Ashdene Court Care Home Service Ferntower Road Crieff PH7 3AL Telephone: 01764 652174 Type of inspection: Unannounced Inspection completed on: 23 February 2018 Service provided by: Ashdene Management Services Ltd Service provider number: SP2003002107 Care service number: CS2004066655
About the service we inspected Ashdene Court is registered to provider care for a maximum of 24 older people living with dementia. the service also provides respite and short breaks. The home is owned and operated by Ashdene Management services Ltd. The home is a modern two-storey building with enclosed garden areas. Residents' rooms are located on the ground and first floor, with the residents' lounge and dining room on the ground floor. A passenger lift provides access for those with impaired mobility. The home provides residential care, which is aimed at maintaining 'an optimum level of wellbeing for each resident, and focused on person-centred care'. The service has been registered with the Care Inspectorate since April 2011. How we inspected the service We wrote this report following an unannounced inspection. This was carried out by one inspector on 23 February 2018. This was the second unannounced inspection for this service since 1 April 2017. During this inspection we focussed on the progress the service had made since the last inspection. During the inspection, we gathered evidence from various sources. We spoke with people using the service, a relative who was visiting and staff working in the service. We looked at care plans, staff training information, accidents and incidents, information and analysis. We also looked at audit records and adult protection procedures and guidance for staff. We observed staff practice and presence within the main areas of the home. Taking the views of people using the service into account People living in the service told us they were happy with the care they received. Comments included: "People are so nice" "They are all so kind" "You couldn't find nicer people" "I can't complain about the food" "They are all lovely" "You couldn't wish for kinder people. They are salt of the earth" "I'm quite happy" "Staff are nice to me" "I'm happy enough" "The food and the staff are fine" page 2 of 9
Taking carers' views into account A relative who was visiting during the inspection told us they felt things were getting better. The new manager was trying to make some improvements and that generally they were happy with the home. What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 In order to make proper provision for the health, welfare and safety of service users, the provider must develop, implement and regularly review appropriate procedures for pain management. This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) Regulation 4(1)(a) welfare of service users Timescale 31 December 2017 This requirement was made on 10 November 2017. Action taken on previous requirement A more effective procedure for managing peoples' pain had been developed and implemented. This was being reviewed as part of the provider's system of quality assurance. People's care plans and risk assessments had been reviewed and updated to provide guidance for staff on how to manage the person's pain appropriately. Care plans provided a strong level of information for staff on how to know when the person may be in pain. This included any gestures, non verbal and body language. Pain assessment tools were being used to identify, assess and effectively manage peoples' pain. This was particularly useful for people who could not say when they were in pain. The service should make sure the information from the completed pain assessment, and any actions taken, should be included in the person's care plan. Pain assessments provide a more accurate assessment if completed during or immediately after the person is active. Staff had a better understanding of how pain can impact on peoples' behaviour. This enabled them to provide appropriate support to people. Met - within timescales Requirement 2 In order to make proper provision for the health, welfare and safety of service users, the provider must develop, implement and regularly review appropriate adult protection procedures. page 3 of 9
This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) Regulation 4(1)(a) welfare of service users Timescale 31 December 2017 This requirement was made on 10 November 2017. Action taken on previous requirement The provider had reviewed and updated the service policy and procedures in relation to adult protection. Accidents and incidents had been appropriately reported to the Care Inspectorate and Local Authority following reporting guidelines. Accident and incident records showed appropriate actions had been taken by the service following these. Actions taken to prevent recurrence were also recorded. The provider completes a monthly audit to check all accidents and incidents had been notified to the appropriate authorities. The audit tool should be reviewed to include confirmation that the actions taken immediately following an accident or incident, and any follow up actions, were appropriate. Met - within timescales Requirement 3 The provider must ensure that service users' care plans provide comprehensive information on how the service users' health and welfare needs are to be met. This must include: (a) Care Plans and risk assessments reviewed as indicated in the plan (b) Plan in place to manage identified risks (c) Appropriate identification and assessment of pain for people with limited verbal communication (d) Risk assessments for people using equipment classed as restraint This is in order to comply with The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) Regulation 4(1)(a) welfare of service users and Regulation 5: Personal plans Timescale: to be completed by 30 November 2016. This requirement was made on 27 October 2016. Action taken on previous requirement The service had reviewed and redeveloped peoples' care plans and risk assessments. These now contained a greater level of information and guidance on what people can do for themselves, and the support they required from staff. Care plans and risk assessments were regularly reviewed. Where a risk was identified, a plan was in place to manage the risk. Pain assessments were being regularly completed to identify when people may be in pain. These were particularly useful for people who were unable to say when they were in pain. page 4 of 9
Risk assessments were being used for any equipment which is classed as restraint. This included consent from the person or their relative. Information was provided to show this was the least restrictive action available. Met - outwith timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 Protocols should be used to provide guidance for staff when people are prescribed 'as required' medication. These should provide guidance on what to do before the 'as required' medication is administered. National Care Standards - Care homes for Older People - Standard 5: Management and Arrangements This recommendation was made on 8 January 2018. Action taken on previous recommendation A procedure was in place for medications which were prescribed for people 'as required'. The service had developed 'as required' protocols to provide guidance for staff on when to administer medication prescribed on an 'as required' basis. The protocols provided appropriate guidance for staff on the circumstances these medications should be administered, and what to try before administration. This recommendation had been met. Recommendation 2 The service should access the Mental Welfare Commission (MWC) document 'Rights, Risks and Limits to Freedom' which would provide guidance for staff. National Care Standards: Care Homes for Older People - Standard 5 - Management and staffing arrangements, and Standard 4 - Your environment This recommendation was made on 8 January 2018. Action taken on previous recommendation The service had obtained copies of the MWC guidance 'Rights, Risks and Limits to Freedom'. These were available for staff. Risk assessments and consents were in place for equipment classed as restraint. page 5 of 9
Training had been provided for staff on 'Non-Physical Interventions'. This included guidance on providing appropriate person centred interventions. This recommendation had been met. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 10 Nov 2017 Unannounced Care and support 2 - Weak Management and leadership 2 - Weak 20 Mar 2017 Unannounced Care and support Management and leadership 23 Sep 2016 Unannounced Care and support Management and leadership 13 Sep 2016 Re-grade Care and support Management and leadership page 6 of 9
Date Type Gradings 16 Mar 2016 Unannounced Care and support Management and leadership 5 Oct 2015 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 17 Mar 2015 Unannounced Care and support 2 - Weak 2 - Weak Management and leadership 2 - Weak 30 Oct 2014 Unannounced Care and support 2 - Weak Management and leadership 16 Oct 2013 Unannounced Care and support Management and leadership 17 Oct 2012 Unannounced Care and support Management and leadership 21 Feb 2012 Unannounced Care and support Management and leadership 16 Dec 2010 Unannounced Care and support Management and leadership page 7 of 9
Date Type Gradings 1 Jul 2010 Announced Care and support Management and leadership 9 Dec 2009 Unannounced Care and support Management and leadership 12 Jun 2009 Announced Care and support Management and leadership 4 Mar 2009 Care and support Management and leadership 15 May 2008 Announced Care and support Management and leadership page 8 of 9
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 9 of 9