Care Home: Ashley House Care Home

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What the care home does well When we asked staff what the home does well they told us, “Pressure area care”, “ Good day to day support”, ”I think the home provides an excellent standard of care”, “I feel that everything is done to the best of our ability” and “ The home offers good care to all of the resident’s and also cares for its staff”. We looked at the training files of three members of staff and there was evidence that they had received training in safeguarding vulnerable adults. We spoke with two members of staff and they showed a good understanding of reporting poor practice. Staff are trained in infection control procedures and we observed them putting these procedures into practice on the day of the inspection. What has improved since the last inspection? The manager is now registered with the Care Quality Commission. Staff told us that the manager is improving the home and that he is very approachable and supportive. We looked at the files of three staff working in the home and we found that they contained evidence that safe recruitment practices were being followed. Staff also told us that they had to wait for the required checks to be in place before they commenced employment at the home. Staff have received recent training in areas of health and safety and care delivery. Staff told us in surveys that they were given training that was relevant to their role, helped them to understand the needs of people they supported and kept them up to date with new ways of working. The manager has produced a workforce plan which identifies the training already in place and any future development for staff. What the care home could do better: Ashley House Care HomeDS0000024625.V377972.R01.S.docVersion 5.2Where the surface temperature of radiators in the home cannot be guaranteed as not exceeding the required safe temperature, a risk assessment must be completed and control measures put into place to minimise the risk. Staff must be available to give assistance to people living in the home when eating, where necessary. More frequent and varied activities should be provided so that all people living in the home have opportunities to spend time doing things they find enjoyable and stimulating. The registered manager must ensure safe working practices with regard to moving and handling. Key inspection report CARE HOMES FOR OLDER PEOPLE Ashley House Care Home Sunnyside Worksop Nottinghamshire S81 7LN Lead Inspector Lynda Dyer Key Unannounced Inspection 17th November 2009 09:30 DS0000024625.V377972.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 House Care Home DS0000024625.V377972.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 House Care Home DS0000024625.V377972.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley House Care Home Address Sunnyside Worksop Nottinghamshire S81 7LN 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) 01909 500541 01909 500542 Ashfieldcare@aol.com Mr L M Patil Ramjogee Neeliah Maistry Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (40) Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd April 2008 Brief Description of the Service: Ashley House is located on the outskirts of Worksop. A car park is available at the side of the home and it is on the bus route into the town. The home provides nursing and personal care for 40 residents, including older people with special mental health needs. Within this number the registration allows admission for up to 10 service users over 50 years of age. The home is privately owed by Mr Patil and was opened in 1988. It consists of a large converted old house, with a purpose built lounge and bedroom extension on the ground floor. Plans have recently been passed by the local council to allow the owner to upgrade the home and build a 32 bed extension. There are 17 single and 9 double bedrooms, 12 rooms having ensuite facilities. The first floor is accessible by a lift. The homes grounds are well laid out and provide a secure environment for residents. At the time of the inspection the owner confirmed that the weekly fees depended on the residents assessed needs. Additional charges are made for services such as chiropody, toiletries and hairdressing. Information about these costs as well as the day-to-day operation of the home are included in the Statement of Purpose and Service User Guide and a copy of the last inspection report is available in the office. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last time we visited this service was 28/11/2008 The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. ‘We’, as it appears throughout the Inspection Report refers to The Care Quality Commission. Two inspectors carried out an unannounced site visit to the home, which took place between the hours of 9.30am and 5.00pm The Registered Manager, general manager, clinical manager and the owner assisted us during the site visit to the home. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this the Short Observational Framework for Inspection (SOFI). This involved us observing a small number of people who live in the home for 2 hours and recording their experiences at regular intervals. This included their state of well being, and how staff interacted with them. We also observed how the people living in the home interacted with other people living there and with the environment. An expert by experience also visited the home with us. An Expert by Experience is a person from a voluntary organisation who has experience of care. They look at areas we ask them to look at, but from an ordinary persons point of view. They spoke with five people living in the home to get their views of the service. We sent out surveys called, have your say, to people who use the service, staff that work there and relatives. This meant we could get an idea of what people thought about the way the home was run. We had 28 completed surveys back and we have included some of the comments in this report. We have not included comments that could identify the writer as we want people to feel they can be open about the way they feel the service is run. We also reviewed all of the information we have received about the agency since we last made a visit to them and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking, which involved us choosing three people who use the service and looking at the quality of the Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.2 Page 6 care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with the manager, the clinical manager, three members of staff and five people who use the service to help us to form an opinion about the quality of the service being provided to people. We read documents as part of this visit and looked at the environment and facilities of the home to form an opinion about the health and safety of people who use at the service. What the service does well: When we asked staff what the home does well they told us, “Pressure area care”, “ Good day to day support”, ”I think the home provides an excellent standard of care”, “I feel that everything is done to the best of our ability” and “ The home offers good care to all of the resident’s and also cares for its staff”. We looked at the training files of three members of staff and there was evidence that they had received training in safeguarding vulnerable adults. We spoke with two members of staff and they showed a good understanding of reporting poor practice. Staff are trained in infection control procedures and we observed them putting these procedures into practice on the day of the inspection. What has improved since the last inspection? What they could do better: Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.2 Page 7 Where the surface temperature of radiators in the home cannot be guaranteed as not exceeding the required safe temperature, a risk assessment must be completed and control measures put into place to minimise the risk. Staff must be available to give assistance to people living in the home when eating, where necessary. More frequent and varied activities should be provided so that all people living in the home have opportunities to spend time doing things they find enjoyable and stimulating. The registered manager must ensure safe working practices with regard to moving and handling. 