Inspection on 07/08/06 for 149 Ash Street

This inspection was carried out on 7th August 2006.

CSCI 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 CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

149 Ash Street 12/03/09

149 Ash Street 14/03/07

149 Ash Street 01/09/05

149 Ash Street 31/05/05

149 Ash Street 16/09/04

149 Ash Street 18/05/04

Similar services:

Thorndene

Magenta

Seabourne House

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Dovedale Court

Lyncol House

Insight - Eastchurch

Southfields

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Ash Street (149) Ash Street (149) Ash Near Aldershot Surrey GU12 6LT Lead Inspector Suzanne Magnier Key Unannounced Inspection 11:00 7th &18th August 2006 &11 30 Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ash Street (149) Address Ash Street (149) Ash Near Aldershot Surrey GU12 6LT 01252 330529 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) jill.woolley@new-support.gov.uk www.new-support.org.uk New Support Options Limited Jill Woolley Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 30-55 YEARS OF AGE 1st September 2005 Date of last inspection Brief Description of the Service: 149 Ash Street is a detached Victorian house in the town of Ash near Aldershot. London and Quadrant Housing Association own the building. Support and staffing is provided by New Support Options. The home offers support to five adults with learning disabilities, aged between 27 and 55 years. There are five single bedrooms, two lounges, a dining room, a breakfast area and three bathrooms available in the home. There is a large well-maintained garden available and some parking at the front of the home. The local shops are within walking distance. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit on the 7th August 2006 took place over 5 hours and was initially conducted with a support worker and later with the homes Quality Auditor Senior Practitioner. On arrival at the home it was noted that the Community Probation service were decorating the home, which included, all hallway ceilings and toilets. The home was therefore in a state of disarray due to the redecoration. As a result the inspector returned to the home on the 18th August 2006 and met with the registered manager and undertook a further site visit of the premises. In discussion with the staff the inspector was advised that the service users prefer to be known as supported people and will be referred to as such throughout the report. The main focus of the site visit was to ascertain that that the previous requirements made during the previous site visit in September 2005 had been met. The inspector met with three supported people over the two site visits and members of staff on duty during both of the days. Due to the complexity of some supported persons needs it was difficult to obtain direct feedback. Therefore, observations of behaviour, body language and ways of communicating were noted during the site visit. A full tour of the premises took place and documents inspected included care plans, risk assessments, health and safety records, menu plans and activity charts. Staff records were sampled at New Support Options local office on the 1st September 2006. The inspector would like to thank the supported people, registered manager and staff for their time, assistance and hospitality during the inspection. What the service does well: The inspector noted in general positive interactions by staff and use of a variety of skills to communicate with the supported persons. The inspector sampled the compliments book and noted that a compliment had been received into the home and a letter expressing thanks to staff for the care of a person regarding specific support. One person’s notes detailed that a relative was happy with the care provided in the home. The home continues to encourage and enable the supported people to lead appropriate and fulfilling lifestyles both inside and outside the home. People are supported in a way, which they prefer and the support is consistent and predicable. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 6 All the supported peoples bedrooms reflected the persons lifestyle, contained personal items and including photos, framed pictures and a variety of leisure items and certificates of achievement. New Support Options are continuing to undertake an evolution pathway which is centred on making the organisation/services as a whole more person centred led. The home has focussed on developing, understanding and actions to ensure all aspects of diversity are recognised. The manager of the home has developed a quarterly diversity group newsletter and the home last year attended a New Support Options Diversity day. What has improved since the last inspection? What they could do better: The home must make sure that risk assessments are reviewed when necessary and at least annually to ensure the supported persons safety and welfare. Documented guidance regarding the current practice of exclusion for one supported person must clearly document agreement with the supported persons significant others, including their care manager, to ensure the persons welfare and wellbeing. The homes manager must ensure that the care home is conducted in a manner that, respects the privacy and dignity of all supported people and encourages and assists staff to maintain good personal and professional relationships with supported people. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 7 The quality rating for the service is adequate as there remain a significant number of maintenance issues that have not been addressed by the landlords for a long period of time which potentially places the supported people and the staff working in the home at risk. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 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 Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People moving to the home have sufficient information available to them in order to ensure that the home would meet their needs. EVIDENCE: There have been no admissions to the home since the previous site visit. The statement of purpose and service user’s guide have been up-dated and both documents remain person centred and have been developed and include pictures and photographs as well as words. Each supported person’s bedroom and the communal areas of the home are illustrated in the guides. The inspector sampled licence agreements within the person centred plans, and ongoing needs assessment documentation. