Care Home: Ashwood Nursing Home

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What the care home does well Those residents and visitors who we spoke with said they were very satisfied with the care and service provided by the home. No one had any complaints about the home. All residents were thoroughly assessed before entering the home and given information and involved in their admission. People living in this home were well cared for and supported by a well managed, educated, committed and competent care team. There was a recreational and activity programme provided which provided stimulation. There was a thorough assessment and review of care with wherever possible resident and relative/family involvement. There was a comprehensive programme of education provided which ensured that staff knew how to care and support people living in the home. This has meant that 99% of care and nursing staff have recognised qualifications. People living in the home lived in clean, well decorated, safe and attractive accommodation. Before a new person enters the home the bedroom is redecorated where required. What has improved since the last inspection? Ten new special profile beds have been purchased to make residents confined to bed because of frailty more comfortable. A new call system has been installed which has improved the way residents can ask for help. A named nurse system has been introduced to allow nurses to have responsibility for a number of people and make the care more personal and person centred. Link specialist nurses have been introduced to give improved clinical care and approaches to people living in the home. A new large plasma television has been provided in the lounge. What the care home could do better: There were no requirements from this inspection. There is a very clear quality assurance system and improvements are identified by the manager, staff andowners. An example being the improvement taking place in making the rear garden more attractive and accessible for people living in the home. CARE HOMES FOR OLDER PEOPLE Ashwood Nursing Home 43 Spalding Common Spalding Lincolnshire PE11 3AU Lead Inspector Tobias Payne Key Unannounced Inspection 4th July 2007 08:10 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 Ashwood Nursing Home DS0000002530.V340373.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. Ashwood Nursing Home DS0000002530.V340373.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood Nursing Home Address 43 Spalding Common Spalding Lincolnshire PE11 3AU 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) 01775 723223 01775 713763 www.countrycourtcarehomes.com Country Court Care Homes Ltd Mrs Suria Kumari Webb Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31), Physical disability (31) of places Ashwood Nursing Home DS0000002530.V340373.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Additional Conditions of Registration (NEW) The registered person may provide the following category of service only: Care Home with Nursing (N) to service users of the following gender: Both whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Physical Disability (PD) Maximum Number: The maximum number of service users who can be accommodated is: 31 19th July 2006 2. Date of last inspection Brief Description of the Service: Ashwood Nursing Home is a care home registered to provide nursing and personal care for up to 31 elderly people. On the day of the inspection there were 24 people receiving nursing and 6 personal care. The home is situated on the outskirts of the town of Spalding approximately 1½ miles from the centre of the town. The building was converted for its current use in 1997 and accommodation is on the ground and first floors. The first floor is served by a stair lift. Most of the accommodation is provided in single bedrooms with one shared bedroom on the first floor. All bedrooms have en-suite facilities. There is limited car parking to the front of the home. The home has gardens and lawns to the front and rear of the property. The fees at the inspection on the 4/7/2007 ranged from £380 to £550. Extras were for hairdressing which range from £6 to £25, chiropody £6, toiletries, personal newspapers and magazines. The statement of purpose, service user’s guide and all information about the home can be found in the entrance foyer in the home. Ashwood Nursing Home DS0000002530.V340373.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 8.10 am. It was undertaken using a review of all the information available to us about Ashwood Nursing Home. We spoke with 13 residents, 6 visitors, 6 staff and the deputy manager and manager. Feedback was given to a representative of the owner. 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. We also examined the Annual Quality Assurance Assessment, which had been completed by the manager and 5 comment cards we had received. What the service does well: What has improved since the last inspection? What they could do better: There were no requirements from this inspection. There is a very clear quality assurance system and improvements are identified by the manager, staff and Ashwood Nursing Home DS0000002530.V340373.R01.S.doc Version 5.2 Page 6 owners. An example being the improvement taking place in making the rear garden more attractive and accessible for people living in the home. 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. Ashwood Nursing Home DS0000002530.V340373.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 Ashwood Nursing Home DS0000002530.V340373.