Care Home: Ashton House

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What the care home does well Ashton House is a well managed home, which provides a safe and pleasant environment for people. It is also very welcoming to its visitors. The designated dementia care unit provides spacious and secure accommodation for the ten residents accommodated there, with allocated staff to provide their care each day. Prospective residents are admitted to the home on the basis of a thorough preadmission assessment, which incorporates a good amount of detail about the person and their needs. On admission to the home residents are fully assessed again, with a full range of appropriate risk assessments carried out, in order to meet people`s health and personal needs safely and in accordance with their wishes. Residents` levels of independence are respected. The home ensures that residents have access to a full range of health services, and works collaboratively with other health care professionals to promote their health and care interests. In the main, residents told us they were happy with their care and the kind way in which they were looked after by the staff, and residents` visitors also echoed this. However, one resident raised one slight concern in this area, and this was referred to the manager to address. There were some good social opportunities here for residents, with a variety of activities to suit different tastes; however not all liked the programme, and chose not to participate. A choice of menu is offered, and residents generally spoke favourably of the food they had. However there were a minority of variations to this, with just a few saying it could be inconsistent. Staff have received training in safeguarding the interests and welfare of vulnerable people, and were knowledgeable about the issues and the home`s polices and procedures in this area. Staff had been recruited in accordance with the required pre-employment safety checks, and had access to some good training opportunities. Good progress was being made with the National Vocational Qualification (NVQ) training programme for care workers. There is a good focus on monitoring standards in the home. What has improved since the last inspection? The home has introduced some good care planning documentation, and staff have done very well to implement it; however there are still some isolated recording gaps that staff should improve upon. The management of residents` medications was better, with statutory requirements addressed. However, there continue to be some recording gaps that need closer attention in order to ensure greater consistency. New curtains had been fitted to the ground floor lounge, and a new carpet had been fitted on the ground floor corridors since the last visit. The passenger lift had been refurbished. What the care home could do better: There was an isolated breach of a resident`s dignity, which the manager resolved to address with the member of staff responsible. Ashton House provides care to a large number of very frail residents who have high dependency needs. Some of these residents were left unattended for extended periods, and this had the potential to limit their opportunities to express themselves and exercise choice. There were isolated areas of the home that needed better attention in terms of maintenance and hygiene. Despite efforts to resolve it, there continues to be some instability within the staff team, and agency staff are regularly employed. There are isolated anomalies in the standard of induction training for new workers, with at least one worker not receiving it in accordance with the common induction standards, despite this being available. Although staff feel well supported here and have opportunities to meet with their manager, the number and recording of formal staff supervision sessions does not quite meet the national minimum standard. CARE HOMES FOR OLDER PEOPLE Ashton House Union Street Stow-on-the-wold Glos GL54 1BX Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 08:30 4 August 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 Ashton House DS0000064572.V365174.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. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashton House Address Union Street Stow-on-the-wold Glos GL54 1BX 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) 01451 830843 01451 831796 manager.ashton@osjctglos.co.uk The Orders of St John Care Trust Mrs Maggie Keyte Care Home 45 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (35) of places Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user under 65 years to be accommodated for respite care. This condition will be removed when the service user reaches 65 years of age or no longer wishes to receive respite at the home. One named service user under 65 years to be accommodated for respite care (DE). This condition will be removed when the service user reaches 65 years of age or no longer wishes to receive respite at the home. 24th April 2007 2. Date of last inspection Brief Description of the Service: Ashton House is a purpose built well-appointed Care Home, situated within easy reach of the town centre of Stow-on-the-Wold. The home offers personal care to older people; it is managed by The Orders of St John Care Trust. Ashton House has 42 single rooms and a double room, which is currently accommodating one resident, and has communal accommodation on both floors. A shaft lift has been installed for easy access to the upper floor; the home is also well equipped with a variety of disability aids. Part of the ground floor has been converted to provide secure accommodation for ten older people who have dementia. The residents have secure access to the extensive attractive private gardens that surround the property. The provider supplies information about the home, including the most recent CSCI report in a file at the entrance of Ashton House. Current fees range from £577 to £652, and the home also provides care at the Local Authority rate of funding. Hairdressing, chiropody and any personal items are charged as extra. Ashton House DS0000064572.V365174.