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Inspection on 26/10/09 for Aspinden Wood Centre

Also see our care home review for Aspinden Wood Centre for more information

This is the latest available inspection report for this service, carried out on 26th October 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a much needed service to a group of people that have experienced homelessness and neglect. Some residents who have chronic alcohol problems, are unwilling or unable to stop drinking alcohol. Residents are free to consume agreed amounts of alcohol in more comfortable surroundings. Staff support and encourage people to keep to agreed limits. The organisation recognises that that rehabilitation may not be a realistic goal for most residents, but where such help is requested appropriate services are identified and referrals made.Aspinden Wood CentreDS0000007058.V378181.R01.S.docVersion 5.3Management and staff are non judgmental and offer residents stability and security and comfort. They also offer a number of activities all of which has lead to some residents not drinking as much as they did when they first came to the home. The home gives them the opportunities to express their individuality, renew and develop their interests and re-establish links with relatives and friends with the support of staff. Residents living at the home receive support that improves and promoting health care, they receive the medication at the right time. People receive a good healthy diet which helps compensate for some of the past self neglect. Staff liaises with community mental health teams and ensures that appointments are kept without taking away residents independence and choice. The staff team are Good, experienced and are vigilant as well as monitoring and recognizing any triggers or signs of relapse. They contact and make referrals promptly to the relevant health professionals.

What has improved since the last inspection?

The organisation has looked at the care planning format and developed this. Staff have now read and signed to say they have read and understood the policies and procedures. We were given a copy of the homes training matrix which has been developed since the last inspection. Most staff have had training or refresher training and are competent on safeguarding procedures that protect vulnerable adults. Staff has undertaken a number of mandatory courses since the last inspection but there are number of courses outstanding including medication refresher training.

What the care home could do better:

Staff training needs to be audited and reviewed and all mandatory training needs to be completed in line with the NMS. Documentation could be more comprehensive and more robust and kept in line with the NMS. The manager needs to ensure all organisational documentation is completed and kept up to date.Aspinden Wood CentreDS0000007058.V378181.R01.S.doc Version 5.3

Key inspection report CARE HOME ADULTS 18-65 Aspinden Wood Centre 1, Aspinden Wood Road London SE16 2DR Lead Inspector Lynne Field Key Unannounced Inspection 26th October 2009 09:00 Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 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. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 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 Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Aspinden Wood Centre Address 1, Aspinden Wood Road London SE16 2DR 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) 0207 237 0331 jennipher@awc.equinoxcare.org.uk Equinox Manager post vacant Care Home 24 Category(ies) of Past or present alcohol dependence (16), Past or registration, with number present alcohol dependence over 65 years of of places age (8) Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. eight of the service users may be over 65 years of age Date of last inspection 27th October 2008 Brief Description of the Service: Aspinden Wood Centre is a care home providing accommodation and personal care to 24 people with past or present alcohol dependence. The home is part of Equinox Care, a voluntary organisation. The home is a detached, two-storey building with off street parking at the front, and a small, well maintained garden at the back. It is in Bermondsey, South London, close to local shops, social and leisure facilities, and public transport links. All service users have single rooms with sinks, and there are ample communal spaces including a dry and a wet lounge, a resident’s kitchen and a large pleasant dining room and conservatory. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 stars. This means the people who use this service experience adequate quality outcomes. The unannounced inspection was carried out over one day in October 2009. The manager facilitated the inspection with the deputy manager. The inspection included a tour of the home and examination of records on care plans, medication records and the complaints book. The home had no vacancies at the time of the inspection. We met and spoke to ten residents and spoke to five care staff and the cook during the course of the inspection and all were very positive about the service. We checked relevant policies and procedures as well as the resident’s files, the care plans and building maintenance records. During the visit we were able to observe how staff interacted with residents and how residents responded to staff. The manager returned a standard form, the Annual Quality Assurance Assessment (AQAA), to CSCI. This was taken into consideration and used as part of the inspection process. There was an excellent level of commitment displayed by the manager and staff to ensure they were meeting the needs of the residents. The information we received from the above sources was used to inform the judgments made in this report. The judgments have been made in relation to the outcomes for the group of residents this home caters for. We recognize that homes such as Aspinden Wood have a very specific remit, which does not necessarily fit in neatly with the NMS. We have therefore tried to apply the standards and regulations in a way that is useful to the development of this service, and the people who live there. What the service does well: The home provides a much needed service to a group of people that have experienced homelessness and neglect. Some residents who have chronic alcohol problems, are unwilling or unable to stop drinking alcohol. Residents are free to consume agreed amounts of alcohol in more comfortable surroundings. Staff support and encourage people to keep to agreed limits. The organisation recognises that that rehabilitation may not be a realistic goal for most residents, but where such help is requested appropriate services are identified and referrals made. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 6 Management and staff are non judgmental and offer residents stability and security and comfort. They also offer a number of activities all of which has lead to some residents not drinking as much as they did when they first came to the home. The home gives them the opportunities to express their individuality, renew and develop their interests and re-establish links with relatives and friends with the support of staff. Residents living at the home receive support that improves and promoting health care, they receive the medication at the right time. People receive a good healthy diet which helps compensate for some of the past self neglect. Staff liaises with community mental health teams and ensures that appointments are kept without taking away residents independence and choice. The staff team are Good, experienced and are vigilant as well as monitoring and recognizing any triggers or signs of relapse. They contact and make referrals promptly to the relevant health professionals. What has improved since the last inspection? What they could do better: Staff training needs to be audited and reviewed and all mandatory training needs to be completed in line with the NMS. Documentation could be more comprehensive and more robust and kept in line with the NMS. The manager needs to ensure all organisational documentation is completed and kept up to date. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 7 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. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 8 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 Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 9 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): 1,2,3,4 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are assessed prior to coming to live at the home. Information given to the prospective resident needs to be in a more accessible format and more comprehensive. EVIDENCE: We spoke to manager about the assessment and admission process. They said following a referral by care management they request the full details of the needs of the prospective residents needs. If the home thinks they can meet the resident’s needs they are invited to the home with either family or appropriate professionals for a comprehensive face to face interview and an assessment of needs. Prospective residents are shown around the centre, to see the layout of the service and the bedroom they are likely to occupy if offered a place. They are also given the opportunity to speak to other residents about the service offered and how the home runs. This gives them an opportunity to make an informed choice to decide if they want to move in or not. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 10 We were given a copy of the statement of purpose and the service user guide. Although this has been reviewed, this needs to be looked at again and be also available in a different, easy to read format. The layout of the text and the text its self do not make it easy to read if you have a learning disability, visually impaired or are not able to read well. We spoke to one new resident and checked two resident’s files. Each file had an assessment of needs that had been carried out by the home. We saw the assessments have been based on information supplied by the referring professionals and by the homes own assessment of the residents needs when they came on their visit to the home. The care plans we checked were signed by the residents and the manager in agreement to the contents of these plans. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 11 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): 6,7,8,9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are involved in planning their care with their key worker, the manager, appropriate professionals and family members. Potential risks are identified and residents are supported to take risks within a risk management framework. Care plans, risk assessments and other documentation relating the residents care needs to be available in hard copy to ensure the residents have access and understand it. EVIDENCE: We looked at four residents files, one was of a relatively new resident. Resident’s are involved in planning their care with their key worker, the manager, appropriate professionals and family members where appropriate. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 12 Not all files had copies of care plans and risk assessments on file. Those that did had not always been reviewed. We were told care plans and risk assessments were now reviewed and recorded on the IT system and in some cases were not printed off and put in resident’s files. Although on one hand this is good, the down side is residents might not feel involved in their care planning. The residents in the home tend to be of the older generation, possibly have been living in reduced circumstances and might not have had the opportunity to be computer literate. This could make them feel inadequate and over whelmed by this type of record keeping. Earlier paper records showed mental health issues, personal hygiene, finance, medication and any other issues that have arisen are all discussed at review meetings and in the past these were signed by the resident and their key worker. With the present system it was not possible to tell if all the residents know about the reviews. From looking at the residents files we could see some residents had six monthly reviews or earlier if the need arises. As stated earlier some care plan reviews are kept on file. The newest residents file we checked had a six weekly review on file as well as the normal six