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The person centred plans reflect the needs of the supported people. Some risk assessments and specific guidelines of supporting people must be reviewed and updated. EVIDENCE: It was noted by the inspector that the homes staff have made a concerted effort to develop, and continue to develop a person centred plan for each person supported at the home. This effort has also included staff working closely with people’s family and friends. The person centred care plan sampled for the supported person at home during the time of the first site visit included a history of their childhood, photographs of the person when they were young and photos of their family and friends. The document also illustrated the skills and abilities of the supported person and an in depth communication profile which included behaviours and key words of the person in order that people in their life are able to understand and communicate with the person. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 11 It was noted that the plan had been reviewed in October 2005. The inspector was told that supported people have two key workers in order to offer continuity of support and care. A full care plan review, with the persons care manager and family in attendance had been recently held and the review notes indicated that the supported persons relative believes that they are happy especially now that staff know the person better. The inspector sampled risk assessments for the supported person, which included concerns regarding personal boundaries, having a bath and preparing meals and snacks. The risk assessments sampled were dated August 2004 and it is required that the home must ensure that any activities in which supported people participate are, so far as reasonably practicable, free from avoidable risks, and the risk assessments are reviewed when necessary and at least annually to ensure the persons safety and welfare. Whilst sampling the person centred plan the inspector noted that there were guidelines, which indicated that on occasions, exclusions were in place for a supported person. There was no documented historical reference to indicate that the support methods had been discussed within a multi disciplinary setting. It is required that the home must ensure that the documented guidance regarding the practice of exclusion for any supported person clearly documents agreement with the supported persons significant others, including their care manager, to ensure the persons welfare and wellbeing. During the second site visit the inspector observed one supported person who was distressed being supported in a safe and caring manner by the senior staff member and on another occasion the manager assisting a supported person to make a drink. On both occasions the inspector noted positive interactions and use of a variety of skills to communicate with the supported persons. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to encourage and enable the supported people to lead appropriate and fulfilling lifestyles both inside and outside the home. Menus sampled evidenced a healthy diet. EVIDENCE: The home has developed an active support approach to all the supported people, which includes working on a one to one with people in a consistent and predictable way. The daily routines of the supported people are documented and a staff member assigned to support the person whilst referring to the daily plan. The daily plans include goals and activities and the outcomes are documented in the daily records and plans are signed by staff to indicate they have provided the required support. One person centred plan evidenced guidelines of safe working practice which included showering/bathing and also guidelines which included guidance for staff if the routine was not adhered to, for whatever reason, and how staff should support the person through the change of routine. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 13 The inspector sampled the supported persons daily records that indicated that they had visited their mother, had attended concerts and been out and about in the local community. During the first site only one person was at home as the other supported people had gone to Hayling Island for the day to have a picnic with two staff members. The supported person at home went with a staff member to the local pub for lunch. One person centred plan illustrated, through colourful photos and pictures that the home supported people to take part in interests and activities for example the care plan documented the persons likes, dislikes, personality, activities that the person enjoys for example reading magazines, doing puzzles, threading shapes onto plastic laces, art venture, arts and crafts in Merrow, going on outings on the bus or train, shopping and going to the pub. The home has focussed on developing, understanding and actions to ensure all aspects of diversity are recognised. The manager of the home has developed a quarterly diversity group newsletter and the home last year attended a New Support Options Diversity day. One persons active support plan encourages them to pace the amount that they have to drink and the home has set up a programme of a timer which sounds each hour and the person identifies that they are free to make a drink in the kitchen which they readily do. During the second site visit to the home one person was getting ready to leave the home to go out for a social event and it was apparent that the person was eager and excited to go with the staff member who had helped them get ready for the event. The inspector sampled the homes menu, which offered a nutritious selection of meals. As each supported person was out and about the inspector did not observe the preparation or serving of the meals on both site visits. It was noted that some of the supported people required specialised diets, which included, gluten free and low fat diets. The inspector was told that some supported people help with the shopping and where possible involvement with the cooking and setting of the table. The inspector sampled the homes fridge and freezer contents, which were noted as well stocked and there was fresh fruit and vegetables available. Food temperature checks, prior to serving the meal were recorded and fridge freezer temperatures recorded. The home encourages the people being supported to be part of the environmental recycling of waste programme. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported in a way, which they prefer and the support is consistent and predicable. The home has improved the arrangements for the administration of medication and supported peoples wishes regarding their final affairs are documented. EVIDENCE: The care plans sampled by the inspector were well documented to evidence that people were supported in a way they preferred and the care practice was predicable and consistent. Documentation in the person centred plans indicated that regular health care appointments had been attended for example eye tests, GP appointments, podiatrist visits, weight records and issues of mobility had been discussed with relevant health care specialists. The home had, following the previous site visit, improved the homes medication administration policy and procedure. The administration records sampled during the site visit were in good order and medication stored appropriately. The inspector noted that the supported peoples plans evidenced that their and their family’s wishes regarding their final affairs were documented and taken into account. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home and the organisation has a complaints and safeguarding adults awareness policy and procedure, which can be used by supported people or their representatives to air their views and to protect them against abuse and neglect. EVIDENCE: The inspector sampled the New Support Options complaints procedure, which the inspector was advised is the complaints procedure used in the home. Due to the complexity of the supported peoples needs and communication differences the inspector and the Quality Auditor Senior Practitioner discussed how the people being supported at the home could make a complaint if they were unable to read or understand the current complaints procedures. The inspector observed a more user-friendly complaints document attached to the office wall, which was designed for the supported people and any one else visiting the home. The inspector was advised that with staff awareness and knowledge of how the people being supported communicate and an openness regarding receiving complaints the home continues to listen and respond if people show dissatisfaction. This matter was also discussed during a telephone conversation with a New Support Options Area Manager following the site visit. The inspector sampled the compliments book and noted that a compliment had been received into the home and a letter expressing thanks to staff for the care of a person regarding a specific medical treatment. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 16 The home has a copy of the Surrey Multi Agency Safeguarding Adults policies and procedures dated 2005 and the inspector sampled the New Support Options generic policy and procedure for safeguarding adults. The home has a missing persons policy and procedure and details of each supported person’s description within their person centred plan. The home has not received any complaints as indicated by sampling the logbook and there have been no safeguarding vulnerable adult referrals. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The premises provide a homely environment however a significant number of maintenance issues had not been addressed by the landlords for a significant amount of time thus potentially placing the supported people and the staff working in the home at risk. The home had no malodours. EVIDENCE: On arrival at the home it was noted that the Community Probation service were decorating the home, which included, all hallway ceilings and toilets. The home was therefore in a state of disarray due to the redecoration. As a result of the upheaval the inspector returned to the home two weeks later and met with the registered manager and undertook a further inspection of the premises. The home had identified a significant amount of repairs and maintenance issues and records indicated that these had been promptly reported to the landlords London and Quadrant Housing Association. During the two site visits the following issues were evidenced and subsequent requirements made. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 18 SECURITY TO THE BUILDING It was observed by the inspector that the front door to the home was an internal door with a central pane of glass, which did not offer a safe level of security to the home. The manager explained that a new door was on order however a requirement has been made that the home must ensure that security to the home is improved. The internal door with a central pane of glass which is currently being used as a front door to the building must be replaced with a hard wood external door of sound construction in order to ensure the safety and security of all persons in the home. SUPPORTED PEOPLES BEDROOMS The inspector sampled all the supported peoples bedrooms and noted that each room reflected the persons lifestyle, contained personal items and including photos, framed pictures and a variety of leisure items and certificates of achievement. Several rooms had been tastefully decorated and adequate furnishings and bed linen was available. It was observed that in the two women’s rooms one ceiling had been leaking and in another damp patches, which had been repaired were not decorated. The internal window surround in the front bedroom was in a state of neglect and disrepair. The metal surround evidenced a build up of a mildew like substance and the external wooden surround of the window, including the window ledge was noted to be rotten. The manager told the inspector that she was aware that new curtains were needed in the bedroom yet due to the state of the window surround these