Inspection on 06/08/09 for Ashwood

This is the latest available inspection report for this service, carried out on 6th August 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Ashwood 34 Woodfield Crescent Kidderminister Worcestershire DY11 6TU Lead Inspector Sally Seel Key Unannounced Inspection 6th August 2009 08:15 Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood Address 34 Woodfield Crescent Kidderminister Worcestershire DY11 6TU 01562 741455 01299 896531 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) Coseley Systems Limited Mr Paul Sankey Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 5 Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) the service users of the following gender: Either Whose Primary care needs on admission to the home are within the following categories: Learning Disabilties (LD) 8 Physical disabilties (PD) 8 the maximum number of service users to be accomodated is 8. 2. Date of last inspection 12th August 2008 Brief Description of the Service: SUMMARY This is an overview of what the inspector found during the inspection. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 6 e quality rating for this care home is two star – good service, which means that the outcomes for people using this service are good. This was an unannounced key inspection that took place over one visit on the 6th August 2009 from 08:15 until 18:00. The purpose of this inspection is to look at all areas of the service to ensure that the outcome for people living there is good, safe and appropriate. This inspection also enables us to ensure that the service runs according to legislation and regulations. During these visits we case tracked two people, this involves reading their records, discussing their care with staff, visiting each person and discussing their experiences where possible. We also looked at policies and procedures related to safeguarding, concerns and complaints and medication. Discussions with the registered manager and some care staff took place. Where appropriate information from these discussions have been referred to in this report. Also any comments that we have received from surveys completed by family members, health professionals and staff are also documented in this report. During the process of the inspection we viewed a variety of areas of the home including the kitchen, laundry and the communal and some private rooms of the people who live there. The management team are working hard with staff in the home to make improvements to the delivery of care and to ensure that the outcomes for the people living there are good and safe. We would like to take this opportunity to thank people who live at this home, staff and the registered manager for assisting us in our inspection and making us feel welcomed on the day we visited. What the service does well: People are provided with opportunities to participate in appropriate activities and have a holiday if they want. The people living there have regular health checks and health professionals are involved in their care to help make sure that their health needs are met. Medication practices in the home are good which mean people are having support to take their medications as prescribed and at the right times. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 7 All the people living at Ashwood have bedrooms that are all very different, some shared and some single, and each person’s room contains the things that are important to them. The staff help people to stay in touch with family and friends. This is in person, by phone and by letter. The commitment of staff to helping people with this is commendable. Staff give support with warmth, friendliness, patience and treat people respectfully which was noted on the responses from relatives. The style of management in the home is relaxed, open and inclusive, and although at times the registered manager struggles with some aspects of running the home they are making clear efforts to develop the service for the benefit of the people living there. The manager is also to be commended for their commitment to people who live at Ashwood. Feedback from some relatives was very positive indicating they were very pleased with the care, felt that residents were looked after in a small caring environment. We also received positive feedback from health care professionals, one who said the home is excellent. What has improved since the last inspection? The statement of purpose has now been updated so people have up to date information. There are now some details of the ways in which individuals communicate to aid staff in their understanding when speaking with people who live at the home. Daily records are now maintained separately so that individual’s personal details are kept private. All care plans have been reviewed and updated so that staff can work to up to date information when meeting individual’s needs. All risk assessments have been updated as required to make sure everyone is kept safe. Health action plans are now in place. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to access. Routine dental appointments are made to make sure everyone has regular checks. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 8 Each person’s medication listed in their care plans have a date when people start to take it, when there are any changes, and when the medication is stopped. This makes sure all records are correct. We were assured that money is available so staff can buy what is needed and we saw staff give individuals their monies to go shopping. A dishwasher has now been purchased which should make sure all dishes are washed cleanly. The registered manager has now developed a staff training planner which now needs to be maintained so that training courses and staff development is planned. The staff training planner shows that staff are receiving mandatory training and highlights where refresher courses are required so that these can be planned in a timely manner. The registered manager is now ensuring that staff support with regular supervision and staff meetings so that everyone works together and in the same way. The gas safety certificate has been renewed and is now in date so that people can be confident that their safety is maintained whilst living at Ashwood. Regular fire drills are now being done to help keep people living and working at Ashwood safe if there was a fire but the registered manager needs to ensure that this is consistently done in the future. What they could do better: The statement of purpose and service user guide now needs to be readily accessible in a variety of formats to aid peoples understanding of the contents when making their decisions. Considerations should be given to further development of care plans into formats that facilitate the involvement of the person so that they are able to ‘have their say’ on how their individual needs are met. Personal care should be delivered with individuals participating in plans that confirm their choices and preferences in relation to specific gender care and the times that suit them with their signed and dated agreement or their representatives. Some considerations to further development of communication plans to facilitate staff understanding of peoples different styles of communication, particularly the use of aids, such as, pictures, photographs and symbols. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 9 To involve people in menu planning by using pictures and photographs to enhance individual’s choices, levels of independence and valuable life skills. People should be weighed on a regular basis to ensure that any underlying medical conditions are ‘picked up’ at an early stage. Staff should receive some training in the Mental Capacity Act and Deprivation of Liberties Safeguards so that they have the awareness and knowledge to protect the ‘best interests’ of vulnerable people who live at this home. The AQAA told us that the registered manager intends to improve the home in the following ways over the next 12 months: • • • • • • • • • • • • • • • Launching the website. An improved user friendly pre-admission assessment proforma which will be symbolised or symbolised electronically with audio etc. Service User care plans to be tried in a symbolised format as an option to become even more person centred and individualised and to further encourage ownership etc. Further educational opportunities for Service Users. Possible work opportunity for one service user via local employment scheme. To ensure care plans and health action plans are regularly reviewed and updated. Further training in challenging behaviour provided by behavioural support team. Staff to be encouraged to document all complaints made. External fire escape and Manager’s office planned. Bathroom to be redecorated as well as service users bedrooms. Staff supervision planned and to involve Deputy Managers. Deputy Managers to undertake Level 4 Leadership and Management training. Annual Development Plan to be followed and maintained to enable continuous improvement. Office to be provided to enable privacy re: supervisions etc and to provide a suitable working environment for Manager More storage space to be made available by destroying old documents and general housekeeping Documents to be scanned and kept electronically and securely for quicker access. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. People using the service experience good quality outcomes in this area. Information about what the service provides is available, which now needs to be made readily available in the updated versions and developed into different formats. This will help people make an informed choice about whether or not the service is right for them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is a statement of purpose and service user guide but on asking staff they could not find these information guides. Therefore we recommend that both the statement of purpose and service user guide are placed in accessible areas within the home such as by the front entrance door where the visitors signing in and out book is kept. This will make sure this information about the home is to readily available. The Annual Quality Assurance Assessments, (AQAA), told us, ‘We have up to date Statement of Purpose and Service User guide which is also symbolised’. However, we found the statement of purpose has been recently reviewed and has been updated by the registered manager. The statement of purpose Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 12 shows what it is like to live in the home, what services and facilities are provided to meet individual’s needs, the management team and staffing details. The service user guide is currently being updated but the registered manager showed us an old copy of this which uses pictures and symbols to make certain people are able to read and understand its contents. The service user guide is a summary of the statement of purpose which includes people’s rights and responsibilities together with the home complaints procedure. Both the statement of purpose and the new service user guide are not as yet readily available in alternative formats, such as, large print, audio visual and or using pictures and symbols to illustrate the written word. The registered manager said that they are going to ensure that the new service user guide is available in other formats. This is important as people living in the home and others who may consider living there would not be able to read and understand the statement of purpose in the format we were shown. Therefore we recommend that the statement of purpose and service user guide are made readily available so that staff can produce these in alternative formats. The statement of purpose confirms, ‘Ashwood is a residential care home for adults with learning disabilities aged between 18 and 64’. It also informs us that people only come to live at Ashwood once their needs have been assessed by a social worker, current carer or representative. We found care plans and risk assessments in the care records that we looked at so that staff had information about each person living at the home to ensure their care and health needs would be met. The statement of purpose also tells us that people are invited to visit the home to meet the other people who live there. The AQAA confirms this, ‘Arrangements can be made for visits and short trial stays’. There have been no new admissions to Ashwood since our last inspection and therefore we could not fully assess this outcome area. The statement of purpose informs us that eleven staff are employed at the home to provide care and support to the three females and five males currently living at the home. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. People using the service experience good quality outcomes in this area. Care plans have been updated to show assessed and any changes in peoples needs. Individuals are being supported to take some risks and they are being consulted about some decisions that affect their lives. The level of their involvement in planning their support, goals and ambitions needs to be increased. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We case tracked two people who live at the home to see if there was sufficient information about peoples needs to guide staff in providing care and support to each person. Each person has a care plan which identifies their care and health needs so that staff are able to provide the level of assistance and or support to each person living at Ashwood. For example, we found care plans to meet people’s needs in personal care, finances, behaviour, sexuality, health Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 14 and activities. Relatives made positive comments about the care provided by the home; this included ‘They seem aware of her needs’ and ‘If she wants to speak to me they facilitate this. I think they show great patience’. Positive comments were also made by a health professional about how well organised the home seems to be. In one of the care records we sampled we saw plans in relation to this person’s communication styles. The need to communicate in a certain way is included in the plan e.g. ‘use simple key words and limit the number of choices offered’. This was good to see as at the time of the last inspection it was recommended that there is some guidance for staff to follow so that they have some understanding of individual’s different ways of communicating. This area could be developed much further using symbols and computer images to help facilitate understanding and choice making opportunities for the less able people who live in the home. We also noted from the training planner that staff have not completed any communication training which may help in improving communication plans. Following the homes last inspection a requirement was made to regular review and update care plans as changes in peoples needs occur. The registered manager confirmed in their AQAA, ‘Service User Plans have all been rewritten, reviewed and kept up to date’. The care plans we sampled were dated March and May 2009, which shows that these have been updated. Further improvements need to be made in making sure care plans are person centred. A person centred plan is an individual plan, written by or with the person and includes information about their needs and aspirations. The care plans we looked at did not indicate that individuals had been involved or consulted about what was in their care plan and it was not produced in a style that was accessible to them. Therefore we cannot make certain that people’s care and health needs are being met in the persons preferred way and at times to suit them. For example, in one care plan that we looked at we found staff had indicated preferred times that the person likes to get up but we could not find times which would inform staff when the person likes to go to bed. We discussed care plans with the registered manager. We recommend that care plans are signed and dated by the member of staff who writes them and the person themselves and or their representative. Also alternative formats for producing care plans should be considered, such as, using pictures and symbols to aid peoples understanding. The registered manager has recognised this in their AQAA, ‘Service User Plans could be further improved by producing a more user friendly, symbolised /pictorial format’. This should make sure that peoples goals are met when assisting and supporting them in meeting their individual needs. There were risk assessments that inform staff of any daily activities where the person may be at risk of harm and or injury when completing them. For example, we found risk assessments to cover, falls, road awareness, physical aggression, burns or scalding if in the kitchen and epilepsy. There were also Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 15 risk assessments for staff to follow in relation to challenging behaviour. These showed the triggers and how staff should conduct themselves when managing a person’s particular behaviour. We were told by the registered manager that one person has been referred to external professionals due to their behaviour and some involvement is now awaited to make sure the person has the required support needed. On the training planner we saw that staff have received some challenging behaviour training and the AQAA confirms that there are plans for further training by the behavioural support team. On the day of our inspection we observed staff using strategies when faced with this person who displays behaviour that they require support with. This was achieved in a sensitive manner with distraction methods used. We were told that peoples care needs are currently being reviewed by the local authority together with staff and or the registered manager. This should make sure where peoples needs have changed this is recognised and care plans are updated. This is also a good forum to discuss any other concerns and or issues with external professionals, such as, social workers, care co-ordinators, psychiatrists and or community nurses. Daily records which show how people make choices to spend their day, updates on how people are and any concerns are now kept in separate files. This was positive to see as this was recommended at the time of the last inspection to ensure confidentiality is maintained for each person who lives at Ashwood. Residents meetings take place every two months and records of the meetings were available for inspection. There was a list of items that were discussed at each meeting, such as, purchase of furniture for the home, decoration of bedrooms, new television for the lounge, lounge repainted with a preference colour and more healthy food options. We found that some of these items were noted on the maintenance schedule which the registered manager showed us. This shows that people living in the home are encouraged to be involved in the running of the home. On the day we visited we observed people who live in the home making choices about what meals they would like for lunch and whether they would like to go to the local shops with a staff member. One person told us that they were going to the shop to buy a card and present. These choices should now be considered within care planning to include gender specific care in relation to meeting individual’s personal hygiene tasks as we could not find examples of this practice within the care records we sampled. However, we are aware that people who live at Ashwood have their own key worker. This is a member of staff that gets to know a person on a one to one basis which includes the individual’s daily routines, likes and dislikes. People were seen walking freely around the home as they chose chatting with each other and or staff. The atmosphere in the home was in the main relaxed. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 & 17. People using the service experience good quality outcomes in this area. In the main opportunities for personal development and independence are developing to ensure people reach their potential, so enabling them to lead a meaningful and fulfilled lifestyle. Individuals are supported to have personal and family relationships so that their self-esteem is enhanced. The arrangements for meals needs developing to provide opportunities for people to be involved in meal planning so that independence and choices are fully promoted. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: On the day we visited some people had already left to begin their day activities and other people were choosing how to spend their day at home. We were told that there are a wide variety of activities for people to participate in, such as, going to the local shops, watching their own film choices on DVD’s in their Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 17 rooms, going to the pub for lunch, Webbs garden centre and lunch, reflexology, arts and crafts. There are opportunities for people to attend day centres, colleges and or work placements. In one care record we saw that one person who lives in the home had refused to attend day services and or college and staff respected their choices. One person told us that they had been to Weston-Super-Mare the day before and everyone who lives in the home are going on holiday in September to Wales. We found plans in the care records we looked at that promoted peoples independence and social skills. For example, what people were able to do in relation to laundry, hovering, tidying bedrooms, making hot drinks and snacks. We observed people being supported by staff to make a drink and or prepare teatime meals. Staff were seen asking people if they would like to join them in their cleaning activities where people could help or watch staff if they wanted. This shows that individual’s independence is valued and supported. We were told that people living in the home are supported to maintain their relationships with friends and family members. The AQAA also confirms this, ’1 Service User is supported to visit his parents in Worcester where previously they would visit him (age and ill health has prevented this). Another service user visits her father every two weeks and phones him every week. Another service user is supported to visit his family in Birmingham’. There is an open visiting policy adopted within this home and staff welcome visitors. One relative survey said, ‘I am always made very welcome and they always show an interest when she has been out and welcome her back’ and one health professional confirmed in their surveys that staff are, ‘Caring. Respectful’. Staff told us that menus are planned but very loosely so as people could choose an alternative meal on the day if they did not want what was on the menu. We spoke to some people who live in the home and they said they liked the food a lot. The food is purchased locally and cooked fresh for each meal. We were told that if a person does not want the meal being prepared they are offered an alternative. The menus have a choice of two dishes for the main meal of the day. The menu looked balanced and varied. There were some gaps in the menu planners that we looked at and this was acknowledged by the registered manager. However, staff ensure that each day they note down what food people have eaten as a record to monitor peoples diets. People are able to ask for fruit whenever they wish and we observed one person requesting some fruit. There is some room for improvement in how menus are planned by encouraging and supporting people who live in the home to take part in this. As with person centred planning which has been mentioned earlier in this report, this will ensure that people are able to choose their own menus. Photographs/pictures would be an aid to this process and people could then go shopping with staff support for the food needed. This provides people with further independent lifestyles that offer valuable experiences. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People using the service experience good quality outcomes in this area. Person centred planning needs to be further developed so that people can be confident they are having their personal care needs met in a way they prefer. Individuals physical health needs are taken seriously but some preventative health care arrangements need to be maintained on a regular basis, such as, weighing. Medication is generally well managed but one area for further improvement has been highlighted. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Previous reports show that people enjoy good relationships with staff that look after them. Direct observations of interactions between them provided further evidence of this. Support was given in a warm and friendly manner and people treated respectfully, as appropriate. Individuals said that they liked the staff and got on well with them. People looked clean and well dressed for the weather conditions in clothes to match their individual tastes and personalities. We were told by staff that people preferred to take a bath than have a shower. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 19 In care plans we saw that some individuals preferred times were noted in relation to morning and evening routines. The recording for all daily routines could be improved upon once a full person centred approach is taken when writing care plans which has been commented on earlier in this report. One person who lives in the home told us they enjoy their bath and use the bathroom downstairs. Relatives surveys told us:‘Loving care given to all residents’. ‘We are completely satisfied’. People who live at Ashwood now have Health Action Plans in place. We examined two peoples health action plans to see whether individuals are able to access and gain health support as required to maintain their health and remain well. We saw some arrangements are in place for regular reviews which include medications. Some care needs to be taken to make certain all reviews are dated within health action plans so that these can be monitored, actions taken and any changes picked up in a timely manner. Whilst we were at the home a community nurse came to provide some care and attention to one person who lives at the home. The registered manager showed that they were being proactive in asking about another persons needs with the nurse. At the last inspection it was recommended that people should have their dental needs reviewed regularly. We saw details of dentist appointments’ in March 2009 to make sure individual’s oral hygiene is promoted. Annual wellman/well-woman checks are being arranged and we saw dates of February 2009. These are recommended under Standard 19 as part of the preventive health care plan. The checks can be particularly important for those individuals who cannot explain how they feel or check their own bodies e.g. breast checks. Positive feedback from surveys were received from two health professionals who have visited people who live in the home, which stated, ‘I have informed a favourable impression’ and ‘I think this is an excellent home’. Consent to treatment forms need to be consistently signed and dated as we saw some that were not. This is particularly important due to the varying abilities of people who live at Ashwood. We did find in one care record that if the person ‘needs medical treatment and refuses this will be documented and social services to be informed and a ‘best interests’ meeting will be held’. This shows some knowledge of the Mental Capacity Act and the introduction of the Deprivation of Liberty Safeguards (DOLS). However, it is strongly recommended that staff receive some training in relation to the Mental Capacity Act and DOLS, which the registered manager has also acknowledged needs to be completed. We saw protocols for staff to follow for a person who has epilepsy. Also staff are provided with the different seizure types which is signed by a doctor. This Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 20 should ensure that staff have some awareness and are able to call for medical help when needed. People living at Ashwood are not being weighed on a regular basis. In the two care records that we looked at we found that the last recorded weights were completed in May on one persons care record and June 2009 on the other. We were told that some staff members had taken the responsibility for undertaking weight checks but this had been overlooked. The registered manager acknowledged that this was the case. We therefore make it a recommendation that individuals are weighed on a regular basis as this is important to make certain any losses and or gains are noted as this can detect underlying health conditions. This is particularly important where people are not able to always say when they feel unwell. We found peoples prescribed medications are noted in their care records, with how it is taken, when, start and end dates together with any changes and what the medication is for. We looked at the medication system that is used with the registered manager. All medications are stored in a locked cupboard. The registered manager showed us the Medication Administrations Records (MAR) and the two individuals medications that we checked tallied with the amounts left on the MAR. This should ensure that people are receiving their prescribed medication in the correct amounts and at the right times. We did find some prescribed creams in the downstairs bathroom which were left on show and we pointed this out to the registered manager. They confirmed that these should have been in the locked cupboard in the bathroom. We strongly recommend that all prescribed creams are stored in locked facilities so that all people living in the home are safeguarded from any potential harm. We were told that all staff that have the responsibility for giving people their medications are trained appropriately to do so. We found this to be the case when we looked at the training planner. One health care professional responded in their survey what they feel the service does well, ‘Manage medications well’. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience good quality outcomes in this area. People who live in this home can be happy that their concerns are listened to and taken seriously. Staff have received training that should ensure people feel safe in their home and are generally protected from abuse, neglect and self-harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is a complaints procedure that is documented in the statement of purpose and service user guide. The registered manager told us in their AQAA that the homes, ‘Complaint procedure is available in symbolised format’. This makes sure people who live in this home are able to have some understanding of how to raise their complaints and or concerns. Also as discussed earlier in this report we would recommend that staff receive training in the Mental Capacity Act and DOLS. This is particularly important as some people who live at Ashwood, some of who would need considerable help and support to raise any complaints and or choose options in their best interests. The registered manager showed us one complaint that they had received in the last twelve months and CQC had also received a copy of this. It showed us that the proprietor and registered manager had taken all the appropriate actions. The Care Quality Commission have also received a further complaint which the inspector shared with the registered manager on the day of Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 22 inspection. This was passed to the local authority for their attention in relation to investigating it further if they felt this was appropriate. The AQAA confirms what plans the registered manager has for the next twelve months and within this they have confirmed that, ‘Staff to be encouraged to document all complaints made’. This improvement should ensure that people feel that they are actively listened to and the registered manager can use this as a tool to improve the quality of the service that people receive at Ashwood. There have been no safeguarding referrals made to the local authority and the registered manager also confirms this in their AQAA. The training planner indicates that staff have received training in the protection of vulnerable adults from abuse. They were also able to show their understanding of relevant issues and of the importance of reporting any incident of actual or suspected abuse. Sampling of staff records showed that appropriate checks had been carried out with the Criminal Records Bureau (CRB), to ensure that people were fit to be employed. As at the last inspection financial policies and procedures are in place. Staff support people with weekly budgeting and information is recorded on finance record sheets. We observed a member of staff organizing individual’s monies so that they could take this with them when shopping. This was checked afterwards by a second member of staff. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30. People using the service experience adequate quality outcomes in this area. Generally people live in a clean, tidy well personalised home that meets their needs and reflects their taste and interest. A number of areas of maintenance require attention to ensure the home provides a safe and homely environment We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the time of the last inspection it was noted that the home would benefit from some refurbishment and redecoration work. Although we were shown a maintenance audit which had been completed by the registered manager it was concerning to find that some redecoration and replacing of furniture still needs to take place. For example, there is a lounge with comfortable settees and chairs for people to sit to watch television or relax. Some of the settees need replacing as they looked old and worn in places. The registered manager acknowledged that this was the case and new settees are needed. There are Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 24 some stains on the carpet which the manager acknowledged. Wallpaper is torn behind one of the sofas. This detracts from the overall comfort of people who live in the home, as well as the whole look of their main communal area. In the AQAA the registered manager confirms their plans for the next twelve months, ‘External fire escape and Manager’s office planned. Bathroom to be redecorated as well as service users bedrooms’. Ashwood is situated in a residential area of Kidderminster close to the town centre. The location means people are within walking distance of local shops and on a bus route. The building is a large, detached property that has been adapted for its present use as a care home. On the day we visited we became concerned about the fire escape which is situated off one of the bedrooms. The door leading to the escape was left wide open when we looked at the bedroom. The fire escape is made of a wooden built construction and in a state of disrepair. For example, we established that people living in the home and or staff would not be able to negotiate the steps out of the home due to them being worn away. We were told that people living in the home recognised this fire exit and therefore would use it if a fire should occur in the home to exit the building. In view of this we did make contact with the fire officer who went to view the fire escape on the same day that we made contact with them. The result of the fire officer’s visit was that within the home there is a small area upstairs which is ‘boxed off’ by doors which should stop fire from spreading into bedrooms. Therefore the fire officer confirmed with the registered manager that they would inspect the new fire escape when it has been erected together with the general environment of the home. The fire officer also provided the registered manager with some recommendations to prevent people accessing the fire escape at present. Also another consideration is that there is only one member of staff who sleeps in the home overnight which means all escape routes are important. We sent the provider an immediate requirement letter to which they responded by telephone contact and letter. This confirmed that the new fire escape would be erected on the 25th August 2009 and would be of wooden construction as opposed to steel as was previously indicated. The dining room has a large table and six chairs so that people in the home are able to choose to have their meals with other people. The dining table and chairs are to be replaced. We were told that one person who lives in the home particularly likes to have meals in their own room and this is respected. We saw that there was a hole in the ceiling and the registered manager said that this is waiting to be fixed. The small kitchen is adjoined to the dining room and looked clean and organised when we visited. Some work needs to be done down by the cooker, the plinth below the oven needs levelling and painting. Also some of the cupboard hinges need adjusting to ensure they close appropriately. The registered manager confirmed that this has been noted. Following the last inspection there is now a dishwasher so that dishes are washed at correct Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 25 temperatures making sure items are clean. The environmental health officer has visited the home and awarded two stars, ‘broadly compliant’. The registered manager could not tell us if the officer would be returning to check anything. On the staff training planner we saw that ten staff have received food hygiene training and this was also stated on the AQAA. This should make certain that people are safeguarded from any unsafe food practices by staff that have the knowledge to prevent this. There is a ground floor bedroom that is shared by two people. The registered manager showed us this room and introduced us to one of the people whose room it is. The beds have bed rails and the registered manager explained that there needs to be as little furniture as possible in this room due to the person’s poor mobility, such as, chairs and tables. There are sensory items which are enjoyed by this person. In the maintenance audit it confirms that this bedroom requires redecorating, thorough clean, ottoman and wardrobe need repairing/replacing, carpet cleaned or replaced. We were shown the ground floor bathroom which has a toilet and assisted bath. This bathroom needs some redecoration work to its walls and floor areas as it looks very worn and tired. These pieces of work are included in the maintenance audit. As discussed earlier in this report we found some items of prescribed cream which the registered manager acknowledged need to be placed in the locked cabinet that was open when we tried its doors. There are also individual items of bathing liquids which should be part of a risk assessment for each person who lives in the home. This would then enable decisions to be made as to the storage of these items to ensure all people living in the home are protected from any potential harm. We looked at some of the bedrooms upstairs with individual’s permission. These reflected individual’s tastes and personalities. For example, in one bedroom we found DVD’s on display which the person enjoys watching, and another person told us they have radios which they like. We saw soap and towels in communal areas so that hygiene practices could be observed by all. On the staff training planner we saw that ten staff have received infection control training and this was also stated on the AQAA. This should make certain that individuals are safeguarded from the potential of cross-infection between people. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. People using the service experience good quality outcomes in this area. Improvements have been made to the arrangements for staff supervision, training and development. Further improvements should be considered in staff receiving specialised training to meet the specific needs of people who live in this home. This is to ensure that staff have the support, knowledge and skills they need in order to do their jobs well, for the benefit of the people in their care. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA shows that there are ten staff who work at the home. It also indicates that agency staff are not employed which means that people living in the home gain consistency in care from staff who are familiar with their individual needs. We were told that there are two staff on duty during the day and evening periods. One member of staff sleeps in at the home during the night. The registered manager also works during the day Monday to Friday so is available if additional support is needed. We examined staffing rotas for a Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 27 four week period and found this to be the case. When asked staff told us that they feel current staffing levels meet individuals needs in a timely manner. On the day we visited we observed staff assisting and supporting people in a relaxed style without individuals having to wait for long periods for staff. The Annual Quality Assurance Assessment (AQAA) shows that eight staff are trained to NVQ level 2. This training meets national standards and statutory guidelines. We sampled two staff files which contained some evidence of people’s qualifications and training. As mentioned earlier in this report we found that all documentation is continuing to be reviewed and updated where needed. This means that some of the paperwork continues to be in paper forms with others on the computer but yet to be completed. This resulted in the registered manager finding it difficult to put their hands on some of the paperwork we needed, such as, the development and training planner. This was eventually sent to us when we contacted the home to chase this up. This provides a further example of the registered manager sometimes struggling with the planning and organizational side of managing Ashwood due to their ‘hands on’ approach. The training planner reflects the mandatory training staff require to complete their responsibilities and duties within the home. For example, manual handling (safely moving people who are unable to stand and walk who may need a specific piece of equipment such as a hoist), food hygiene, health and safety, infection control, first aid, fire safety, adult protection and medications. Some staff have also attended more specialised courses which include, challenging behaviour and one member of staff has attended a course in relation to Autism awareness. Relatives surveys told us:‘We are in regular contact with Ashwood and found all staff to be brilliant’. ‘They seem aware of her needs’. As reported earlier in this report staff recruitment was also viewed. Two staff recruitment records were sampled. These showed that specific forms of identification are being obtained and that application forms are required to show past employment. A CRB and two references had been obtained for workers before they took up their post at Ashwood. This practice should ensure that vulnerable people who live in the home are safeguarded from any potential harm. It was also reported at the time of the last inspection that arrangements for the formal supervision of staff needed to improve significantly. One staff member who was employed in July has had no supervision as yet although they confirmed to us that they have worked at the home previously. Another staff member told us that their supervision sessions are about every three months and their staff file confirmed this to be the case. We recommend that staff have at least six supervision sessions per year. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 28 We were told that staff meetings are held every two to three months which is an improvement that has been made since we last inspected. Staff spoken with found these are invaluable in sharing any updates, any issues and promoting smooth communication. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. People using the service experience good quality outcomes in this area. The Manager must now ensure that necessary improvements to the way in which the service is run continues to be organised and planned so that practices are timely and consistently put into practice. This will ensure that the home operates in the best interests of people who live in the home, and that everyone is supported to stay healthy and safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Mr. Paul Sankey is the registered manager of Ashwood and as reported at the last inspection has many years experience working with people with learning disabilities. Following the last inspection of Ashwood it was recognised that Mr. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 30 Sankey spent a lot of his time working ‘hands on’ to give priority to the people who use the service. From our discussions with some staff and observations on the day of inspection this is still the case. However, the registered manager did point out that they now have two deputy managers that assist with various aspects of managing the home which include staffing rotas and managing shifts. The registered manager told us in their AQAA that they want to include deputy managers in taking staff supervision sessions. We were told that the deputy managers are now waiting to attend NVQ Level 4, Leadership and Management course and the training planner confirmed this. From our observations it was clear that people who live in this home have good relationships with the registered manager. Also the registered manager has knowledge and understanding of each persons needs which is good. We were also told that surveys are completed by people living in the home which is confirmed within the AQAA. These should be reflected in the analysis of the quality assurance system which helps to promote good outcomes for people who live in the home by looking at the standards of service individuals receive at Ashwood. It is the responsibility of the organisation to ensure that their representative visits the home on a monthly basis under Regulation 26 (Care Homes Regulations 2001) to ensure it is being well managed. The proprietor of Ashwood undertakes these visits and their report is made available in the home. These provide the management team with an overall picture of what improvements need to be made. We found the reports from these visits included an inspection of the environment, speaking with people who live in the home and staff, checking care plans and whether any complaints have been received. As mentioned earlier in this report we recommend that some consideration is given to staff receiving some specific training in the Mental Capacity Act and DOLS together with communication. This should ensure that staff have further knowledge and skills to meet the individual needs of people who live at Ashwood. We found that health and safety checks were completed. For example, water temperatures are checked to make sure they are not too hot or cold. Generally records showed that they were within the recommended safe limits so that people were not at risk of being scalded. The water had been tested for Legionnella. A registered engineer completed the annual test of the gas equipment and an electrician completed the five yearly test of the electrical wiring and stated that it was in a satisfactory condition. An engineer regularly services the fire equipment to ensure it is maintained in good working order. Regular fire drills are held so that staff and the people living there know what to do if there is a fire. These records show that people are protected from any risks to their health or care needs within their living environment apart from the fire escape which has been reported on earlier. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 31 As reported at the last inspection the registered manager is trying hard to maintain all the records and systems in the home by trying to update and place on their computer. We were told that there is a lack of office space and we saw that the registered manager is using a computer that is in the dining area of the home. This is a communal area that does not support confidentiality. It is also not a quiet area in which work can be completed due to constant interruptions. We were told that this is due to lack of office space. However, a manager does have to organise and commit their time to running the home together with the business that goes with this role otherwise there is some risk that some issues will be overlooked. Therefore the registered manager must now give priority to the planning, monitoring, reviewing and organisational work that is required. This should make certain that improvements continue and the home is run in the best interests of the people who live there. A survey received from a health care professional said, ‘I think this is an excellent home’. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 X X 3 X Version 5.2 Page 33 Ashwood DS0000070094.V377063.R01.S.doc 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. 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. 1. Refer to Standard YA1 Good Practice Recommendations To make the statement of purpose and service user guide readily accessible and in alternative formats. This will ensure that people will be able to have some understanding of their contents prior to making their decisions about whether the home is right for them. To further develop care plans so that they are in formats that people living in the home will have some understanding. This should enable people to participate in how their individual needs are met with their goals and aspirations clearly noted. Further development of communication plans to ensure photographs, pictures and symbols are used as aids for the purpose of facilitating staff in understanding individuals varying communication abilities. Menu planners should be completed with the involvement of individuals with the aid of pictures and photographs so that peoples choices are facilitated together with the promotion of peoples own independence. DS0000070094.V377063.R01.S.doc Version 5.2 Page 34 2. YA6 3. YA6 4. YA17 Ashwood 5. YA18 6. 7. 8. 9. 10. YA19 YA19 YA20 YA24 YA35 11. YA35 12. YA36 Considerations should be made to further development of care plans to make sure that individuals preferences stated in terms of gender care, times together with daily routines are clearly noted with the agreement of the person. People should be weighed on a regular basis to assist in identifying any losses and gains so that any underlying medical conditions can be detected at an early stage. Consent to treatment forms need to be signed and dated so that staff can be seen to be working in individuals best interests. All prescribed creams should be stored in lockable facilities so that all people living at the home are protected from harm. All redecoration, repairs and replacement furniture should be actioned in a timely manner so that people live in a safe and comfortable home. Staff should receive training in the Mental Capacity Act and DOLS so that they have the knowledge and awareness to support individuals in areas of protection and ‘best interest’ decisions. Some consideration should be given to staff receiving some specialised training, particularly in communication so that further knowledge and skills can be gained to support people who live at Ashwood. To ensure staff receive at least six supervision sessions per year so that they have adequate support to discharge their duties and responsibilities. Ashwood DS0000070094.V377063.R01.S.doc Version 5.2 Page 35 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.westmidlands@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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