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, 3, 4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People coming into the home receive an assessment and know their needs can be met. There is information provided to enable them to make a decision whether or not to come into the home. EVIDENCE: Since the last inspection the statement of purpose and service user’s guide had been reviewed and each person was given a handbook about the home when being admitted. Both documents were in large print and explained clearly about all the services in the home. A copy was placed in each bedroom. This information was also available in the entrance foyer to the home. Each person was assessed by the manager before coming into the home and written confirmation was sent to them that based on this assessment the home could meet all their assessed needs. We spoke with 2 residents who had been recently admitted to the home. They confirmed that they had been assessed. One commented, “ I was told about the home and invited to see the home. The manager answered all my questions and I was welcomed when I came here”. A survey carried out by the home had the Ashwood Nursing Home DS0000002530.V340373.R01.S.doc Version 5.2 Page 9 following comment, “we received a brochure and staff gave a lot of information and answered all our questions”. The home did not provide intermediate care. Ashwood Nursing Home DS0000002530.V340373.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. The general health and welfare of residents is addressed. Procedures relating to the delivery of personal care are efficient. Medication is safely given by staff who know what they are doing. EVIDENCE: All residents had detailed and clearly written care plans, which described their health and welfare needs. Care records included assessment of daily living activities, medication, nutrition, weight, admission details including a photograph for identification purposes, moving and handling assessment, risk assessment, care plan and daily report. We examined 2 resident’s care plans. There were clear records outlining their care and welfare needs. Efforts have been made to include residents wherever possible in identifying their care needs and being involved in reviews of their care. Their signatures showed this. Care plans were up to date and reviewed. The manager also carried out monthly audits. Ashwood Nursing Home DS0000002530.V340373.R01.S.doc Version 5.2 Page 11 The residents and visitors we spoke with all felt staff knew about their needs and were satisfied with the care and approach of staff. All staff received training about privacy and dignity during their induction. We saw staff attending to people promptly, quietly and sensitively. Comments were, “If I need any help it is there”, “everyone is so helpful and friendly” and “staff always knock on my door and are sensitive about my privacy and dignity”. The last pharmacy inspection was on the 29/4/2007. There were no concerns. Nurses were responsible for the administration of medication. The manager had assessed each person and records confirmed this. The manager also carried out a monthly audit of medication. There were no concerns about the medication arrangements. The home had established link nurses for tissue viability, continence and infection control and met up with other nurses to promote up to date practice in consultation with Lincolnshire NHS Primary Care Trust. Ashwood Nursing Home DS0000002530.V340373.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. Resident’s social and cultural needs are met at the home. Activities are provided by the home. There was a variety of nutritious food provided. Visitors were made to feel welcome. EVIDENCE: Staff provided activities in the home. There was a written activities programme. This was on notice boards throughout the home and a copy was placed in each bedroom. The manager also had meetings twice a year with residents. A recent birthday had been celebrated and there were balloons in the lounge. Activities included board games, music and gentle exercises, Bingo, cheese and wine, reminiscence, video afternoons and outside entertainment. Residents were also assisted with shopping and library books were available. A church service also takes place. Residents also were given choice about how they spent their lives. We spoke to 6 visitors all of whom were very complimentary about the home. Comments were “we can visit whenever we wish and always receive a warm and friendly welcome and are offered refreshments”, “we are kept fully informed” and “Mrs Webb is so helpful”. Ashwood Nursing Home DS0000002530.V340373.R01.S.doc Version 5.2 Page 13 The last Environmental Health Officer’s inspection by South Holland District Council was on the 27/9/2006 and as a result the home was awarded 3 tulips excellent award for its catering service. The award was displayed at the entrance to the home. There was a set menu but an alternative was available if a resident did not like what was on the menu. Lunch was observed in the dining room, which was nicely decorated with residents having lunch attended by care staff who served food in a discreet manner. The cook served food from a hot trolley. No resident had any complaints about the food and it was well served and residents were not hurried. The menu was displayed on the wall. Comments were, “food is excellent” and “I have put on weight since I came here which was what I wanted to do”. The manager made monthly audits of the kitchen. Ashwood Nursing Home DS0000002530.V340373.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 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to make a complaint and feel that staff will listen to their views. Staff are aware of how to respond to a complaint or an adult protection allegation. Residents are protected from abuse. EVIDENCE: There was a complaints procedure displayed at the entrance to the home and each person received a copy of this in the service user’s guide handbook. The home had received no complaints since the last inspection. We received an anonymous complaint on the 9/5/2007. There were concerns about the number of foreign staff in the home and that some staff had poor communication skills. We sent it to the management to investigate and their report showed no evidence to support any of the issues. It was acknowledged that there were a large amount of foreign staff employed. However no one had any concerns about this and the home had provided training on communication. Comments made were, “although we have a lot of foreign staff they are all very helpful and polite”. No one had any complaints about the home during the inspection. Staff were correctly recruited with an application form, references obtained, and induction. A member of staff confirmed she had been recruited with a criminal records bureau check and a well supported induction. Staff knew about abuse and their role and training had been provided for all staff on abuse prevention in 2007. Ashwood Nursing Home DS0000002530.V340373.