had not been purchased due to potential additional damage to the new curtains. It is required that the homes premises are of sound construction and kept in a good state of repair externally and internally. CORNER BATHROOM The home has three bathrooms, which the manager advised that two currently meet the needs of the persons supported. One bathroom upstairs has a corner bath, which the manager explained is only used by one person occasionally. As a result of concerns a risk assessment has been completed as the staff have addressed potential hazards in using the bathroom which include a supported person collapsing in the bath and staff’s inability to safely get the person out of the bath, concerns regarding issues of safe moving whilst cleaning the bath and the restricted access in the bathroom due to the split level flooring, which poses a trip hazard to all persons in the bathroom. The toilet, within the bathroom has a siphon system, which regularly is blocked and requires repair. The lining paper on the ceiling is in a poor state of repair. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 19 The inspector was advised that window of the bathroom was replaced approximately two years ago. The requirement that the inner frame of the window surround inside the bathroom be plastered and decorated to conceal the exposed brickwork had not been met from the inspection in May 2005 and September 2005 and a further immediate requirement has been made. Continued failure to action and comply with this requirement will result in legal action being taken against New Support Options by the Commission of Social Care Inspection. The manager advised that a requisition by the home for an updated bathroom suite and completion of the inner surround of the window has been made to the Housing Association. Immediate requirements have also been made that the home must ensure that there are sufficient numbers of lavatories and baths within the premises which are suitable for the needs of the supported people. ‘FROG’ BATHROOM. The flooring along the join of the lino and the edge of the bath was noted as damaged due to the spillage of water and the flooring around the edge of the base of the toilet required replacing. The internal window surround was noted as rotten and several tiles in the bathroom required replacing. FLOORING IN THE FOYER AND FRONT ROOM It was noted that the flooring in the front foyer and a corner area in the front room of the home was shaking underfoot which could potentially indicate that the flooring joists were broken. The manager explained that slugs and snails were often found on the mildewed carpet in the front room and a corner cabinet had been placed over the affected area to ensure that no one trod on the area due to the hazards identified. The manager told the inspector that this concern had been reported to the Housing Association and an immediate requirement has been made that the hazard is rectified to ensure that safety and welfare of all persons in the home. The communal areas of the home include the large lounge area and the adjoining dining area, which were evidenced as meeting the current needs of the supported people. The home had no malodours. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Supported people in the home benefit from clarity of staff roles and responsibilities. Staff achievement of the National Vocational Qualification (NVQ) needs to be reviewed. EVIDENCE: The inspector sampled the staff files on the 1st September 2006 at the New Support Options local area office in Aldershot. New Support Options undertake the initial advertising of the vacancy and the short listing process is undertaken by two senior managers which includes the registered manager. New Support Options have recruitment and selection policy, which incorporates equal opportunities and the inspector, sampled three staff files all of which complied with the current legislation regarding information and documentation in respect of persons working in the care home. All staff have job descriptions and employment contracts in order that they are clear about their roles and responsibilities. The inspector was advised that staff applicants are invited to visit the care home in order that both parties can meet and the supported people have an opportunity to express their views about the prospective member of staff. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 21 The inspector sampled the finance records for one person supported and noted that the procedure was robust and all transactions accounted for and measures in place to safely secure peoples finance. The inspector sampled the New Support Options training and development plan and all staff training was sampled as current. The service is not on track regarding achievement of the National Vocational Qualification (NVQ). The Quality Auditor Senior Practitioner advised that the home had been concentrating on specialised training for example cctive support and intensive interaction training. There has been a recent large turnover in the staff group and the general lack of NVQ assessors in the region has caused additional difficulties in achieving the targets. CSCI have required a training plan to address this shortfall. The inspector sampled a variety of staff support and supervision records and some staff told the inspector that they are well supervised and supported. The inspector evidenced that team meetings are held and also additional support and supervision is undertaken by the Area Manager. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The supported people benefit from a well run home. Improvements must be made to ensure that all staff conduct in the home respects the privacy and dignity of all supported people. Supported people can be confident that their views will be taken into account regarding development of the home. The health, safety and welfare of supported people must be improved. EVIDENCE: The manager has been registered with the Commission for Social Care Inspection as the registered manager to the home following the previous inspection requirement. Throughout the two site visits it was noted that overall the people supported at the home benefit from a well run home which has a staff team who generally work well together for the benefit of the people they support. On arrival at the home the inspector met with the staff member in charge of Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 23 the service. The staff member proceeded to show the inspector the way to the office and when passing by a bathroom opened the door of the bathroom and introduced the inspector to a gentleman who was sitting on the toilet in a state of undress. The staff member did not, at the time, offer an immediate apology to the person for the intrusion. An immediate requirement has been made that the homes manager makes suitable arrangements to ensure that the care home is conducted in a manner that, respects the privacy and dignity of all supported people and encourages and assists staff to maintain good personal and professional relationships with supported people. New Support Options are continuing to undertake an evolution pathway which is centred on making the organisation/services as a whole more person centred led. The organisation has several documents regarding the pathways of the process, which evaluates each month the progress made within each service. The Quality Auditor Senior Practitioner visits the service each month to support and encourage staff to work and support people in a person centred way for example how can the aspirations of the supported person be met within the residential setting. The manager and staff team have been working towards the National Autistic Society Autism Accreditation process, which will enhance the lives of the people who live at the home. KITCHEN During the tour of the premises the inspector noted that the kitchen cabinets and worktops were evidenced as worn and damaged and doors to cabinets were ill fitting. The inspector was informed that the home had requested an upgraded kitchen with new cabinets and worktops over two years ago. An immediate requirement has been made that the worktops and cabinets must be replaced immediately due to the health and safety concerns for service users and staff working in the kitchen. In addition it has been required that in order to support people to maintain their skills and abilities the home must provide adequate facilities for the supported people to prepare their own food and ensure that such facilities are safe and well maintained for use by all people in the home. For additional safety concerns the kitchen has been split into two by a solid stable door due to the safety issues presented in the home. The inspector observed that there were cracked tiles in the corner of the kitchen wall and re grouting of tiles on the splash back tiles was required. DOORS WITHIN THE PROPERTY Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 24 During the tour of the premises the inspector noted that two bathroom doors were not closing properly which was viewed as potentially hazardous. An immediate requirement was made that all doors within property are checked for appropriate closure in order that all person’s safety and welfare in the home is promoted and maintained. It was also noted on the second site visit to the home that the downstairs single toilet door did not close and there was no handle on the inside of the door which raised a potential risk of someone getting shut in the toilet. STORAGE During the tour of the premises the inspector noted that incontinence pads and plastic aprons had been left in full view in peoples bedrooms and on bathroom radiators. It is required that the home stores the items more appropriately to reflect dignity, confidentiality and privacy for people being supported. INFECTION CONTROL The inspector noted that in one downstairs bathroom used disposable wipes had been discarded into an uncovered waste bin. A requirement has been made that the home ensures that suitable arrangements are in place to prevent infection, toxic conditions and the spread of infection in the care home. LAUNDRY The laundry area is sited in the centre of the home and it was observed that the laundry did not have any windows and only a ceiling vent. The ventilation in the laundry was poor and as a result condensation from the homes dryer was seeping onto the floor causing a potential slip hazard. The manager explained that currently the people supported in the home can not use the laundry due to the hazards and lack of space/ventilation and as a result were not able to maintain or learn new skills relating to their daily living tasks such as folding clothing and using the washing machine with support. The flooring of the laundry area was noted as worn and damaged and requires replacing. The manager explained that she had suggested to the Housing Association that the laundry be re-sited to the back of the building in a room which was originally a small kitchen and is not in use, where there are existing water and electrical supplies. As the laundry would be in the back of the building, clean laundry would not have to be carried through the kitchen or lounge area and the facility would be accessible to people being supported at the home and would have direct access to the back garden. The lack of appropriate laundry facilities also included a clothes rail stand in the main hallway where articles of clothing are left to air and was viewed as unsightly. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 25 LIGHTING The inspector noticed that a light in the downstairs hallway was not working and there was no cover to the light in the upstairs corridor. The inspector was advised that both repairs had been reported to the Housing Association. The inspector sampled all fire records, which were up to date and illustrated safe fire prevention practices. All fire extinguishers in the home had been serviced. Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 26 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 3 2 3 3 X 4 X 5 3 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 2 26 3 27 1 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 2 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 3 3 3 3 2 X 3 X X 1 X Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 YA9 Regulation 13.