Care Home: Ashton Manor

What the care home does well We spoke to all of the staff who was on duty at the home on the day of our visit and they told us that there had been a significant improvement since the new manager had started work. Staff told us that the atmosphere in the home was better and one staff member told us "I used to dread coming into work but now I look forward to going in each day." We sampled the care records of three residents. We found evidence that an individual care plan was in place for each resident. The manager was able to demonstrate they were in the process of reviewing each care plan to ensure the needs and wishes of each resident are clearly recorded and that staff have clear guidelines to follow to ensure residents needs have been met. The manager informed us that they had completed the review of care plans for two of the ten residents currently accommodated. We found evidence that visits made by district nurses and by GPs together with the purpose and outcome of the visit had been recorded. There was also evidence that risk assessmenttools were place. We spoke to three care staff who were on duty. They were able to demonstrate they were familiar with the needs of identified residents and the actions they should take to ensure they have been met. We observed medication being administered over the lunch time period. We were informed that a senior member of staff, who has received training, is responsible for this task. We noted that this person is identified with a white bib which also advised they should not be disturbed. We were shown the facilities provided for the storage of medication. This included a medication trolley, a separate cupboard for controlled drugs and a small refrigerator for medication that required storage in this way. They were located in manner which ensured medication is stored securely. We looked at the staff rota and this showed that the home employs a total of nine care staff, one cook and one domestic. The manager explained the staff rota to us. Between 8pm and 6am there is one member of staff on duty who is awake throughout the night and this person is backed up by a member of staff who sleeps in and is available if required. Between 6am to 8am there are two members of staff on duty. Between 8am and 4pm there are three members of staff on duty and from 4pm to 8pm there is two staff on duty. These staff are supported by a domestic who works 9am to 2pm five days a week and a cook who works 8am to 4pm seven days per week. We spoke to staff on duty and they told us that with the current number of residents that they felt that staffing levels were sufficient. The manager also told us that she thought the staffing levels were about right to meet the current need of the residents and she told us that staffing levels would be kept under review as the number of residents increased and peoples needs changed. We looked at the training records for all of the staff employed at the home. We found evidence that staff had completed training in adult protection, challenging behaviour, basic first aid, infection control, mental capacity act, caring for people with dementia, health and safety, food hygiene, medication, diet and nutrition, fire training, moving and handling and palliative care. We found that there had recently been an increase in the training and in since March 2010 all of the care staff, with the exception of one person, had completed training in caring for people with dementia, challenging behaviour, moving and handling and health and safety. Staff spoken with on the day of our visit told us that training had been provided and that they felt that they had the skills and training they needed to enable them to support the service users effectively. During our time in the home we observed staff supporting residents. We saw staff consulting residents throughout the day about such things as the choice of music playing or what they wanted to drink. Staff spoken to said that they always ask residents what they want and would always respect their wishes and views. Staff were observed speaking to residents appropriately using their preferred form of address. Staff were calm and relaxed and were patient and friendly. We observed the mid day meal and this was unhurried and staff provided suitable support for those residents who required it, staff gave residents ample time to eat their meal and encouraged and prompted residents to eat their meal while it was hot and fresh. What the care home could do better: Whilst we found evidence that changes to care practices have been made which are benefiting residents we remain concerned that changes have not become embedded in practice. Not all care plans have been reviewed. As a result there were some gaps in the information for staff to follow to ensure residents needs have been met. For example a residents assessment indicated they may encounter breathing difficulties as they can be prone to chest infections The manager was unable to confirm that a short term care plan would be drawn up to cover the changing needs of the resident when they require treatment. Training has been provided recently and staff supervision has begun. The manager now needs to work with their staff team to develop good care practices. We expressed concern about the arrangements to manage the care home when the manager will go on leave. As the changes are so recent it is important that the arrangements made support this progress and do not detract from them. Random inspection report Care homes for older people Name: Address: Ashton Manor 104 Aldwick Road Bognor Regis West Sussex PO21 2PD zero star poor service 11/05/2010 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: David Bannier Date: 0 5 0 8 2 0 1 0 Information about the care home Name of care home: Address: Ashton Manor 104 Aldwick Road Bognor Regis West Sussex PO21 2PD 01243842196 01243842196 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Stargate Partnership Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 24 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 24 The maximum number of service users to be accommodated is 24. The registered person may provide the following categories of service only: Care home only - (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home Ashton Manor is a care home offering personal care only to people with dementia. It is situated in Bognor Regis and can accomodate 24 people. It is owned by Stargate Partnership Ltd who registered with The Commission in September 2008. The responsible individual is Mr Ayaru Shandakumar; the home is Care Homes for Older People Page 2 of 11 1 1 0 5 2 0 1 0 Brief description of the care home currently without a registered manager. Accomodation is laid out on three floors with passenger lift access to the second floor only. People are not currently accomodated on the third floor. There are 22 bedrooms all with ensuite facilities. Care Homes for Older People Page 3 of 11 What we found: We carried out a key inspection in May 2010 and our findings indicated that residents were receiving a poor service and the service continued to be rated Zero stars. At that time we found care practices were unsafe and we alerted the local authority under Safeguarding Adult procedures. We also wrote to the registered provider advising them that as the care provision had deteriorated since our previous visit in January 2010 we were considering canceling the registration of the care home unless they could provide us with evidence that they had taken action to make improvements to the quality of care provided. The registered provider, Stargate Limited, wrote to us with an updated copy of an improvement plan documenting the actions they had taken to address the concerns we had identified. We also met with Mr Shandakumar, who is the responsible individual, to discuss the improvements needed to ensure the safety and wellbeing of residents. The purpose of this visit was to gather evidence that residents care and accommodation has progressed