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 star. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this inspection on one full day in August 2008. Checks were made against the statutory requirements issued at the last key inspection, in order to assess the home’s compliance. Care records were inspected, with the care of five residents being closely looked at in particular. The management of residents’ medications was also inspected. A number of residents and relatives were spoken to directly in order to gauge their views and experiences of the services and care provided at Ashton House. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. Some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, supervision, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. We required an Annual Quality Assurance Assessment (AQAA) from the home, which was provided, the contents of which informed part of this inspection. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 6 What the service does well: Ashton House is a well managed home, which provides a safe and pleasant environment for people. It is also very welcoming to its visitors. The designated dementia care unit provides spacious and secure accommodation for the ten residents accommodated there, with allocated staff to provide their care each day. Prospective residents are admitted to the home on the basis of a thorough preadmission assessment, which incorporates a good amount of detail about the person and their needs. On admission to the home residents are fully assessed again, with a full range of appropriate risk assessments carried out, in order to meet people’s health and personal needs safely and in accordance with their wishes. Residents’ levels of independence are respected. The home ensures that residents have access to a full range of health services, and works collaboratively with other health care professionals to promote their health and care interests. In the main, residents told us they were happy with their care and the kind way in which they were looked after by the staff, and residents’ visitors also echoed this. However, one resident raised one slight concern in this area, and this was referred to the manager to address. There were some good social opportunities here for residents, with a variety of activities to suit different tastes; however not all liked the programme, and chose not to participate. A choice of menu is offered, and residents generally spoke favourably of the food they had. However there were a minority of variations to this, with just a few saying it could be inconsistent. Staff have received training in safeguarding the interests and welfare of vulnerable people, and were knowledgeable about the issues and the home’s polices and procedures in this area. Staff had been recruited in accordance with the required pre-employment safety checks, and had access to some good training opportunities. Good progress was being made with the National Vocational Qualification (NVQ) training programme for care workers. There is a good focus on monitoring standards in the home. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There was an isolated breach of a resident’s dignity, which the manager resolved to address with the member of staff responsible. Ashton House provides care to a large number of very frail residents who have high dependency needs. Some of these residents were left unattended for extended periods, and this had the potential to limit their opportunities to express themselves and exercise choice. There were isolated areas of the home that needed better attention in terms of maintenance and hygiene. Despite efforts to resolve it, there continues to be some instability within the staff team, and agency staff are regularly employed. There are isolated anomalies in the standard of induction training for new workers, with at least one worker not receiving it in accordance with the common induction standards, despite this being available. Although staff feel well supported here and have opportunities to meet with their manager, the number and recording of formal staff supervision sessions does not quite meet the national minimum standard. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 8 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. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. EVIDENCE: The home’s AQAA stated that someone from the home visited all prospective residents in order to undertake a pre-admission assessment before admission could be agreed. It also stated that other people involved in the care of an individual were consulted as part of this process, such as family members and health care professionals. We inspected two examples of pre-admission assessments, both of which were for residents more recently admitted to the home. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 11 Each had been conducted prior to admission being agreed, and had been recorded on the home’s designated tool for the purpose. The assessments were comprehensive, and took account of the person’s health and care needs, their past medical history, their ethnicity, socialisation and cultural needs, their understanding, legal status and medications and treatments. The manager told us that staff had developed a good understanding of many of the residents’ needs through the respite care programme that many had used prior to moving into the home fully. Ashton House does not provide intermediate care. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although there remain isolated areas where care management could improve, people living in this home can generally expect to have their health and care needs met in a way that is mindful of their privacy and dignity. EVIDENCE: The home had recently introduced new assessment and care plan documentation. Staff had done well to implement it so far, although isolated areas remained where improvements could be made, and a training exercise was being undertaken in this area for relevant staff. Residents had their own care plan that had been drafted on the basis of an assessment of all their health and personal needs. Recorded risk assessments in each case included pressure sore vulnerability, falls, nutrition and moving and handling. Each had been regularly reviewed. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 13 Assessments had also taken account of individuals’ past life and their social interests. In one case a plan of care had been drafted on the basis of a pressure sore risk. The plan demonstrated the support that was in place, but made no direct reference to action needed by staff to relieve or treat any vulnerable pressure areas. In the same case the daily records showed that some oral hygiene had been necessary, but there was no recorded plan of care to direct staff in this. In another case a care plan to promote a secure environment included a degree of reference to the person’s dementia in terms of familiarisation to surroundings, but little else regarding how best to manage their particular mental health needs. On meeting this person however, it was clear that they were very settled and contented, with staff meeting their needs very well. In a third case the care plan to manage someone’s diabetes instructed staff to monitor blood sugars each week. There was no record of this, and it transpired this was because the doctor had advised it was no longer necessary; in this case the care plan should have been reviewed more thoroughly so as to reflect the change in circumstances. There was some good care planning and recording associated with wound and pain management, and dealing with some challenging behaviour, and each person had been medically reviewed on a regular basis, with a range of health care interventions provided when needed. There were a large number who required a lot of help and support from the staff, with a high level of dependency indicated. Residents spoken to directly confirmed they were generally satisfied with the care they were receiving. One person mentioned in conversation that ‘some staff don’t care as much as some of the others’. The manager resolved to discuss this further with the resident concerned. Resident comments on surveys included ‘there is always someone around to help’, and ‘the staff are good and so nice’. Relatives’ comments included ‘I am impressed with the support. They are caring and attentive staff. The people I see are always well cared for’. Another wrote ‘There are gentle and kind staff who know the residents well’, and others included reference to staff ‘showing they care’, and providing ‘individualised care’. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 14 People working in the dementia care unit seemed very aware of individuals’ needs, and adopted an appropriately sensitive and respectful approach with them. Residents were able to manage their own medications at Ashton House, although there were none who were currently able or choosing to do so. Assessments took account of individuals’ wishes in relation to this aspect of their healthcare. Medications were safely stored, and medication administration charts were clearly printed by the supplying pharmacist. Two members of staff had signed any additional handwritten entries, and any boxed and bottled items had been dated when opened to identify date expiry, and for auditing purposes. Discontinued items were generally identified on charts, although there was at least one gap with this, where the discontinuation date and who had ordered it was not made sufficiently clear on the record. In some cases where medication had been prescribed for use ‘as directed’ care plans had been drafted to provide direction for staff in their usage, as had been previously required of the home by the CSCI pharmacist. However, there were still some inconsistencies with this, such as with an external cream and an aperient prescribed ‘as necessary’ for one particular person, with no directions in the plan of care. There was clear intention on the home’s part to achieve greater consistency with this. Records of administration had been introduced into residents’ rooms for when external creams needed to be applied by care staff, although in one case they appeared unclear about the current use of one person’s cream, which had reportedly been discontinued. The directions for the use of a resident’s anticoagulant therapy could have potentially been confusing, with a range of dosages being on the medication administration chart, and with staff directed to refer to another record for the current dose. This needed to be made much clearer on the medication administration chart. The manager and senior staff took the identified remaining gaps in otherwise good medication practice very seriously and resolved to address them straight away. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 15 An audit was carried out on a boxed medication and a discrepancy was found. This had arisen through a reduced dosage being given temporarily, due to an undetected change on the prescription; this had been rectified. The arrangements for controlled drugs were safe and well managed. Care staff responsible for managing medications had received accredited medication training through a local college. Staff had received instruction in the core values of respect for residents’ privacy and dignity, and care planning also directed staff towards this, and towards residents’ levels of independence. Staff seemed very busy, particularly during the morning, and were providing care in the privacy of residents’ own rooms. Most were mindful of people’s dignity and were respectful when addressing them. However one instance was witnessed when a member of staff took a resident to the bathroom on a wheeled commode in nightclothes, and with nothing to cover her or protect her dignity. This quite clearly went against the expectations of the home, and the manager and senior care leader resolved to address it with the member of staff concerned. Some residents chose and were able to lock their door, and some had their own telephones in their room. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 16 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most people living in this home have opportunities to exercise choice and maintain social contact, however the ability to express choice could be compromised for a few. A nutritious diet is available, which in the main offers choice and variety. EVIDENCE: The home had a designated social activities coordinator. Residents’ past lives, interests and hobbies had been assessed, and residents had been consulted regarding their views and ideas for activity. A programme of events was displayed, and this showed a variety of organised group activity for people to suit diverse tastes and abilities; something was on offer twice each day. Some residents preferred to spend their time alone, pursuing their own particular interest of listening to the radio or reading their newspaper, and the staff respected this. One resident said that she did not like the programme that was on offer. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 17 One relative commented on survey that the home ‘could do with providing more activities’. The home’s AQAA stated that the activity programme had been extended, and that the number of entertainers visiting the home had increased. Some of the residents had been taken out to visit a local school. Visitors were seen coming into the home and were made welcome by staff. The home imposed no restrictions on them. One relative wrote on a survey that ‘I am always kept well informed by the home’. Another spoken to in person said that they ‘always felt most welcome here’, and that ‘he had anything he wanted’. We saw residents spending time how they chose, although many were frail and were more reliant on staff to assist them in this regard. There were extended periods when these residents were left unattended, and consequently it was our view that their ability to make choices could be compromised when staff were not around. Residents in the dementia care unit were free to move around as they chose in safety, with staff respectful of what they wanted to do. Some of the residents themselves confirmed to us that the staff were respectful of their personal choices when they expressed them, and could do as they liked. Staff were heard offering choice to people in a variety of ways. One resident expressed some concern about his choice not being observed over being in the home at all. Residents’ rooms were very personalised for some, with all able to introduce personal items if they chose. Residents were offered a choice with their meals, and were consulted each day about their choices for breakfast, lunch and supper. On the day of this visit the cook was absent with a replacement cook not found. Two care staff had undertaken the catering duties very successfully, and although had not adhered to the menu, had managed to produce a very appetising and wholesome looking meal. The dining room was nicely laid, and staff assisted residents where necessary. However the service of the meal was slightly staggered, with staff going in and out of the kitchen to pick up one plate at a time and deliver it to the resident; this was also slightly disruptive as the kitchen door was constantly, and very obviously, opening and closing in the dining room. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 18 The manager told us that she was already considering ways to overcome this problem. Residents generally spoke positively about the quality and quantity of food, although three indicated that in their view the quality was not always consistent. One resident said that the food ‘could be a bit monotonous’, whilst another said they ‘would like to see more interesting vegetables’. A visitor to the home also felt that the home should vary the meals a bit more. The manager told us that it was her intention to include questions on food in a forthcoming survey for residents to say exactly what they would like to be different. Despite the difficult circumstances on this day, the kitchen appeared well organised and was clean. Catering and cleaning records were in place and food storage was satisfactory. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home are able to express their concerns, and can be reassured regarding the policies and procedures to address complaints and the protection of their rights and prevention of abuse. EVIDENCE: The home had a clearly written and accessible procedure for addressing any concerns and complaints; a copy was issued to all residents and their families. The home had a good system for addressing and managing any concerns or complaints that might arise, but had received none recently. Residents and their relatives confirmed that they knew how to raise complaints if they had any. The home had documented policies and procedures to address forms of abuse and whistle blowing procedures, which were readily available for staff to read. The AQAA stated that the ‘No Secrets’ document published by the Department of Health was made available to staff, and that further training was needed to enhance staff awareness in relation to managing challenging behaviours. Staff had received training in safeguarding vulnerable adults, and those who were interviewed were able to talk knowledgeably about what might constitute Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 20 abusive practice, how they might recognise it, and about the actions they would not hesitate to take if they identified any concerns. However, two of them were slightly vague in their knowledge regarding the existence of the designated adult protection unit within the local authority. The home had provided all staff with an easy-read version of the Mental Capacity Act 2005 (MCA). Staff have not received training in this yet, and given that this piece of legislation is now in force, affecting some of the decisions taken in relation to residents’ care, should receive it as soon as possible. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite some areas for attention, people living in this home are provided with comfortable and generally pleasant accommodation, which is suitable and safe to meet their needs. EVIDENCE: The home had a maintenance person, and records of cyclical maintenance carried out had been kept. Although there were areas where a degree of maintenance was needed, such as damaged plasterwork on upstairs walls where a seating area for residents had been provided, the home was generally adequately maintained. The home had a gardener, but this person had been on leave at the time of this visit, and the garden was very overgrown with weeds. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 22 The AQAA stated that residents’ access to the garden had been improved with a sensory garden planted, and new curtains had been fitted to the ground floor lounge. A new carpet had been fitted on the ground floor corridors since the last visit. The passenger lift had been refurbished. Doors were clearly marked in the dementia care unit, and the layout allowed the residents there to wander freely and in safety. Two cleaners were on duty, and were cleaning areas throughout the home. This was done to a satisfactory standard, although unpleasant odours were detected in certain areas from late morning onwards. Clinical waste was correctly managed, and sluice rooms were clearly well used, and although functional, were slightly untidy and unclean in places. There were good supplies of liquid soaps, paper towels, gloves and aprons for staff to use as part of the prevention of cross infection. The laundry room was well organised, with items appropriately segregated and washed in accordance with infection control measures. The laundry assistant had been well trained, and evidently took pride in her work. One visitor commented that their relative’s room was ‘always kept very clean’. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite instability within the staff group and the ongoing use of agency staff here, people living in this home generally receive care from a competent work force, who undergo full pre-employment checks, and who are supported to train and develop professionally. EVIDENCE: Since the last inspection Ashton House had made changes to its registration status, and no longer provided nursing care. Adaptations to the staff structure had been made, which now reflected this. The staff care team is made up of care workers, with senior care leaders as shift leaders. The home’s AQAA identified that ten staff had left the home in the past year. This had given rise to instability within the team, with the result that agency staff had to be employed. Although attempts were being made to recruit and stabilise the team there continued to be significant agency usage, with at least three of the team being from an agency during the morning of this visit. The staff were divided between the two areas of the home, with two working specifically with the ten residents in the dementia care unit. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 24 An ancillary team of administration, maintenance, cleaning, catering and laundry staff supported the care team. Despite this there were occasions on the rota when care staff had to be involved in non-care duties, such as doing laundry at weekends, and catering on some evenings. The cook was off sick on the day of this visit, and the home had been unable to replace her at short notice. This had meant that two care workers had to cook the lunch. This had undoubtedly contributed to the home appearing very busy on this day, but staff had generally coped very well. Two members of staff commented on survey about the very high dependency needs of some of the residents requiring a lot of input from the staff, which in their view was more than the home could give. One member of staff observed during conversation that the home looked after a lot of high dependency residents and that staff tended to have to rush on occasions. Staff were clearly very busy throughout this visit, and there were evidently a lot of people with very high dependency needs. There were significant periods when residents were left sitting unattended, with staff not always readily accessible. One resident commented on survey that ‘more staff would help’, and this was echoed by at least two visitors. One visitor expressed some concern about the amount of agency staff the home had to use, and about how these seemed less aware of residents’ needs. A resident spoken to directly said that ‘staff were always very busy and rushing around’. The home was making good progress with the National Vocational Qualification (NVQ) training programme for care staff. Twelve carers were qualified to level 2, with another two having achieved the higher award at level 3. A further five staff were currently on a level 3 NVQ course. We inspected two staff files of recently recruited carers. In each instance, the prospective employee had completed an application form providing details of their employment history, with evidence that any gaps in it had been explained. Interview notes were recorded. Two written references had been provided in each case, with at least one of each of these having been obtained from the previous employer. Proof of identity and medical statements had been obtained. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 25 Each file contained an employment contract, a job description, a copy of the gifts and gratuities policy that had been signed by the worker, and evidence of equal opportunities and sickness monitoring. Staff confirmed that they had some good training opportunities, with one saying that ‘the training coordinator does their best to get staff onto relevant courses’. One new worker said that she had felt well supported when she started at the home, and had worked under supervision. This person had received in-house and Trust induction when she started many months ago. However, she had not had training that was in line with the Common Induction Standards for care workers, as she had not commenced the electronic learning package available that would have ensured this happened. A second new worker who started more recently had started this training. Training records were computerised, and these showed the range of training courses undertaken by each member of staff. This had included mandatory topics, mostly related to health and safety issues, and also other optional topics that were relevant to people’s roles within the home. Staff had done training in dementia care, although the AQAA stated that there were still a few to do this. The home was developing a dementia link worker who would attend meetings and other development opportunities outside the home, and who would cascade best practice information back to other staff. All had received training in infection control. The home had three designated moving and handling trainers who shared responsibility for updating this particular training for the staff on an ongoing basis. One senior care leader had completed a course in supervisory management, and a second was currently on a course. The manager and deputy had attended a Dignity in Care conference. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 26 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, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management systems in place here ensure that the interests, and health and safety of the residents living in the home are safeguarded. EVIDENCE: The manager is an experienced care home manager. She is a registered nurse, has achieved the Registered Manager’s Award, and is registered with CSCI for her position. The manager was present throughout the day of this visit, and had strong administration support. The majority of systems seemed to be organised and well managed. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 27 One visitor said that ‘the home was very well run’. The home’s AQAA was completed to a good standard. The Trust within which the home operates has a ‘County Focus and Operating Framework’, which demonstrates a range of specific objectives for The Trust and leadership roles for personnel within it, including the manager of Ashton House. Residents and their families had recently been surveyed as part of a quality monitoring exercise. Resident meetings had not produced the best in terms of responses, and the manager was considering other ways to encourage residents to have a say in how their home was run. Residents and a representative of their choice, usually family, had received a full review of their care and experiences in the home as part of an ongoing six monthly quality review. The home had had an external audit, and had received the ISO quality award. The manager viewed the CSCI inspection as a valuable contribution to quality monitoring in the home as well. A number of residents had chosen to place personal money with the home for safekeeping. The systems for managing and safeguarding these arrangements were immaculate and completely transparent, with good clear records maintained. Staff said that they felt well supported in the home, and had regular access to the manager for support and supervision. However, the recommended level for formal supervision of at least six times in a year was not being achieved, with supervision tending to be more on an ad-hoc basis with no recording to support it. The manager acknowledged that this was an area in which she needed to concentrate. The home had written policies and procedures in relation to the promotion of the health and safety of the residents, visitors and staff, and associated training was provided for staff. Records showed that regular safety checks and planned maintenance visits had been carried out on the fire safety systems. Fire drills for staff had only been carried out twice in recent months, and had not encompassed all staff. However, staff had recently been trained in the latest fire safety procedures, including evacuation of residents, and with that completed, a new phase of more regular fire drills was planned. Individual fire safety risk assessments were carried out and recorded in each resident’s plan of care. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 28 Hot water temperatures were regularly checked for safe levels, and regular Legionella checks on the water supply had also been carried out, with the appropriate control measures in place, including for the cold-water storage. The necessary safety checks and maintenance of utilities and equipment had been undertaken, and the associated records were kept in these areas. There was no evidence that the electrical installation had been checked for safety in recent years, and the administrator was informing the trust’s property and maintenance manager about this. The portable electrical appliances had been safety checked earlier this year, but the home had not received certificated evidence of this to date. Accident records were checked and were up to date with notifications that had been sent to CSCI. The home was secure, with coded door entries in appropriate places. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 29 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 30 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 OP9 Good Practice Recommendations The home should review all prescribed medications to ensure that corresponding care plans can be drafted more consistently for all of those items prescribed to be used ‘as directed’ or ‘as necessary’. The manager should review the way in which staff are deployed in order that their presence and availability is improved around residents. • • 4 OP26 The damage to the plasterwork in the area where residents sit on the first floor should be repaired The garden, to which residents have access, should be cleared of the excessive weeds. 2 OP14 3 OP19 There should be a more robust system for addressing the transient and unpleasant odours that arise. Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 31 5 OP30 All new carers recruited to the home should undergo induction training that complies with the Common Induction Standards for care workers within six weeks of their appointment. The manager should ensure that care workers receive formally recorded supervision at least six times in a twelve-month period. 6 OP36 Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Ashton House DS0000064572.V365174.R01.S.doc Version 5.2 Page 33 - 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. 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