(4)(bc) Requirement The registered person must ensure that any activities in which supported people participate are so far as reasonably practicable free from avoidable risks, and the risk assessments are reviewed when necessary and at least annually to ensure the persons safety and welfare. The registered person must ensure that the documented guidance regarding the current practice of exclusion for one supported person clearly documents agreement with the supported persons significant others, including their care manager to ensure the persons welfare and wellbeing. The registered person must ensure that home must ensure that security to the home is improved. The internal door with a central pane of glass which is currently being used as a front door to the building must be replaced with a hard wood external door of sound construction in order to ensure DS0000013450.V308500.R01.S.doc Timescale for action 07/09/06 2. YA9 14 (2)(b) 15(2)c 07/09/06 3. YA24 13.(4)c 18/08/06 Ash Street (149) Version 5.2 Page 28 4. YA24 23.(2)(b) 5 YA24 13.(4)(a) 23.(2)(b) 6 YA24 23.(2)(b) 7. YA27 12(1)(a) 23((2)(j) 13.(4) (a-c) 8 YA24 23 (2) (d) the safety and security of all persons in the home. The registered person must ensure that the homes premises are of sound construction and kept in a good state of repair both externally and internally for example the leaking ceiling in a bedroom, the decoration of a past leak in another bedroom ceiling and the repair of the corner bathroom ceiling must be addressed. The registered person must ensure that the flooring in the front foyer and a corner area in the front room of the home which was shaking underfoot and could potentially indicate that the flooring joists were broken must be repaired. The registered person must ensure the replacement of all external rotting window frames for example in a persons bedroom, the ‘frog’ bathroom and the mildewed internal window frame in a persons bedroom. In order to ensure that the homes premises are of sound construction and kept in a good state of repair both externally and internally. The registered person must ensure that there are sufficient numbers of lavatories and baths within the premises in order to promote and make proper safe provision for the health and welfare and meet the assessed needs of the people being supported. The registered person must ensure that the exposed brickwork of the inner frame of the window in the corner bathroom, which was replaced approximately two years ago is DS0000013450.V308500.R01.S.doc 18/08/06 18/08/06 18/10/06 18/08/06 18/08/06 Ash Street (149) Version 5.2 Page 29 9 YA27 23 (2) (b) 10 11 YA27 YA35 23 (2) (b) 18.(1)c(i) 12 YA37 12.(4)(a) 12.(5)(b) 13 YA42 16(2)(h) 14 YA42 23 (2) (b) 15 YA42 16(2)(h) plastered and decorated. Not met 31/05/05 and 01/09/05 The registered person must ensure that the flooring in the ‘frog’ bathroom is replaced due to water damage along the edge of the bath and around the edge of the base of the toilet. The registered person must ensure that several tiles in the ‘frog’ bathroom are replaced. The registered person must ensure that all staff receive training appropriate to work they are to perform. CSCI have required a training plan regarding the homes achievement of the National Vocational Qualification. The registered person must make suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of supported people and encourages and assists staff to maintain good personal and professional relationships with supported people. The registered person must provide adequate facilities for the service users to prepare their own food and ensure that such facilities are safe and well maintained for use by service users and people working in the home. The registered person must ensure that the cracked kitchen tiles and the re grouting of tiles on the splash back in the kitchen must be repaired or replaced. The registered person must provide adequate facilities for the supported people to prepare their own food and ensure that such facilities are safe and well maintained for use by all persons DS0000013450.V308500.R01.S.doc 18/10/06 18/10/06 18/10/06 07/08/06 07/08/06 07/10/06 07/10/06 Ash Street (149) Version 5.2 Page 30 in the home. 16 YA42 23.(2) (b) The registered person must ensure that the premises of the care home is of sound construction and kept in a good state of repair internally, attention must be paid to the bathroom doors that were not closing properly and suitable repairs must be carried out to resolve this matter. The registered person must ensure that the downstairs toilet door is repaired in order that it can close and a door handle must be sited on the door to ensure people’s dignity and privacy, and promote a safe and well maintained environment for all persons in the home. The registered person must ensure that people’s dignity and privacy, is promoted and incontinence aids are stored appropriately to reflect dignity, confidentiality and privacy for people being supported. The registered person must ensure that suitable arrangements are in place to prevent infection, toxic conditions and the spread of infection in the care home as it was noted that in one downstairs bathroom used disposable wipes had been discarded into an uncovered bin. The registered person must ensure that adequate safe facilities, including ventilation for service users to wash, dry and iron their clothes, if they so wish. The registered person must ensure that the slip hazard is eliminated in the laundry area in order to ensure that unnecessary risks to the health and safety of DS0000013450.V308500.R01.S.doc 07/10/06 17 YA42 12.(4)(a) 13.(4)(a) 23.(2) (b) 18/08/06 18 YA42 12.(4)(a) 10/08/06 19 YA42 13.(3) 14/08/06 20 YA42 13.(4)(a) 23.(2)(p) 18/08/06 21 YA42 13.(a)(c) 18/08/06 Ash Street (149) Version 5.2 Page 31 22 YA42 23.(2)(p) service users are eliminated and all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. The registered person must 18/09/06 ensure that there is adequate lighting in all parts of the care home and the light in the downstairs hallway is repaired and the cover to the light in the upstairs corridor is replaced. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ash Street (149) DS0000013450.V308500.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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