monthly reviews. We spoke to them during the inspection and they said they were happy with the support they received from the staff in the home. Resident’s annual reviews are conducted by the residents’ care manager and include the residents’ family members, key worker and any relevant professional involved in the residents’ development if this is appropriate and they have family members. Medication is reviewed at the same time. If a resident have refuses to attend their annual review even though it was being held in the home and this would be recorded in the review notes. There were detailed guidelines and risk assessments on the files we viewed on how the residents behaviour could be managed and supported safely. Potential risks are identified and residents are supported to take risks within a risk management framework. We were told residents are involved in their risk assessments and managing the risks in their life. The homes manager said they continue to encourage the residents to participate actively in decision making of the home, for instance, decoration of their room, choice of furniture and their own choice of paintings. They are always kept informed on activities and they participate actively in the choice of their outings and leisure activities. We noted some residents are very active and go out and about a lot but others are very reluctant to go out at all. Through out the inspection we noted residents came and went as they pleased, having made decisions about what they wanted to do for the day. One resident we met was elected to represent the residents of the home and goes to meetings set up for all the homes in the organisation to represent the residents of the home. They then feed back at the residents meetings. They said it was good to hear other people’s ideas. He has suggested they develop the garden and grow their own vegetables. This will link in with the health eating plan. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 13 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: 11,12,13,14,15,16,17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents engage in appropriate, enjoyable and fulfilling activities and mix with the general community. Residents are actively encouraged to keep in touch with friends and family and develop appropriate friendships. Residents’ rights and responsibilities are respected. The meals are enjoyable and nutritious. EVIDENCE: We were shown around the home and could see the daily routines are flexible. The residents we spoke to all had very different interests that they followed Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 14 and took part in. They said they felt free to come and go as they pleased and were supported to continue with their activities. We meet and spoke to eight residents. They all said and we could see they were able to freely come and go from the house. We saw them moving around the home, visiting other residents in their rooms and making drinks in the kitchen. Each resident has a daily schedule and from this we could see how the residents spend their day. This is flexible and can be changed they want to do something else that they feel is more important or enjoyable. We were shown copies of the resident’s activities and daily living skills. The staff said they continued to try to motivate the residents and it is an ongoing. We noted the home has set up different activities, including cookery group every Friday morning where residents can choose what they want to cook, buy things they want for the day, prepare, cook and share with other service users who did not take part. We were told other activities which have become very popular at the home include reminiscence, from seed to plate, talking points and women’s group, which all have improved residents well being and boosted their morale. This has resulted in them drinking less because the activities act as a distraction from the older habit of wanting to drink alcohol all the time to having different focus. Staff said they are encouraging and supporting residents to develop daily living skills they will need should they move on into a flat of their own. One resident told us he “hoped to get a place of his own”. We were told on resident was in the process of moving out because they had improved so much since coming to the home. The manager said they were concerned this person could relapse when they had their own flat because they would not have the same support in the community they had in the home. The home has separate meetings for residents and joint meetings for residents and staff. The residents representative is consulted on the service and organisational issues, which he in turn reports back to other residents. We were shown copies of the minutes of these meetings that are held on monthly basis. We saw during residents meetings they are asked if they would be interested in a holiday or having several different outings. Residents told us about their holidays and days out. One resident had recently been supported to go on holiday to meet a relative he had not seen for many years. We were as told the home encourages the residents to see their family as often and were possible. One resident said they were in touch with their family and they visited them at the home. A number had lost touch or just didn’t have family or friends. The manager said they had planned days out and although generally residents wanted to go there were some residents just were not interested in taking part. There were photos on the walls showing them at various places they had been to recently. The main meal is in the middle of the day at the home. We spoke to the cook who said the food was all freshly cooked. There is a four week rotating menu and the weekly menu is displayed on a board in the dining room. These Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 15 showed that the meals offered are balanced and nutritious. The cook said the home has a flexible approach to menus and depending on resident’s wishes the meal offered is not always as stated on the menu. If the resident does not want what is on the menu that day they can ask for something else and as long as they have given the cook enough time to cook it will be provided. The manager said they try to ensure that whilst taking into account the preferences of residents, there is sufficient variation of meals offered. We were able to eat with the residents at lunch time and found the food tasty and hot. We spoke to residents over lunch who all said they were happy with the meals. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 16 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. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal support, in the way they prefer and their physical and emotional needs are met. Residents are protected by the homes policies and procedures for dealing with medicines. Risk assessments are in place for residents who take their medication out with them and the box is labelled appropriately. Medication administration was found to be properly documented and is handled safely. EVIDENCE: We saw from the files we checked, residents are registered with the local GP, dentist, optician and mental health services upon admission to the home. Care plans are drawn up from identified health care needs in the single care Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 17 management assessment. The home provides the care that is how the resident would like to be supported and around their lifestyle, health concerns and personal and social skills. The nature of the service means that the majority of residents have developed alcohol related health conditions that require monitoring and treatment. Each person has an allocated named key worker who they have regular meetings with where they can discuss any issue that is of concern to them. Staff said they take time to discuss with the residents particular needs and circumstances. They said they encourage residents maintain their own personal hygiene. Staff regularly provides information regarding the dangers of consuming excess alcohol and also refer them to the alcohol advisory service, these are discussed at key working sessions. Staff said the key worker or a member of staff tries to make sure that hospital and other health care appointments are attended. The daily diary is used to record information on all residents such as doctor and hospital appointments but this is not transferred to the individual file. We were able to sit in on the hand over of the staff team. We noted that staff made sure the door was properly closed and there was no one near the window because of confidentiality. We were told by the manager the issues around independence, right and choice have made it more challenging for staff to work with residents. For example, a resident who refuses to take their medication as precribed, despite several attempts to explain the reasons why they should be taking their medication by claiming that the medication is their property and that they have a right to take it or not and they have chosen not to take it. Others also refuse support with personal care or cleaning their rooms claimimg it is their choice to either shower/bath or wash or to live in the dirty enviroment. This can be difficult for staff to deal with and they need to use all their skills and stratagies to support residents in these situations. Key workers carry out risk assessment with residents to clearly identify the risk they are exposing themselves to by not attending to their personal care/ cleaning their room or refusing to take medication. We were told in these situations key workers also discuss the daily schedule with residents and clearly state how they want to be supported to meet the specified needs, discuss it at the meeting and diarise it for all staff to support them and ensure consistence approach. The manager said they would also consult the residents GP if a resident is consistently refusing their medication and would carry out a medicine review. There is a robust policy in place regarding the administration, receipt and disposal of medication. We examined the procedures. The manager told us that all the permanent staff administers medication to the residents and that staff have received training from Boots the Chemists to do with the safe handling of medicines. Staff confirmed they have received appropriate medication training. We were shown copies of training records staff had signed to say they had medication training. Medication is checked into the home. This is counted in and records confirm this. One resident self medicates. They come to the office and to check their blood, then they administer the medication to themselves. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 18 This is something they have done for many years before they came to live in at home. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 19 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): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service promotes the views of residents and uses these ideas and suggestions to inform the service development. The financial system that is in place leaves residents open to possible abuse and staff to allegations of financial abuse. EVIDENCE: The organisation has its own complaints policy which ensures that complaints are investigated thoroughly, speedily and impartially. A copy of the complaints procedure is in the service user guide that is given to residents when they come to live in the home. The manager said they keep complainant informed about the progress of the complaint as it is investigated and progresses. We were shown the complaints book. There has been one complaint from a neighbour about noise. There was a record of the action taken and outcome. We were told where necessary staff will support residents to complete written complaint forms. Residents are encouraged to speak up in the residents meetings about issues that concern them and this is helped them be more confident about speaking up for themselves. The home has a policy and assures residents they will not to be victimised or mistreated for making a complaint. The manager said she deals with complaints and treated them all with the same seriousness. We found that staff understands the client group and that those suffering from alcohol induced dementia may be verbally Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 20 abusive due to their