Care Home: Ashley Manor Nursing and Residential Care Home

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Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashley Manor Nursing and Residential Care Home Winchester Road Shedfield Hampshire SO32 2JF     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: Ian Craig     Date: 0 6 0 2 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 26 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Ashley Manor Nursing and Residential Care Home Winchester Road Shedfield Hampshire SO32 2JF 01329833810 01329835137 info@ashleymanorhome.co.uk 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 Theresa Andrews care home 45 Number of places (if applicable): Under 65 Over 65 45 45 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 Ashley Manor is a registered care home providing nursing care and accommodation for 30 service users of both sexes in the older people category. Accommodation is provided on three floors, which are accessed by stairs and passenger lift. The home has large well-maintained gardens and parking is available in the grounds. The accommodation comprises of sixteen single and seven shared bedrooms. Two of the single rooms have en suite facilities provided. The home is privately owned and situated on the outskirts of Southampton close to the village of Wickham. The homes weekly fees range from 699.00 to 770.00 pounds a week. Care Homes for Older People Page 4 of 26 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 inspection consisted of a visit to the home of approximately 4.5 hours. A tour of the home took place. Discussions took place with the manager and deputy manager. Three staff were interviewed. Four residents were spoken to in private. Staff were observed working with the residents. Records, policies and documents were looked at. These included care records for 4 residents. Surveys were sent to residents, staff and professionals asking for their views on the home. These were returned by two general practitioners, 4 residents and 6 staff. Care Homes for Older People Page 5 of 26 Care services are required to complete an Annual Quality Assurance Assessment (AQAA). This was completed by the service and returned to the Commission. What the care home does well: What has improved since the last inspection? What they could do better: Improvements are needed in the recording of pre admission assessments. These are not always signed and dated by the person completing them and information is not recorded about decision making regarding the suitability of people to live at the home. Care records need to be recorded for neurological needs for one person and indicators of when medication as required should be administered by staff. The medication Care Homes for Older People Page 7 of 26 records need to be securely stored. The manager should develop her knowledge of the procedures for referring people to the Protection of Vulnerable Adults (POVA) list. The manager accepted that these improvements should be made and stated her committment to addressing them. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 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 26 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. Whilst the home carries out assessments of need of those referred for possible admission to the home, basic recording of this needs to improve so that the home ensures it accommodates those whose needs it can meet. Evidence: The process of assessing potential residents needs was looked at for 3 people. The home has a pre admission assessment pro forma. This includes spacce for the assessor to enter personal care needs, whether or not a social services assessment has been received, and if the person has been assessed as suiatable for the home. For one of these 3 people the assessment details were partially recorded. The person completing the assessment had not signed or dated the document. It was therefore not possible to tell if the home had fully assessed the persons needs before making a decision about suitability. The sections regarding receipt of a care managers assessment and a decision about whether or not the person is suitable for the home had not been Care Homes for Older People Page 10 of 26 Evidence: completed. A care plan for this person had been completed on the day of the persons admission. The manager and deputy manager described the consultations regarding the persons admission but these had not been recorded. For a second person the pre admission assessment form was completed and had been signed but was not dated and for the third person the assessment forms were signed and dated. Care records included details from of health care needs if the person was in hospital before moving to the home. The completed pre admission assessments cover the following needs: dental care, foot care, personal hygiene, continence, dietary needs, hearing, sight, communication, mental state, pressure areas, social activities and medication. Three residents said that their next of kin relative came to look round the home to check on its suitability. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home meets the health and personal care needs of the residents, although some improvements are needed regarding the individuals care plans. The home promotes the dignity and privacy of the people who live there. Evidence: Care plans were looked at for 4 residents. These are based on an assessment of needs and include guidance for staff to follow on a range of identified needs. For instance, one persons included the following: specialist suport with diet and fluid intake, skin care, mobility, continence, contact with people and communication. These are evaluated on a regular basis. Assessments are also carried out regarding nutrition and food. It was noted that an assessment and care plan is needed regarding a residents neurological needs, which the manager agreed to implement. Care Homes for Older People Page 12 of 26 Evidence: Records show that health care needs are monitored such as weight, blood pressure, respiration and body temperature, Risk assessments are completed where needed, such as for the use of bed rails. Moving and handling assessments are also completed and recorded. A daily planner is kept in residents room which gives details of preferred routines and preferences. A staff member said that the home is good at catering for individual details such as how residents like to be dressed. Care records refer to individuals preferences such as food and the name they prefer to be addresssed by. Each of the 4 residents spoken to said that the home meets their personal and health care needs. One person referred to the help he/she receives with his/her specialist diet and that he/she is satisfied with this. Residents or relatives who returned a survey said that his/her relative always or usually receives the care and support they need. A survey completed by a health care professional states that individuals health care needs are always met, adding, Overall care is very good. 4 of the 6 staff who completed a survey said that they always have the right