in terms of safety. We found evidence that residents are safe and that their basic needs are being met. However, we have also expressed concerns that the changes made have not yet been embedded. We were introduced to the current manager, who informed us they had been appointed to this post since June 2010. They were able to demonstrate a clear understanding of the current areas of concern regarding poor practices at Ashton Manor. They were also able to demonstrate the actions they had taken and were planning to take to ensure residents are safe and improvements are made where necessary. We did not assess all the requirements made at our last visit. We focused on those requirements that related to the health and social care, staff and management and administration of the care home. We have removed those requirements where we found sufficient evidence to demonstrate compliance. Those requirements that remain highlight the areas where work is still required. What the care home does well: We spoke to all of the staff who was on duty at the home on the day of our visit and they told us that there had been a significant improvement since the new manager had started work. Staff told us that the atmosphere in the home was better and one staff member told us I used to dread coming into work but now I look forward to going in each day. We sampled the care records of three residents. We found evidence that an individual care plan was in place for each resident. The manager was able to demonstrate they were in the process of reviewing each care plan to ensure the needs and wishes of each resident are clearly recorded and that staff have clear guidelines to follow to ensure residents needs have been met. The manager informed us that they had completed the review of care plans for two of the ten residents currently accommodated. We found evidence that visits made by district nurses and by GPs together with the purpose and outcome of the visit had been recorded. There was also evidence that risk assessment Care Homes for Older People Page 4 of 11 tools were place. We spoke to three care staff who were on duty. They were able to demonstrate they were familiar with the needs of identified residents and the actions they should take to ensure they have been met. We observed medication being administered over the lunch time period. We were informed that a senior member of staff, who has received training, is responsible for this task. We noted that this person is identified with a white bib which also advised they should not be disturbed. We were shown the facilities provided for the storage of medication. This included a medication trolley, a separate cupboard for controlled drugs and a small refrigerator for medication that required storage in this way. They were located in manner which ensured medication is stored securely. We looked at the staff rota and this showed that the home employs a total of nine care staff, one cook and one domestic. The manager explained the staff rota to us. Between 8pm and 6am there is one member of staff on duty who is awake throughout the night and this person is backed up by a member of staff who sleeps in and is available if required. Between 6am to 8am there are two members of staff on duty. Between 8am and 4pm there are three members of staff on duty and from 4pm to 8pm there is two staff on duty. These staff are supported by a domestic who works 9am to 2pm five days a week and a cook who works 8am to 4pm seven days per week. We spoke to staff on duty and they told us that with the current number of residents that they felt that staffing levels were sufficient. The manager also told us that she thought the staffing levels were about right to meet the current need of the residents and she told us that staffing levels would be kept under review as the number of residents increased and peoples needs changed. We looked at the training records for all of the staff employed at the home. We found evidence that staff had completed training in adult protection, challenging behaviour, basic first aid, infection control, mental capacity act, caring for people with dementia, health and safety, food hygiene, medication, diet and nutrition, fire training, moving and handling and palliative care. We found that there had recently been an increase in the training and in since March 2010 all of the care staff, with the exception of one person, had completed training in caring for people with dementia, challenging behaviour, moving and handling and health and safety. Staff spoken with on the day of our visit told us that training had been provided and that they felt that they had the skills and training they needed to enable them to support the service users effectively. During our time in the home we observed staff supporting residents. We saw staff consulting residents throughout the day about such things as the choice of music playing or what they wanted to drink. Staff spoken to said that they always ask residents what they want and would always respect their wishes and views. Staff were observed speaking to residents appropriately using their preferred form of address. Staff were calm and relaxed and were patient and friendly. We observed the mid day meal and this was unhurried and staff provided suitable support for those residents who required it, staff gave residents ample time to eat their meal and encouraged and prompted residents to eat their meal while it was hot and fresh. Care Homes for Older People Page 5 of 11 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 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 13 The registered person must ensure that all medication is given at the prescribed times. This must happen to ensure the residents needs are met and they are safeguarded. 11/06/2010 2 8 13 The registered person must 11/06/2010 ensure that all medication no longer required is safely disposed of. This must happen to ensure the residents are safeguarded. 3 9 13 To ensure medicine are given 30/04/2010 using safe methods and records are true and accurate. So that people get the the correct dose of medicine and there is written evidence of medicines given which is true and accurate including recording reason for when medicines are not given 4 9 13 The registered manager must ensure that a there is clear documented evidence for any treatment changes showing that there was professional input. 30/04/2010 Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To ensure that healthcare needs of residents are met. 5 9 13 To have a Care Plan on the use of medicines that are to be given only when needed. So that there is consistency in the use of this medicine 6 10 12 The registered person must 11/06/2010 ensure that the residents daily routines including rising and bed times are recorded and staff adhere to them at all times. This must happen to ensure the residents are given choice and flexibility and their needs are met. 7 12 16 The registered person must 11/06/2010 ensure that a planned programme of activities based on residents interests is devised and implemented. This must happen to ensure the residents needs are met. 8 15 16 The registered person must 11/06/2010 ensure that suitable catering arrangements are made in the absence of the cook. This must happen to ensure the residents needs are met and they are safeguarded. 9 26 23 The registered person must ensure that clinical waste is appropriately disposed of as 11/06/2010 30/04/2010 Care Homes for Older People Page 8 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action according to policy and procedures. This must happen to ensure the residents are safeguarded. 10 27 18 In line with regulation 28/02/2010 18(1)(a) the registered person must ensure that suitably qualified staff are on duty at all times, with particular attention to night shifts. This must happen to safeguard residents from harm. Care Homes for Older People Page 9 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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