Care Home: Ashlyn

What the care home does well The manager`s staff recruitment process is thorough; this means that people living at Ashlyn are protected by the safe recruitment of professional and friendly staff. Relatives told us they were generally happy with the service and care provided, they particularly expressed they were impressed with the care and support provided by the staff team. The staff members demonstrated good knowledge of how each person preferred to be cared for and supported. The organisation has a comprehensive staff training provision that ensures each person has the skills necessary to safely look after the people living at Ashlyn. What has improved since the last inspection? People living at Ashlyn were observed being treated with dignity and respect. Some work has been undertaken to make the environment more suitable for people living with dementia. A more robust staff training schedule has been developed to provide staff with the skills to look after people safely. The management and ethos of the home is more open and approachable, this means residents, staff and visitors can feel confident that their views and opinions will be listened to and taken seriously. What the care home could do better: Work needs to be done to improve the methods of communication from health professionals to the care staff team to ensure that important guidance and advice is handed over to all staff and that the care plans are amended accordingly. People living at Ashlyn would benefit from alterations being made to the home to ensure all residents are able to have access to their personal bedrooms and are able to wander freely around their home. Key inspection report Care homes for older people Name: Address: Ashlyn Ashlyn Vicarage Wood Harlow Essex CM20 3HD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Greaves     Date: 1 5 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Ashlyn Ashlyn Vicarage Wood Harlow Essex CM20 3HD 01279868330 01279868332 julie.cox@excelcareholdings.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashlyn Healthcare Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 60 The registered person may provide the following categories of service: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Ashlyn is a care home owned by Excelcare Holdings PLC. It is located approximately 2 miles from the centre of Harlow but is within walking distance of shops, and local amenities. Ashlyn is a purpose built home that provides residential accommodation for 60 older people with low to high dependency needs, 31 of whom have Dementia. Care Homes for Older People Page 4 of 30 Over 65 0 60 31 0 2 7 0 4 2 0 0 9 Brief description of the care home The home provides personal care to those people who have been assessed as needing this. The home has bedrooms located on both the ground and first floor; the upper floor of the house is accessible to all residents through the passenger shaft lift. The homes fees for care and accommodation range between £460.60 and £503.58 dependent on assessed needs. Care Homes for Older People Page 5 of 30 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: This was an unannounced key site visit undertaken by two inspectors over 8 hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, a sample of care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent into the Care Quality Commission the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Care Homes for Older People Page 6 of 30 Before the site visit a selection of surveys with addressed return labels had been sent to the home for distribution to residents and staff. Views expressed in these surveys and by visitors to the home during the site visit have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager, the staff team and visitors for the help and co-operation throughout this inspection process. The previous key inspection of this service took place on 27th April 2009. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 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 30 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. A detailed assessment of prospective residents wishes and requirements ensures the home can meet their needs. Evidence: There was a Service User Guide and Statement of Purpose in place. The service User Guide was available in the reception area of the home and we saw copies in peoples individual rooms. The manager told us that since the previous inspection visit alternative formats have been considered including a talking book format or CD version rather than larger print, however this had not been undertaken at this time. The manager expressed a sensible approach to admissions. Even though the home had many empty beds, they would assess peoples needs carefully and not just take people whose needs they may not be able to meet. The manager gave us an example of a person that they had taken the decision not to admit, the pre admission process identified behaviours and dependencies that the manager did not feel the home could Care Homes for Older People Page 10 of 30 Evidence: manage in the best interests for the individual concerned. In completed surveys 50 of the respondents said they had received enough information about the home before making the decision to move in, 30 said they did not know and 20 said they had not received enough information. The managers AQAA stated: Prospective service users are encouraged to visit the home before the pre-assessment is undertaken and invited to stay for a meal and meet other residents on a very informal basis. A full pre-assessment is undertaken by trained senior team members, wither within the service users home or in hospital. This is often with the family present to assist with the information of identified needs and to begin the person-centred life plan process. We also receive information on a Com 5 sent by Social Services. All service users are admitted on a four to six week trial basis and reviewed incorporating information from the resident/families and friends, the homes views and Social Service input. We looked at pre admission assessments for two people who had moved into Ashlyn since the previous inspection visit. Both files contained the required assessments to provide an overview of their health, personal and social care needs. Staff files and the training schedule reflected that people working in the home had received training to provide them with the required qualifications, skills and experience to meet the needs of the people living in the home. This was confirmed in discussion with staff during the