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Care Home: Ashmead Care Centre

  • 201 Cortis Road Putney London SW15 3AX
  • Tel: 02082466430
  • Fax: 02082466431

Ashmead Care Centre is a purpose built care home with nursing that provides care for people who may have dementia. The home is able to accommodate up to 110 residents. The home is situated in Putney, close to the main A3 road and has access to local bus routes within walking distance. There is provision for car parking on site. The accommodation is situated on the ground, first floor and second floor, with the kitchen, staff rooms and some offices in the basement. The home is organised into six residential units, each containing communal areas and individual en-suite bedrooms. The service is managed by Southern Cross Healthcare Ltd. The weekly fee range from a minimum of £633 - £860 per week.

  • Latitude: 51.455001831055
    Longitude: -0.23100000619888
  • Manager: Moise Louis Jennah
  • Price p/w: £633
  • UK
  • Total Capacity: 110
  • Type: Care home with nursing
  • Provider: Southern Cross (LSC) Ltd
  • Ownership: Private
  • Care Home ID: 2158
Residents Needs:
Dementia, Old age, not falling within any other category

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Ashmead Care Centre.

CARE HOMES FOR OLDER PEOPLE Ashmead Care Centre 201 Cortis Road Putney London SW15 3AX Lead Inspector Louise Phillips Key Unannounced Inspection 10:00a 3rd July 2008 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 Ashmead Care Centre DS0000060799.V361176.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. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashmead Care Centre Address 201 Cortis Road Putney London SW15 3AX 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) 020 8246 6430 020 8246 6431 ashmead@schealthcare.com www.schealthcare.co.uk Southern Cross (LSC) Ltd Moise Jennah Care Home 110 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (50) of places Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th January 2008 Brief Description of the Service: Ashmead Care Centre is a purpose built care home with nursing that provides care for people who may have dementia. The home is able to accommodate up to 110 residents. The home is situated in Putney, close to the main A3 road and has access to local bus routes within walking distance. There is provision for car parking on site. The accommodation is situated on the ground, first floor and second floor, with the kitchen, staff rooms and some offices in the basement. The home is organised into six residential units, each containing communal areas and individual en-suite bedrooms. The service is managed by Southern Cross Healthcare Ltd. The weekly fee range from a minimum of £633 - £860 per week. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection took place over one day by three inspectors. Time was spent talking to nine staff, seven residents, two relatives/ advocates and viewing paperwork. One relative was also spoken to by telephone. A tour of the premises was carried out and care records were inspected. Information has been gained from the inspection record for the home, the Annual Quality Assurance Assessment (AQAA), that the manager completed and surveys received from 11 residents, 12 staff, 16 relatives/ advocates of residents and 3 health/ social care professionals involved with the service. What the service does well: What has improved since the last inspection? What they could do better: Areas where the home could be doing better are highlighted in the report and were discussed with the manager during the inspection. These include improvements to the activities provided, medication checking and staffing levels. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 6 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. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 7 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 Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 8 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, 3 and 6 Quality in this outcome area is good. The residents are appropriately assessed prior to moving to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the arrival of the new manager earlier this year the home has updated the Statement of Purpose and Service Users Guide to provide relevant and comprehensive information about the service. Prospective residents to Ashmead Care Centre are appropriately assessed by the manager or deputy manager, to ensure that the service is able to meet their needs. The manager said that some of the registered nurses are also being trained to perform assessments. At the start of the assessment the service receives needs assessments and care plans from the local authority and from this the home carries out its own assessment. This information is then used to form the basis of the pre-admission care plan for the resident Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 9 during their move to the home. This covers a number of areas such as personal care, mental state and cognition, mobility, diet and communication. As part of the assessment process potential residents are invited to visit the home to meet staff and residents and look at the service provided. Residents move in for an initial trial period of six weeks. Prior to the end of the six weeks a review meeting is held between the resident, their relative, social worker and manager of the home to review their stay and for the resident to decide if they want to stay. Intermediate care is not provided by the home. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 10 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 and 11 Quality in this outcome area is good. The residents’ needs are met through care planning that takes into account individual needs and preferences. Some improvements are needed to ensure medication is given safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The responses to the surveys provide a valuable insight into the experience of residents living at Ashmead Care Centre, along with the observations of their relatives. Responses from residents indicate that they feel they generally get good care and support from the care staff. Residents say that the care is delivered with kindness and with respect to their privacy and dignity. Relatives similarly say this, adding that they believe the home is able to meet the differing needs of the residents and that staff keep them informed of important issues affecting their relative. One relative commented that “…my father is always clean and looks comfortable…”, whilst another said “…my Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 11 mother never complains about bathing or having her hair washed or cut, which is a change from her previous care home…”. Responses from staff reflect that they are positive about their work, where they state that “…the service is concerned about the quality of care given to the service users…”, “…I like to enhance the quality of care of the elderly…”. In addition, feedback from health and social care professionals involved with the service is that they feel the home contact them when necessary, and that staff seek and utilise the advice that they give. One professional commented that: “…overall the nursing care provided at Ashmead is good. Staff have made good use of the training courses regarding care related issues and this is being implemented in care plans and care delivery…”. Where asked if they feel they get good medical support, some residents said that they would like to be seen more regularly by the visiting doctor and dentist, but a majority of residents said they are happy with the medical input they get. In relation to this, one relative said that “…it would be helpful if our (relatives’) hearing aid could be serviced and batteries supplied…”. Additionally, some relatives expressed frustration at the lack of feedback from staff when they raise issues, and they feel that staff should have some training in this area. One area that was highlighted by a number of residents is that sometimes they feel that there are not enough staff on duty, where one commented that “…I have to wait for carers to hoist me back into bed…”, whereas another said “…sometimes they do not come as quick as I would like…”. Indeed, some relatives also highlighted this, with them commenting that the home could improve by: “…having more staff, as two carers are often needed to change/ bathe residents, which leaves a shortage of staff…”. Another relative has observed that “…sometimes the call bell rings for some time before a carer can attend as they are dealing with another resident…”. One relative also said that on a couple of occasions they have assisted residents who have fallen, as there were no staff around to help. The service must ensure that the staffing levels are kept under review, and adjusted where necessary to ensure that the needs of the residents are met at all times. The care plans for a number of residents were looked at during the inspection. Information in these is very detailed. There is an ‘autobiography’, completed with help from residents’ families, which includes information about the residents’ background such as their early life, family, work and interests. There is also a ‘map of life’ that is current and includes personal information regarding favourite television programmes, details of relevant family members, hobbies, favourite music and holidays. The care plans contain individualised information such as dementia assessments, physical and social assessments, communication, breathing, Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 12 eating and drinking, hearing, personal cleansing, mobilising, sleeping and expressing sexuality. There is a good standard of record-keeping in the files, providing information about how each resident spends their day. The care staff team are in the process of receiving dementia care training, and the care plans are improved as a result of this. However, some dementia and bedrail assessments had not been reviewed since being carried out in June and October 2007, and it is recommended that these are carried out more frequently. Throughout most of the care plans seen, there was evidence of the involvement of residents or their next of kin. This was demonstrated by the care plans being individualised to each persons needs and them being signed by the resident or relative. One relative also described that: “…my mothers file is regularly presented to me to read and any new action raised for my agreement…”. Another relative also confirmed that: “…if the ward sister is on duty when I visit she makes a point of personally going through the care plan with me and getting me to sign it…”. The care plans regarding ‘death and dying’ have been completed but contain very standardised wording, with no evidence they are individualised or personal centred. Also the comments in the care plan refer to the procedures, such as which professionals to inform, which forms to fill in and how long to keep documents for, with no reference to religious, spiritual or cultural wishes, for example, whether the person wishes burial or cremation. The care files are well-maintained, with records to demonstrate that appropriate assessments are carried out around the risks of pressure sores, nutrition, moving and handling, continence, falls and the use of wheelchair straps. The risk assessments are carried out either by a staff nurse employed at the home. Consent is also sought from relatives for the use of bedrails. One resident had a risk assessment for ‘…absconding…’ which stated that they ‘…went to the sluice room and opened tap water and was found sitting on floor…’. The risk assessment states, ‘…sluice room door should be locked to avoid this incident…’. However, the sluice room door (which is directly outside this resident’s bedroom) was open throughout the period we spent on the unit. This was highlighted to the manager during the inspection. Also, the use of the term ‘absconding’ should be reviewed if the resident is simply moving around the home. The medication for a number of residents was looked at. The medication profiles include photographs of each resident, and the balance of medication in stock is recorded daily. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 13 Where medication is not stored in a monitored dosage system it is clearly labelled with the name of the resident for whom it is prescribed and the date of opening the date is recorded. These were generally maintained well, although a number of discrepancies were noted and highlighted to the manager at the time. This included: - the allergy section on the medication administration record (MAR) chart was not completed for all residents, - on one occasion the total number of tablets on the MAR chart was 25, whereas the amount in the blister pack was 24, - on one occasion the medication received had not been properly checked in when received from the pharmacy, leading to a resident being given an extra dose of medication. Following the inspection the manager promptly investigated this and put plans in place to avoid this occurring again. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15 Quality in this outcome area is adequate. Residents have the opportunity to be involved in some in-house activities, though improvements are needed to ensure all residents have the choice to be involved through more variety of activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: “…I have been out on several occasions and enjoyed seeing the birds and the zoo…”, “…they do not mind re-organising their routine to suit visitors…” These were comments from residents who say that they enjoy living at Ashmead Care Centre, and like the relaxed atmosphere that enables them to spend their time as they wish, and their family to visit at any time. The manager said that there are now three activities staff, which is more than previously, and that care staff are encouraged to participate in arranging and supporting activities. The manager said that the plan is to have two link workers allocated on each floor to develop activities in addition to the activities co-ordinator. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 15 Feedback from surveys indicates that there are more opportunities now for residents to go out, with approximately three to four trips planned each month throughout the summer. One resident did say that there are more trips out, but that when he has wanted to go there is not a space, and consideration should be given to spreading trips over number of days to allow all residents who want to attend trips the opportunity to do this. A relative said about how they had seen some staff playing cards, board games and dominoes with some residents, saying that they feel the staff enjoy being with the residents. Feedback from staff is that they feel the activities are much more structured now, and they like to get involved in these. Whilst one relative acknowledged activities had improved, still felt the service could improve by having more staff to spend time with residents who are ‘bed bound’, where they said: “…they do pop-in when they can…”, One relative wrote about their mother being a ‘very private person’, where they went on to say that although staff previously helped her into the lounge/ dining area it was too much, and the staff respect that she wants to stay in room. Similarly, one healthcare professional also said that “…more could be done to provide individual activities for service users who do not like group activities, along with more opportunities for service users to be taken out…”. During the inspection we saw that staff were seen involving some residents in doing some stencilling, whilst some others read the newspaper. The television was on in the units, but it was not apparent that anyone was particularly watching it. One relative said that they feel that there should be more interaction between staff and residents, instead of “…leaving them sitting in front of the television all day…”. We spoke to one resident who said that they enjoy going out in the garden, particularly since the new garden furniture has been installed. They also said that they enjoy the concerts by visiting entertainers. Care plans are in place for activities, and also for those who prefer to spend time alone in their room. Improvements have also been made to the ‘recreational activity form’, where staff now write what activity the resident has done, and their involvement in this. However, further work is needed on this, as for one resident, the activities recorded seemed to only focus on their reading the newspaper, and another for their watching television. Staff were in both lounges during the morning and afternoon and interacted well with residents. One member of staff was giving residents manicures in the morning and a member of staff ran a card making session in the afternoon. Age appropriate music was playing and the atmosphere was positive and relaxed. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 16 Positive work has been done in the area of activities, and the manager also acknowledges that activities need expanding to cater for all the residents. The manager spoke about the cultural mix of residents in the home, such as Polish, West Indian, British and Pakistani residents. She highlighted issues regarding communication, but said that there are care staff who can speak relevant languages, and they involve the family as much as possible. An example of this was that a Hindi lady was admitted to the home on the day of inspection, and her room is on a unit where three Hindi-speaking staff work. The needs of this resident were discussed with the manager in light of the resident’s ability to express their needs when none of these staff are around, and further consideration needs to be given to this to ensure the residents needs are met. The manager said that the home aims to respect and value all residents’ cultures, and a Cultural Awareness Day is planned regarding this, to raise awareness of different cultural issues. During the inspection we spoke to some visitors who said that they are always warmly welcomed by the staff, and that they are supported to take their relative/ friend out when they wish. They said that they are able to visit at any time but tend not to visit after 7pm as the residents are being assisted to get ready for bed. The issue of residents going to bed early, and being got up early was discussed with the manager. She said that it is something that she is aware of, but that she is trying to change with the introduction of more person-centred care. We observed lunch being served on two of the units in the home. The tables in the dining areas were nicely laid up, with matching tablecloths, napkins, a laminated menu, jugs of juice and flowers in