Care Home: Ashton Court

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What the care home does well The home is managed in the best interests of the people who live there. There is a stable staff team of experienced, mature carers who respect peoples choice to live a life of their choosing. There is a thorough assessment of peoples needs to ensure they can be met in the home before an admission is accepted. A good range of healthy meals are provided. People spoken to praised the staff team and comments in the returned surveys included; Mother eats well, far better than when at home. The meals are very good. I cannot praise staff too highly. The care my Mother gets is excellent. The staff are friendly and cheerful. What has improved since the last inspection? Following a complaint about the service the manager and staff team have received training relating to the protection of vulnerable people. A range of other training to promote good practices in the home has also been provided. The homes complaint process has been improved and all complaints are now forwarded to the area manager for the home. What the care home could do better: The home does not now employ an activities coordinator and many people critisised this area of care. One person commented that the shared mini bus is always at the other home and that residents never go out. Also one person commented that although he went to the pub with staff he hardly ever goes out. The environmental standards are not good. Although some redecoration of bedrooms has taken place and some new furniture purchased, the decoration is generally outdated and the home lacks good storage for wheelchairs, linen baskets and hoists. A redecoration and maintenance programme would improve the homes appeal. The water temperature at some baths and wash hand basins was too hot to ensure people are safe from harm. A manager from head office visits the home each month to review the care provided but a quality monitoring tool to identify areas for improvement is not used. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashton Court 376 West Road Newcastle Upon Tyne NE4 9RJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Allan Helmrich     Date: 0 4 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ashton Court 376 West Road Newcastle Upon Tyne NE4 9RJ 01912750638 F/P01912750638 noemail Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Solehawk Limited care home 37 Number of places (if applicable): Under 65 Over 65 37 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accomodated is: 37 The registered person may provide the following category of service only Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age not falling within any other category - Code OP, maximum number of places 37 Date of last inspection Brief description of the care home Ashton Court is a care home that provides personal care for 37 older people. The home is situated on the corner of the West Road and Two Ball Lonnen and is close to local amenities and public transport. There is an accessible garden and car parking space. Accommodation is over two floors and a passenger lift is provided. All bedrooms are currently single occupancy and there are larger rooms that can be used as doubles. The home has a large lounge that is divided into smaller areas and there is an adjoining dining room. Information about the home is readily available to prospective service users. The current weekly fee is £414. Care Homes for Older People Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 5 of 27 The Visit: The inspection was unannounced and was undertaken by the link inspector for the service over two days. The inspection started at 9:45am on 21st May 2009 and lasted 9hrs. During the visit we: Talked with people who use the service. Talked with the home manager and staff on duty. Looked at information about the people who use the service and how well their needs are met, Looked at case records for three residents and other records that must be kept, including medication. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to assess if it was clean, safe and comfortable. Checked what improvements had been made since the last visit. Also surveys were sent to residents, staff and visiting health care professionals. Responses were received from seventeen residents supported by relatives, five staff members and three health care professionals. Information from these sources is used in this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 7 of 27 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process reduces the possibility of admitting someone whose needs cannot be met and a good range of information is available to prospective residents. Evidence: Everyone is given the opportunity to spend time in the home prior to admission and a brochure or a more comprehensive guide to Ashton Court is available to anyone enquiring about the home. Brochures can be printed on the homes computer so large print is available to people who require it. Fifteen out of seventeen people confirmed in a survey that sufficient information was provided before they moved in. People spoken to during the inspection were happy with the arrangements made when they moved into the home. A range of information about the home and the service it provides is on display in the Care Homes for Older People Page 10 of 27 Evidence: home. Four care plans reviewed contained details of an assessment done by management before a place is offered. This assessment was done before admission to the home and included information provided by care managers. This ensures the home can provide the level of care needed by the resident. Following admission a range of assessments are used to measure wellbeing. Senior care staff ensure that any problems are identified and that the home has appropriate equipment to meet the residents needs. Shortly after admission each resident is given information by senior staff about their care plans and to ensure their care needs are being met. The resident then has the opportunity to sign the care records. The care records are clear and easy to read. Staff spoken to used the care records to provide appropriate care. The home does not accept referrals requiring rehabilitation but vacant rooms are used to provide respite care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team support people to maintain their health needs and to consult medical professionals when necessary. The homes system for administration of medicines ensures people in the home are safe. Evidence: The care plans reviewed all contained a social assessment and a plan for daily living. Care plans describing to staff how care is to be provided are written and risks in daily living are assessed. Risk assessments are written with how these can be reduced. Each residents health is assessed. Residents, weights are regularly recorded and sit on scales are available to better weigh less mobile people. Care plans are generally reviewed monthly to ensure the