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. Residents lived in clean, well decorated, homely and safe accommodation. Any maintenance was promptly addressed. EVIDENCE: The home was clean, tidy, well decorated and odour free throughout. There was a decoration and maintenance programme. There were lounge and sitting areas throughout the home. All the residents and visitors we spoke with were very satisfied with the accommodation and said how much they liked their bedrooms and accommodation in the home. Comments were, “my clothes are returned the same day” and “my room is very comfortable and the home immaculate”. There were infection and clinical policies, gloves and aprons and there were alcohol rubs throughout the home in dispensers. The rear garden was to be Ashwood Nursing Home DS0000002530.V340373.R01.S.doc Version 5.2 Page 16 developed in the future with a summer house with an accessible pathway and seating areas. Gardens to the front and rear were well maintained. Ashwood Nursing Home DS0000002530.V340373.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 excellent. This judgement has been made using available evidence including a visit to this service. Residents are protected by robust recruitment practices. Residents benefit from a staff team who are well trained and work well together and compliment each other’s skills. Residents are protected by robust recruitment practices. EVIDENCE: All staff spoke of working as a team. Staff residents and visitors felt there were sufficient staff in the home. The manager monitored dependency and was able to employ more staff where required. There were separate staff for catering, domestic, laundry and gardening/maintenance. Each member of staff had a detailed and supported induction and annual appraisal. There was a training programme for 2007 with training each month. This had covered moving and handling, medication, catheterisation, tissue viability and dementia care. Future training would cover abuse, managing challenging behaviour, moving and handling, care planning, first aid and fire safety evacuation. There were 99 of care, nursing and catering staff who had recognised qualifications. The home was a placement for nurses from other countries outside the European Union undertaking an adaptation programme to be registered by the Nursing and Midwifery Council and nursing students. The home was awarded the Investors in People award in 2005. Staff commented,” I have received a lot of training”, “the manager is very Ashwood Nursing Home DS0000002530.V340373.R01.S.doc Version 5.2 Page 18 supportive” and “the manager has supported and given me the confidence to develop my skills”. Ashwood Nursing Home DS0000002530.V340373.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 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home ensures that that the residents have the opportunity to voice their views and opinions. Feedback from questionnaires is made available to residents/visitors. Accurate records are kept. Residents benefit from the positive leadership and commitment of the manager and staff. EVIDENCE: The manager was a registered nurse who had extensive nursing, teaching and managerial experience. She was also an assessor. She was supported by an experienced deputy manager. Staff, residents and visitors had confidence in the manager. Staff received supervision regularly and spoke of the support received from the manager and deputy manager. There was a very good quality assurance system developed. Each resident received a questionnaire to learn of their views 3 months after arriving in the Ashwood Nursing Home DS0000002530.V340373.R01.S.doc Version 5.2 Page 20 home and then a further questionnaire was sent after 4 to 5 months. We looked at 13 completed questionnaires. There were no negative comments. Specific comments were, “meals are very nourishing and cater for own preferences”, “staff very helpful”, happy with the food choices”, “we were made to feel welcome”, “most grateful and satisfied” and “first rate all round”. The latest survey was displayed at the entrance to the home. Also on a notice board were letters thanking staff for their care and support. There were also established internal audits every month of care practice, medication and the kitchen. There were monthly monitoring visits by a representative of the owners. Each person received regular supervision and records were kept. The home had detailed policies and clinical procedures, which were reviewed on the 18/7/2006. Records examined were well maintained, available for inspection and up to date. There was a detailed equal opportunities policy, which referred to discrimination, disability, victimisation, race and sexual equality. The manager had been on recent training about the Mental Capacity Act 2005. Information from the home acknowledged that there were foreign staff and it was their intention to recruit more local staff. However there was no indication that the residents were dissatisfied with the communication or skills from staff. Comments were “I am very satisfied”, “If I need help to is there”, “everyone is so helpful and friendly” and Suria is gorgeous”. There were no concerns about equality and diversity. The home had detailed health and safety procedures. There were also infection control policies and staff made use of alcohol hand rub dispensers throughout the home to further prevent infection. Where required risk assessments had been carried out and documented. Ashwood Nursing Home DS0000002530.V340373.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 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 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 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X X X X 3 Ashwood Nursing Home DS0000002530.V340373.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashwood Nursing Home DS0000002530.V340373.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 Ashwood Nursing Home DS0000002530.V340373.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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