the tables. The staff were relaxed, and some were seen appropriately supporting two residents to eat, engaging them in conversation whilst doing this. Responses from the surveys and conversations with residents and relatives varied considerably about the food provided at the service. Comments from some relatives were that: “…the food has improved and the menu is a little more varied…”, “…the menu is published but very often differs from what comes up from the kitchen…”, “…it is a bit confusing for the residents when they and the menu see that it offers a choice between two main meals, but find that there is only one item available…”, “…the staff take their time in feeding and talking to my (relative)…”, “…there needs to be more fresh fruit provided…” “…there should be improved provision of fluid intake for the residents…” Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 17 And comments from residents is that: “…food is good get a choice…” “…I feel rushed out of the dining room…”, “…the food is not very good. I’d like fish and more vegetables…”, “…there is so much noise in the dining room…”, “…there is an unimaginative repetition of menu…”, “…the head cook has responded to requests for new kinds of main meal…” And one healthcare professional said that: “…more could be done to meet cultural dietary needs of minority ethnic service users…”. Indeed, during the inspection the manager mentioned that a resident on one unit, who moved in on the day of inspection, did not eat pork. This resident was initially given sausages by staff at lunchtime. One member of staff realised the mistake before the resident began to eat, but the home needs to make sure that staff have a better awareness of cultural/dietary needs. The manager said that the organisation sets the menu, which is on a 4-week cycle to ensure that it is nutritionally balanced, but that the home has the flexibility to adapt the menu to meet residents’ needs. The manager said that the chef includes alternatives where residents want these. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is good. There are systems in place to minimise risks to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure that is provided in the Service Users Guide and Statement of Purpose. The procedure is also displayed prominently around the home. Feedback from residents is that they know how to make a complaint if there was something they were not happy about. One resident spoke about the time they had to raise an area of concern, saying that “…the nurse took instant action as appropriate…”. Relatives said that they are aware of how to raise any issues, and that they also appreciate that they are able to use the book held at the nurse’s station to highlight any issues needing attention, eg. Their relatives’ glasses mislaid. Other relatives spoke about the accessibility of staff, where one said, “…a senior member of staff is always available to talk about problems…”, another commented that, “…their response to concerns is immediate…”. However, another relative said that they find that senior staff are not always around, and issues can sometimes take a while to resolve. They said that this is particularly around the issues of staff answering the telephones and messages being passed on. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 19 Healthcare professionals involved with the home said that they generally found the responses to concerns good, though one did say that the “…exception reported by service users, is time staff take to answer bell…”, Survey responses from staff demonstrated that they have a good awareness of how to deal with a complaint should they receive this, where they feedback that they would refer to the complaint procedure and direct the complainant to more senior staff in the service. There is a book held in the managers’ office specifically for the logging of complaints, along with records of actions taken and any correspondence relating to these. There are also copies of any relevant correspondence. At the time of inspection over half of the staff team had received recent training in abuse awareness and safeguarding adults, so to minimise risks to residents. The manager showed evidence of planned training for the rest of the staff team to receive this training in the next couple of months. Some of the staff also spoke about how they are encouraged by the manager to report any safeguarding issues immediately. Staff spoken to during the inspection had a good understanding of what they should do should there be suspicion of abusive practice taking place, and they were of ‘whistle blowing’ procedures. In addition, a majority of the staff have been recently trained in moving and handling, with further training planned for those who need refresher training. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is excellent. The environment is welcoming, relaxed and clean. The staff help create a calm atmosphere throughout the home. The décor and furnishings are of a good standard, all of which makes it a nice place for the residents to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents at Ashmead Care Centre comment that the home is fresh and clean, where a number commented that the environment is “…excellent…”. Staff also say that the service particularly excels by “…providing a lovely and clean environment for the residents…”, and that“…the atmosphere is relaxed…”, with another staff member saying that nice thing is“…the ambience…the atmosphere is calm…”. Relatives also praised the environment as having good furnishings, “…a bright and friendly atmosphere…”, clean open areas and pleasant staff, which all adds Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 21 to a welcoming feeling for them when they visit. One relative also liked that “…there are always fresh flowers on display and the home is clean and sweet smelling…”. One relative did suggest that the chairs be cleaned regularly, and that the bedrooms could be painted. But the overall general feedback from relatives was very positive about the environment. The manager spoke about the work she and the team have done on focussing on improving the environment. She said about work done to make the bedrooms, bathrooms and communal areas better, through re-painting some area in more vibrant