Care Home: Ashurst

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What the care home does well The people who live in the home are well cared for and respected by staff. They are able to choose their own routines. All the relatives spoken with said that the manager and staff respected their dignity at all times. One person did praise the staff to the `expert by experience` saying `the carers are very helpful` another person said to the inspector `the carers are very helpful` Feedback received before the inspection said `I am very happy with the care my mother is given at Ashurst` and `I am very satisfied wit the excellent way we are looked after` and `no complaints the staff provide a caring service to the highest standards` Throughout the day it was clear that the welfare of the people in the home was at the core of the philosophy of the manager and staff. Staff are properly checked to ensure they are suitable to work with vulnerable people before they commence their employment. They have supervision and team meetings that keep them informed and up to date with policies and procedures. The food is of a good quality and people said that they had enough to eat. There are three meals a day and drinks and snacks available at all times. What has improved since the last inspection? Since the last inspection the manager has been registered with the Commission. He has introduced an open door style of management and staff said he was supportive. People living in the home said that they could go to see the manager if they had any problems. The environment is in the process of being upgraded and this means that people live in a well maintained home What the care home could do better: During this inspection only a few issues were raised as needing attention. One of the bedrooms had a very unpleasant odour and the registered person must ensure this room is appropriately cleaned or re-decorated to get rid of the smell. It was also discovered that the temperature of the room in which the medication is stored gets higher that 25 degrees C. The temperature in this room should not exceed 25 degrees C. This will help to make sure that the medicines are always stored at temperatures recommended by the manufacturer. Staff should be encouraged to do the national vocational training. This will mean that all staff have an understanding of their role at Ashurst. Key inspection report Care homes for older people Name: Address: Ashurst 36 - 38 Westbourne Park Scarborough North Yorkshire YO12 4AT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Pauline ORourke     Date: 2 2 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Ashurst 36 - 38 Westbourne Park Scarborough North Yorkshire YO12 4AT 01723360392 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Monami Care (Scarborough) Limited Name of registered manager (if applicable) Mr Andrew Brian Lawson Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category of service only: Care Home Only - Code PC; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP. Date of last inspection Brief description of the care home Ashurst is registered to provide accommodation and personal care for nineteen older people. Ashurst is a detached property and is located in a central area of Scarborough. The home is conveniently located for all main community facilities including the public Care Homes for Older People Page 4 of 26 Over 65 19 0 2 5 0 9 2 0 0 8 Brief description of the care home transport network. Restricted on-street parking is available. The property consists of four floors with the accommodation for people who live in the home being located on the ground, first and second floors. The home has a small passenger lift. There are three double bedrooms although currently one double is being used as single accommodation. Two of the bedrooms have en suite facilities. The care home has a small front seating area and rear garden. Information about the home is available in a Service User Guide and on the 22nd September 2009 the weekly cost of staying at Ashurst is between three hundred and forty four pounds and three hundred and eighty nine pounds. The actual amount payable by the person living at Ashurst is dependent on a financial assessment. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Care Quality Commission inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 26 The key inspection has used information from different sources to provide evidence for this report. These sources include: Reviewing information that has been received about the home since the last inspection. Information provided by the registered person in an Annual Quality Assurance Assessment form (AQAA) Comment cards returned from people living at Ashurst and from other people with an interest in the service. A visit to the home by one inspector that lasted for six hours. An expert by experience accompanied the inspector for three hours of the visit. During the visit to the home people who live there, staff and relatives were spoken with. Care records relating to people who live at Ashurst staff members and the management activities of the home were inspected. Care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Ashurst for the people living there. The Registered Manager was available for feedback at the close. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 26 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are fully assessed before they are admitted to the home and this means that staff will know what level of support they require. Evidence: People who are thinking about moving in to Ashurst are provided with information about the home in a Service User Guide along with a Statement of Purpose. Both of these documents have recently been amended to include information about how the service can meet the diverse needs of the local community. The registered manager is looking to improve these documents further by producing the information on a DVD and in braille. Feedback received from four people living at Ashurst indicated that they had received enough information about the home before they decided to move in. Four case files were seen and they each contained a full assessment of the help and support required by the individual concerned. This information is gathered by the registered manager when he goes to visit people thinking about moving in to Ashurst Care Homes for Older People Page 11 of 26 Evidence: and through discussions he has with social and health care professionals. People spoken with during the inspection said that the Manager had visited them before they moved in. They also said that they had been able to have a look around the home and spend some time talking to other people resident in the home before making their own decision. Staff surveys received prior to the inspection indicated that they were given up to date information about the needs of people in the home. All of the information gathered enables the registered manager ensure that staff have the necessary skills to look after people in the home. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are clearly identified in their care plan and staff ensure they remain up to date so that they can continue to provide appropriate care. Evidence: Four case files were seen and they each contained a care plan pertinent to the individual concerned. The plans were based around Activities of Daily Living. Information is gathered from the first meeting and continues to be developed and reviewed on a regular basis to ensure they remain up to date. Where possible the individual concerned is fully involved and if they are unable then a representative or relative is asked to oversee the process. The care plans are written in plain english and staff do take time with people in the home to go through them. This is done through the key worker process. All of the surveys received from people in the home indicated that they received the care and support they needed. They also indicated that staff are available when they are needed and staff listen to them. Evidence was available in the case files that people see their own doctor, chiropodist, optician and other health care professionals as necessary. One relative spoken with Care Homes for Older People Page 13 of 26 Evidence: said they take care of my relative and they always let me know if she is not very well People in the home said that they could arrange their own appointments with their doctor if they wanted to or the manager would do it for them. The medication is delivered in a monitored dosage system supplied by a large pharmacy. Staff who administer the medications have received training through the Primary Care Trust. A medication round was observed and medicines are dispensed in to a pot taken to the person concerned and the member of staff signs the administration sheet when the medicines have been signed. This is called the pot and dot system staff are instructed to only do one persons medication at a time so that there can be no confusion with the records. The records seen were accurate and up to date. The medication is stored securely in the office, however, the manager needs to look at putting some ventilation in this room as the temperature rose above 26 degrees. This level of temperature is too high for some of the creams stored in the cupboard. Throughout the inspection people were seen to be treated as individuals and with respect at all times by the staff. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported in their leisure activities when staff have the time and they are encouraged to maintain positive relationships with their friends and visitors. Evidence: Throughout the visit people were seen to follow their own routine. There was no pressure for them to get up and come down for their breakfast. They are encouraged to retain their independence within their daily routines. One lady requested a taxi so she could go out, another person spent time in their bedroom with their cat whilst others came in to the lounge. A programme of activities is also available and these can be on a one-to-one basis or in a group. Some of the activities include, a visit to a local cafe, the pub, church, gardening, dominoes, coites, crafts, knitting and on one occasion people enjoyed someone who brought in unusual animals for them to touch and discuss, the animals included a lizard, a tarantula, a snake and a dog. People told the expert by experience that they enjoyed the activities and didnt have to join in if they didnt want to. An activities log is kept for each person. There is a visitors policy in place and this is supportive of people who dont want to receive visitors. People spoken with said that visitors are welcome at any time and they are invited to lunch or offered a drink when they arrive. A visitor spoken with Care Homes for Older People Page 15 of 26 Evidence: said that they could visit or ring at any time. One person in the home has had a restriction put on their visitors as they were found to be taking advantage of them financially, this is clearly documented in their care plan and advocacy alliance have been involved representing their interests. A rolling three-week menu is used in the home. The cook and the assistant manager devise it with input from people in the home, people spoken with said they offer suggestions about the food to the manager. Special diets are catered for and currently they are providing vegetarian and diabetic diets. The meal observed was hot, well presented and where necessary assistance was offered sensitively and appropriately. People said the food is lovely and if you dont like the food they will offer you something different Several people told the expert by experience that the food was very good. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected from risk of harm or abuse. Policies are in place to inform staff of the actions they should take where they suspect abuse has occurred. Evidence: A complaints procedure is in place and is displayed clearly in the communal areas. The manager recognises that this document would benefit from further development that will allow for people with different communication abilities and disabilities to access this information. No complaints have been received by the Commission or by the home. People spoken with said that if they had any concerns or complaints they would discuss them with the registered manager. People are asked how they would make a complaint as part of the quality assurance surveys. Several responses showed that several people stated they would go to Andy the registered manager or Michelle the deputy manager. A safeguarding policy is in place and is in line with local protocols, this has been reviewed in the last twelve months. Training is planned on the 07/09/09 with North Yorkshire Social services to ensure everyone has a good understanding of their responsibilities. Staff spoke with were aware of their responsibility to report any suspicions of abuse occurring. Staff are thoroughly checked prior to their employment to ensure they are suitable to work with vulnerable people. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, comfortable and safe environment Evidence: All areas of the home were seen and improvements have been made since the last inspection. One room was noted has having a strong smell and action must be taken to remove this odour. The expert by experience noted two of the bathrooms had been re-decorated and improved since the previous inspection and all bathrooms were clean and tidy. Some of the passage area and stairs had been re carpeted. I visited several bedrooms and all were clean and tidy some with personal items he also said Ashurst does not pretend to be a modern purpose built home but it appears warm, clean and comfortable Feedback received from people in the home said that the home is always fresh and clean. The laundry facilities are suitable for the purpose of the home. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who know them and have received some training to ensure they have the skills needed to carry out their roles. Evidence: During the day there are three carers on and in the evening and during the night there are two carers. A cook is employed on a daily basis. There is no ancillary staff employed in the morning only in the afternoon and this means care staff have to carry out cleaning duties rather than have time to spend with the people in the home. Evidence provided in the Annual Quality Assurance Assessment provided in September 2009 showed two staff members have an National Vocation Qualification level two in care and a further two members of staff are working toward this qualification. The current ratio of staff who have an NVQ level two is 25 and will only reach the required level of 50 once current staff have completed their training. The files of three staff were examined and two of the files contained evidence that a thorough recruitment procedure had been followed. The third member of staff had been supplied through an agency and there was no evidence that their employment checks had been carried out. It is the responsibility of the registered manager to ensure that he has evidence that proper employment checks have been carried out whether they are employed directly by him or through an agency. Care Homes for Older People Page 19 of 26 Evidence: Staff have completed statutory training and a safeguarding course run by North Yorkshire Social services. The manager is looking to ensure that other training related to the care and support of older people is provided. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well managed. Evidence: The manager is now registered with the Commission. He has had a variety of experience within the care field and has brought this experience to his current position at Ashurst. He is looking to update his training with a management qualification. People spoken with in the home said that he had brought a sense of stability to the home and everyone spoken with would go and see him if they had any concerns. He has implemented the changes requested at the last inspection and has a clear idea of what he wants to achieve at Ashurst. A quality assurance system is in place and questionnaires are sent out to people using the service, their relatives and other professionals every three months. This information issued alongside information gathered through the house meetings. Some of the comments received include No complaints the staff provide a caring service to the highest standards possible within the limitations of the building and I am very Care Homes for Older People Page 21 of 26 Evidence: satisfied with the excellent way we are looked after and I am happy with the care given to my mother at Ashurst Where possible people look after their own monies. If people need support with their money this is done in a sensitive manner. The cash and records kept by staff is held in the safe and all accounts checked tallied. The health and safety records were checked and were found to be up to date with the exception of the electrical safety certificate which was valid for only three years and expired in June 2008. Risk assessments for fire, the environment, COSHH and people who live in the home. All accidents and incidents are recorded and when necessary they are reported to the Care Quality Commission. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 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, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 16 The registered person must ensure that all areas of the home are kept free from offensive odours. This will allow people to live in a home that is always clean. 06/11/2009 2 29 19 The registered person must ensure that all the employment checks have been carried out prior to the commencement of employment. This will ensure that people are suitable to work with vulnerable people. 14/10/2009 3 38 23 The registered person must supply the Commission an up to date electrical safety certificate This will ensure that people live in a safe environment 06/11/2009 Care Homes for Older People Page 24 of 26 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 1 9 Arrangements should be made to control the temperature of the room in which the medication is stored to keep it below 25 degrees C at all times. This will help to make sure medicines are always stored at temperatures recommended by the manufacturer. Care Homes for Older People Page 25 of 26 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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