Care Home: Ashminster House

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What the care home does well The home and site present an impressive first impression and the location is generally suitable for the home`s stated purpose, and convenient for visitors. A high level of compliance with the National Minimum Standards in respect of the building has been generally maintained. All areas inspected were odour free and in good decorative order. Documents presented for inspection were generally informative and organised systematically. The standard of catering was judged very satisfactory. Feedback from the residents, and relatives confirmed that staff treated the residents very well What has improved since the last inspection? What the care home could do better: No matters are raised for required attention, but a number of recommendations are made to further improve provision. These recommendations cover aspects of this home`s documentation (public information, care planning); identified individuals` personal or social care needs; accommodation issues; and staff training and support. CARE HOMES FOR OLDER PEOPLE Ashminster House Clive Dennis Court Hythe Road Ashford Kent TN24 0LX Lead Inspector Jenny McGookin Unannounced Inspection 10:00 20 March and 1st April 2008 th 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 Ashminster House DS0000069284.V359146.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. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashminster House Address Clive Dennis Court Hythe Road Ashford Kent TN24 0LX 01233 664085 01233 647944 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) Barchester Healthcare Homes Ltd Mrs Alison Butler Care Home 60 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (39), Terminally ill (5) of places Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Patients detained under Sections of the Mental Health Act my not be admitted to the home Service users under age of 65 years to be restricted two (2) whose DOB are 24/03/1947; 15/10/1948 22nd and 23rd November 2006 Date of last inspection Brief Description of the Service: Ashminster House is registered to give nursing care for up to 60 people, and this currently includes 21 places for people with dementia and 5 people with terminal illnesses. It is one of a group of homes owned by Barchester Healthcare Homes Ltd. And Alison Butler is its registered manager. The property is an attractive detached 2-storey building, which was purpose built about twelve years ago. There is a shaft lift and stairs to connect both floors. There are 54 single en-suite bedrooms (each of which is over 10sq. metres), and two double bedrooms with en-suite facilities (each of which is at least 16sq.metres). All aspects of the building are wheelchair accessible. In terms of access and scope for community presence, there are 18 car parking spaces around the boundaries of the site. Its nearest bus stop (on Hythe Road) links the home to Canterbury and Tenterden as well as Ashford centre itself, with all the community resources and transport links that implies (the nearest train station is about a mile away). The current range of fees are: £555.05 (average for social services funded places) - £921 (average for privately funded places) per week. Additional charges include: additional one-to-one care; chiropody; dental requirements (not within NHS provisions); optical requirements (not within NHS provisions); pharmaceutical; physiotherapy; hairdressing; newspapers; personal dry cleaning; staff escorts to hospitals; taxis and other transportation (this list is not exhaustive). Information on the Home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose / Service User Guide. The e-mail address for this home is: ashminster@barchester.com Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on two site visits, the first of which was unannounced, and the second of which was prearranged. The visits were used to inform this year’s key inspection process and to check on any developments since the home’s registration under its current ownership. The inspection process took about seventeen and a half hours. It involved meetings with three residents (over lunch), and four others individually during a tour of the building; as well as one visiting relative. Interactions between staff and residents were observed throughout each day. The inspection also involved meetings with registered manager and a range of other staff representing various aspects of this home’s operation: the activities co-ordinator, the home’s trainer, the head chef and assistant chef, the head housekeeper, the maintenance officer and the visiting hairdresser (who is also a relative of one resident). The opportunity was also taken to meet with a visiting GP, Quality Assurance Nurse Advisor (from the local Primary Care Trust) and two Care Managers. The inspection involved the examination of records and the selection of three residents’ case files, to track their care. The home had submitted an Annual Quality Assurance Assessment (AQAA) by its due date, as required. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. This was judged a well written, comprehensive account of the issues raised, which reflected provision fairly. A selection of feedback questionnaires was taken to the inspection for distribution to residents and other stakeholders, and several were submitted in time to be taken into account in this report (from five relatives and four staff). Account was also taken of the home’s own thematic quality assurance feedback exercises over 2007 and 2008. Five bedrooms were inspected for compliance with the National Minimum Standards on this occasion, along with communal areas / facilities. What the service does well: The home and site present an impressive first impression and the location is generally suitable for the home’s stated purpose, and convenient for visitors. A high level of compliance with the National Minimum Standards in respect of Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 6 the building has been generally maintained. All areas inspected were odour free and in good decorative order. Documents presented for inspection were generally informative and organised systematically. The standard of catering was judged very satisfactory. Feedback from the residents, and relatives confirmed that staff treated the residents very well What has improved since the last inspection? What they could do better: 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. Ashminster House DS0000069284.V359146.