care provided meets the individuals needs. Systems are in place to meet the needs of any resident with a pressure sore and residents at risk are provided with the equipment to support them. The assessment of care plans is done regularly by staff to ensure peoples needs are met. Care Homes for Older People Page 12 of 27 Evidence: People spoken to were content with the support they get from staff and sixteen people surveyed stated they always get the support they need with one person recording they usually receive this support. Professional people surveyed provided many positive comments that included; Very good at meeting the health care needs of people. Very good at raising concerns. Very good at meeting the health care needs of people. The system for the administration of medicines was checked and found to be good. Staff who dispense medicines are trained and records are maintained for ordering, receiving, administering and disposal. Medicines are stored safely. Staff were seen to treat people respectfully and deal with any personal issues with dignity. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live a lifestyle of their choice and they are provided with wholesome nutritious meals, but the homes activities schedule could be developed more to meet peoples individual choices. Evidence: The home provides support for people to be as independent as they are able. Each persons preferences regarding activities are recorded in their care records and a record is maintained of activities but not who is involved to identify those people who are not included. The range of activities recorded as having been provided included; foot spas and massage, nail painting and pamper sessions, cooking away from the kitchen, bingo, dominoes, board games, sing alongs, chair exercises and reminiscence. When asked in a survey if the home provides suitable activities, one person recorded never four people sometimes, five usually and six always. One person commented, there should be a bus to take them out but it is always at the other home, they never go out. People spoken to during the inspection also had differing comments. One person said they hardly ever get out although they had been to the pub with staff. Another person said that although the home has access to a mini bus they dont get out that much. Others confirmed the home does provide activities and others said that Care Homes for Older People Page 14 of 27 Evidence: they are not interested. Three people spoken to during lunch were happy with everything except the activities provided. The manager stated the home has access to the mini bus one day each week and seven people can be transported or four people and two in wheelchairs. Religious needs are met. Church visitors provide communion each week, a Church of England Representative visits the home each month, one person has a visitor who talks about The Koran and one person is supported by family to attend Salvation Army meetings. Menus seen showed that wholesome meals are provided. During a tour of the premises the kitchen was inspected. A range of fresh vegetables, salads and fruit were available. The cook is aware of good food practices to ensure residents are well nourished and meets regularly with people in the home to ensure they get the meals of their choice. The kitchen has recently been awarded five stars for excellent standards by the local authority environmental health department. A new system has recently been introduced at mealtimes where more needy people are assisted first then meals are provided for other people in the home. This ensures everyone gets the level of support and encouragement they need. The inspector had lunch with residents. The lunchtime meal was hot and tasty. Appropriate numbers of staff were around to ensure that any residents who needed it were supported. Tables were set with tablecloths and centre decorations. Residents spoken to said that they had enjoyed their meals. One person chooses to eat meals in their room. Appropriate covers for transporting these meals in the home were seen in the kitchen. One person who chose to rise late in the morning was seen to be offered several choices for breakfast. This demonstrated good flexibility and choice for people. Most residents have good family support. People spoken to stated their visitors are made welcome and they can see them in private if they choose. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Following a review of the complaints process, people can feel confident their concerns will be addressed by the company and a trained staff team. Evidence: This inspection follows a complaint made to the manager that the complainant felt was not handled appropriately. The complaint was escalated and company management conducted an investigation. The complaint was upheld and new procedures were introduced into the home. All but one of the people surveyed stated they were aware of how to complain and one person commented, I have never had a reason to complain. The home has a complaints procedure given to people in a service user guide when they first enter the home and a copy is displayed for visitors. As a result of the complaint the manager has recently completed a two day safeguarding training course and two senior staff are completing a safeguarding risk management course. Also between May and August 2009 all staff will undertake refresher training. Staff spoken to demonstrated their awareness of issues related to protecting Care Homes for Older People Page 16 of 27 Evidence: vulnerable people and residents spoken to stated they feel safe in the home. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is fresh and clean but the maintenance systems are poor and residents may not be safe due to the water temperature to baths and wash hand basins. Evidence: Ashton Court is near some shops and on a main bus route into the city centre. There is a large car park at the rear with ramped access into the home. Generally the home is clean and no odours were detected during a tour of the building. Maintenance of the building is not good and some decoration is needed to improve the environment for people who live there. The ceiling in a bathroom needed painting, an air extractor was not working and a towel holder could not be used as the lock was broken. There is limited storage space for wheelchairs, lifting equipment and laundry baskets. These were stored in various areas including bathrooms. The water temperature to some baths and hand basin was excessively hot and could cause harm to people who live there. An immediate requirement was made to make the water system safe. The proprietor visited the home with a maintenance operative Care Homes for Older People Page 18 of 27 Evidence: and immediate steps were taken to limit the dangers to people in the home. The laundry was well organised and contained appropriate washing equipment to meet disinfection standards. Of the people surveyed, twelve stated the home is always fresh and clean and five stated this is usually the case. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Trained staff are employed in sufficient numbers to meet peoples needs. The home operates a thorough recruitment process to ensure people are safe. Evidence: The staffing levels are unchanged from the last inspection. There are four carers including a senior, 8.00 am - 2.00 pm; three carers including a senior, 2.00 pm 10.00 pm; one senior and one carer, 10.00 pm - 8.00 am. This level of staffing can meet the needs of the current residents. In addition the home employs sufficient catering, domestic and laundry staff but the activities are not now directed by a specific person and this change has reduced the service provided (see comments in outcome 3 daily life and social activities). The manager is supernumerary but does assist in care tasks to ensure the smooth running of the home and to be available to people in the home on a regular basis. The home uses an induction, foundation and training record that meets the SKILLS requirements. This ensures that before staff work unsupervised they have been assessed as able. Care Homes for Older People Page 20 of 27 Evidence: Staff are well trained. 75 of care staff have achieved NVQ level 2 in care or above. The manager maintains a list of all training undertaken by staff. This is regularly reviewed and any training requirements are obtained. This is a good basis for providing appropriate care for residents in the home. The personnel records for the two members of staff were inspected. The files contained applications forms, appropriate references, evidence of checks made by the Criminal Records Bureau and information required to confirm the identity of the person employed. A list of the information provided to staff is retained in the individual files. Many of the staff team have worked in the home for several years and throughout the inspection residents praised the quality of care provided. Staff spoken to stated that a good range of appropriate training is provided, that clear direction is provided by management and that good support is available from other staff. This helps them provide a good service to the residents. People confirmed in the returned surveys that the staff team provide the support they need and listen and act on what they say. Individual comments included; I cannot praise the staff too highly, they are always cheerful and helpful. The staff know everyone and their needs. The staff are friendly and cheerful. The care my mother receives is excellent. One person commented the care staff are good hard workers but there are not enough staff. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run for the benefit of the people who live there but a better quality monitoring system would identify areas for improvement to benefit all. Evidence: The Registered Manager has been in charge of this home for several years. She is a Registered General Nurse and has the Registered Managers Award to demonstrate her awareness of caring for older people. In addition to recent safeguarding training to promote better support for vulnerable people she has also enrolled for training in personal safety at work. Residents spoken to during the inspection stated that the manager is always available to discuss matters relating to the running of the home. Surveys returned contained praise for the manager and the standard of care provided. A quality monitoring system is not in place to ensure care practices are continually Care Homes for Older People Page 22 of 27 Evidence: improved for residents. A requirement related to this was made at the last inspection to promote better standards in the home. A Representative of the company visits the home each month to review care practices. Questionnaires are periodically sent out to relatives and these are analysed and any issues are attended to. The last surveys were reviewed in January. Two staff spoken to stated that the home is well run and that they feel supported in their work. Meetings are held regularly with the workforce and a record is kept of those in attendance and the issues discussed. The minutes of the last meeting could not be found but staff confirmed it was held. Many residents control their own monies. A system is in place to hold monies should residents require this service. Transactions are recorded and evidenced by two signatures, receipts are obtained and management audits the accounts. Systems are in place to ensure the home is safe for residents. Certificates were seen to demonstrate maintenance tasks carried out by external contractors were done. The homes electrical wiring has been checked and is safe. Portable electrical appliances are checked for safety and the gas system was recently serviced. Accidents in the home are recorded and analysed on a monthly basis to ensure problems for residents are identified. A fire risk assessment has been produced and regular fire checks are recorded and staff training provided to ensure residents are safe. Each member of staff is provided with health and safety training. Infection control systems and systems to ensure a good standard of hygiene is maintained are in place. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 19 12 The manager must ensure that people are safe in the home until the water temperature can be made safe. Water to baths and wash hand basins should be maintained at a safe comfortable level of 43 degrees centigrade so that people can wash and bath in safety and comfort. 21/07/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 12 The system of heating water 31/07/2009 in the home must be reviewed and a new system capable of delivering water at the safe comfortable level of 43 degrees centigrade should be installed. Residents should be able to wash and bathe safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Older People Page 25 of 27 No. Refer to Standard Good Practice Recommendations 1 1 The manager should ensure that shortly after admission people are asked if they have sufficient information about the home. Any shortfalls can then be remedied. A record should be kept of activities together with those people involved and their level of enjoyment. This can then be used to produce activities schedules that meet peoples expectations. Ensure all staff receive the safeguarding training being provided between May and August 2009. The proprietor should produce a long and short term programme of refurbishment for the home with target dates for completion. This programme should identify how storage is to be improved, which areas are to be redecorated and how the home is to be modernised to meet current expectations. A quality review system should be introduced to measure the standards of care in the home. Any issues identified should be developed in a plan of improvement. This plan should be costed and include timescales for achievement. 2 12 3 4 18 19 5 33 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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