Care Home: Ashwood Rest Home

What the care home does well The dietary assessments and the service users meals are well managed and meet with their satisfaction. What the care home could do better: The pre admission assessment was inadequate and does not ensure that the home can make an informed judgement relating to the service users needs and meeting them. The care plans and risk assessments including moving and handling, pressure ulcer risk and continence management must be developed for all the service users as appropriate. The development of risk assessments, care plans relating to people who are administering their medicine must be put in place. The standard of record keeping, relating to medication use, must be improved. The staff training and recruitment must be improved to safeguard the service users. The lack of risk assessments and action plan put the health and welfare of people using the service at risk of harm. The lack of up to date mandatory staff training put the service users at unnecessary risk of harm. There is a lack of clear management system to identify and take appropriate action to protect the health and safety of people using the service. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Ashwood Rest Home 10/12 Shirley Avenue Shirley Southampton Hampshire SO15 5NG zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anita Tengnah Date: 0 9 1 2 2 0 0 8 Information about the care home Name of care home: Address: Ashwood Rest Home 10/12 Shirley Avenue Shirley Southampton Hampshire SO15 5NG 02380780232 Telephone number: Fax number: Email address: Provider web address: gill@ashwoodcare.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Gill Miller care home 20 Number of places (if applicable): Under 65 Over 65 20 20 20 4 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 0 No more than 4 service users in the categories PD(E) May be accommodated at ony one time. Date of last inspection Brief description of the care home Ashwood is a registered care home providing personal care and accommodation for twenty older people over the age of 65 years. The home is owned and managed by Mrs Gill Miller, and provides a service to people with frailty of old age, mental health disorders, dementia and physical disability. The location of the home, in a residential Care Homes for Older People Page 2 of 17 Brief description of the care home area close to Shirley (a suburb of Southampton), means it is close to the local shops and amenities. The house is a large two storey residential property that has been extended at the back to provide further accommodation. There is a car parking available at the rear of the premises. The home has eight single and six double rooms and en-suite facilities are available in two of the double rooms only. There is a passenger lift for access to the upper floor. Care Homes for Older People Page 3 of 17 What we found: An unannounced inspection was carried out over one day on the 9th of December 2008. This was to follow up on the last visit in October 2008 where a number of requirements were made and to look at what action the registered person has taken in order to address the concerns and meet these requirements. The report also includes the unannounced visit following a Pharmacy inspection at the service on the 8th December 2008. The medication section of this report will reflect the Commissions Pharmacist findings. The areas that we did not assess during this visit and where requirements were made during our visit in October 08 will remain, this will be reviewed when we undertake our next announced visit to the service. We looked at the care records for two of the recently admitted service users to assess the pre admission process. The last visit required that the registered person to have in place a a thorough pre admission assessment of the service users needs prior to admission and them receiving care. The records we looked at showed that for one of the service users a detailed assessment was carried out on the day of the admission. The manager said that this person was transferred from another care home that was a long way out of county and had not visited the service user to carry out an assessment. However there was no information available about whether this persons previous home was contacted and information sought as part of this transfer. There was no care managers assessment in place ,as the manager stated that she had not received them. The manager also reported that the service users daughter had visited and had a long conversation with her. There was no record of these meeting at the service and as discussed records of all information gathered must be available in order to assist in making judgement prior to admission and providing care. The other service user was admitted from hospital. There was no care management assessment available for this person and the manager stated that she had requested this and has not received this as yet. There was no evidence that the home had carried out their own pre admission assessment for this person. We made repeated request to the manager for us to see the pre admission assessment , however this was not made available to us. As discussed at the time of the visit the assessments are important to look at the needs of the prospective service users and must consider compatibility in terms of those that are already accommodated. The registered person should confirm in writing how the home intends to meet the needs of the prospective service users following a detailed assessment. The manager reported to us that she had agreed to admit the service user prior to the placing agency concluding their financial agreement, and considered no payment in the interim as she was keen to fill the vacancy at the home. Care Homes for Older People Page 4 of 17 This requirement has not been met. The manager continues to fail to complete an adequate assessment of the service users prior to providing care in order to ensure that the home can meet their needs. We looked at a sample of three care plans as part of this visit. We found that some care plans had been developed and some basic information was available. The care plan for one of the service users showed that