support, experience and knowledge to meet the differing needs of the residents; the 2 other staff answered usually. A registered general nurse is on duty in the home at all times. The 3 care staff interviewed said the home meets the individual health and personal care needs of the residents and that the standard of care is good. Staff also said that they receive regular training in health and personal care as well as up dates on clinical practices such as catheter care. Residents said that they are treated with respect and kindness. One person said, The staff are marvellous. One person, however, commented on the frequent changes of staff at night time which sometimes affects his/her care routines. A health care professional said that the care service always respects individuals privacy and dignity. It was identified that even though the home has keys for bedroom doors, residents are not offered a key to their bedroom door for privacy and seciurity. The manager agreed to address this. It was suggested that the choice of the resident could be recorded, or an assessment, if the person is not capable of handling a key. A residents relative commented that the staff listen and act on what the residents say, but, that the response of staff can sometimes be slow due to the arranagement of care routines by the staff. Care Homes for Older People Page 13 of 26 Evidence: The homes procedure for the handling and adminstration of medication was looked at. The home has a treatment room and medication trolleys for the secure storage of medicines. Examination of medication adminsitration records shows that staff record a signature each time medication is adminstered to a resident. Controlled medication is securely stored and the recommended recording and checks are carried out. It was noted that the controlled drug register was not securely stored. The manager agreed to address this. Guidance for staff to follow when adminstering occassional, as required, medication was inconsistent. For one persons medication the guidance was recorded, but, this was not the case for another medication. The manager agreed to address this. Care Homes for Older People Page 14 of 26 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. Residents benefit from a range of activities and links with the community. Nutritious meals are provided including specialist diets. Evidence: The home has a staff member who works for 15 hours a week as an activities co ordinator and a second staff member who provides two four hour sessions of one to one with residents. A notice board displays the activities for February 2009, which includes quizzes, a Valentines day party, nail and beauty sessions and singing. An entertainer visits the home once a month and music to movement sessions take place every 2 weeks. Residents confirmed that acitivies are provided and that they enjoy them. Some of the residents said that they prefer not to join in the activities. One person said how much he/she enjoys completing craft activities in his/her room. The home also provides craft classes for the residents. Residents said that they are able to spend their time as they wish. This includes getting up in the morning at preferred times, which was also evidenced from discussions with the manager and from observation. Care Homes for Older People Page 15 of 26 Evidence: Religious services are provided by visiting priests. Residents made favaourable remarks about the food. One person said, The food is first class. Another person said the food is very good and is well presented. Residents are able to choose from a range of food for breakfast. Each person has a card detailing their preferred breakfast and the time and place it is to be served. The midday meal on the day of the visit was poached fish, mashed potatoes and peas. An alternative was available for those who did not like fish. Dessert was trifle. Staff were observed helping residents with their midday meal. Pureed food was well presented and looked apetising. Residents confirmed the provision of special diets. One person was satisfied with this arrangement and the standard of the food, whereas another persons relative said in a survey that the soft option diet is sometimes inedible. The homes menu plan is displayed. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an effective complaints procedure. Steps are taken to protect residents, but the homes management is not fully aware of the systems operating to safeguard vulnerable adults. Evidence: The homes complaints procedure is displayed on a notice board in the hall. Each of the surveys completed by a resident or their relative confirms that they are aware of the complaints procedure. This was also confirmed from discussion with a resident. The home has not received any complaints. Discussions took place with the manager regarding adult protection procedures and referral to the Protection of Vulnerable Adults list. The home has a copy of the local authority adult protection procedures. Staff have received training in this, which was evidenced from discussions with staff, training records and discussions with the manager. The home takes action regarding the protection of residents, but the manager was unaware of the procedure for referring someone to the Protection of Vulnerable Adults list. The manager agreed to address this and it was suggested that the home devises a written procedure for this. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a clean and well maintained home, with good facilities. Evidence: A tour of the home took place, which included several residents bedrooms and the communal areas. The home was found to be clean and well maintained. There was an absence of any unpleasant odours. Residents said that the home is always fresh and clean. Residents were observed using communal areas. These consist of a main lounge/dining room with ramped access to a garden which has a patio and seating for residents to use in the summer. The television in the lounge has Sky channels. The home also has a conservatory with blinds to prevent glare and excessive heat from sunlight. A relative said that the arrangements of the furniture in the lounge could be improved so that it would be easier for residents to get to know each other. A comment was also made that the lounge has 2 televisions which play different channels at the same time; this was not the case on the day of the visit. Care Homes for Older People Page 18 of 26 Evidence: 24 of the bedrooms have an en suite toilet. All rooms are single apart from 4 which are shared. Bedrooms have specialist profile beds so that height can be easily adjusted. Each room has a lockable storage space to securely store belongings. Labels with the rooms occupant are displayed outside each bedroom door. A resident said how much he/she likes his/her bedroom and that the home is spotlessly clean. Bedrooms contained items of personal belongings brought to the home by the residents. There is a salon room for hairdressing and chiropody. The home has 4 sluice rooms equipped with sterilising equipment for bedpans. There is a contract for the collection of clinical