Care Home: Ashurst Park Care Home

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What the care home does well The home provides a very friendly and welcoming environment. Staff are relaxed as well as professional, and carry out their duties in a caring manner. The service users` guide states that the aim is to provide a "home from home", and the service demonstrates that it is meeting this aim. Residents are confident that their health care is well managed. Health professionals such as GP, dentist, speech and language therapist, dietician andphysiotherapists are accessed as needed. The home has a contract with a local physiotherapy practice, so that a physiotherapist visits the home twice weekly. Food is generally well managed, and provides sufficient variety and nutrition. Several residents stated that the food is "always good" or "excellent". Only one resident was less complimentary. Staff training is reliably carried out, and residents benefit from a competent and well trained staff team. The manager leads the way in all aspects of the running of the home, and residents and staff said that she is available and approachable. What has improved since the last inspection? Requirements given at the last inspection have all been met. These include obtaining increased pre-admission information; improved care planning; and better infection control procedures. There has been an extensive refurbishment of all communal areas, which has considerably enhanced the premises. Ongoing redecoration of bedrooms has been commenced. A new team of gardeners have improved the grounds; and the providers have obtained a government grant to enable them to build a sensory garden within the grounds. This was nearly completed at the time of the visit. All staff have attended "Equality and Diversity" training; and there is a new and comprehensive staff induction programme. There has been recognition that insufficient activities are available for residents. A new activities co-ordinator has been recruited; and a survey has been carried out to find out the type of activities which residents would most prefer. CARE HOMES FOR OLDER PEOPLE Ashurst Park Care Home Fordcombe Road Fordcombe Tunbridge Wells Kent TN3 0RD Lead Inspector Mrs Susan Hall Unannounced Inspection 26th June 2008 09:00 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 Ashurst Park Care Home DS0000066424.V365206.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. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashurst Park Care Home Address Fordcombe Road Fordcombe Tunbridge Wells Kent TN3 0RD 01892 709000 01892 709053 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) www.fshc.co.uk Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Manager post vacant Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care to be provided to 3 named older people with a diagnosis of dementia (details of the named people held at the CSCI office in Maidstone) 23rd July 2007 Date of last inspection Brief Description of the Service: Ashurst Park Care Home is a purpose built detached building, situated in a rural area, in large park land, approximately five miles from the town of Tunbridge Wells. It is owned by a subsidiary of Four Seasons Health Care Limited, who are providers for many homes (approximately 400) in England and Wales. The home has accommodation on two floors, with a large passenger lift providing easy access between floors. All areas of the home and gardens are accessible by wheelchair users. Although the home is registered for up to fifty three residents, some of the shared rooms are now more often used for single use, so the total number of residents is usually limited to forty-nine. There are still two shared rooms available for any residents who choose to share. The home has a large lounge, a smaller quiet lounge, and a separate dining room on the ground floor and a smaller dining/lounge area on the first floor. All bedrooms on the ground floor have en-suite facilities; and all bedrooms are fitted with a nurse call bell, telephone point and colour television. The extensive grounds are very attractively presented, and many residents find the varied wildlife is enjoyable to watch. The home can be accessed by car via Tunbridge Wells, and this attractive town provides all of the usual facilities such as banks, shops, churches and theatres. There is plenty of parking space at the front of the building. There is a very limited bus service to the end of the drive. Current fee levels range from £429.25 to £980.00 per week, depending on the assessed needs of the resident. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home is assessed as having a rating of good, 2 stars. This was a key inspection, which includes taking into account all information obtained about the service since the previous inspection. All of the key standards were assessed, and many other standards, so as to provide a comprehensive assessment of the home. The visit was carried out by one inspector, and lasted for eight and a half hours. During this time, we (i.e. CSCI) talked with nine staff, five residents and two relatives; observed staff carrying out their duties; viewed all areas of the home; and read documentation including care plans, staff files, maintenance and servicing records, and medication charts. Residents spoke highly of the staff with comments such as “you can’t fault them”, and “they are brilliant”. They also expressed contentment with the general running of the home, and the facilities. The home was seen to be clean in all areas, and has benefited from extensive redecoration and refurbishment to all communal areas during the past year. CSCI received notification of one allegation which was referred to the Social Services Safeguarding Adults team. An investigation was carried out by the providers at the team’s request, and no regulations were found to be breached. CSCI was not contacted directly by any other complainants. Survey forms were sent out by CSCI prior to the visit, and nine responses were received from residents, staff, and visiting health professionals. These contained some very positive