colours, replacing carpets where needed, the removal of notice boards, putting more pictures on the walls and providing fresh flowers around the home. She said that work is ongoing in this area, with the replacement of all curtains occurring at the time of inspection. Relatives and residents say that they appreciate the improvements to the environment, where one said that the purchase of garden furniture and the accessible raised beds has “…enormously improved…”. All residents have single rooms with en suite bathroom. The standard of décor and furnishings is of a good standard, and bedrooms seen were clean and tidy and personalised with photographs and other mementoes of each resident. During the inspection one communal bathroom was seen to have liquid toilet cleaner in an open cupboard and therefore potentially a risk to residents. This was addressed by the manager during the inspection. However, the service must ensure that all cleaning products are stored securely at all times. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is good. The service provides training so that residents receive a good level of care, and recruitment procedures protect the residents. Staffing levels need to be kept under review to ensure that needs can continue to be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ashmead Care Centre has a consistent staff team, some whom have worked at the home since it opened, and who have a good understanding of the needs of the residents. Staff feedback that they are confident that the service they provide promotes the well-being of the residents. Feedback from residents is generally positive, where they say that the staff are caring, kind and respectful of their privacy, however they do say that they often feel the home is short staffed, and sometimes have to wait a while for a nurse or carer to attend to them. Similarly, an area that some relatives comment on was that they feel there are inadequate staffing, particularly where they have assisted residents who have fallen, where staff on the unit are not around. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 23 Some relatives also felt that some staff could do with improving their communication skills, regarding their speaking English, so that there is a better understanding of their relatives need. One other suggested that staff should receive training in physical conditions that affect residents, such as arthritis or osteoporosis. A number of relatives did feel that staff have the right skills and experience to meet needs, and they also like that they are kept informed about staff changes and introduced to new staff. The home holds recruitment information on each member of staff. The staff files are well organised and contain relevant information such as proof of identification, correspondence relating to offer of job, Criminal Records Bureau check, two references and record of the interview of staff. All new staff receive an induction to the service which covers areas such as fire safety, first aid and communication. Staff who responded to the survey say that they received a good induction that prepared them well for their work. Staff also said that they get enough training to support them in their role. With one commenting that there is: “…mandatory training arranged regularly to keep me up to date with new ways of working…”, and another saying “…the service does well in terms of training…”. The manager said she has made sure night staff are included in the training, which did not happen previously. Training records indicate that staff havve training in dementia care, fire safety, basic food hygiene, nutrition, first aid and person-centred planning. A number of staff have achieved their NVQ level 2 in Care. Some staff said that they would like more opportunities to attend professional conferences and meetings. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 24 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, 36 and 38 Quality in this outcome area is good. There is a committed manager at the home who is progressing the service for the benefit of the residents. The staff receive good support in their work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the survey sent to staff, they were asked to comment on what they feel the service does well. Some of the responses to these are: “…the manager is very supportive and open to suggestions…”, “…my current manager asks if I have any difficulty during my shift and any area of concern, she is always ready to solve it or give you support in order to meet with the care of the residents…”, Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 25 “…my manager makes sure that we are comfortable, knowledgeable and safe in our work, making it a point to ask how we are and supporting our endeavours…” “…manager has a listening ear and is always open to suggestions…”, “…Ashmead is a better and nicer place to work now…”, “…manager is very supportive…”, Staff also said that the management does well at communicating important information and promoting teamwork. The manager said that she and the deputy manager have put a lot of work into improving teamwork and practice throughout the staff team. She said that she has introduced a number of meetings to get particular staff groups together, such as monthly meetings between trained nursing staff, monthly meetings with carers and monthly meetings with ancillary staff. There are also three monthly full team meetings for all staff to attend. Each morning the manager and deputy manager has a meeting with the trained nurses to increase communication between units and to discuss staffing issues. These new measures were discussed with staff during the inspection, where they said that they felt that staff morale had improved and that the meetings introduced by the manager have been useful, for example in improving the information they get about residents and about practice issues. Where asked where the service could do better, one staff member said that the senior managers in Southern Cross should: “…listen to the new manager who is ready to bring the home up to standard, in supporting her with money and staff where needed…she has done a lot of improvement to the home…”. Similarly, one professional also commented that “…the new manager is working