course of the inspection who demonstrated a clear understanding of peoples individual care and support needs. The home does not provide intermediate care. Care Homes for Older People Page 11 of 30 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. People living at Ashlyn receive health and personal and medical care, based on their individual needs and wishes. Evidence: Information provided in the managers AQAA and verified at the inspection confirmed that each resident had a care plan that clearly identified their health, personal and social care needs. We looked at the records and care pathways of four people living in the home to confirm this. The care plans set out in a way that could be easily used by people unfamiliar with the individual to deliver a personalised and consistent service. The plans included photographs of residents to identify and personalise their care plan. Care plans were built around the individual needs of residents and included their preferences, choices and daily routines. Evidence was seen to confirm that care plans were reviewed monthly ensuring that the information held was current and accurate. People living at Ashlyn told us that they received appropriate care, treatment and support. This was confirmed in residents Have Your Say surveys, 6 out of the 10 surveys returned told us they felt they always received the care and support they Care Homes for Older People Page 12 of 30 Evidence: needed and 2 people told us they usually received the care and support they needed with 1 person commenting that this is sometimes the case and one person commenting I dont know yet!. Staff spoken with, had a good understanding of the people living in the home and were able to give a verbal account of individual residents needs and preferences. Conversation with people living in the home confirmed, that staff treated them with dignity and respect. They also told us: They look after me very well to be honest. Families and representatives of people living at Ashlyn told us: I cant commend my relatives care highly enough and The care the staff give is good, better that hospital, cant fault the grass roots care. Interactions between residents and staff, during the day were observed to be friendly and appropriate. Care plans contained assessments that identified the risks for activities of daily living. These covered the risks associated with mobility, falls, use of wheelchairs, nutrition and personal hygiene and the actions required by staff to minimise these, whilst enabling the individual to maximise their independence and choice. Information included in the care plans confirmed that people had access to health care services and social care professionals. The manager reported that the home had a positive relationship with the local General Practitioners and District Nursing team, who made regular visits to the home. We saw that the District Nurses maintained their own care plans about people they were caring for at the home and these were kept separate from the residents care plans that staff referred to. We spoke with District Nurses visiting the home on this day. They told us that generally the staff provided good care but voiced concerns about how the advice and guidance they gave was handed over to the care staff team. We noted a discussion taking place between the manager and the District Nurses addressing this concern and exploring ways to ensure the information was handed over safely. There were records in the care plans to show the outcome of health professional visits. We found that this information was not always carried forward to the relevant section of the care plan, this meant that staff may not always have access to the latest information necessary to promote residents health. An example being that a care plan for one person had been amended to reflect changes made as a result of a visit by the dietician in February but not for a more recent visit. However, care staff were able to confirm that the latest diet regime was in place. The manager told us that care plan training was in place for all new staff joining the home and that recording training was being put in place for the existing staff team. At the inspection visit of April 2009 we were concerned to note some examples where Care Homes for Older People Page 13 of 30 Evidence: daily practice did not reflect the homes philosophy to promote peoples dignity. At this visit we observed staff treating residents respectfully and courteously and people were dressed and groomed appropriately. People we spoke with praised the staff team for the way they worked hard to promote their dignity. We looked at the practice of storage and administration of medications held at the home. There was a list of staff signatures at the front of the Medication Administration Records (MARs) folder so it would be possible to confirm who had given people their medication. There was a list of all medications held within the home, what conditions they were prescribed for and any potential side effects that could be expected. For each person living at the home there was a page with their name, room number and photograph to assist with positive identification. There were clear protocols in place for medications that were to be administered as required. We saw some good recording included in the MARs when prescribed medications were not given for any reason however this practice was not consistent and therefore did not contribute to providing a clear audit trail of the medications held in the home. The medication trolley was securely kept in a locked room when not in use. The trolley was clean and organised, nearly empty as the new stock of medication was due to be delivered to the home the next day. Some medications were provided by means of a monitored dosage system however there remained many medications supplied in packets or bottles. Some the the packets of medication were not dated to indicate when they had been opened. This also did not assist in providing a clear audit trail of medications held in the home. The manager told us the shortfalls with medication administration had already been identified and reported that an alternative supplier had been sourced and was due to start in May. This would be using the Biodose system, a Total Medication Management System that facilitates the dispensing and monitoring of liquid and solid oral medications together in a tamper-evident sealed unit. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Ashlyn are offered stimulation and entertainment and enjoy a healthy and nutritious diet. Evidence: The managers AQAA stated: Our activities co-ordinator embraces her role and has recently won the regional activities co-ordinator award. She has spent a lot of time and effort of late creating ideas for day to day living skills for our service users with dementia. On a monthly basis the activities co-ordinator tries to arrange for an average of 2 special events brought in from outside and works very hard to raise the funds for these activities. Themed days around cultural and religious festivals and events are celebrated throughout the home. We have involvement from the local community including schools and spiritual organisations. The service had created a Sensory Garden for the residents to access in good weather, this was opened in September 2009. Visitors told us they felt this was a positive development however, the residents on the dementia unit were accommodated on the first floor of the home and therefore were not able to visit this garden area unless accompanied by staff. This therefore reduced their access to a stimulating and safe environment. Care Homes for Older People Page 15 of 30 Evidence: 10 people responding in have your Say surveys gave mixed feedback on the activities provided at Ashlyn. 4 people said the always had activities to take part in, 2 people said this was sometimes the case, 2 people said usually whilst a further 2 people responded dont know. We looked at activity records, these showed that all people living at the home were offered the opportunity, and actively encouraged, to take part in a wide variety of activities including word games, painting, darts, church services, indoor bowls and skittles, an Easter Hat competition and Quizzes. The opportunity for 1:1 interaction was also provided, examples of this included manicures and outings to the local pub. It was clearly documented where people had taken part in activities and if they had enjoyed them. There were also clear records to show where people had refused to take part in activities and the reason why. Records showed that the home was dressed for Halloween and residents were offered Halloween decorated biscuits and scary juice drinks. records showed that low noise fireworks were provided so that residents could enjoy a firework display without the risk of the possible distress caused by loud explosions. We visited the kitchen as part of our initial tour of the home. At the previous inspection in April 2009 we noted that kitchen staff were preparing the sandwiches for afternoon tea at 09:30 hours. At this inspection we found that there was a new team of kitchen staff since the previous visit and new regimes were in place including preparing the sandwiches for afternoon tea later in the afternoon. We were provided with a copy of the menu provided for people living at Ashlyn. This showed that people were offered a varied and nutritious diet with 2 choices for all main meals. Residents told us that if they didnt like the choices on offer they only had to say and the kitchen would provide them with an alternative. We took lunch with the people living on the residential unit. We noted that each person was offered a choice of main meal at the point of dishing up from a hot trolley taken to the dining room. This day there were options of roast chicken or steak and kidney pie with cauliflower, green beans, roast or mashed potatoes. A dish of vegetables and jug of gravy was placed on each table for people to make their own selection. Tables were nicely laid with table cloths and serviettes. We observed staff providing gentle encouragement for people to eat. We visited the dementia unit at lunch time to observe the mealtime experience. The same practice was followed as on the residential unit with peoples independence encouraged through the use of plate Care Homes for Older People Page 16 of 30 Evidence: guards etc. There was a lively atmosphere in this room with staff providing gentle and unhurried assistance where needed. Residents told us: The food is very good, probably not as varied as if I was living on my own but on the whole it is very good. Care Homes for Older People Page 17 of 30 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. People living at Ashlyn are safe, secure and can be confident that concerns would be listened to and taken seriously. Evidence: The home had a clear complaints procedure in place. The complaints procedure was on display for people in the entrance area. It was also available to refer to in copies of the Statement of Purpose and Service User Guides that were placed in each persons bedroom. In spite of this on surveys, although people said that they knew who to talk to if they had any concerns, seven out of ten people said that they did not know how to make a formal complaint. We discussed with the manager ways of making the complaints procedure more accessible, perhaps through using different formats. The manager said that the Company were looking at all systems and ways of making information accessible and usable. The AQAA told us that nineteen complaints had been received over the last year. We looked at complaints records and saw that complaints had been made that related to various issues such as communication, laundry, care, and staffing. We saw that peoples concerns had been listened to, where appropriate investigated, and a conclusion reached. We saw from issues recorded, for example one person complaining that their cup was dirty and stained, that the home take all comments seriously. Care Homes for Older People Page 18 of 30 Evidence: Staff training records and staff spoken with confirmed that training in safeguarding had been undertaken. Staff demonstrated a good awareness of safeguarding. A senior member of staff told us that they knew what to do and where to find the information and paperwork needed should an incident occur. The home had their own policies and procedures in place relating to safeguarding vulnerable adults. These contained clear guidance for staff. They highlighted the need to use local safeguarding procedures, which were also readily available. Over the last year a number of safeguarding referrals had been made by, or about, the home. Many of these related to resident to resident incidents. The home had tried to address issues raised and worked with the local safeguarding team. Ashlyn is registered to provide dementia care and therefore people can behave in ways that are challenging for staff. We saw that some staff had received training in managing challenging behaviour and that further training was planned. The care plans we looked at reflected where peoples behavioural needs required additional support and specific management strategies. Care Homes for Older People Page 19 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home does not enable all residents to freely and independently access all areas of their home. People live in a safe environment. Evidence: Ashlyn provides accommodation and care for up to sixty older people. The home is divided into 2 units, the residential unit is sited on the ground floor of the home with the dementia unit occupying the first floor. Each unit has its own dining area and separate lounge. 