Care Home: Ashling Lodge

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well The "expert" wrote "This home strikes me as a caring homely place with dedicated staff and managers. The food in the home was well prepared and enjoyed by the residents in congenial surroundings. One relative wrote of Ashling Lodge that it has a " ... home from home atmosphere and truly care about their residents."There are good systems in place for ensuring that people`s needs can be met through pre-admissions assessments and information given to them to enable a decision to be made about the home and whether it is right for them. Staff have the information they need to ensure they can support people in the way that they want and also understand individuals` needs through involvement of the individuals in this process. A relative wrote "X has only been there.....but is thriving on the care she is receiving. I am most impressed with the staff." Another relative and family member told us that, "staff are very good and understand their needs." The GP also supports these views and wrote of the home that, "Ashling Lodge offers excellent holistic care to all its residents. The manager and care staff are a pleasure to work with." It is clear from the information provided that people are treated with respect and dignity in all areas of their life in the home. A good standard of food is provided to ensure people receive a varied and nutritious diet. There are opportunities on offer for people to be stimulated and undertake activities that suit them as well as having regular entertainment provided. The recruitment practices have improved to a good standard which means people are protected from risk of harm presented by unsuitable staff working there. Staff also receive training in a variety of areas to ensure they are competent and have the skills and understanding to care and support for the people living there. The manager is very involved in the day-to-day care provision providing a caring, "hands on" and a "leading by example" approach to managing the home. She runs the home with openness and a desire to ensure the care provided meets individuals needs. This means that concerns or issues are managed well with very few escalating to a formal complaint. Staff and management have an understanding of the adult protection procedures and their role in ensuring appropriate action is taken to ensure people in their care are protected from harm. There are generally good systems in place to ensure the health and safety of people in the home.Ashling LodgeDS0000006918.V368040.R01.S.docVersion 5.2Page 7The organisation has a number of ways in which it monitors the service and tries and includes people in improving the quality of care. This enables the manager to try and provide more person-centred and individualised care. What has improved since the last inspection? Care plans continue to improve to ensure staff have the information to care and support individuals in their everyday needs and ensure they receive the care they want. We have been told that contracts have now been developed for people who use the service for respite only. This provides people with the information they need to know about the service and what is expected from them whilst living there. There have been some improvements in the environment, particularly the refurbishment of the first floor bathroom and fitting of a new adapted bath. Conservatory furniture has also been purchased providing more a more comfortable area for people to be seated and sp[end their day. What the care home could do better: Ashling Lodge generally provides a good overall standard of care. There are however, some areas where further improvements are needed. Medication practices could be made more robust to ensure, whilst supporting people to be independent, there are systems in place to protect them from potential risks. There must also be more monitoring of the bath time routines to ensure people are receiving the personal care detailed in their individual care plan. The environment must be improved in a number of areas, not only to ensure all areas are maintained to a good standard but also ensure access for those with disability is improved. This is also true of ensuring people with visual impairment or other disabilities receive support in these areas. There is also a need to ensure the conservatory windows have a suitable covering for privacy and also to protect people from the sun. Following on form this there is a need to ensure that information provided to people is given to them in a way in which they will be able to interpret and understand it.Care plans have improved since the last inspection and what is needed now is to ensure all areas of need are addressed and the plans be made more personcentred: for example through more involvement of the individual and use of the first person whilst writing the plans. We recognise there have been improvements in the activities provided. However, this is an areas that people believe further improvement could be made to make people`s lives more interesting and stimulating and improve social inclusion. The manager must also ensure she is fully conversant with the events affecting the people living in the home or the actual service provided requiring notification to us by Regulation 37. This will enable us to determine if the people living in the home are safeguarded. CARE HOMES FOR OLDER PEOPLE Ashling Lodge 20 Station Road Orpington Kent BR6 0SA Lead Inspector Wendy Owen Unannounced Inspection 24th July 2008 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashling Lodge Address 20 Station Road Orpington Kent BR6 0SA 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) 01689 877946 01689 819315 ashlinglodge@tiscali.co.uk Chislehurst Care Limited Ms Sally Ann Perry Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care Home Only (CRH - PC) to service users of the following gender: EITHER whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 13 3rd April 2008 Date of last inspection Brief Description of the Service: Ashling Lodge is a large detached two-storey house converted to provide care and accommodation for elderly people who