comments such as “I always receive the care and support I need” (from a resident); “the meals are always excellent” (a different resident); and “the general care of residents is very good” (from a health professional). What the service does well: The home provides a very friendly and welcoming environment. Staff are relaxed as well as professional, and carry out their duties in a caring manner. The service users’ guide states that the aim is to provide a “home from home”, and the service demonstrates that it is meeting this aim. Residents are confident that their health care is well managed. Health professionals such as GP, dentist, speech and language therapist, dietician and Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 6 physiotherapists are accessed as needed. The home has a contract with a local physiotherapy practice, so that a physiotherapist visits the home twice weekly. Food is generally well managed, and provides sufficient variety and nutrition. Several residents stated that the food is “always good” or “excellent”. Only one resident was less complimentary. Staff training is reliably carried out, and residents benefit from a competent and well trained staff team. The manager leads the way in all aspects of the running of the home, and residents and staff said that she is available and approachable. What has improved since the last inspection? What they could do better: Some aspects of care planning could be improved still further, with increased attention to detail. For example, wound care would be better if each dressing change is clearly documented in the care plan, so that a pathway of progress can be clearly seen. Some of the nursing reports do not contain much factual evidence, and are very clinical, so that they do not reflect the holistic care given to the residents. Some reports are in poor hand writing which is difficult for others to read. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 7 The medication room is overcrowded when new supplies of medication are delivered. Consideration needs to be given to creating some additional storage space. The controlled drugs cupboard is too small to meet the needs for this number of residents. The clinical room temperature is at a borderline level, and some action needs to be taken to prevent medicines from deteriorating due to a high room temperature. Two bathrooms are out of action due to a leaking and damaged roof, which has had an impact on these bathroom facilities. These bathrooms should be refurbished to ensure that there are a sufficient number of bathrooms available for when the home is fully occupied. The manager has been in post for nearly two years, but is not yet registered with CSCI. There have been some difficulties with documentation going astray; however, it is important that the manager has formal approval by the regulatory body. 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. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 8 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 Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 9 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): 1-5 (standard 6 does not apply in this home). Quality in this outcome area is good. The company provides suitable information to enable prospective residents to make a choice about moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose is a well produced document, containing all the required information. This includes the philosophy and core values of the company, to provide a “home from home” for people who need nursing care. The home is registered for older people, but may from time to time admit adults with long term illnesses below the age of 65 years. The service users guide is set out in easy read large print, and forms part of the “welcome pack” given to all new residents. The guide includes information about items such as staff uniforms, so that residents know how to recognise different categories of staff; meals and mealtimes; that there is a minibus to Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 10 take people out; and that there are visiting services such as optician, dentist, chiropodist and hairdresser. There are two dining rooms – one on each floor and a quiet room/library on the ground floor as well as a large lounge area and bar. This information package is kept available in the entrance hall for anyone to read when they visit. The home’s entrance and reception area creates a good first impression, as it is light and spacious, and very welcoming. There are photographs of staff and their designations and a small notice board stating which nurse is in charge for that day. Residents and relatives are invited to view the home prior to making a decision to stay. As many residents are admitted from hospital, it is often their relatives who make the initial decision about choosing the home. There is a trial period of four weeks, after which the placement is reviewed to see if it is suitable. All residents have a pre-admission assessment carried out by a trained nurse. Three of these were viewed, and were seen to have sufficient information. The home sometimes admits residents for respite care, and the same preadmission assessments also apply for these residents. All residents are provided with a contract, which includes the terms and conditions of residency. They clearly state the fees and the breakdown of costs, and ensure that residents are informed of the reasons why a contract may be terminated. Two residents spoke highly of the admission process, stating that the manager and staff had been helpful in supporting them through the process. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 11 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): 7-11 Quality in this outcome area is good. Care plans show that residents are treated as individualsh and that their assessed needs are met by the staff. Health care is well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are set out in individual folders, and we inspected three of these. Each care plan includes comprehensive assessments, and these include items such as: the risk of developing pressure ulcers; moving and handling risks; nutritional assessment (including an oral assessment regarding mouth care/teeth-cleaning/dentures etc.); continence assessment; and a general risk assessment for walking/sitting/use of wheelchair. Each assessment has specific details, - such as the nutritional assessment will show the type of cup and cutlery used by the resident. Admission checklists are used to ensure that everything is properly completed. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 12 Consent for photography is obtained, and one consent form was seen to be signed by a representative as the resident was assessed as lacking the capacity to consent. A care plan index highlights the care plans for that person: e.g. personal hygiene, catheter, mobility, and pressure area care. The plans are individually written and assess the needs and the expected outcomes. They include good specific directions such as: “washes own face, but does not use soap on it”; “able to brush own teeth with a soft toothbrush”; “reassure, and change position hourly when in bed.” Moving and handling directions are clear, with specific information about the type of hoist and sling to use, and how many staff should be present during the hoisting process. There are good additional plans for items such as seizures and diabetes. Any injuries or pressure ulcers are clearly documented on arrival in the home, and photographs are taken. Each wound has a separate written assessment and evaluation sheet. Details of the dressing to be applied are clearly written. However written evaluations are not included for each dressing change in the section on wound care, but tend to be written in the daily progress report sheets. This means that the progress of the wound cannot easily be seen, as the details are not in the right place. Some of the written records are vague with comments like “no change in condition”; or “wound healing”. There is a recommendation to improve the documentation for wound care. The staff carry out a mental health assessment as part of the pre-admission process. This is to determine if the resident can make every day life decisions (like what time to get up, what to wear); and also if they can make complex life decisions such as: if they would wish to attend hospital if taken ill suddenly; or would they want to be resuscitated. The guidelines on the data sheet do not include following the Mental Capacity Act 2005, which is key legislation in determining capacity to consent. The manager was fully aware of this, and said that this has been highlighted to the company. Forms about end of life care do not show how the Mental Capacity Act has been applied. This is also a recommendation. There is good evidence for input from other health professionals, such as dietician, speech and language therapist, GP, dentist, and physiotherapist. The home has a contract with a local physiotherapy practice, and residents pay a reduced rate for this service. A physiotherapist visits the home twice per week, which is excellent. Medication is stored in a clinical room which includes hand washing facilities, and sufficient cupboard space, but the room was very cluttered with medication just dispensed by the pharmacy. Some attention needs to be given to ensuring the floor is not cluttered with items, so that nurses have difficulty accessing the cupboard space. There are two medication trolleys – one for the ground floor, and one for the first floor. These were seen to be in good order, Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 13 with no out of date items found. Liquid medication and eye drops are dated on opening, which is good practice. The controlled drugs cupboard is too small for the needs of the home and there is a requirement to provide a suitably sized cupboard. The room temperature is borderline (24-26 degrees C) and this needs attending to, to ensure that no medication deteriorates due to a high room temperature. Medication Administration Records (MAR charts) were all viewed and are well completed. The drugs fridge was in good order. Care plans stress throughout that all aspects of care must be given with respect, and upholding the residents’ dignity. This could be seen in practice by observing interaction between care staff and residents, as staff showed gentle and caring attitudes, and ensured privacy is maintained. Residents and relatives spoke highly of the staff with comments such as “the care is excellent” (a relative); “you can’t fault them” (from a resident), and “they look after us very well” (another resident). Residents who are dying are able to have visitors as they wish, and staff try to ensure that they are kept comfortable and pain free. There is some evidence in care plans that the home tries to follow any preferences stated by individuals in the event of death. The manager said that this is an area of care which they are working on to improve it further. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 14 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): 12-15 Quality in this outcome area is good. The home is in the process of increasing the type and range of activities available. Food is well managed, and has a suitable nutritional value. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been without an activities co-ordinator for some time, but the manager has just appointed a new one. There is a realisation that there have been insufficient activities to keep all residents stimulated and able to carry out their preferred pastimes. However, the home has continued to have some activities, such as “pat dogs” once per week, and church services; and there is a resident who is an accomplished piano player who entertains other residents. The home has a large open plan lounge with a piano at one side, a fish tank, and a bar area. This is a comfortable area to relax in. The manager has sent out survey forms to find out what activities residents would like to do, their previous hobbies, and any unfulfilled ambitions. The results have been very helpful in determining plans for future activities, and include items such as crosswords, arts and crafts, one to one time, reminiscence, gardening, bingo, Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 15 and cookery. Many of the current residents are keen on gardening, and new raised garden beds are being fitted to enable residents to grow flowers/vegetables etc. as wished. The home has also developed a new sensory garden with different raised beds for herbs, colours etc., and the pathway is bright white, to enable residents with poor vision to follow the path more easily. Some sensory flowerbeds are being developed for the sound that the plants make, or the scents. The home is surrounded by lovely garden/park areas, with lots of wildlife, and some residents have their own garden areas outside patio doors from their bedrooms. There are pathways all round the home, and these are accessible for wheelchair users. Residents can have visitors at any time, and they are welcomed into the home. They are often offered hot drinks, or they can make these for themselves in the quiet lounge. They are also able to stay for meals, and one resident had recently enjoyed having their family stay for lunch. They can join in with others in the main dining areas; or use the quiet lounge, or their own room as they wish. Relatives are invited to take part in entertainment, and the home was planning a concert in the near future. The home has a minibus with a full time driver. The minibus is used for taking residents to appointments, out for shopping or drives out, and also for fetching staff and taking them home. The home is only a few miles out of Tunbridge Wells, but the bus service is very limited. Residents said that the food is good, and that they look forward to it. Each resident is provided with a copy of the menus for the forthcoming week, and a hospitality assistant goes round each day to find out what the residents would like to eat. There is a four weekly menu cycle, which is altered to include seasonal changes. When the revised menus have been drawn up, the menus are submitted to the company’s head office for a dietician to view them, and check that the nutritional value is well balanced. The home uses fresh meat, fruit and vegetables, and cakes and pastries etc. are home made. The kitchens were seen to be well organised, and there are daily/weekly cleaning programmes in place. The chefs come on duty at 07.30, and residents can have their choice from a full range of cooked breakfast items, as well as cereals, toast etc. The chefs are familiar with different diets such as diabetic, and pureed foods, and are trained to the intermediate standard for food and hygiene. The chefs work together on one day per week so that they can liaise with each other. There is an outer kitchenette area for staff to make hot drinks for themselves or for residents. This means they do not have to enter the main kitchen, and so this promotes good infection control. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 16 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. Residents are easily able to voice any concerns to the staff or manager, and are confident that any complaints will be taken seriously. The home provides good staff training for the protection of vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is on display in the front entrance hall with other documentation about the home, so it is easy for anyone to access this. However, it lacked some required data. This includes a timescale for responding to complaints within a timescale of twenty-eight days. Also, there was no data for contacting CSCI. The manager stated that she would amend the procedure within the next few days. Individual complaints’ forms are also available. The complaints log is well maintained, and shows that complaints are taken seriously and are properly investigated. The manager entered two items on to the log this year from concerns which were highlighted on residents’ survey forms, so that she could be sure that their concerns were properly investigated. A notebook is kept on each floor for recording any matters which arise, so that staff can give prompt feedback to the manager. The manager is present in the home for one weekend per month, so that she can meet with Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 17 relatives and visitors who can only come at weekends. She has an open door policy, and this enables residents, staff or visitors to speak to her at any time. Staff recruitment is well managed, and all staff and volunteers have the required Protection of Vulnerable Adults (POVA) and enhanced Criminal Record Bureau (CRB) checks. The protection of vulnerable adults is discussed at the beginning of the staff induction period, and there is separate ongoing training. The staff training matrix shows that all staff are being kept up to date with this training. There is currently a training programme in place, which involves all staff in answering written questions. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 18 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 good. The residents benefit from a home and grounds that are generally well maintained. Some prompt action is needed to repair/refurbish two of the bathrooms. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a purpose built residence, set in large gardens and parkland. It is in a conservation area, and so attracts a lot of wildlife, which residents enjoy. This includes squirrels, foxes, pheasants, rabbits and bats. The rabbits tend to dig up the flowerbeds, and so some of these are protected with surrounding fencing. There are many areas in the grounds to sit or to walk. The management are looking at the possibility of installing some form of call bell in the main patio area, so that residents feel more confident about sitting outside unattended. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 19 The entrance leads into a wide, light reception area, with the open plan lounge just behind this. First impressions are of a spacious, light, and pleasant environment. All of the communal areas and corridors have been refurbished since the last year – including redecorating, new carpets, and some new furniture. There is a large, airy dining room on the ground floor, as well as a smaller dining area on the first floor. These have kitchenette areas for serving the food and for making snacks/drinks. A number of bedrooms have been redecorated in the last year, and there is an ongoing programme of redecoration for all rooms after some residents and relatives highlighted the need for this last year. Bedrooms are personalised with residents’ own belongings, and many ground floor rooms have patio doors out on to the gardens. Several larger rooms on the first floor which used to be for shared use, are now let as single rooms, although there are two rooms large enough for two people to share if they wish to do so. All rooms are fitted with call bells and with a telephone land line. Most of the time it is not possible to pick up signals here for mobile phones. All rooms have TV points, and some have Sky television. This is difficult to install as the home is in a conservation area, and they are not allowed to put Sky dishes where they are visible on the roof. The cost of residents’ phone calls are absorbed into the fee levels, unless they are making frequent calls abroad. All ground floor rooms have en suite toilets and baths. However, these baths cannot be used, as they are not safe for residents to use unaccompanied, and not large enough to use with hoisting facilities. There are current discussions in the company about taking the baths out and refitting these en-suite areas more appropriately; and this matter is being discussed with residents and relatives at the next joint meeting. Each en-suite has an old type of heater and heated towel rail. These were put out of use some time ago as the heat could not be controlled sufficiently to provide safety for residents. These are all currently being removed, and the walls/wiring/plumbing and redecorating are being made good. The home has disabled toilets near to communal rooms, and five bath/shower rooms. One of the bathrooms on the ground floor is not well presented as it has a scratched bath and the ceiling needs repairing. There is insufficient space for using a hoist in this bathroom. Another bathroom on the first floor was out of use as the ceiling has been damaged by a problem with the roof above. (The estates management have been informed of the roof problem). These bathrooms need to be refurbished and brought back into commission to ensure that there are sufficient numbers of bathing facilities in use. There are current discussions about altering one or two of these into “wet” rooms, so as to enable residents to have the choice of a shower. Other rooms have assisted baths so that residents with reduced mobility can access them. The home is provided with suitable hoisting facilities, and the servicing records for these are up to date. There are also profiling beds, air mattresses and Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 20 other equipment, such as raised toilet seats, grab rails and handrails. There is a passenger lift between floors. Radiators have controlled low surface temperatures or have radiator guards. Water temperatures are checked monthly by the maintenance man to ensure that thermostats are working correctly. Window restrictors are in place. The home has a sluice on each floor with sluicing disinfectors. The laundry is situated on the ground floor, and has two washing machines and two dryers. The outside door is protected by a keypad lock. The laundry has separate areas for dirty laundry and clean laundry. All items are ironed by hand or with a roller iron. A red alginate bag system is used for soiled items. The home was seen to be clean in all areas, and generally well maintained. A housekeeper oversees all aspects of cleaning. There are usually three cleaning staff on duty – two on the ground floor and one upstairs, with an additional person on duty on some days to do extra duties (lampshades, skirting boards etc.). There is a separate laundry person on duty each day. Infection control is well managed in the home, and this is an improvement since the last report. There are alcohol gel dispensers prominently displayed around the home for all staff and visitors to use. A storage room on the first floor can be seen from the driveway when entering the building. This is a shame, as a large amount of stored equipment is visible, and detracts from the initial view of the home Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 21 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): 27-30 Quality in this outcome area is good. The home has a competent staff team, who deliver good standards of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are two nurses on duty in the home throughout the 24 hour period, with one for the ground floor and one for the first floor. There are five care staff on duty on the ground floor in the daytime, and four care staff for the first floor. Night duties include two care staff on the ground floor, and one on the first floor. These staffing levels can be increased if there are residents admitted with higher dependency levels. The floors mostly operate with dedicated staff for each floor, so that they are familiar with the needs of the residents, and can act as competent key workers for them. Agency staff are used if the home cannot meet the staffing needs with their own staff. The home has a contract with an agency, and is usually able to use the same agency staff who know the home, if agency are needed. Nine of the twenty-one care staff have completed NVQ 2 or 3 training, making this a percentage of 42.8 . There are another two working towards NVQ 2, and one doing NVQ 3. This will take the percentage over the 50 mark. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 22 All overseas staff are required to be sufficiently proficient in speaking English, before they are employed for care work. The home has a comprehensive induction programme, which includes mandatory training. There are two staff trained as moving and handling trainers, and the maintenance man and minibus driver are trained as fire wardens, and carry out all the fire training. All staff are trained in fire awareness, infection control, moving and handling, health and safety, POVA, communication skills, and customer care; and care staff and kitchen staff also complete basic food hygiene training. The staff training matrix was viewed, and confirmed that training is up to date. Nursing staff are enabled to carry out training for courses such as venepuncture, male catheterisation, and use of syringe driver for pain relief. Some nurses seemed less familiar than others with the illnesses that affect old age, and the provision for ongoing training (for illnesses such as Parkinson’s Disease, strokes, and diabetes), was discussed with the manager. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 23 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, & 35-38 Quality in this outcome area is good. The manager provides the staff with a clear lead in caring for residents effectively. Management procedures are well established, and the home is running smoothly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for nearly two years and is in the process of applying to CSCI for formal registration. She is a trained nurse, and has previously been a registered manager at another home. She has a visible presence in the home, and speaks to most residents nearly every day. She also works during some weekends, and visits the home at night sometimes. This enables her to take quick action in regards to anyone who expresses any Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 24 concerns. She leads the way with all of the staff team, and it was evident that they are confident in her leadership. There are excellent systems of auditing in place, covering all aspects of the home such as medication, domestic cleanliness, laundry, care plans, catering, caring, activities, infection control and involvement of relatives. The regional manager checks these each month. There are formal and informal staff meetings, so that staff can share their views easily. Relatives are invited to join in with entertainment such as concerts and buffets. This provides an opportunity to chat with them informally. The home is shortly holding an open afternoon for relatives to meet the new activities co-ordinator. Formal meetings are held two to three times per year, and residents meetings are held every two months. Residents and relatives can also make their views known via surveys if they wish, and these can be completed anonymously if preferred. A general survey is carried out once per year, and other, smaller, surveys are carried out as applicable – e.g. for activities, or for the food. The last survey had a 27 response, and 81 were overall satisfied with the way the home is running. The results will be discussed at the next relatives and residents meeting. An action plan is formed at each meeting for action to be taken before the next meeting. Residents’ pocket monies are stored in individual bank accounts, with a small amount of personal cash kept available. Each resident is given a statement each month. All transactions are recorded, and all receipts are retained. The home has a weekly “shopping trolley” for residents, and they appreciate being able to buy some of their own items. Staff members are given one to one supervision every eight to ten weeks. The manager gives supervision to heads of departments, and they delegate supervision down to other staff. Staff who are in their probationary period have monthly supervision – or even more frequently if needed. Policies and procedures are checked yearly by the company, and staff sign to state that they have read new or revised policies. Other records were seen to be well maintained, up to date, and stored so as to protect confidentiality. Maintenance records and fire logs are kept meticulously, and show that fire drills, fire training, health and safety and other mandatory training are kept up to date. An outside company services all medical equipment every six months. “PAT” training is done yearly, and electrical items brought into the home are given a visual check when new residents are admitted. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 25 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 3 3 3 2 3 3 3 3 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 2 3 3 X 3 3 3 3 Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 26 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. 1 Standard OP9 Regulation 13 (2) Requirement To improve medication storage, by: • ensuring that the clinical room is not overcrowded with items. • providing a larger Controlled Drugs cupboard; • ensuring that the room temperature is kept under the maximum recommended level of 25 degrees Centigrade. To ensure there are a sufficient number of bathroom or shower facilities available for the numbers of people in the home. Action needs to be taken to address the repairs and refurbishment needed with two identified bathrooms. To provide CSCI with an action plan, with timescales, for this work to be done, by the specified date. Timescale for action 31/07/08 2 OP21 23 (2) (b,j) 31/07/08 Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 27 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 OP8 Good Practice Recommendations To improve wound care documentation, by ensuring that each dressing change is documented in the care plan evaluation so that a clear pathway of progress for the wound can be followed; and by ensuring that details about the wound’s healing are more specific. To evidence how the Mental Capacity Act 2005 is applied to decision-making processes, including end of life care. To ensure that any allergies are highlighted in care plans. 2 3 OP16 OP31 To ensure that the complaints procedure is amended, so that it includes all of the required details. To ensure that the manager applies to CSCI for formal registration. Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Ashurst Park Care Home DS0000066424.V365206.R01.S.doc Version 5.2 Page 29 - 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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