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 House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 8 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 House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 9 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): People using the 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 that are admitted to the home have their needs assessed prior to admission, which means staff, will be able to plan for their individual needs and know how to care for them. EVIDENCE: The manager told us in the homes Annual Quality Assurance assessment (AQAA) that the home has a multidisciplianary approach to assessment of care needs of residents using the homes staff resources as well as those of specialist external agencies. They also said that prospective residents are given an information pack consisting of the homes brochure, statement of purpose, philosophy of care, complaints procedure, weekly menu, and recreational activities. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 10 We looked at the care plan of the person most recently admitted to the home and there was an assessment from the Local Authority as well as an assessment carried out by the home. We spoke with staff about the admission process and they told us that they always got to know if there was going to be a new admission and were given details of their needs. We received surveys back from people living in the home and information in these told us that most people felt they had received enough information before they decided to live in the home. The home does not offer intermediate care and so standard 6 does not apply. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 11 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): People using the 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 in the home have up to date and relevant care plans, which give guidance to staff to deliver the appropriate individual care. Medication procedures are safe and people are supported to access external healthcare when needed. EVIDENCE: The manager told us in the homes Annual Quality Assurance assessment that care plans are developed and agreed with residents and their relatives and kept up to date and that referrals are made to specialist services as appropriate. We looked at the care plans of three people living in the home. The care plans contained risk assessments in some areas of daily living and there were action plans in place to tell staff how to manage the risk. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 12 There was evidence that people were being referred to external health professionals when needed and also that some aspects of the Mental Capacity Act was being applied to peoples care. The care plans were being reviewed monthly but there was not much detail of the reviews with information mostly recorded as, ‘No change’. The care plans we viewed were not person centred and where there were tasks recorded there was no reason as to why the tasks were to be carried out in the way the care plan identified. There was no evidence in one of the care plans that the person living in the home or their representative were involved in its development and people we spoke to said they did not know about their care plan. We spoke with the clinical manager about the care plans and they told us that they were currently upgrading the plans and were able to show us a sample of other care plans they had been working on. These care plans contained more person centred information and also contained evidence that people were being involved with their care planning. We spoke with staff about the needs of two people they cared for they showed a good depth of knowledge of individual health and personal needs. They also told us that they had seen people living in the home being actively involved in their care planning recently. One member of staff told us, “We offer a high level of care to the best of our ability with clients given privacy and respect”. When we asked what the home did well, one person living in the home told us, “Keeps me clean and tidy. I have a shower every day”. When we asked staff what the home does well they told us, “Pressure area care”, “ Good day to day support”, ”I think the home provides an excellent standard of care”, “I feel that everything is done to the best of our ability” and “ The home offers good care to all of the resident’s and also cares for its staff”. We looked at the homes medicine practices and we found that the practices were generally safe. Where handwritten entries are being made on the Medication Administration Record (MAR) staff are not signing or having a witness sign to say that the entry is correct. We observed a member of staff administering medication and saw that they followed the correct procedures. Staff told us that only the trained nurses administered medication and that they were trained to do so safely. We identified some areas of improvements needed in the homes environment in order that people’s privacy and dignity could be maintained. We spoke with the manager and owner about this and they made provision very quickly for these issues to be addressed. We observed staff on the day of the inspection and they knocked on peoples doors before entering. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 13 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): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that live in the home do not have their individual preferences represented in the activities and some people are not being fully supported in their nutritional wellbeing. EVIDENCE: The manager told us in the homes Annual Quality Assurance assessment that the home establishes residents preferred choice of daily living activities through a process of assessment and their past history and that the home offers a varied programme of activities. The home has a recreation room which is very pleasant and has a snooker table and other games and one person living in the home told the expert by experience that they liked to play snooker and did this most days. Since the last inspection, two activity organisers have been recruited but have since left and the home are in the process of recruiting another one. We saw evidence that there were external entertainers visiting the home on a monthly Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 14 basis and staff told us that they sat with people where possible and did activities. Other than this, there is not currently a structured activity timetable and on the day of the inspection there was very little activity in the home. Two people living in the home told us that they would like to have a computer to use. One said, “I don’t really do much in the week and I would like a part time job to fill up my time” When we asked relatives what the home could do better one relative said,” “Provide a computer to service users” and another said, “Provide more entertainment or activities”. We observed staff interaction with a small group of highly dependent people living in the home over a two hour period, which included lunch being served, and we saw some evidence of positive interaction between staff and people living in the home. One member of staff started to have a sing-a-long and one person living in the home joined in but otherwise, throughout the observation, people remained in a sleepy or withdrawn state with no activity or stimulation being offered. During lunch we observed people having their meal in the lounge area. The meal was placed in front of three people and one of them attempted to eat, taking one or two mouthfuls and then left the rest. Staff did not try and assist these three people for 25 minutes and then one person was encouraged to eat even though the meal was by now cold. The cook also attempted to encourage one person to eat and they did eat the meal when the support was offered. We observed that some staff did not speak with people while they were assisting them to eat. We spoke with the manager about these observations and he said that maybe the staff were uncomfortable with an inspector observing and said that they usually would speak with people. He also said that mealtimes were a problem with some service users not wanting to eat but agreed that assistance should still have been offered. One person had very specialist need with regard to nutrition and we observed this being maintained well with information in the care plan supporting the observation. There was a menu on display in the dining room and this displayed what was on offer and what the alternative choice was. One person living in the home said, “I like the food here and if I do not like whats on the menu I will be offered an alternative”. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 15 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): People using the 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 in the home are safeguarded from abuse and although they don’t know about the complaints procedure, they know how to raise concerns. EVIDENCE: The manager told us in the homes Annual Quality Assurance assessment that the home has a clear and effective policy and procedures for complaints which forms part of the service users guide. They also told us that any potential for allegations or and that staff have undertaken training on abuse and safeguarding of adults. The manager told us that the home had received seven complaints in the last twelve months and that six had been resolved and one was still in progress. The Commission has received one complaint about the home since the last key inspection and this led us to carry out a random inspection to look at concerns raised. We did not make any requirements as a result of this random visit but we set some recommendations of good practice around personal care. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 16 We spoke with people living in the home and they told us that they didn’t know about the homes complaint procedure but said they knew who to speak with if they were not happy and staff told us that they knew what to do if someone raised a concern. The complaints procedure is located in the lounge area outside the office. It is not very prominent and was not on display anywhere else in the home. The complaints procedure has details of how to contact the Commission but the address is out of date. The home has the current local safeguarding referral procedures in place and the manager has used these appropriately to make referrals when needed. We looked at the training files of three members of staff and there was evidence that they had received training in safeguarding vulnerable adults. We spoke with two members of staff and they showed a good understanding of reporting poor practice. When asked what the home does well, one person living in the home said “Makes me feel safe and secure”. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 17 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): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is clean and well maintained with procedures in place to prevent the spread of infection. There is a degree of risk in the environment due to the temperature of some radiators. EVIDENCE: The manager told us in the homes Annual Quality Assurance assessment that Ashley Nursing Home provides a clean, safe and supportive environment which is condusive to comfortable and therapeutic for individuals accessing the service. On the day of the inspection we found the home to be clean and free from odours and people living in the home told us that the home was usually clean. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 18 There is a recreational room which is also a lounge are and is very pleasant. The main lounge where the majority of people sit did not appear to be as ‘homely’ as the recreation lounge. The home is undergoing a period of improvements to the environment and we viewed areas that had been freshly decorated. We received comments from relatives in surveys and two people commented that they felt the bedding was worn and would benefit from being replaced. We spoke with the manager about this and they said that they were in the process of replacing bed linen in all rooms and that this would be completed within the next few weeks. Since the inspection, the manager has sent evidence that all bedding has now been replaced. Health and safety regulations state that where there is a risk of burns to people who cannot move away from a heat source quickly enough (for example, hot water pipes or radiators), a risk assessment should be carried out to identify potential risks of burning from hot surfaces and to assess the vulnerability of those who may be at risk. The maximum surface temperature of hot water pipes, radiators etc should not exceed 43°C and if this cannot be guaranteed then control measures need to be put into place. On the day of the inspection we found that some the radiators in the home had a higher surface temperature that the required maximum and there was nothing in place to protect people who were at risk from falling against them. One person that we case tracked suffered from epilepsy and so had the potential to fall. Their bedroom radiator was very hot and there was nothing in place to protect them from that and there was no risk assessment in place. When we asked relatives what the home does well, one relative said, “The overall appearance of Ashley House has much improved”, “They look after my relative in pleasant surroundings”. When we asked relatives what the home could do better they said, “Provide better recliner chairs for less mobile residents as the current ones are a bit worse for wear”, “I think Ashley House has improved a lot but I still think they could improve on the cleaning side” and “The environment could be a little bit more homely”.. We viewed five bedrooms and these were clean and personalised with peoples own belongings. We saw evidence in staff files that staff are trained in infection control procedures and we observed them putting these procedures into practice on the day of the inspection. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 19 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): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home operates a safe staff recruitment process and staff are trained effectively in supporting people living there. EVIDENCE: The manager told us in the homes Annual Quality Assurance assessment that the recruitment and selection process is in accordance to the homes policy. They also told us that there is a comprehensive induction programme for all staff with the opportunity for training and development in the workplace. We looked at the files of three staff working in the home and we found that they contained evidence that safe recruitment practices were being followed. Staff also told us that they had to wait for the required checks to be in place before they commenced employment at the home. There was not a photograph of the staff member in any of the files. The staff files contained evidence that staff have received recent training in areas of health and safety and care delivery. Staff told us in surveys that they were given training that was relevant to their role, helped them to understand Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 20 the needs of people they supported and kept them up to date with new ways of working. The files also contained evidence that staff were completing an induction based on the skills for care model. Staff told us that the induction covered everything they needed to know when they started the job. One member of staff said, “Training is very good and enables staff to meet and understand individual needs”. The manager has produced a workforce plan which identifies the training already in place and any future development for staff. We asked staff in surveys and also on the day of the inspection if they felt there was enough staff on duty to meet the needs of the people living there and they told us that there usually was. On the day of the inspection we found staff to be helpful and friendly. One relative told us in a survey, “Staff are always approachable and friendly and they care for my relative well” and “They keep my relative clean and treat them with respect”. Another said, “The staff are very nice and very considerate”, “There is always a nurse to answer and questions you have on the medical side”. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 21 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): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there is evidence that the home is run in the best interests of the people that live there. EVIDENCE: The manager told us in the homes Annual Quality Assurance assessment that the management team comprises a general manager, a home manager, a clinical manager and the registered provider. They also told us that the team is very experienced, trained and compliments each others specific expertise in the planning, organising and delivery of the service with the roles and responsibilities of each individual being clearly defined. The manager also told Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 22 us that the required health and safety checks were carried out with contracts in place for servicing equipment and appliances. The manager is now registered with the Care Quality Commission. Staff told us that the manager is improving the home and that he is very approachable and supportive. One member of staff told us, “With the new manager in post past issues have been resolved and the quality of life for the residents has improved considerably as well as the physical environment”. Although we saw evidence that staff have been trained in safe moving and handling procedures, we observed some staff using a procedure that is no longer appropriate to re-position one person in their chair. We have since spoken with the manager about this and he has addressed this with the staff involved. The home has a quality assurance survey that is completed annually and people living in the home and their relative’s complete surveys as a part of this process. The results are them compiled and an action plan put into place to address any issues identified. The manager also completes a monthly audit in the home and this covers some areas of health and safety as well as health care monitoring. We saw that equipment was being maintained regularly and that staff were trained in areas of health and safety. We looked at the personal spending money of two people in the home and we found that these were being managed well and that a second person was now witnessing the transactions. Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 23 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 X X 3 X 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 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 24 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. 4. 5 Standard OP15 OP38 Regulation Requirement Timescale for action 01/01/10 01/02/10 6. OP38 Regulation Staff must be available to give 12 (1) assistance with people who need help with their meals. Regulation The registered manager must 23 (4)(5) ensure safe working practices with regard to moving and handling practices. Regulation Where the surface temperature 13 of radiators in the home cannot (4)(a)(c) be guaranteed as not exceeding the required safe temperature, a risk assessment must be completed and control measures put into place to minimise the risk. 01/03/10 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. Refer to Standard OP7 Good Practice Recommendations Continue to update the care plans to demonstrate that the Mental Capacity Act and Deprivation of Liberty are being considered in every decision, which challenges the DS0000024625.V377972.R01.S.doc Version 5.3 Page 25 Ashley House Care Home 2. 3. OP7 OP7 4. 5. OP9 OP12 capacity of the resident. Continue to develop the person-centred approach to all the care plans including the implementation of a detailed life history. Continue to develop care plans to ensure they all contain evidence that people living in the home or their appointed representative (should lack of capacity be determined) are involved in decisions that affect how their care is delivered. Handwritten entries on the medication administration records should be signed by staff and witnessed with a further signature. More frequent and varied activities should be provided so that all people living in the home have opportunities to spend time doing things they find enjoyable and stimulating. The complaints procedure needs to be updated with the current address of the Commission and it should be displayed in different areas of the home. Staff files should contain an up to date photograph of the staff member. 6. 7. OP16 OP29 Ashley House Care Home DS0000024625.V377972.R01.S.doc Version 5.3 Page 26 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@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. 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