56 bedrooms are for single occupancy and 23 of these have the benefit of en-suite facilities. The home has sufficient bathrooms and toilets available to meet the needs of the people living there. These include toilets at frequent intervals in corridors and assisted baths. People are able to move freely around part of the dementia unit however there is one corridor (Coronation Street) housing a number of bedrooms that is situated separately from the main unit and therefore not accessible to the residents. This is because the main stairwell is accessed from a landing situated between the main dementia unit and Coronation Street. The manager spoke of plans to alter this area to open up the unit and make it more dementia friendly. These plans have not been set in concrete yet though, there needs to be some exploratory work done to be sure they are feasible. Care Homes for Older People Page 20 of 30 Evidence: We saw that memory boxes had been placed outside peoples rooms on the dementia unit. These were for people to put personal items that meant something special to them to enable them to locate their rooms easier and to feel comforted entering their rooms. We saw that clear signage had been introduced on bedroom doors throughout the home. The manager is arranging for Braille name plates to be provided for people living with impaired vision so that they will be able to identify their own bedroom doors. Peoples bedrooms were saw were generally very personalised with items of own furniture, pictures etc brought in from their own homes. One visitor on the dementia unit told us that it was not feasible to personalise their relatives room because everything they brought into the home went missing courtesy of other service users wandering in and out of each others rooms. The outside of the building had a tired appearance and was in need of some attention. Some decoration had taken place internally and efforts had been made to make the environment more homely for the residents with more pictures and items for them to interact with such as textiles. The managers AQAA identified in the section what we could do better: Update some of the tired furniture in the bedrooms, redecoration of some of the bedrooms, replace one of the baths and open up the dementia unit to enable access to both sides of the unit The environment was maintained by a team of domestic assistants and was clean and tidy throughout with some minor odours. The laundry facilities contained the appropriate equipment to launder soiled linen, clothing and bedding. Appropriate protective equipment, such as aprons and gloves and hand washing facilities of liquid soap and paper towels were provided in the laundry, all en-suite and toilet facilities, where staff may be required to provide assistance with personal care. Relatives told us: The cleaners are very good indeed I feel the Dementia Unit should be on the ground floor so that residents could enjoy the garden and sensory area. People on the residential unit would be able to access this area more independently that the people living with Dementia It is difficult to bring in personal items to make (Persons name) room more homely because things just walk. Other residents wander in and out taking things, we have learned to keep (persons name) room spartan as a result Care Homes for Older People Page 21 of 30 Evidence: The layout of the home is not visitor friendly, the lounge can become quite loud and chaotic at times meaning you need to shout to converse The buildings arent the best ever, but the staff, friendliness and activities have impressed us (Persons name)room is in a separate corridor, they cant access their room independently and has always liked to spend time in their room pottering with their belongings, additionally there is no en suite bathroom facilities Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a staff team that are safely recruited, trained, skilled and in sufficient numbers. Evidence: On the day of inspection forty six people were being accommodated. We looked at staffing rotas and saw that staffing levels were being maintained at seven (or occasionally eight) care staff and two senior staff during the morning, six or seven care staff and two senior staff during the afternoon/evening and five staff at night which will include one or two senior staff. The managers hours were supernumerary. Additional support and hours are provided for domestic, laundry, catering, administration, maintenance and residents activities. During the site visit there were generally staff around in the communal areas to monitor, interact with, and assist people. In one case however during the morning when we used a call bell to summon assistance for a resident in their room the response was extremly poor. There was no response to the call bell within 15 minutes so we approached staff directly to obtain assistance for the resident. We brought this to the managers attention. The home had been heavily reliant on agency staff to cover the home, the managers AQAA told us that in the previous three months 177 shifts had been covered by agency staff. This would not help in providing people with consistent care from people that they are familiar with, and who understood their Care Homes for Older People Page 23 of 30 Evidence: individual needs. At the time of this visit the manager reported that the situation had greatly improved, that the home was nearly fully staffed and the use of agency workers had much reduced. Copies of staff rotas we looked at confirmed this. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. Information provided in the managers AQAA indicated that out of 46 care staff 22 people held an NVQ at level two or three. In discussion with the manager, and viewing a training matrix, it seemed that due to recent recruitment these figures had changed slightly. There was now a care team of 48 with 23 staff holding NVQ in levels two/three or both. The home had therefore nearly achieved the basic 50 target. The manager said that eight further care staff were about to commence their NVQ training, with other staff also planning to undertake NVQ training relevant to their individual roles. This shows a commitment to providing a well trained and skilled workforce. The previous inspection found that recruitment procedures and practice at Ashlyn were generally satisfactory and protected residents. We looked at the files of three members of staff who had been most recently started to work at Ashlyn to ensure that good practice was being maintained. We saw that staff files were clear and well organised making it easy to find the information that we needed. All proper recruitment checks had been undertaken. ISA first and Criminal Records Bureau checks, (CRB,) had been undertaken. Where a CRB check was not in place before people started work we saw that a risk assessment was in place to confirm that all other checks had been satisfactory, and what safeguards were to be in place. References had taken up and proof of identification sought. All 5 staff responding via surveys said that CRB and references were taken up before they were able to start work at the home. Staff told us via surveys that they felt the induction mostly served to provide them with the knowledge they needed at the commencement of their duties at the home. We saw from staff files that induction processes were in place to ensure that staff had a good initial introduction to the home. A set format was used for this that covered administration details, aspects of the home and principles of care. Those viewed had been well completed. Ashlyn made extensive use of elearning, and Skills for Care Common Induction Standards were covered through this route. We saw that new staff had undertaken a good level of elearning modules that should equip them well for their role. Staff spoken with, staff files viewed and a training matrix provided showed that the home were proactive in encouraging training in all areas. Staff were trained in important areas such as dementia care. We spoke with visitors from various units around the home during this visit. Care Homes for Older People Page 24 of 30 Evidence: Comments made to us included: Staff are very good and The staff are so kind to (Persons name), it gives us peace of mind to knoe they are happy here. Residents told us: The staff are very good, some are even better than they should be, if you know what I mean! and Staff are very good. Care Homes for Older People Page 25 of 30 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. People living at Ashlyn benefit from living in a well managed home that is safe and meets their needs. Evidence: Ashlyn had been unfortunate in having been without a registered manager for some time. Several managers had been in post but not stayed long. At the time of this visit the service was being managed by a Regional Manager from the organisation who was considering taking the position of manager of Ashlyn permanently. People made positive comments about the recent management of the home. When we visited the home was very well organised, and all the information needed to undertake the inspection was readily available. Discussion observation and information viewed at this inspection showed that the manager had a very good awareness of, and rapport with, the residents, was aware of things happening in the home and proactive in dealing with issues when they arose. Care Homes for Older People Page 26 of 30 Evidence: The provider had strategies in place to ensure that the quality of the service was kept under review and that people had the opportunity to express their views and give feedback about the service. We saw that regular residents, relatives and staff meetings were held. The provider undertook regular quality reviews of the service. This last took place in September 2009 when surveys were used to seek peoples views. A comprehensive report of results was produced and was available for people to view. To comply with Regulations a senior person in the organisation conducted a formal visit to the home once a month. We saw that these visits were undertaken regularly and included talking to people about the service. The home operated a number of internal audits to ensure that good practice and standards were maintained. These included monitoring care plans and auditing medication systems. The AQAA was completed by the manager. The AQAA was accurately completed and showed us that management know what they needed to do better, and how they could continue to improve the service for the benefit of residents. People can feel confident that if they or their families asked the home to help them look after their personal monies, this would be done in a way that safeguarded their interests. Monies checked were correct, with receipts in place for all transactions. Records viewed showed that proper systems were now in place to ensure that staff received regular supervision to support them in their roles. The managers AQAA identified that systems and services within the home were monitored and maintained. A sample of records looked at confirmed this. A partial tour of the premises showed that the home seemed well organised and safe. When the fire service last visited the home in June 2009 they found everything to be in order. A local fire risk assessment was seen to be in place. Fire records were well maintained. Systems were tested weekly, and fire drills were carried out to ensure that staff knew what to do in an emergency. The last environmental health officers visit in March 2009 found that excellent standards of food hygiene were being maintained and awarded the home a five star rating. Training records showed that staff were kept up to date in core areas such as moving and handling, health and safety and food hygiene. Care Homes for Older People Page 27 of 30 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 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is recommended that staff training should continue to give them the necessary skills for recording and documenting peoples care needs and the care and support provided for people. This is so that care plans contain relevant and up to date information to ensure people receive the care and support they need. It is a recommendation of good practice for external and internal redecoration and refurbishment of the home should take place to make it a more pleasant and enabling environment for people to live in. 2 19 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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