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 Ashminster House DS0000069284.V359146.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 1, 2, 3, 4, 5 Prospective residents and their representatives have almost all the information needed to decide whether this home would meet their needs. Prospective residents have their needs properly assessed, and each placement is confirmed by a contract which clearly tells them about the service they will receive. EVIDENCE: The home has a Statement of Purpose and Service User Guide, each of which usefully describes a range of facilities, services and service principles. They do not have all the information prescribed by the National Minimum Standard, but these matters were minor, and have been reported back to the manager separately. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 9 The home also issues a Welcome Booklet, which invites the reader to ask staff for assistance to read its information. One relative confirmed having received a Statement of Purpose and Service User Guide and another said she gone through both documents with the then manager, as part of the admission process. But the files selected for case tracking did not evidence their issue, or whether other languages, assistance or formats (e.g. large print or tape etc) were warranted. This is recommended. There was good evidence of the home carrying out preadmission assessments, to ascertain whether the home could meet residents’ needs. Prospective residents or their representatives are able to visit the home to judge it for themselves, before admission. Each admission is subject to a 4-week trial stay before being confirmed by a contract. The home’s contract was judged compliant with the elements of the National Minimum Standard, but could be further improved. These matters were minor, and were reported back to the manager for attention. Feedback from two relatives indicated that they were not aware of any contracts in place, and the files selected for case tracking did not evidence the issue of a contract, or whether other languages or formats (e.g. large print or tape etc) were warranted. This is recommended, so that anyone authorised to inspect the records can be assured that people know what their rights and responsibilities are. On their admission, the home carries out further assessments and sets up a care plan (see next section). See sections on “Environment” and “Health and Personal Care” for a description of services provision; and the section on staffing for information on deployment and training. Ashminster House DS0000069284.V359146.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 7, 8, 9, 10 Residents benefit from the health and personal care they receive at this home, and records reflect the level of care given. The principles of respect, dignity and privacy are put into practice EVIDENCE: The format of this home’s care planning processes is designed to enable each aspect of the residents’ personal and health care needs to be addressed, and these are spot-checked by the manager, which is judged sound practice. The care plans provide good practical instruction for staff, and are properly underpinned by day-to-day checks (general care issues, continence, dependency, tissue viability, nutrition etc), and a range of risk assessments, all of which is reviewed monthly. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 11 The home has satisfactory arrangements for the safe storage of medication, particularly since it installed a new clinical room in the Memory Lane unit, which ensures a good temperature controlled environment. An examination of three residents’ medication administration record (MAR) sheets showed no apparent gaps or anomalies. There are audits of the medication arrangements every six months by a pharmacist, to ensure sound practice standards are maintained (though these do not generate written reports), and the home also carries out its own rolling programme of compliance checks. A sample was examined, showing 96 compliance with specified standards – though it was dated April 2007 and had lost its currency by the time of this visit. There are detailed records kept in each resident’s file of appointments with doctors, hospitals and other healthcare professionals. These provided evidence that the home properly supports service users to access medical services. Residents can stay with their own GP if their GP agrees, but in practice almost all the residents are registered with the home’s local GP practice. A GP from this practice visits the home twice a week, and this arrangement ensures that each resident’s medication is effectively being reviewed at least twice a year. When asked about this home, the GP told us, “I think the nursing staff here are very competent. They seem to be well organised here and the quality of the facilities is good”. A meeting with a visiting Quality Assurance Nurse Advisor (from the Primary Care Trust) was also positive. He has been reviewing patients who are particularly frail and he told us that he had been impressed with the standard of care