waste. The AQAA states that the home has implemented the Essential Steps of infection control guidance and that the homes procedures in this have been updated. A staff member said that the home has good standards of hygiene and that the supply of protective clothing for hygiene is of a good standard. Several residents have their own telephone line in their rooms. Residents also have access to the homes cordless telephone which is provided free of charge. A resident was observed using the cordless telephone in the lounge. The home has 8 bathrooms, 7 of which have a specialist bath facility of either a bath with a hoist or specialist baths for those with mobility needs. A range of hoists and lifting aids are available for staff to use. Two passenger lifts are provided for access to the first and second floors. Care Homes for Older People Page 19 of 26 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. Residents benefit from a well trained staff team supplied in sufficient numbers to meet their needs. Evidence: The home aims to provide the following staffing levels: 8am to 2pm, 12 staff consisting of between 2 and 4 Registered General Nurses (RGN) and 8 to 10 care staff; 2pm to 8pm, 8 staff consisting of 2 to 3 RGNs and 5 or 6 care staff. The manager and deputy managers hours are in addition to this. Night time staffing consists of the following waking staff, 1 RGN and 4 care staff. The staff rota shows that the home is providing these hours. Each of the care staff spoken to state that there are sufficient staff to meet the needs of the residents. From the 6 surveys returned by staff, one states that there are always enough staff to meet the individual needs of the residents, three state usually and two state that there are sometimes enough staff. The manager confirmed that addittional care staff are being recruited. Staff said that they work as a team and confirmed that staff meetings are regularly held. One person said, Every shift we are given a report before we start work so we are aware of any changes in any of the clients. In addition to the care and nursing staff, the home provides 2 cooks from 8am to 6pm each day plus a kitchen assistant from 12.30pm to 4pm Monday to Fridays. Laundry Care Homes for Older People Page 20 of 26 Evidence: staff are provided from 8am to 4pm each day. Between 2 and 3 cleaners work every day and the home has a maintenance person working full time. The home employs 14 RGNs and 27 care staff. 12 of the care staff have NVQ level 2 in care and 10 of these also have NVQ level 3. A further 5 staff are studying for the NVQ level 3 and one person the NVQ level 2. The home has 5 staff who are NVQ assessors. Records for newly appointed staff show that an induction takes place which uses nationally recognised standards. Evidence from the staff spoken to, and those who returned a survey, confirms that an induction and training are provided, including NVQ 2 and 3, infection control, food hygiene, moving and handling and clinical updates. Surveys completed by staff said the induction was of a good standard. One person said that staff can suggest training courses they would like to attend and that this is usually catered for. Training records show that training is also provided in abuse awareness, dementia, dsyphagia, activities and continence care. The home has training links with a local hospital and is affiliated to the Hampshire County Council Partnership in Care Training (PaCT). Records of staff supervision and appraisal are maintained. Staff confirmed that they receive supervision and appraisals. One person said, Every 2 months I meet with the manager to discuss what I have been doing, what I need to learn and what things I can do to improve at work. Recruitment procedures were looked at for 3 recently appointed staff. Each person had completed an application form. 2 written references had been obtained for each person and enhanced criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks had been obtained before the person started work. Records of interviews and interview assessments are held with staff files. Staff confirmed that their recruitment included reference and CRB checks. Checks are also made that nurses are registered with the nurse registration body, the Nursing and Midwifery Council (NMC). This check is recorded in staff files. Residents described the staff as kind and helpful. one person said, The staff are marvellous. Care Homes for Older People Page 21 of 26 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 home is well managed and run in the best interests of the people who live there. The health and safety of the residents is promoted. Evidence: The manager is a Registered General Nurse and has managed the home for more than 10 years. She has completed the Registered Managers Award and the NVQ level 4 in care. She has also completed a number of other training courses including the following: supervision and appraisal of staff, interview and selection of staff, Mental Capacity Act 2005, managers development day and Living Life to the Full for residents. Staff report the manager to be approachable and supportive. One person said that he/she felt comfortable raising any concerns or problems. Care Homes for Older People Page 22 of 26 Evidence: The home uses surveys to ask residents and their relatives about the home. The results of the surveys are collated. There is a quality assurance file which includes checklists on the following: care plans, water temperatures, bed sides, fire log, controlled drug register, nutrition of the residents, stock take of medication, health of residents, hoist servicing, and storage of chemicals. An annual development plan was seen for the period October 2008 to October 2009. The home looks after the monies and valuables for some of the residents. A record is made of the amounts depositted and withdrawn plus a corresponding balance. These were checked against the amounts held and were found to tally. Each of the RGNs has been trained in first aid so that there is always someone on duty who is trained in first aid. Training is also provided in moving and handling, infection control, fire safety and food hygiene. The fire log book shows that the fire safety equipment is serviced and tested. Water temperatures are controlled to prevent possible scalding and radiators are covered to prevent possible burns. Restrictors are fitted on windows to prevent possible falls. Care Homes for Older People Page 23 of 26 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 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The home must only admit residents following the completion of an assessment. This must be recorded, and include the dates and signature of the person completing the assessment. Details of liaisons with other agencies involved in the assessment must be recorded. So that the home ensures that it accommodates only those whose needs it can meet. 27/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) 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. Care Homes for Older People Page 26 of 26 - 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!