assistance was required to wash and dress. For continence management this asked staff to ensure adequate and correct pads are supplied and fitted. As discussed the care plans need further development to demonstrate action needed and details such as type and size of pads and the frequency that these need to be changed. The home has developed risk assessment for one of the service users that related to their dignity. One service user had assessment and information about moving and handling that indicated that a glide sheet was needed to move up the bed. We noted that these assessments had been recently completed as part of the development of care plans and risk assessments. The care record for another service user showed that there was a risk assessment for their moving and handling on the computer, however this was a generic assessment and did not reflect the service users needs or equipment available. The manager confirmed that there was no profiling bed in place, as reflected in the action plan required for this person. The manager is required to ensure that assessments and care plans accurately reflect the service users needs and action needed in order to meet their assessed needs. There has been some action taken in relation to care planning, however this is not fully embedded and sustained in practice. The provider was required to ensure that arrangements were in place for the safe management of medication including safe handling, recording, safe administration and disposal of medication at the service. Following the last visit we had serious concerns about the management of medication and a referral was made to the Commissions pharmacist to assess the medication management at the service. An unannounced visit was carried out by the pharmacist inspector on the 8th December 2008 and the findings are as follows. From the records and supplies of medicines in the home we could see that people do not always get their medicines at the dose and frequency that they are prescribed. Examples we saw included that one person had a medicine prescribed to be given four times daily but the records showed that it was being given five times daily. One persons medication administration record chart listed Paracetamol to be given at a dose of two tablets five times daily. The labelled supply for this person said that it was to be given at a dose of 1 or 2 tablets four times daily. The records showed that it had not been given five times daily. If staff were to follow the instructions on the chart then they would be giving an overdose. Another person had a medicine prescribed to be given at night only when required but Care Homes for Older People Page 5 of 17 the records showed that it was being given every night. This same person had another medicine prescribed as half a 50mg tablet to be taken at night. Their medication administration record chart listed one 25mg tablet to be given at night. Whilst this equates to the same dose there is still a risk of staff following the instruction to give one tablet and not realising the difference in strength between what is listed and what is available in the home. There is no record of the type of insulin prescribed and given to one resident. Nor is there any record of which carer prepares the insulin for the resident to inject. When the doctor makes any changes to medicine doses or frequency of administration these are written on the chart but there is no record of who made the changes or on whose authority. These failings put people who use this service at an unnecessary risk of harm. All medicines, including creams and ointments, are stored safely for the protection of people who use the service. Controlled drugs were not stored in a cupboard that meets the requirement of the law. Controlled drug records were checked and stock levels corresponded to the balance indicated in the register, though the register entry on two pages did not indicate the medicine being referred to. Staff on duty did not have access to the policies and procedures for the safe handling of medicines so these could not be assessed. It is of concern that staff did not have access to the procedures as this could lead to inconsistent practice between staff. The manager reported that two of the service users were administering their own medications such as Insulin and inhalers. There was no risk assessment in place for the service users self administering their medication and this must be developed and put in place. Risk assessment relating to another service user who had received agreement for keeping their cough medicine was not available. These were brought to the attention of the manager and must be developed. We observed the lunchtime medicine administration that two carers were carrying out. We found that one carer was dispensing and administering the medication and another carer was signing for these on the MAR sheets. The person who was dispensing and administering was not reading the instruction on the MAR sheets. This was brought to the attention of the manager during the visit and needs to be addressed. This requirement has not been met. The manager was required to take immediate action following the last visit to ensure that the service users privacy and dignity were promoted and preserved at all times. We noticed that a screen has been supplied that surrounded a service user. We spoke to the service user who they had been told that they must have the screen in order to protect their privacy and dignity, however this made them feel isolated. The service user reported that they like to leave their door open so that they can see people passing by. This was not possible with the screen around, and they were unable to see Care Homes for Older People Page 6 of 17 their photos that were displayed due to the screen. They were also worried that one of the service users keep coming into their room and may take their belonging. We were told that the manager was looking at a different screen that would be lower, however this must ensure the service users dignity is not compromised. Action has been taken, however this is not fully embedded and sustained in practice. We walked around the service as part of the visit. We did not detect any