planning he had seen in this home. He said the interactions between carers and nursing staff were “excellent. As soon as you walk in it is calm. There are nice conversations going on”. Even though the dementia care unit is not within his remit he had, nonetheless, observed that “whenever I’ve walked around it’s a good environment - people talking to each other and they’re always smiling. The clients have been clean and well presented”. He said he hadn’t seen anyone slouched or seen teas left to go cold. A visiting care manager said she felt this home gave a high quality of care. “The care planning is person-centred, set up for the residents rather than the convenience of staff. You don’t hear Radio One blaring out as people are being wheeled about”. And both care managers pointed out there were no unpleasant smells. There are only two double rooms in this home, and all the bedrooms have ensuite facilities, so that personal care and medical interventions can generally be assured of some privacy. One relative said she felt the resident s/he visited would benefit by having more than one bath a week, and this was reported back to the manager for her attention. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 12 Residents do not, however, have keys for their bedroom doors, and one resident told us that she had been unable to prevent another resident from wandering in and out, causing her persistent nuisance. The rooms inspected all had lockable facilities, so that residents would be able to safe-keep medication (subject to risk assessment, should this apply) and items of value, as required. See section on “Daily Life and Social Activities” for findings in respect of social care needs, and section on “Environment” for findings in respect of furnishings and accommodation. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 12, 13, 14, 15 Residents are supported to make choices about their life style, and social activities as far as they are able. The home’s arrangements enable residents to keep in contact with family and friends. Residents receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: The admission process properly identifies social care interest and issues, in the first instance, and the home has an Activities Co-ordinator to lead on this element of the home’s organisation thereon. Although the residents spoken to on this occasion were not able to give many examples of any particular interests or hobbies being actively promoted by the home, activities are planned on a weekly basis from Monday to Friday, and there is something organised every morning and afternoon. However, there is Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 14 no equivalent post to cover after 5.00pm during the week or over the weekends. Examples of activities include sedentary recreational pursuits such as artwork, and themed music sessions (war-time music being the current theme). The Activities Co-ordinator told us “We have a film on Fridays and we get all the old films out and let them choose. One wanted “On the Buses” but one gentleman did not like it so he chose the next week. We serve them ice cream and pop corn”. There are mind and body exercise sessions such as “parachute” fun sessions (whereby balls are put into a small parachute and tossed into the air), wheelchair basketball, and card games. There are socialising events such as wine and cheese events (every 1-2 weeks, where they experiment with different cheeses), and sherry and beer are served before lunch each day. And there are outings in the home’s minibus. There are therapeutic sessions such as nail care, and sensory sessions. The Activities Co-ordinator told us that money had been raised at Christmas for equipment, and they are hoping for a sensory garden to be set up. A hairdresser comes in on Tuesdays and Wednesdays, and is proving popular. And the home has been visited by Mollie (PAT dog service) and her puppies. Some residents help feed the fish in a large tank on display in the home. Some like to help pack things away or wipe down the tables. The Activities Co-ordinator told us that, after going round asking if residents wanted to attend church services, a lot of them had said they did, so services are held in the main lounge on a regular basis. This is a large home with discrete units, and the Activities Co-ordinator is to be commended for the work she has done to organise activities to motivate residents to join in so far. The dementia unit presents a special challenge, and one session was observed during which she and other staff sat with and moved around individuals to engage them in art work and reminiscence. One resident’s personal collection of pictures of the royal family was used to good effect to stimulate comments from her as well as the others. And as individuals wandered in and out of the group they were gently guided on their way. One agitated lady was constantly being reassured. The Activities Co-ordinator told us that as well as having obtained NVQ level 2 accreditation, she had also attended training given by the Alzheimer’s Society to meet the special needs of this client group. One recent emerging development was the introduction of a life story for each resident – a questionnaire to find out about their backgrounds, favourite colours, family etc so she can build up a picture to work with. She has also introduced clip art to act as cues for individuals, and is compiling daily activities records to chart the residents’ participation thereon. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 15 This is all judged very promising, but only as long as there is pointed crossreferencing between all relevant documents – e.g. daily reports, incident/accident reports, risk assessments, complaints, and her involvement in the setting of care plan objectives etc, so that care can be tracked and to ensure a fully rounded approach. Care planning should be able to address one relative’s stated concern that “it’s all too easy for those people who sit quietly to be overlooked”. Care planning should also be able to address one relative comment that the resident s/he visited would benefit by having access to a sports channel on television, and this was reported back to the manager for her attention. On-going training for staff in dementia care and person centred planning will be crucial to the success of this. Residents are able to have visitors at any reasonable time. The home is reasonably well placed for links with the local community (see also section on “Environment”). There is a communal payphone in a ground floor corridor, and telephone sockets in each bedroom - residents can have lines installed, at their own expense. Unless other arrangements have been made, residents receive their mail unopened. Catering needs are properly identified as part of the preadmission process and updated or amended thereon e.g. by the home’s own feedback exercises on specific dishes. Feedback indicates a generally sound level of satisfaction with the meals and the Commission’s own survey endorsed this. The home is committed to healthy eating and takes pride in its use of fresh non-genetically modified, additive free produce and its ability to offer a range of choices. A number of special needs are catered for (cultural and medical), and where food needs to be pureed, the components of each meals are generally presented separately so that people can enjoy their individual taste colours and smells. However, one relative expressed concern that the resident s/he visited would appreciate some aspects of their meals not being puréed and would also enjoy more seasonings (including salt). There are plate guards and some adapted cutlery. Staff are available to assist though one resident told us “Sometimes during meal times I need to go to the toilet and have to wait until staff are available to help me”. One resident told us, “The meals are delicious, well balanced and appetising. There is always a choice of dishes, main meal and pudding”. One resident said she missed the taste of garlic and French cuisine, but had assumed that others might not appreciate that. The inspector joined two residents for lunch on one site visit and another resident for lunch at the second. In each case the meal was judged well prepared and well presented. The residents confirmed this was representative, and that alternatives were readily available. The pace was unhurried and the setting was judged congenial. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 16, 17, 18 Residents are welcome to access to the home’s complaints procedure. Residents are protected from abuse and have their legal rights protected. EVIDENCE: This home has a complaints procedure, which clearly sets out the process and timeframes involved. The manager will, however, need to remove its reference to the CSCI as the lead agency, now that social services have assumed this role. Information supplied by the home’s AQAA and on the day of these site visits indicated that there had only been one complaint registered over the past twelve months, and none have been received by the Commission direct. This is not usually judged a realistic reflection of communal living, but for the generally sound level of confidence expressed by residents and relatives in their feedback in raising any concerns they might have, and their satisfaction with the care they receive. But one complaint from a resident about constant intrusions into her room by another could usefully have been pursued through this process, for example. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 17 No independent advocacy services are currently being used to support the residents, but information provided to residents as part of the admissions process does include some contact numbers. Residents would need to rely on relatives or staff to represent their interests, where they are not able to do this for themselves. The manager reports that the home has a range of policies on the protection of the residents, to ensure a timely and co-ordinated approach, should an incident arise. Feedback from staff confirmed their commitment to report any instances of adult abuse, should it apply. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 19, 20, 21, 22, 23, 24, 25, 26 Residents benefit by this well-maintained and comfortable environment. The physical design and layout of the home generally enable residents to live in safety. EVIDENCE: The entrance creates a very favourable first and last impression of this home. All areas of the home inspected were found to be comfortable, clean, adequately lit and maintained at comfortable temperatures. All radiators have guards or low surface temperatures, to keep people safe. The furniture tends to be domestic in style wherever possible. There were homely touches throughout. All the bedrooms, bathrooms and WCs seen had accessible call bells. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 19 There is pleasant landscaping of the site at the front and back (where a sensory garden is planned), and there is parking space along the boundaries of the site for up to 18 vehicles. There are good bus links within fifty yards of the entrance of the site to Ashford and Canterbury – with all the community and transport links that implies. The nearest train station is about a mile away, with links to London. Accommodation is arranged over two floors. A shaft lift provides access for both the ground and first floor, and there are also stairs. There is a generally good range of equipment and adaptation available in this home, as befits a nursing home. Residents would have access to their own wheelchairs, Zimmer frames and other mobility equipment. When asked, the manager said that a Loop system for use with hearing aids was not currently warranted. The building and site were purpose built about twelve years ago, but there have been no overall periodic audits by specialists such as Occupational Therapists since then, to ensure the home maintains its capacity to meet the needs of its residents. Residents currently have a good choice of communal areas. There are four lounge areas as well as two dining rooms. See section on Daily Life and Social Activities for details on telephones and contact with families and friends. The single bedrooms in this home are at least 10 sq. metres (the standard for new registrations is 12sq. metres) and their standard of finish is generally very high. Two bedrooms are registered for use as potential double room, and are at least 16 sq. metres (and currently compliant, therefore with the current National Minimum Standard). Five bedrooms were assessed, and found to be generally compliant with the elements of the National Minimum Standards. Notable exceptions appeared to be in respect of the provision of appropriate comfortable chairs. Although each room inspected had one reasonably comfortable domestic type chair, the National Minimum Standard is two, and concern has been expressed for the length of time residents spending in bed, for want of adequate chairs. It is accepted that the manager is in the process of introducing more suitable models. Two bedrooms did not have a table to sit at. The manager will need to ensure that the non-provision is justified in each case by properly documented consultation or risk assessment. All the rooms seen were clean but two others had signs of damage (in one case to a wall and in the other to the surface of a chest of drawers). . Although bedroom doors are not lockable (the intrusion of one resident has become a source of annoyance for another), they are being kept closed for fire safety reasons. Concern has, as a result, been expressed for the isolation of Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 20 residents effectively being closed away from the rest of the home’s community. The propping open of bedroom doors could be safeguarded by magnetic door closers linked to the fire alarm, which would slam close if the alarms are activated, to keep people safe. This home has accessible WC and bathroom or shower facilities on both floors i.e. reasonably accessible to all the bedrooms and communal areas. All bedrooms have their own en-suite facilities, so that privacy can be guaranteed for personal care. Two of the three washing machines in this home have sluice cycle – the third is reserved for woollens. Continence appears to be managed well at this home. There were no unpleasant odours, and visiting healthcare professionals indicated this was representative. All the maintenance records seen were up to date and systematically arranged, to facilitate access, and the home has its own systematic health and safety audits. Not surprisingly, the last Environmental Health inspection (on 31st January 2008) gave this home a 4star quality rating. Maintenance and housekeeping / domestic staff are to be commended. See schedule of recommended action for matters requiring attention or consideration. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 27, 28, 29, 30 Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of residents. EVIDENCE: This home’s staffing arrangements are reported to be based on dependency assessments, and are designed to ensure that (excluding the manager): • On the ground floor (frail elderly) there is always one trained nurse on duty (day and night) along with 5-6 carers during the day and one carer overnight • On the first floor (dementia unit) there are always two trained nurses (day and night) on duty, plus 7-8 carers during the day and two carers overnight In the absence of the manager there is reported to always be someone in charge, with an on-call system as a back up. Some feedback suggests staff are over stretched. One relative told us “there are staff shortages especially during the weekend. It would be nice if members of staff had more time to talk to residents in their rooms. Perhaps a little more supervision might have prevented some falls. Not possible if insufficient staff”. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 22 Some staff have told us that communication could be improved, but the quality of the rapport between staff and residents, and between care staff and nursing staff have been identified as key strengths by visiting professionals. There have been no concerns raised with the Commission about the home’s capacity to maintain these staffing levels, though feedback surveys indicated this was not always assured. An examination of three personnel records, selected to represent recruitment within the last 12 months, confirmed feedback from staff, that this home has a systematic recruitment process to comply with the key elements of the standard. Staff also confirmed that there is a generally sound level of investment in mandatory training (e.g. moving and handling, medication, food hygiene, First Aid and Health and Safety, COSHH and infection control), with more in prospect, to keep the residents safe. One member of staff said that the home’s reliance on electronic learning tools, should be balanced with more hands-on training (e.g. life support interventions) and clinical updates. Specialist training such as dementia care (e.g. person centred planning) was identified as an ongoing training need, as was nutrition (screening, use of supplements) so as to optimise this home’s capacity to meet the emerging needs of residents. The overall level of NVQ accreditation is currently reported to be over 75 of the workforce. It was not clear, however, whether staff were issued with copies of the General Social Care Council Code of Practice – which is designed to help ensure national practice standards, rights and responsibilities are properly understood. This is recommended. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. 31, 32, 33, 36, 37, 38 Residents benefit by the management and administration of the home, which is based on openness and respect. The home can demonstrate that it is implementing a range of quality assurance systems in place, which can demonstrate how residents and their representatives can influence the way services are delivered. EVIDENCE: Mrs Butler is a Registered Nurse, and has NVQ Level 4 in care and management as well having had training in dementia care and palliative care. She has been able to demonstrate that she has the necessary qualifications in care and care management that are required to be registered by the Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 24 Commission as the Registered Manager on 4th February 2008. Feedback indicates a growing confidence in her leadership skills. No matters were raised for required action at the last inspection, and the home has responded positively to all three recommendations raised on that occasion. There are clear lines of accountability within the home and within Barchester Healthcare. Investments in staff training, good quality care planning and rapport with residents appear to be key strengths in this home. There was good evidence of residents exercising choices and control over their own daily routines, as far as they were able. The home submitted an Annual Quality Assurance Assessment (AQAA) by its due date, and in good time for this site visit. This document was judged a comprehensive account of the issues raised, and reflected provision fairly. The Barchester Healthcare group has an exemplary range of quality assurance tools in place, which clearly place the views and interests of its stakeholders (residents and their relatives – familial and professional) at the centre of its business planning. The home does not manage any resident’s finances – everything is subject to invoicing arrangements. There were risk assessments in place in respect of each individual, their activities and the environment), to ensure their health and safety are being properly safeguarded. In terms of diversity, and the home’s capacity to meet needs, the home’s AQAA told us that 55 residents are white British, and 2 are of Italian origin. One is Jewish but not Orthodox, the rest are Christian. 40 are female and the rest are male. The staff group comprises 38 females and 9 males, and shows slightly more diversity: 12 are white British and the rest are Caribbean. There were no unresolved diversity issues identified by this inspection. Feedback indicates that staff giving direct care are receiving supervision (which has been delegated to senior staff) to comply the provisions of the National Minimum Standard. But the frequency of this is only becoming regularised under the direction of the new manager. Comments include “I have found with the new management this is happening more” and “Recently we changed to a new manager – hope the training and support will be better in future”. This standard was not further explored on this occasion. Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 3 3 3 2 2 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 4 X X X X 4 Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The home could usefully include in its admission procedure a checklist to certify the issue of a Statement of Purpose, Service User Guide and contract; and whether other languages, assistance or formats were warranted. The home’s Statement of purpose and Service Users Guide should be checked for full compliance with all the elements of the National Minimum Standard. The home’s contract should be checked for compliance with all the elements of the National Minimum Standard. One relative requested that the resident s/he visited be offered more than one bath a week. One resident’s privacy should be managed, in respect of another resident’s intrusions. DS0000069284.V359146.R01.S.doc Version 5.2 Page 27 2 OP1 3 4 5 OP2 OP8 OP10 Ashminster House 6 OP12 Residents’ activities should be subject to the same person centred planning processes as other aspects of their care, to ensure a holistic approach. One relative requested that the resident s/he visited be offered the opportunity of watching sports channels. Complaints procedure. This should be amended, now that social services has assumed lead responsibility for complaints. Residents’ bedrooms should be checked for compliance with the elements of the National Minimum Standards, and non provision should be justified by documented risk assessment or “opt out” consultation. Residents should not be confined to their beds, for want of available suitable chairs. Barchester Healthcare should give consideration to installing magnetic door closers, so that residents can have their bedroom doors left open, without compromising their fire safety. The following staff training needs have been identified: • dementia care • person centred planning • nutrition screening • hands-on life support interventions Each member of staff should be issued with a copy of the General Social Care council Code of Practice. The manager should ensure that all staff receive supervision to comply with the provisions of the National Minimum Standards, in terms if their content and frequency. 7 8 OP12 OP16 9 OP23 10 11 OP23 OP23 12 OP30 13 14 OP36 OP36 Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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 Ashminster House DS0000069284.V359146.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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