to bring stability…”. The manager said that she has spent a lot of time ‘on the floor, getting to know both residents and staff. The AQAA completed by the manager, and conversations with manager demonstrate that she has a very good understanding of what is needed to continue to improve the service for the benefit of the residents. She has a number of years experience in care of older people, and is appropriately qualified for the role. The manger is currently in the process of applying to the CSCI to become the registered manager of Ashmead Care Centre. The manager said that residents’ and relatives were surveyed in May 2008, where feedback was sought on areas such as environment, privacy, communication, catering, standard of care and approachability of staff and the manager. The manager said that responses from these have been used to develop the service, and also enabled the setting up of a quarterly ‘relatives group’. The responses to the survey were 31 from a possible 155 people, and the service needs to look at ways of increasing this, or looking at alternative ways of seeking feedback from residents and their relatives. The quality Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 26 assurance surveys need to be developed to include other stakeholders to the service, such as social workers, district nurses, etc. During the inspection, the visits carried out by the Registered Provider, or their representative, were not held at the home, and it is required that these are held for inspection at all times. Every two months one-to-one supervision of care staff is carried out by the trained nurses, who are supervised by the manager or deputy manager. Records of supervision sessions are held in the staff files. The home holds a personal allowance for each resident that is funded by themselves, their family or through social services. This money is used for when a resident wants to go shopping or use the hairdresser, etc. Records are maintained of all transactions, with statements printed each month and given to the next of kin, where applicable. The management of the money is overseen by the manager and operations manager for the service. The service users financial records are held on the computer in the administrators’ office. This is the only computer linked to the online network throughout the home. The manager and administrator discussed that this is an issue, and can hinder work, particularly when receiving and replying to emails and accessing the intranet. It is recommended that, at a minimum, the computer in the managers’ office is set-up for on-line working. The service maintains records to demonstrate that appropriate health and safety checks are carried out on the fire system and equipment, electrical installation, gas safety and Portable Appliance Testing, etc. The last inspection identified that staff did not have uniforms to wear whilst working. The manager said that these have been ordered and will be worn by all staff soon. Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 27 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 4 3 3 3 3 X 2 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 2 3 2 X 3 3 X 3 Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13(2) Requirement The Responsible Person must ensure that: - the allergy section on the (MAR) chart is completed for all residents, - medication received at the service is thoroughly checked and any discrepancies addressed immediately, - the staff record which homely remedies each resident can take, based on advice from a general practitioner. Timescale for action 31/08/08 2. OP8 & OP27 18 The staffing levels must be 30/09/08 reviewed, and adjusted where necessary, to ensure there are appropriate staff on duty to meet the needs of the residents. The service must provide a varied programme of activities that caters to the needs of all the residents. The Registered Persons must ensure that staffing are reviewed to enable more one-to-one activities to occur with residents. DS0000060799.V361176.R01.S.doc 3. OP12 16(2)(m)( n) 30/09/08 4. OP14 18 30/09/08 Ashmead Care Centre Version 5.2 Page 29 5. OP26 13(4) The Registered Persons must ensure that all cleaning products are stored securely at all times to minimise risks to residents. The manager must submit an application to the Commission to be registered as the service manager. (Partially met at time of inspection) 31/07/08 6. OP31 9(1) 31/08/08 7. OP33 24(3) The quality assurance system must include the views of stakeholders. (Within timescale at time of inspection) 01/09/08 8. OP33 26 A copy of the report written following the monthly Regulation 26 visit must be available in the home at all times. 31/07/08 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. Refer to Standard OP8 Good Practice Recommendations It is recommended that dementia assessments are carried out a minimum of six monthly. The care plans regarding ‘death and dying’ should contain individualised information regarding religious, spiritual and cultural wishes. Consideration should be given to spreading trips over number of days to allow all residents who want to attend trips the opportunity to do this. OP11 3. OP13 Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 30 4. OP14 Consideration should be given to how the needs of residents can be met, where they are not able to communicate in the same language as staff. The service should ensure that residents go to bed, and get up at a time of their choosing, and that this is detailed in their care plan. The service should ensure that all staff develop a cultural awareness of the needs of the residents in their care. The use of the term ‘absconding’ in risk assessment should be reviewed if the resident is simply moving around the home. It is recommended that, at a minimum, the computer in the managers’ office is set-up for on-line working. The service should look at using alternative ways of seeking feedback from residents and their relatives, to ensure all can provide feedback on the service. 5. OP14 6. 7. OP14 OP18 8. 9. OP32 OP33 Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Ashmead Care Centre DS0000060799.V361176.R01.S.doc Version 5.2 Page 32 - 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!

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