Care Home: Ashtree House

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What the care home does well Efforts have been made to ensure that the change in ownership has been done smoothly without affecting the residents living in the home. A committed and competent care team care for the residents living in this home. All the residents and visitors we spoke with expressed satisfaction with the care and service provided by the home. All residents were assessed before entering the home and there was a recreational and activity programme provided which provided stimulation. There was an assessment and review of care with wherever possible resident and relative/family involvement. Residents lived in clean, comfortable and safe accommodation. What has improved since the last inspection? Three flat screen televisions have been purchased as well as a fish tank in order to enhance the pleasure for residents living in the home. There was one new commercial washing machine and one commercial tumble dryer. This had improved the laundry service in the home. What the care home could do better: In order to ensure that residents are safe from harm the manager must ensure that each member of staff is aware of adult protection and what their role is if abuse was suspected. In addition further efforts need to be taken to expand the amount and detail of information in care plans in order to ensure that staff know how to support and care for the needs of residents living in the home. The manager is already identifying ways in which the existing service can be improved in the future. CARE HOMES FOR OLDER PEOPLE Ashtree House Ashtree House 10 Church Lane Withern Alford Lincolnshire LN13 0NG Lead Inspector Tobias Payne Unannounced Inspection 3rd October 2007 08:30 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 Ashtree House DS0000070311.V351613.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. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashtree House Address Ashtree House 10 Church Lane Withern Alford Lincolnshire LN13 0NG 01507 450 373 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) ashtreehouse@fsmail.net Tinfloyd Healthcare Limited Lisa Kim Floyd Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22) of places Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The provider may provide the following category of service only: Care home - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia - aged 65 years of age and over - Code DE(E) The maximum number of service users who can be accommodated is: 22 New service 2. Date of last inspection Brief Description of the Service: Ashtree House is a large converted 2 storey building in the small village of Withern, which is on bus routes to Mablethorpe, Louth and Alford. The home provides personal care to 22 older people. On the day of the inspection there were 21 residents. The home has 12 single and one shared room and 15 additional single rooms, which have en-suite facilities. A shaft lift serves rooms on the first floor. There are sitting areas throughout and a conservatory at the rear of the home, which leads onto a large garden, which overlooks fields to open country at the back of the home. Mr and Mrs Floyd trading under Tin Floyd Healthcare Limited have recently purchased the home, which had been established for 21 years under the previous owners. As a result of this, changes were being introduced to further improve the quality of lives of the residents living in the home. The fees at the inspection visit on the 3/10/2007 ranged from £343 to £431 each week. Extras are for hairdressing which range from £4 to £10, chiropody £10, toiletries, personal newspapers and magazines. The statement of purpose and service user’s guide and information about the home can be obtained from the manager. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit was unannounced and started at 8.30 am. It was undertaken using a review of all the information available to us about Ashtree House Home. We spoke with 10 residents, 2 visitors, 5 staff and the manager who is also one of the owners. The main method of inspection was called “case tracking”. This involved selecting 2 residents and tracking the care they received through the checking of records, discussion with them, the care staff and observation of their care. The inspector also examined an Annual Quality Assurance Assessment, which had been completed by the previous owners. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 6 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is information available which accurately describes the services provided by the home. This enables residents to make a decision about whether to come to the home or not. Residents receive a comprehensive assessment to ensure that their needs can be met. EVIDENCE: The new owners have been in control since early September 2007 and the home is in a state of transition. However despite this, there was a new statement of purpose and service user’s guide. Both were clear, detailed, in large print and described all the information about the home. Each new person was assessed by the manager before coming to the home. There was a pre-admission assessment completed. There was however no written confirmation sent to the resident that based on the assessment the home was able to meet their needs. The manager agreed to ensure this was done for future admissions. Each resident/family had been written to regarding the change in ownership and issued with new terms and conditions with reference to the new company. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 9 We spoke to residents, staff and visitors all of whom spoke of the smooth transition, which had taken place and that; the owner was always available in the home. We also spoke with a newly admitted resident who commented, “before I came here I was told all about the home and I have settled in the home and found everyone very helpful”. The home does not provide intermediate care. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and welfare are met by comprehensive care planning and staff know the needs of the residents. Medication is safely given by people who know what they are doing. Residents are protected by clear medication policies. EVIDENCE: Each resident had a care plan. The new manager was in the process of introducing new care records, which would be more person centred and detailed. At our inspection visit the 2 systems were being used. Gradually records would be transferred over to the new system and staff would receive training. The manager had obtained guidance from the Alzheimer’s Society. We examined records for 2 people. Records included assessment details, dependency, nutritional assessment, life history, significant life events, hobbies interests, likes and dislikes, risk assessment, care plan. In another folder was the daily record. Records were clear, up to date, dated with signatures. However, we felt that the care plans needed further development in order to detail what the specific needs of each person was and how staff could meet them. No resident during our visit was seen to be in distress or Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 11 calling out for help. Staff who knew the needs of the residents cared for them in a kind and sensitive manner attended to their needs promptly. The home had medication procedures and there were 6 staff who had received training and been assessed as competent to administer medication. We examined medication records. There were no concerns. The manager had requested an inspection visit by the local pharmacy to ensure practices were up to date. There was also an up to date reference book on medication. Safe medication practices were taking place. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 12 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): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities were varied and provided stimulation and interest for the residents living in the home. Efforts are to be made to further improve the range of activities. Visitors were made to feel welcome. Meals were varied and nutritious. EVIDENCE: The manager was reviewing the activities provided in the home as they were not felt appropriate or varied enough for the residents. She had obtained guidance from the Alzheimer’s Society as well as information from Lincolnshire County Council about reminiscence resources. Care staff provided activities. The manager felt this was a priority and had spoken with the residents about what they wished to do. From her discussion they had said they wished to go out more. She was also looking into changing a small sitting area into an activities room. She was keen to improve the range of activities. The last Environmental Health Officer’s inspection was on the 11/1/2007 and as a result the home was awarded 3 stars for its catering service. There was a set menu but an alternative was available if a resident did not like what was on the menu. The kitchen was clean, tidy, well organised and well stocked with meat, fresh fruit and vegetables. The cook was appropriately dressed and Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 13 there were clear up to date records of food, menus, and food temperatures using a food probe and cleaning rotas. Lunch was observed in the dining room and conservatory. Residents were attended by care staff who served food in a discreet manner. No resident had any complaints about the food and it was well served and residents were not hurried. Comments from residents were, “the food is excellent”, “we get plenty of food”, and “the food is perfect”. The menu was displayed on the wall. A number of relatives were in the home with their relatives at both breakfast and lunch. Comments were, “I like to come here every day to spend time with my wife”, “I always receive a warm welcome, am offered lunch and refreshments and am very satisfied with the care and approach of the staff”. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 14 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): Standards 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints received a taken seriously and residents and visitors knew that any complaints they had would be addressed. Staff were recruited correctly but due to lack of recent training some staff may not know how to react if they suspected abuse was taking place. EVIDENCE: Each person received a copy of the complaints procedure with the service user’s guide. We had been made aware of concerns from a member of the public about the care towards a resident. We did not know the name of the person who had made this complaint or the resident. We investigated the issue and discussed this with the manager during our inspection visit. We were satisfied that the home was aware of the resident’s needs and had been trying to address them. We had no concerns about the care in the home. We spoke to 10 residents and 2 visitors none of whom had any complaints and were very satisfied with the care and approach of staff. New staff were correctly recruited with a check by the Criminal Records Bureau and a supported induction. The new manager was in the process of establishing a more comprehensive 12 week induction. There was no evidence to show that staff had received recent safeguarding adults protection. The manager agreed to address this. However despite this, staff were aware of their role in case abuse was suspected. There was an adult protection policy and the home had a copy of the new Lincolnshire Adult Protection procedure. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 15 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): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, safe and odour free and provides a suitable environment for the residents living in the home. EVIDENCE: The home was clean, tidy and odour free throughout. There was a decoration programme. There were lounge and sitting areas throughout the home. The manager had audited the environment in the home before it was bought and there were no major issues. However areas of the home were to be repainted in the future. She was also aware of the need to introduce discreet signage to help orientate the residents who may be confused to bedrooms, toilets etc. This to improve their quality of life and promote their independence. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 16 All the residents spoke highly of the accommodation and how much they liked their bedrooms. Comments were, “ I have a very nice room” and “the home is always clean and comfortable”. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 17 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): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was adequately staffed with employees who were competent to care and support older people. Residents were protected by robust recruitment practices. EVIDENCE: Staff and residents felt there were sufficient staff in the home. There were no staff vacancies. A new member of staff had been recruited correctly. The manager monitored dependency and was able to employ more staff where required. She had also worked in the home on a night shift to monitor the needs of the residents. She was also to review training, as apart from training in care (National Vocational Qualifications), first aid and food hygiene there was little evidence that any other training had taken place since the last key inspection. She was to ensure that mandatory training covered adult protection, moving and handling, dementia awareness, medication, communication, health and safety, first aid and infection control. Out of 14 care staff, 3 had obtained a qualification in care (National Vocational Qualification) and a further 8 were studying for this. Two staff were studying for NVQ level 3 and one of cooks was also studying for a NVQ in catering. There were 80 of staff who had or were studying for NVQ. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 18 The manager was to review the induction and introduce a 12 week introduction to adult care in line with Skills for Care. Most of the staff had received 12 week dementia awareness training in the past. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 19 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): Standards 31, 32, 33, 35, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been a smooth transition in ownership and the home is competently managed. Residents’ health and safety is protected. EVIDENCE: The manager is also one of the owners and has been actively involved in the home since September 2007. The manager had been a deputy manager at a previous care home and she and her husband had business experience. She was aware that she needs to study for a management qualification and was looking into this. She was in the process of introducing gradual changes throughout the home. Each resident and relative had been written to explaining about the change on ownership. An outside consultancy was involved in producing personnel policies, staff handbook and new staff contracts. The manager was also reviewing policies and procedures. Staff, visitors and residents had confidence in the manager. Comments were, “they Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 20 look after me well”, “staff are very helpful”, “the new owners have improved the home” and “I am very satisfied”. Staff received supervision regularly and spoke of the support received from the manager and care manager. The manager acknowledged quality assurance needed to be addressed. The last residents’ questionnaires had been sent out in 2005. There was no evidence that any surveys had taken place in 2006 and 2007. The manager was keen to address this. She had introduced a programme of internal audits for each month up to January 2008. All essential equipment had been maintained. Records examined were well maintained, available for inspection and up to date. A fire risk assessment was carried out on the 25/4/2007. There was a detailed equal opportunities policy, which referred to discrimination, disability and victimisation. There were no communication issues. There were no concerns about equality and diversity. We saw throughout our inspection visit staff had the skills and knowledge to care and support each resident. The manager was also aware of the Mental Capacity Act 2005. The home had detailed health and safety procedures, which were new and produced on the 5/9/2007. There were also infection control policies. Where required risk assessments had been carried out and documented. There were a range of policies and procedures available in the home relating to fire safety and fire risk assessments. There was also evidence that fire alarm; fire drills and emergency lighting checks and testing. Care staff also received fire training as part of the homes initial training and as a regular training event. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 13(6) Requirement All staff working in the home must be made aware of what abuse is and what they should do if abuse is suspected. This will ensure that all residents are safe and protected from abuse. Timescale for action 03/12/07 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 OP7 Good Practice Recommendations The amount of information in care plans needs to be expanded upon. This will ensure that staff providing the care and support understand the individual needs and approaches required to meet these needs for each resident. Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Ashtree House DS0000070311.V351613.R01.S.doc Version 5.2 Page 24 - 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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