malodour when we looked around the home and some of the service users bedrooms. A random check of mattress cover showed that this were in a satisfactory condition. We found that two bedrooms had portable heaters that may pose unnecessary risk to the service users. The manager confirmed that the risk assessments were not available. Risk of these include trip hazards and the heaters getting very hot and posing burn risk. During our visit we observed one of the service users wandering into the kitchen where two saucepans were found boiling on the cooker. We spoke to this person who was confused and brought them back to the dining room. The kitchen was unattended at the time and this posed serious risk to the safety and welfare of the service user. Risk assessment relating to access to the kitchen and appropriate supervision of the service users must be in place to ensure they are not put at risk of harm. Following the last visit the manager was required to ensure that suitable arrangements were in place to prevent the spread of infection at the care home. At the time of the last visit they put in place hand washing facility in one of the communal toilet when this was brought to the managers attention. However they had failed to amend other areas. During this visit we found that three communal toilets did not have appropriate hand washing facilities in place. One communal bathroom also contained toiletries that could be used as communal and posing infection control risk to the service users. These were again brought to the attention of the manager. The registered person must consider all areas of potential cross infection risks and take appropriate action to safeguard the welfare of people accommodated at the home. We made requirements relating to the staff training and recruitment of staff following the last visit in October 08. The manager reported that the home had not employed any new staff since our visit. We looked at three staff records during this visit as the manager has responded to us and stated that the staff have Criminal Record Bureau( CRB) and POVA first checks. We looked at three staff records and identified that references were not always sought from the last employer. We found that one staff member had been employed without the appropriate Criminal Record Bureau CRB) check that the home is required to complete prior to employment. The CRB check related to an agency and not the care home where this person is employed. Care Homes for Older People Page 7 of 17 Another carer had been employed prior to their CRB clearance and there was no evidence that a POVA first check had been completed as this could not be found. We asked the manager for evidence of this several times and this was not provided to us. The recruitment of staff is not robust and puts the service users at unnecessary risk. The commission has clear information about the CRB requirement for registered services that the manager must ensure she is familiar with and follows the procedures. This requirement has not been complied with. The manager was required to ensure that staff had completed training appropriate to their work and ensuring to prevent unnecessary risks to the health and welfare of the service users. We looked at the training records for staff in particular to mandatory training in health and safety that the registered person must have in place for the protection of people using the service. We received a record of fire training during the visit that showed eleven staff had completed fire safety in March 08 and eleven in September 08. Information we have received indicated that other training included infection control in September 07 and and first aid that dated from March 02 and February 07. The manager gave us a training record matrix and this indicated that a number of staff had not received training and updates in moving and handling. We received conflicting reports about moving and handling training for staff, as the manager stated that this training was completed in June to July 08 when they had a new equipment. Other information was this training was completed in November 08 and the staff had not received their certificates. The record showed that some staff had not received training and updates in moving and handling as far back as May 02 and November 06. This requirement has not been complied with. The registered person was required to ensure that the home is conducted in a manner that prevents unnecessary risks to the health and welfare of the service users. We found that some assessments had been developed, however this must be in place for all the service users. A robust pre admission assessment is lacking to ensure that the home can demonstrate they are able to meet the needs of the service users prior to admission. The medication management at the home remains inadequate and put the service users at risk of harm. The continued lack of risk assessments for portable heaters, access to the kitchen, infection control procedures and the staff training in the safe moving and handling put the service users at risk of harm to their health and safety. Care Homes for Older People Page 8 of 17 The registered person must ensure that actions as required are taken to ensure that the home is conducted in a manner that does not put the health and welfare of the service users at risk. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person must 15/12/2008 ensure that a thorough pre admission assessment of the service users needs have been completed prior to admission and them receiving care. So that you can ensure that the assessed needs of the person can be met and people are not put at risk of their needs not being met. 2 7 15 The registered person must 30/11/2008 ensure that individual care plans are developed for the service users to show how their needs in respect of health and personal care are to be met by the home. So that you can ensure that they receive appropriate care at all times to meet their assessed needs. 3 8 12 The registered person must ensure that the home is conducted to make proper provision for the health and welfare of people using the service. This must include risk assessments for pressure ulcers and skin integrity, continence and moving and handling. 