cognitive impairment and that careful consideration must be give on how to resolve any issues raised that could be contentious. The manager said the organisation would refer staff to POVA as appropriate and all staff received POVA training and the training records we viewed confirmed this. We were told all new staff would have this training as part of their induction training. The home has a policy regarding the protection of the resident’s finances. As part of the inspection the residents’ money and petty cash accounts were inspected. Although the resident’s money was in order there were some discrepancies in the entries of recording of the resident’s money. We found all staff could have access to resident’s bank cards and their pin number was kept in their personal file for all staff to see. This is very poor practice and must be reviewed. We discussed the methods used currently, which leaves the system open to abuse and staff vulnerable to possible accusations of financial abuse. There needs to be a more robust system in place to protect residents from potential abuse, and staff from possible accusations of financial abuse. We were told this would be addressed. Since the site visit a number of staff have returned the surveys we sent out as part of the inspection and they too have voice concerns about pin numbers and bank cards being freely available to staff. The manager does weekly financial checks. A financial audit needs to be done by someone in authority outside the home. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 21 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): 24,25,26,27,28,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable with adequate private and shared space, toilets and bathrooms. The home is also clean and hygienic. Resident’s bedrooms are comfortable and are decorated to reflect their personalities. The premises offer a safe and clean environment where people can find security. EVIDENCE: The home is a large building over two floors a short way from main transport links. The home is in keeping with the local community and not identifiable as a care home. There is space for parking to the side and rear of the property. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 22 We found the home clean and smelt fresh. There are two cleaners who keep the communal areas clean but residents are expected to assist where possible. There are two laundry rooms where residents can wash their laundry but are supported to do this if needed. Residents are encouraged to make their own breakfast in the residents kitchen as a way of maintaining independence and this is used for the cookery class where residents can learn cooking skills. We toured the communal areas, including the main kitchen, dining room, two communal lounges with TV and a computer connected to the internet for residents to use if they wanted to. There are two laundry rooms and an activities room and toilets are on all floors. The residents pay phone is located in the hallway on the ground floor. We saw a number of bathrooms including shower rooms on each floor. We spoke to five residents in their bedrooms which gave us an opportunity to see their bedrooms and ask what they thought of the home. Each room was comfortably furnished with a bed, sofa chairs, chest of drawers, beddings and a wash basin. None are ensuit so residents have to use the communal bathroom or shower rooms. Residents choose to express themselves as they like and rooms reflect choices of lifestyle. Bedrooms are the only private, personal space residents have in the home. For some it may be the first time for many months/years that they have had such a space. The bedrooms varied according to individual resident’s wishes. Some residents choose to display possessions that they have treasured over the years, others have few possessions as they had been homeless for sometime in the past. Key workers and the manager encourage and help residents to personalise their bedrooms. Staff promotes individuality and prompt residents into taking take responsibility to ensure that the home is clean and hygienic although the individual choice of each resident is respected. We found evidence on this visit to demonstrate that staff at the home work hard to achieve a good balance. We found the general maintenance throughout the home was seen to be good. The home has a maintenance man who works 4 hours a day. The home has a large rear garden with a patio and this is mainly laid to lawn with a shrub border and some small trees. It is nicely enclosed and affords the residents some privacy. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service benefits from the presence of a good, stable staff team. The organisation needs to audit the training needs of the staff and provide training and development plans to ensure staff have the relevant skills to meet the needs of the residents. The organisation needs to provide staff with mandatory training and training needs that comes from their assessed training and development plan and audit to ensure they are able to develop professionally and meet the assessed needs of the residents. EVIDENCE: We joined staff for the handover. Staff were very though and went through the welfare of each person using the service, stating how they had been and any issues that had arisen on their shift. They demonstrated a good awareness of confidentiality during the handover. We spoke to staff after the hand over Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 24 session. Staff are happy working in the home and said they had training to help them give the residents the care and support they needed. All are long standing members of staff. They said they had regular supervision and team meetings which they found helpful and they felt supported by the management of the home. We found staff very conscientious and knowledgeable about the service they were giving to the residents. We were not fully able to assess the recruitment practices of the home because no staff had been employed since the previous inspection. Staff we spoke to were long standing members of staff who said they had gone through and induction process and had to provide references. We were told CRB checks