are physically frail. The home is situated on a busy main road accessed by a steep drive with some off street parking. The home is within a short walking distance of Orpington Town centre with its range of shops, leisure facilities and public transport links. The building has two floors with service user accommodation on both floors, accessed by a stair lift. There is a large conservatory built on the front. The laundry and further storage is located in a wooden framed structure in the back garden. There is wheelchair access to both the front door and the fire exit leading directly onto the rear garden. Central heating is provided to all area of the home and the radiators are guarded to lesson the risk of an accident. There are handrails in the corridor areas with grab rails provided in toilet and bathroom areas and specialised bathing equipment available. The manager also manages another one of the organisation’s homes, Heatherwood, located on the other side of the main road. Information is provided to prospective residents in the form of a Service Users Guide. Contracts are provided and details of the fees are included in this information. Fees range from £380 -£630 with details of what is included for people included in the contracts. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 2 star. This means the people who use this service experience good. This unannounced inspection included a visit to the service over one day by an inspector and an expert by experience (expert). An expert by experience is someone who discusses with residents their experiences of living in the home. Whilst we were in the home the expert and the inspector spoke to residents and relatives. The expert also had lunch with the residents. The inspector also spoke to staff members and the manager and area manager. We also viewed records and had a short tour of the home. We also sent out surveys to staff, health professionals, residents and relatives. Some were returned fully completed: five from relatives; one from a staff member; one from a health professional and six from residents. We have included in this report information provided to us by the manager in the form of the Annual Quality Assurance Assessment (AQAA). This provides us with information on how the service is meeting the standards for the service and what improvements they have made or are due to make. During January 2008 we visit the home to undertake a short unannounced inspection. The reason for this inspection was to monitor compliance with some of the requirements made at the last inspection. This unannounced visit during the morning included discussions with two residents and the manager, a tour of the home and viewing of records. We have included the findings from this visit in this report and has been used in forming the judgement made about the service. What the service does well: The “expert” wrote “This home strikes me as a caring homely place with dedicated staff and managers. The food in the home was well prepared and enjoyed by the residents in congenial surroundings. One relative wrote of Ashling Lodge that it has a “ … home from home atmosphere and truly care about their residents.” Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 6 There are good systems in place for ensuring that people’s needs can be met through pre-admissions assessments and information given to them to enable a decision to be made about the home and whether it is right for them. Staff have the information they need to ensure they can support people in the way that they want and also understand individuals’ needs through involvement of the individuals in this process. A relative wrote “X has only been there…..but is thriving on the care she is receiving. I am most impressed with the staff.” Another relative and family member told us that, “staff are very good and understand their needs.” The GP also supports these views and wrote of the home that, “Ashling Lodge offers excellent holistic care to all its residents. The manager and care staff are a pleasure to work with.” It is clear from the information provided that people are treated with respect and dignity in all areas of their life in the home. A good standard of food is provided to ensure people receive a varied and nutritious diet. There are opportunities on offer for people to be stimulated and undertake activities that suit them as well as having regular entertainment provided. The recruitment practices have improved to a good standard which means people are protected from risk of harm presented by unsuitable staff working there. Staff also receive training in a variety of areas to ensure they are competent and have the skills and understanding to care and support for the people living there. The manager is very involved in the day-to-day care provision providing a caring, “hands on” and a “leading by example” approach to managing the home. She runs the home with openness and a desire to ensure the care provided meets individuals needs. This means that concerns or issues are managed well with very few escalating to a formal complaint. Staff and management have an understanding of the adult protection procedures and their role in ensuring appropriate action is taken to ensure people in their care are protected from harm. There are generally good systems in place to ensure the health and safety of people in the home. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 7 The organisation has a number of ways in which it monitors the service and tries and includes people in improving the quality of care. This enables the manager to try and provide more person-centred and individualised care. What has improved since the last inspection? What they could do better: Ashling Lodge generally provides a good overall standard of care. There are however, some areas where further improvements are needed. Medication practices could be made more robust to ensure, whilst supporting people to be independent, there are systems in place to protect them from potential risks. There must also be more monitoring of the bath time routines to ensure people are receiving the personal care detailed in their individual care plan. The environment must be improved in a number of areas, not only to ensure all areas are maintained to a good standard but also ensure access for those with disability is improved. This is also true of ensuring people with visual impairment or other disabilities receive support in these areas. There is also a need to ensure the conservatory windows have a suitable covering for privacy and also to protect people from the sun. Following on form this there is a need to ensure that information provided to people is given to them in a way in which they will be able to interpret and understand it. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 8 Care plans have improved since the last inspection and what is needed now is to ensure all areas of need are addressed and the plans be made more personcentred: for example through more involvement of the individual and use of the first person whilst writing the plans. We recognise there have been improvements in the activities provided. However, this is an areas that people believe further improvement could be made to make people’s lives more interesting and stimulating and improve social inclusion. The manager must also ensure she is fully conversant with the events affecting the people living in the home or the actual service provided requiring notification to us by Regulation 37. This will enable us to determine if the people living in the home are safeguarded. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission systems including the provsion of information enable people to make decisions as to whether the home meets their needs. Staff have information about the individuals before they come into the home to ensure they care for them in the way they wish to be supported. EVIDENCE: During the inspection in January we viewed the information provided about the home, and found that they had been reviewed. It is positive to see the information is provided in written and pictorial format and that much more information is now provided. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 11 We found that the information was available in people’s rooms, although the Commission’s address and telephone number details need to be changed in light of the changes within our organisation and the closure of the local area office. We also noted that at least one of the residents has visual impairment ad cannot read well. The manager must therefore provide this information in another format or very large print. We found that the pre-admission and assessment procedures were good at the last inspection. People had been provided with information about the service and in giving details about their needs with family member involvement. We did note that cultural needs and language are not always recorded and this is important to ensure people receive the care they want. It was positive to note that the manager had already contacted the GP to request District Nurse to obtain a pressure-relieving cushion as part of the treatment to reduce risks. The GP has also visited the individual and changed some of the medication prescribed. During this inspection the “expert” spoke to a number of people. As most of the residents have been in Ashling Lodge a considerable time they found it difficult to gauge what the pre-admission procedures might have been like and whether assessments had taken place or residents given the chance to visit the home beforehand. One resident had moved away from the home to be closer to her family in Sussex and then chosen to return to the home, so she was clearly very happy with it. Another chose to come to the home because she had visited a number of times for respite. She said her daughter had dealt with the admission and had, she thought, been sent appropriate information. On viewing the records of two individuals in relation to the admission processes we found that assessments had taken place, assessments obtained from the Care Manager, where required and that there were opportunities to visit the home to enable people to make a decision about whether the home was right for them. The AQAA also tells us that they are hoping to further improve this area to enable people to spend more time in the home The home’s assessments individuals needs. contained some good information about the Contracts have been developed for those living in the home and, where arrangements have been made by the local authority, placement agreements have been produced. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 12 We have also been informed in the AQAA that a contract for those receiving a respite service has now been developed as required at the last inspection. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Staff generally have information to provide individualised care to meet peoples’ needs. Health care needs are also met through accessing appropriate professional services. Medication practices promote independence and ensure those people living there recevie prescribed medication to address any healthcare issues. EVIDENCE: Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 14 During the last visit in January we spoke to two residents who told us about the good quality care they were getting. They felt staff were kind and caring and that they were well cared for. They felt the rooms suited their needs and that the food was adequate, with one person telling me that it “needed some getting used to” but “was “generally alright”. During this visit the “expert” and inspector spoke to a number of residents and relatives to obtain their views. We found that people were very pleased with the care they received. One resident was full of praise for the carers praising particular staff. ‘ X is wonderful! ……………running around doing things for people. You couldn’t get better carers, I have a laugh and a joke with them and if I am pulling their legs they know it’s a joke.’ It is positive that people feel relaxed and at home enough to have these relationships. Information had been produced for the people living there about how their needs can be met and there was some indication that the residents and relatives are involved in the development of these. The information is provided in the form of a long-term assessment of need and care plan, along with the risk assessments detailing identified risks. This information provided staff with a lot of information on the needs of the individuals to enable them to provide the support people require. Residents and relatives confirmed this by telling us staff did understand their needs and delivered care to their expectations. The information viewed was also written in an easy to read and personalised way making it easy for staff and others to understand. A family member also told us about how well their relative had been since coming to the home and the improvements in their overall well-being. There were some areas on the care plans that had not been addressed, such as finances, pain care, medication and communication. The information should also include areas such as how visual impairment may affect the individual and how their care is to be delivered. We also discussed how information could be provided on peoples’ routines or pattern of the day that may help provide more person centred information. The use of the first person would also show how people are deciding their care. Whilst staff were aware of these needs it must be remembered that care plans and other information is there to enable any member of staff (agency or new member) to be able to pick up the care plan and deliver the care required. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 15 It is positive to note, however, that the manager and staff are already reviewing the care plans to make the changes. We have therefore made this a recommendation at this inspection. On looking at the care plan and supporting information we found risk assessments in place for pressure care, nutrition and risk of falls and, where risks were identified, these generally had support plans in place with the exception of pressure care risks which needed a care plan detailing how the risk is to be minimised. Where risks of pressure sores had been identified the equipment had been provided from the Primary Care Trust (PCT). We viewed the records of one person with diabetes and found there to be a care plan in place to meet his care needs. We would also expect to see more information about the individual’s health care needs, such as where a person has a pacemaker. Whilst this information was included on the long tern assessment of need it had not been transferred to a care plan. Overall the information is provided in the combined records but there is a need to ensure the information is transferred from the long-term assessment to form a care plan of the action staff are to take to make sure the needs are met. There was evidence of people registered with a GP and receiving regular health checks. We noted records of District Nurse visits, in some cases and people accessing of optician and chiropodist. There is evidence of staff monitoring people’s weights through regular weighing and making a record. We did, however, notice that one person could not be weighed, as they were not able to stand on the weighing scales. The manager should look at the equipment used and find alternative ways or purchase equipment that is more appropriate for the people living there. Feedback from the GP was extremely positive “staff are open to feedback and always looking to improving the service” And “All staff are kind and caring and offer excellent holistic care.” They felt that staff acted appropriately and followed the treatment or care requested. The GP also told us how staff respect the privacy and dignity of people being seen, saying “staff always close the curtains etc during the consultation and maintain respect for patients.” Care plans also inform staff of the individuals preferred name and how often they like to be have their hair done etc. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 16 From observations people looked well presented and groomed and were supported well during the day, being treated with respect and courtesy. A relative of one resident commented ‘Carers have a tremendous amount of sensitivity towards the residents. I have been impressed by their cheerful friendliness and obvious care.’ The “expert” saw carers working with residents using good humour, patience and kindness. One carer told her that she liked the home best because of the residents. “You get very attached to them all” she said. However, we noticed whilst reading the records and care plans together that where people had requested baths weekly or twice a week etc these were not always being provided and records did not show reasons why. There must be accurate records of the care taking place and, if not, why not. We looked at the medication practices and found them to be generally satisfactory. Medication records (MAR) were generally complete with photographs in place, allergies, full details and records of administration. We noticed that each MAR had been numbered to give staff indication of further medications to be provided. Handwritten records of prescribed medication had two signatures confirming the accuracy of the records and there was evidence of staff counting the medication being carried forward each month to the next. This enables an audit of the medication being administered to take place. We checked the records against the medication in the blister pack and found that they were accurate. Controlled drugs have been prescribed for some residents and these are stored correctly. Records were checked with medication stored and these were found to be recorded appropriately reflecting the numbers still stored. There is a refrigerator to store medicines requiring storage at lower temperatures and we noted eye drops stored appropriately. However, two of the four viewed did not have the date of opening recorded as required for medicines with limited life span on opening. This means people using medicines after their shelf life may be at risk of infection. Currently only one resident administers their own medication and only in respect of inhalers. Staff prompt the individual to take them but the inhalers are kept by the person. The individual is safe and able to do so and it also promotes independence, especially as the individual does go out Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 17 independently. There is evidence that the person is taking their medication and that staff do monitor this. Records viewed for this person did not accurately reflect the current practice and situation in respect of their medication administration. For instance there was no record of the inhalers being given to the person or that they took these themselves or the risks involved or compliance Since the inspection the manager has produced a detailed risk assessment and system for ensuring the medication is taken. They have acted quickly to address these shortfalls. Standard 6 is not applicable to this service. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive a varied and healthy diet to ensure their nuturional needs are met. Routines in the home are flexible to meet peoples’ expectations and the way they wish to live. There are activities in the home that provide opportunities to stimulate and imporve overall well-being. EVIDENCE: The “expert” spoke to people, observed the routines of the home and observed interactions between staff and residents. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 19 A very active older lady enjoys going out to see her friends at a number of local clubs (Civil Service and church clubs were mentioned.) She also appreciated being taken shopping. There is a visiting hairdresser but she had not visited this week as she was on leave. At one point in the afternoon when most residents had been taken out into the garden, there was a period when residents were not being supervised. It was a very hot day and drinks had been left for them outside but not offered personally. Some were too frail to help themselves to drinks. Two residents commented that they had not been offered cold drinks during the morning. One resident who has sight problems was full of praise for the home in general and for the care given when I spoke to her in the morning. She seemed exceedingly happy as she sat enjoying the sunshine in the conservatory. Several residents told me that they had enjoyed a trip to a lavender farm at Eynsford recently, and one resident volunteered that the ‘Activity lady is very good’. Another said that the Activity lady had taken her out for fish and chips a week ago. It didn’t matter that the destination was modest. ‘Just a trip out is something’ she said. One of the residents is keen on looking after the garden and was enjoying filling up bird feeders with supplies of seed and nuts. Residents also mentioned a visiting entertainer who plays the violin and entertainment from a member of staff who sings hymns to them. One resident mentioned that she would enjoy reading some books such as biographies and travel and wondered whether we could contact the local library service for her to do this. The manager told us that they had tried to do this but the individual was not interested. The resident also told us that she used to enjoy having a radio in her room at home but since she had moved to Ashling Lodge, she had not known how to get hold of one. Her own one had not come with her, she said. We strongly recommend that more effort be spent on giving this person some special attention to her needs such as purchasing a radio for her to keep up to date with news etc. She also mentioned that she used to have someone from the local Blind Club come to visit her but this didn’t happen here. The Kent Association for Blind people (KAB) would possibly be able to help her, perhaps. This was more brought home as later in the day she seemed to be quite tired and mentioned a number of things regarding her visual needs, which did not paint such a good picture. She said, for example, that she had lost her glasses and despite an optician visiting yesterday, she had been told that he thought he couldn’t do anything for her. He had not looked at her eyes, she said. “ Last year with help, I could have walked around the garden, but this year I just can’t do it. I need new glasses.” A member of staff commented that there is a great need for a minibus for the residents. It seems that the manager and other staff are taking a handful of Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 20 residents at a time out in their own cars at the moment, which is noble and appreciated but might be better addressed with a dedicated, larger vehicle. A staff member said ‘ Not all families with cars can take them out and B.A.T.H (community transport) cannot always provide us with the right transport or at a price we can afford. We feel that residents would feel less housebound and an outing would give them something to look forward to’. Since the inspection we have been given a schedule of outings that have been arranged over the coming months. We would hope that with limited spaces all people are given an opportunity to enjoy these activities. We were also told by the manager and others, about the Garden Party on July 4th, which according to people was very successful and also enjoyed by all. One relative also stated that the experiences could be improved by providing more outings “…...not just for the more mobile or infirm.” Some of the feedback also suggests staffing could be improved to enable more activities to be provided. This is reflected in the outcome of the recent survey undertaken by the home and completed by visitors and service users. It s clear, however, that activities have improved over the last few years and the outcome of the surveys reflect peoples growing expectations in this area. During lunchtime, the “expert” had a meal with the residents whilst the inspector observed practices from a distance. There was a relaxed atmosphere with residents talking to one another and seeming at ease. Residents complimented the Manager on the meal. In conversation with residents one said it was ‘good‘, another ‘very good’ and a third said it was ‘excellent’. The food was found to be appetising and tasty. The sauce accompanying fried vegetable fingers was very flavoursome but we wondered if it contained meat products? Vegetarian residents who chose that dish, as opposed to the meatballs on offer might have been concerned to find a meat-based gravy with their food. We were pleased that fresh fruit salad was available as a dessert because the day was very hot. There was also a home- baked cherry pie that residents enjoyed and soft options available too. Two residents told the “expert” that they would appreciate a change of menu from time to time. One said “ It is always the same menu, week after week and you don’t always get what you ask for”. Another said they would like, once in a while, to eat a proper steak, but they thought the home might go bankrupt if they asked for it. Another resident also hankered for a steak! We spoke to the manager and area manager who told us that they do have such treats. For example: salmon and duck have been provided recently at individuals request. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 21 There were occasions staff needed to be more proactive. For example at lunch, it was the manager who sorted out most of the residents’ queries when other staff could have been more involved. A very elderly lady, who had just been discharged from hospital needed more assistance with her meal than was offered. At one point she was given a drink in quite a heavy glass, which she had difficulty lifting and a dessert from a plastic pot, which she could not see or deal with very easily. A carer could have sat with her to ensure that she coped better with her meal. It was clear from the survey undertaken by the home and the feedback from the Commission’s survey that people have choice and are generally satisfied with the quality of the food provided. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place to ensure people can raise concerns and issues which are resolved without delay and to their satisfaction. Adult protection procedures have also been produced which provide staff with information and guidance on how they can protect people from harm. EVIDENCE: Two residents confirmed that they would know how to raise a complaint or a concern about the home, and one of these, said they had in fact done so that morning. She had been dissatisfied with the morning care from, she thought, an agency carer and had told the manager so. A copy of the complaints procedure is on display in the hallway with a copy also the Service Users Guide. The procedure is satisfactory and does contain details of how to complain, although reference to CSCI in the process gives an old address. This should be updated to provide people with the correct Commission contact number and address. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 23 They also need to make sure the Guide and procedure are provided in the appropriate format eg for one resident who has commented on visual impairment difficulties. The recent survey completed by the home, including service user and relatives questionnaires shows that not all are aware of the complaints procedures. This was also reflected in the Commissions comment cards received. However the feedback also stated that there would not hesitate in making a complaint if they felt the need to do so with many saying “there is no need.” The manager has a strong ethic in ensuring people receive good care and therefore understands the importance in dealing with minor issues without delay. This ensures people can feel confident that they will be listened to and that actions will be taken to ensure their concerns are addressed. The AQAA shows no formal complaints in the last twelve months nor has the Commission received any complaints about the home. Procedures to ensure people are protected from abuse are also in place, along with the different Local Authority Inter-Agency guidelines on safeguarding adults. Copies of the guidelines are available for all Local Authorities who have made placements there. The home’s procedures also include information for staff on “whistle-blowing”. Staff have received guidance in how to safeguard people though video training and, whenever possible, training through the Bromley training consortium. The staff also have information and guidance through completion of the Common Induction Standards and when studying for the NVQ in care. One member of staff spoken to was aware of their role in protecting people having a good understanding of types of abuse and what to do if there were allegations or their noted an issues they were not happy with. The manager and area manager are both aware of the role of social services in co-ordinating any investigation into allegations of abuse and ensuring they are informed without delay. People spoken to and who provided written feedback did not raise any concerns in this area with a number saying how safe they felt in the home. We have received no indication of adult protection issues over the last twelve months from the home, social services or directly from people receiving care or involved in this way. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 21,22,23,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Ashling Lodge is generally comfortable and homely although there are areas that need improvement to ensure all individuals benefit from a well-maintained environment. EVIDENCE: We found at the last inspection in January that the home was kept clean and reasonably well-maintained and individual bedrooms were personalised and had a homely and comfortable feel. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 25 Some changes to the environment were being planned with the downstairs bathroom being made into a shower room and the bathroom upstairs to be refurbished. This work has now been completed. During a tour of the home the WC on the ground floor had some woodwork/wall needing repair to make it a more comfortable and pleasant area for people to use. We spoke to one resident in their bedroom, which looked homely with many personal pictures and photos evident. We also noted another person’s room looked personal to her Most of the users have been resident in the home for a number of months and their rooms looked well decorated, personalised and homely. One person told us that their room is cold and noisy. This is currently being addressed with double-glazing on order for the front of the home. Some residents and the inspectors were sat in the conservatory for part of the day. It is positive to note that new furniture has been purchased for this room. However, the day was hot and there were no blinds on the windows to provide shade to the people sitting in there. Covering the windows would also provide more privacy. At the beginning of the visit we sat in the conservatory with another resident and witnessed a resident being aided out into the conservatory from her room, which abutted it. The person has extremely precarious mobility and was being helped by two carers because there is a step down from her room into the conservatory. It is sufficiently pronounced to present a hazard if residents are not supported properly. The rear garden is accessible from the back of the house only by means of a resident’s room. Apparently they have given consent to this arrangement, except when she has visitors of her own. This arrangement compromises the person’s privacy and dignity as their room is acting as a corridor for all comers when access to the garden is required. The other exit to the garden is at the side of the house and involves a walk down a longish ramp and around the side of the house, through a locked gate and out into the rear of the property. This is not an ideal arrangement for residents, particularly those who are frailer and more unsteady on their feet. These access issues must be investigated, reviewed and adaptations made. The garden at the home is broad and pleasant, with some shaded areas, trees, and wooden cushioned garden furniture. Parasols were erected to help keep residents in the shade on the day we visited. Some residents stayed close to the house on a variety of chairs, not all of which had cushions or looked very Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 26 robust. White plastic garden chairs without cushions might be suitable for staff but at least one resident found such a seat too uncomfortable to stay seated on. One resident was observed at lunch and afterwards having difficulty getting up from the dining table. Her leg got caught between the table and her chair and she was unable to push the dining chair backwards to free herself, as the dining chairs do not have castors or other means of easy movement. This lady cannot walk at the moment without the help of a carer and asked me for assistance in freeing herself and also in acquiring a walking stick or Zimmer frame. We discussed this with the manager and area manager who agreed to order some chair adaptations that would enable easier movement. The “expert” noticed as a person walked down a corridor that they caught their hip against a fire extinguisher. It may be possible to site fire extinguishers away from gangway walls as they present a slight obstacle to residents who depend on staying close to the wall and rail for support. We suggest this is looked into by the manager. There was evidence of some aids and adaptations to support and make movement easier around the home. For example: there were ramps with handrails for access to outside areas. Grab and handrails were located around the home and a stairlift to assist people to manage the stairs. However, please note the comments made previously regarding safe access to all areas Bathrooms were fitted with hoists with a new “Malibu” bath recently fitted in the newly furbished fist floor bathroom. We noted that the equipment used had been serviced as per the guidelines and regulations to ensure the safety of the residents and staff. Throughout the home we noticed gloves, aprons and hand-washing facilities to ensure any risks of cross infection are minimised. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are competent and skilled to provide good care and support to the people living there. Staffign levels are adequate although improvementss could be made to further improve individual well-being through increasing the activities offered. Recruitment procedures and practices ensure people living in the home are not placed at risk bythe employment of unsuitable people. EVIDENCE: People are cared for a team of care staff with one senior and domestic and kitchen staff. Staffing levels remain at two carers for the morning and afternoon and two at night. The manager oversees the care and often provides a more hands own role or directing the care throughout the day. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 28 We received good feedback about the quality of care with relatives writing “Carers have a tremendous amount of empathy and sensitivity towards the residents.” “X has only been there…..but is thriving on the care she is receiving. I am most impressed with the staff.” The home’s survey shows that 100 of visitors who answered the questions are completely satisfied with the care provided whilst 83 of service users were always and the remainder sometimes satisfied with the care. However, some people told us that there should be more staff or time for activities and involvement in this aspect of their care. At one point in the afternoon when most residents had been taken out into the garden, there was a period when residents were not being supervised. It was a very hot day and drinks had been left for them outside but not offered personally. A member of staff commented ’There are times when there are not enough staff to deal with residents’ needs…At times I could do with another pair of hands when doing certain activities, but carers are always too busy.” We have also made comments in the daily activities and routines about how staff could be more proactive at times. We looked at the recruitment records of the most recently employed staff, of which there were two. These were found to have the required checks completed before the person commenced employment. In the one case the home had requested references from the person’s previous employment but had not received them so they obtained references from the current college tutor and one other. The person had already been working in the home as a student and therefore the manager felt reasonable steps had been taken. Both employees had Criminal records Bureau checks prior to staring work in the home. There was evidence of induction taking place for both members of staff with Common Induction Standards currently being completed to ensure staff are competent and knowledgeable about he people they care for. A training matrix has now been developed that shows the training provided to all staff. It shows a range of training provided through the Bromley training consortium and training through videos to staff. Core training includes moving and handling, abuse, first aid infection control and food hygiene. The medium for the training is mixed and includes training Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 29 by competent people such as in moving and handling and first aid with training through use of the video as in abuse and infection control. Staff have also been able to undertake the NVQ in Care with a number of staff currently in receipt of the qualification. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 30 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and experienced to ensure the health, safety and well-being people being cared for. There are systems in place to monitor and review the quality of care provided to ensure continuous improvement. EVIDENCE: Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 31 The manager has been in post for a few years and is experienced and qualified to manage the home. She also manages a home in the same group located opposite on the other side of the road. Feedback from residents, relatives and staff were positive about the manager’s approach to running the home. She is very much “hands on” and involved with the care of the people living there running the home with an open and inclusive approach. Previously the administrative tasks have not been as organised as they could be to ensure the efficient and effective running of the home. This has been resolved by the employment of a new administrator who takes away many of the administrative tasks from the manager. Systems are more organised now with records more easily accessible. The area manager undertakes regular monthly visits to the home with reports produced. These reports include audits of various practices and discussions with people about the service. A survey has also been undertaken to determine the quality of the service. The survey relfects the current findings although needs to have a report on the outcome with any actions being taken to imporve the areas identified eg actvities. We sampled the checks undertaken on the services and equipment used as detailed in the AQAA. These were found to be satisfactory. Environmental Health officers have given the kitchen a 3 star award (good) and the gas and fixed wiring have both been checked by a competent person. With the employment of an administrator it was much easier to view the records and obtain the information we and the manager needs to make sure staff are trained, employed within the regulations and the health and safety of the people living there. The previous key inspection highlighted issues with the checking of the fire alarms system on weekly basis. The inspection in January found that these are now undertaken as required to ensure the safety of those living and working there. We were told that a resident is currently in hospital due to an illness and one other resident has just returned from hospital. We were not informed of these events as required under Regulation 37. The manager was reminded of her duty and the need to ensure that all staff are aware of the procedure in her absence. The registration certificate and Employers Liability are both on display and showing the information required. Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 32 Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 33 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 3 3 3 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X x 3 Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4&5 Requirement People must be provided with information in a way in which they are able to interpret and understand it. Individual bathing routines must be met to ensure people receive the personal care that they prefer. Records must show the action staff take in this area. Medication practices must be improved to ensure there are safe systems in place for those wishing to take responsibility for their medication. The ground floor toilet must be repaired and redecorated to en sue it provided a comfortable area for the people living there. All areas of the home must have access for people living there to ensure they can move about the home with limited risks to their safety. There must be appropriate covering for the conservatory windows to ensure the area is more private but also protect people from the suns rays. We must be informed of any DS0000006918.V368040.R01.S.doc Timescale for action 01/11/08 2 OP7 12 01/09/08 3 OP9 13 01/09/08 4 OP21 23 01/10/08 5 OP19 23 01/12/08 6 OP24 23 01/11/08 7 OP38 37 01/09/08 Page 35 Ashling Lodge Version 5.2 events affecting the well-being of people living in the home as required under Regulation 37. This is to ensure the home takes action to ensure the safety of the people there. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP12 Good Practice Recommendations There should be more opportunities for those with visual impairment to become involved in day to day living and activities. Care plans should be more person centred and include all areas of need identified in the long terms assessment of need. Assessments should include more details on the cultural and communication needs of the people being assessed. The provision of activities should be reviewed to ensure they are varied and meet individual needs. The Manager should provide staff with equipment for transporting laundry that minimises moving and handling risks. Garden furniture should be made more comfortable for the people who use them. Training and development plans should be developed for individual staff. There should be an easy to view record of staff training to date. OP7 OP3 OP12 OP38 6 7 OP24 OP30 Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashling Lodge DS0000006918.V368040.R01.S.doc Version 5.2 Page 37 - 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!