30/11/2008 Care Homes for Older People Page 10 of 17 So that you can ensure the service users are not put at risk of harm. 4 9 17 The registered person must ensure that arrangements are in place for the safe handling, recording, safe administration and disposal of medicines in the care home. So that the service users are not put at risk of harm. 5 10 12 The registered person must 30/11/2008 make suitable arrangements to make sure that the service users privacy and dignity are promoted and preserved at all times. So that people receive care in a respectful manner and are not harmed. 6 18 12 The registered person must ensure that the home is conducted in a manner that promote and make proper provision for the health and safety of the service users. Records as required by Regulations are maintained. So that the service users are not put at risk of poor care and abuse. 7 19 13 A programme of 30/11/2008 refurbishment must be in place to ensure that the service users are provided with a well maintained, clean and safe environment. So that the home is in good state of repair and meet their needs. 8 26 13 The registered person must ensure that suitable 30/11/2008 30/11/2008 30/11/2008 Care Homes for Older People Page 11 of 17 arrangements are in place to prevent the spread of infection at the care home So that people using the service are protected. 9 29 19 The registered person must ensure that all necessary staff checks are completed prior to employment. So that the service users are not put at unnecessary risk of poor practice and abuse. 10 30 18 The registered person must ensure that staff employed receive training appropriate to their work. Records of these must be available. So that people living at the home receive appropriate care for their health and welfare. 11 31 12 The registered person must ensure that the home is conducted at all times in a manner that safeguards the health and welfare of the service users. So that you can ensure that people receive the care they deserve. 12 35 17 The registered person must 30/11/2008 ensure that records of all transaction undertaken on behalf of the service users are available at the home for inspection So that the financial interests are safeguarded. 13 37 17 The registered person must ensure that reports as required by regulations are sent to the commission 30/11/2008 30/11/2008 30/11/2008 30/11/2008 Care Homes for Older People Page 12 of 17 So that you can ensure that the rights and interests of the service users are best safeguarded. 14 38 13 The registered person must ensure that the home is conducted in a manner that prevents unnecessary risks to the health and welfare of people using the service. So that you can ensure that care is provided in a safe environment with staff who have been trained and are skilled. 30/11/2008 Care Homes for Older People Page 13 of 17 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 3 14 The registered person must 19/01/2009 ensure that a thorough pre admission assessment of the service users needs have been completed prior to admission and them receiving care. So that you can ensure that the assessed needs of the person can be met and people are not put at risk of their needs not being met. 2 7 15 The registered Person must ensure that individual care plans are further developed for the service users to demonstrate how all their needs in respect of health and personal care are to be met by the home. So that you can ensure that they receive appropriate care at all times to meet their assessed needs 19/01/2009 3 8 12 The registered person must ensure that the home is conducted to make proper provision for the health and welfare of the service users. 22/01/2009 Care Homes for Older People Page 14 of 17 So that people are not put at risk of harm through lack of assessments. 4 9 13 Controlled Drugs, including Temazepam must be stored in a Controlled Drugs cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. To comply with the law 5 9 13 Complete and accurate records must be kept of all medicines given to people. To show that people get their medicines correctly. 6 9 13 Staff must have access to clear and comprehensive policies and procedures for the receipt, recording, storage, safe handling, administration, selfadministration and disposal of medicines, specific to the homes current practices. To ensure that staff follow current best practice. 7 26 13 The registered person must 22/01/2009 make suitable arrangements to prevent the spread of infection at the care home. So that the service users are protected . 8 29 19 The registered person must ensure that all necessary staff checks are completed prior to employment. So that the service users are protected from the risk of poor practice and abuse. 22/01/2009 22/01/2009 15/01/2009 20/02/2009 Care Homes for Older People Page 15 of 17 9 30 18 The registered person must ensure that all staff employed receive training appropriate to their work. So that service users receive the right care as required for their health and welfare. 22/01/2009 10 31 12 The registered person must ensure that the home is conducted in a manner that safeguards the health and welfare of the service users So that people receive the care they deserve in a safe manner that protects them from harm. The registered person must ensure that the home is conducted in a manner that prevents the unnecessary risks to the health and welfare of the service users. So that you can ensure that care is provided in a safe environment , with staff having the necessary training and risks are identified and action put in place 22/01/2009 11 38 13 22/01/2009 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 It is strongly recommended that when it is necessary to handwrite on a medication administration record chart in the home that the member of staff writing the chart signs and dates the chart and that a second carer checks the entry for accuracy and then initials the chart. In addition the entry should include a reference to where this information was sourced, such as the name of the prescriber. Care Homes for Older People Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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