staff has a Criminal Records Bureau check to make sure that they are safe to work with vulnerable people. 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. People living at the home benefitted from a clean, comfortable and well maintained environment. Evidence: We saw that the home was clean, tidy and free from unpleasant odours. There were two lounges these were pleasantly decorated and had pictures and plans placed around. People living at the home told us that it was always clean and tidy and they were happy with the environment. One person told us it is very pleasant, homely. The dining room was bright and airy and tables were set with tablecloths and flowers. This means that people were able to sit and enjoy their meals in pleasant surroundings. We saw a sample of peoples bedrooms. These were personalised with ornaments and family photographs. We sat with one person in their bedroom. they told us I spend a lot of time in my room and have bought the carpet and furniture and I brought the lamp from home, I think it is cosy. We saw that people had brought their own armchairs from home. One person told us this is my own chair, I find it very comfortable. Care Homes for Older People Page 19 of 27 Evidence: We saw that there were enough toilets to meet the needs of people living at the home and these were close to the lounges and easy for people to access. We saw that there were aids and adaptations available to meet peoples needs. These included a special walk in bath and raised toilet seats. Special beds were provided for those people who were assessed as needing them. We saw that there was an emergency call system fitted in each bedroom. This means that people could access staff quickly in an emergency. One person living at the home told us there is a button next to my bed and if I need anything in the night I just press it and they come to me. We saw that staff carried bottles of sanitising hand gel. This is to reduce the risks of infection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safeguarded by the homes recruitment and selection process and a range of training is available to staff. Evidence: We saw that the numbers and skill mix of staff on duty during our visit was sufficient to meet the needs of the people living at the home. We saw that most of the staff had worked in the home for a number of years. This means that people living at the home were familiar with the staff and that staff knew people well. They told us that new staff had been employed recently but that this was to replace staff who had retired. We saw a sample of staff recruitment files. These had an application form with an employment history. We saw that each person had two written references on file. Each member of staff had a Criminal records Bureau check (CRB). This is to make sure that they are safe to work with vulnerable people. We saw that all staff have an induction period. During this time they work alongside an experienced member of staff. We saw that staff attended training courses in relation to health and safety. This included moving and handling, first aid, safeguarding and mental capacity. This means that staff have the skills and knowledge needed to care for people. Care Homes for Older People Page 21 of 27 Evidence: We saw that 4 staff have achieved NVQ at level II and 4 staff have just commenced NVQ level II training. There was a district nurse at the home on the day of our visit. They told us staff are very helpful they cant do enough, they care immensely. they also said I have never heard staff being abrupt with people. The district nurse told us if we advise them that someone needs to be bathed or showered twice a day they do it without any complaints. Supervision is observed practice and any issues are raised and recorded. This is provided 2-3 monthly and keeps staff up to date with any changes to policy and procedure. It also helps to identify and discuss any changes in peoples care needs. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the skills, knowledge and experience to run a care service for older people. Evidence: The manager has a number of years experience of running a care service for older people. Comments from staff and other professionals about the management of the home included requests received from the home for assessment are appropriate the manager is in tune with things and the manager is approachable. One person living at the home told us she is always available another said she is not a bossy boss she gets on and helps the girls with the work. People living at the home manage their own financial affairs. Where this is not possible a relative or legal representative helps. Care Homes for Older People Page 23 of 27 Evidence: A system of staff supervision is in place. Records are kept of the meeting time and date but in depth records of discussions are only kept if problems are identified. Supervision is held 3 monthly. Staff confirmed that they received on the job supervision and an annual appraisal. This means that any problems or training needs can be identified. We saw a fire risk assessment and health and safety risk assessments of the building. This makes sure that the building is safe for the people living there. We saw that fire drills were carried out on a regular basis. This is so that staff are familiar with the emergency procedures. We saw that they had a visitors book that was not being used on a regular basis. We recommended that visitors to the home are asked to sign in and out. This book provides a record of who is in the home at any time during the day. This information should be used in an emergency situation to give full details of who is in the home in the event of a fire or an emergency evacuation. We saw the accident record. The completed accident reports were removed from the book and stored on the individual persons file. This means that personal information about people is stored correctly. The homes certificate of registration and public liability insurance were displayed in the hallway. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It was recommended that the monthly reviews be recorded on the risk assessment to show that they were an up to date and accurate assessment of the persons risk. Medication Administration Records are part of the persons care plan it is recommended that they should not be removed from the home. A recommendation is made that the home contact the General Practitioner and asks that directions show the dose and times that medication is to be administered. 2 9 3 9 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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