were kept at the head office. Residents take part in the recruitment process and there is a service users panel. They ask prospective staff to come to the home to meet the residents before their interview. We were told new staff shadow staff and have to complete an induction program. As at the last inspection concerns were raised with the manager to do with staff training. Training records showed there are shortfalls in relation to statutory training and the manager needed to address this if she was to ensure a competent and appropriately trained staff team able to best meet the needs of the residents at Aspinden Wood. We were given a copy of the staff training matrix which had been developed from a recommendation in the last inspection and noted that although the home had made efforts to ensure staff had up to date training, there was still a short fall. This could impact on staff having the appropriate skills to deliver the service the residents need and want. The manager must audit all training needs of the staff and each staff must have a training and development plan in place based on their training and development needs. The staff team is consists of a group with a wide range of individual skills and experiences. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 25 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): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service benefits from the presence of an experienced and competent manager. There needs to be an effective quality assurance process in place. Working practices and associated records ensure that the health and safety of residents is promoted. EVIDENCE: The manager has worked at the home for seven years, is experienced in managing the centre and was a deputy manager for 9 months before that. She said she has achieved her NVQ 4 in management and is a RGN. The Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 26 manager is not yet registered with the CQC. When we spoke to them they said they had applied but there were some complications. They need to follow this up and complete their registration. We met the deputy manager who has many years experience at Aspinden Wood, who has also completed their NVQ level 4 and Registered Managers award. We found both managers open and approachable. From a management point, generally the homes record keeping needs to be more comprehensive and robust. The organisation completes the monthly monitoring required by the National Minimum Standards and keeps copies of file which we were able to view as part of the inspection. The home has a quality assurance process at Aspinden Wood and we were told a survey was in place for the residents. The visitor’s evaluation forms have been re-introduced but we did not see them. Residents said they would speak to the manage or staff if they were unhappy with anything in the home. Individual issues relating to quality assurance are addressed in joint resident and staff meetings or in key worker meetings. The quality assurance process for Aspinden Wood needs to be completed so residents and other stakeholders can be confident that their views underpin the self-monitoring and development of this home. The home had a policy on health and safety and we viewed health & safety records held in the home. Certification was in place regarding the Landlord’s Record of Gas Safety, Portable Electrical Appliance testing, and Certificate of Electrical Installation. Records showed that regular checks of the fire alarm call points were made and that fire drills were conducted. All other health and safety checks were inspected and there is a range of certificates available to show these are being properly addressed in the home. A fire was due on the day of the inspection and was carried with all residents assembling at the fire assembly point. All confidential records are kept locked up in a filing cabinet in the staff office and accessible only to the management of the home. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 27 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 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 2 X 2 3 x Version 5.3 Page 28 Aspinden Wood Centre DS0000007058.V378181.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5 Requirement The registered person must ensure that the service user guide and statement of purpose is clearer to read in a more accessible format and contains all the information prospective residents need to make an informed choice. The registered provider must ensure care plans and other documentation relating to resident’s choices needs to be available in a format residents can access easily. The registered person must ensure there is a more robust financial system in place to protect both residents and staff. The registered person must ensure all the information required to be held under Standard 34 is available for inspection. The registered person must ensure that the training needs of the staff have been assessed and a training and development plan is in place for all staff. The registered person must ensure that all members of the DS0000007058.V378181.R01.S.doc Timescale for action 01/02/10 2 YA6 15.2 01/02/10 3 YA23 13 01/01/10 4 YA34 19 01/02/10 6. YA35 18 01/02/10 7. YA35 18 01/02/10 Aspinden Wood Centre Version 5.3 Page 29 8. YA39 10 staff team have received training in all areas that will ensure the residents assessed needs are meet and appropriate records kept including induction training. The registered provider needs to ensure quality assurance system is more robust and is carried out more regularly Aspinden Wood that enables a level of self-audit and monitoring. The registered provider needs to ensure all organisational documentation is completed and kept up to date. 01/02/10 9 YA41 17.Sch 4 01/02/10 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 YA23 Good Practice Recommendations The Manager should ensure that any staff who have not done so enrol on POVA training in the near future. Certificated evidence will be required to be seen. Aspinden Wood Centre DS0000007058.V378181.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@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). 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