Inspection on 26/06/08 for 4 Ashley Drive

This inspection was carried out on 26th June 2008.

CSCI found this care home to be providing an Poor 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.

Other inspections for this house

4 Ashley Drive 06/12/08

4 Ashley Drive 21/08/07

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 4 Ashley Drive Tylers Green Buckinghamshire HP10 8BQ Lead Inspector Jane Handscombe Unannounced Inspection 26 and 27th June 2008 11:10 th 4 Ashley Drive DS0000069095.V365158.R03.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 4 Ashley Drive DS0000069095.V365158.R03.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. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 Ashley Drive Address Tylers Green Buckinghamshire HP10 8BQ 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) 01494 814569 www.turnstone.org.uk Turnstone Support Stuart Murphy Care Home 6 Category(ies) of Learning disability (0) registration, with number of places 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the follwing gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disabilities (LD) The maximum number of service users to be accommodated is 6. Date of last inspection 21st August 2007 Brief Description of the Service: The home provides twenty- four hour care for six people of both sexes with learning and associated physical disabilities. The house is owned by McIntyre Housing Association and the care is provided by Turnstone Support. The service has been in existence for many years but was registered in March 2007 when it was transferred from the Health Authority to Turnstone Support, a private provider who offer care to people with diverse special needs. The house is a domestic dwelling that has been adapted into accommodation for six people, there are three bedrooms on the ground floor, with en-suite facilities and three bedrooms on the first floor. The first floor is accessed by a staircase and is not accessible to those with physical disabilities or frailties. Communal accommodation is comfortable and includes a sizeable kitchen and dining area. There is a pleasant rear garden, which is accessible to those with physical difficulties. The home is approximately seven miles from the town centre and there are local facilities within walking distance. The home has its own vehicle and residents are able to access public transport. The fees are £1,317.20 TO £1,379 per week, which includes £179.94 for rent and housing services. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection, which took place over 2 days and was carried out by one inspector. The visit took place on the 27th and 28th June 2008. The purpose of the visit was to see how the home is meeting the National Minimum Standards. Prior to the visit we sent out surveys to people using the service, staff members and health and social care professionals to gain feedback on the service. Results of this inspection report are derived from feedback gained from the service users, discussions with staff during the visit, viewing client’s records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the day, along with information provided to us within the AQAA, an annual quality assurance assessment which is a self assessment which focuses on how well outcomes are being met for people using the service and gives us some numerical information about the service; we ask providers to complete and return these to us on an annual basis and any other information that CSCI has received about the service in order to gain an understanding of how the service meet the service users’ needs, and impact upon their lives. A tour of the home was undertaken, care plans were examined and meeting the residents to see if the care plans gave a true reflection of their care needs and how these were being met followed this up. The inspector met with residents, staff, visiting relatives and friends to find out their views on how well the service is doing. Records required by regulations were examined, including staff files and the home’s policies and procedures We looked at how well the home was meeting the key standards set by the government and have in this report made judgements about the standard of the service. The inspector would like to thank all those who gave their time during the inspection process. What the service does well: The home deals with a number of diverse care needs and always ensures to offer a very personalised service to meet the needs of those using the service. There is a very real commitment to ensure that all users of the service, however diverse their needs may be, receive a person-centred package of care which meets their needs appropriately. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 6 The home has a flexible visiting policy and welcome family, friends and any other visitors to the home. Relatives and friends are encouraged to visit and are made to feel welcome. Appropriate systems are in place to ensure any potential admissions to the home have their needs assessed and are provided with an opportunity to visit the home to ensure that it is suitable and able to meet their needs appropriately What has improved since the last inspection? What they could do better: Undertake a regular audit of care plans to ensure that all assessments are signed by the person who undertook the assessment and signed by the service user/representative to evidence they have taken part in the process. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 7 Where risk assessments highlight situations in which it is felt that some form of restraint is required, a multidisciplinary assessment should be undertaken, the rationale fully documented and signed by all parties including that of the service user/their representative. Ensure that regular and engaging activities, suitable to the needs of those using the service, are provided to provide stimulation and variety to their lives. Ensure that detailed logs of food provided to service users is kept to evidence that appropriate nutritionally balanced meals are provided which meet their health needs appropriately and to allow for tracking purposes Ensure that all users of the service have access to the garden which is accessible, well maintained and free from hazards to their safety; at present the rear garden is inaccessible to those using a wheelchair due to a large shrub obstructing the ramp. Ensure to gain a full employment history, together with a satisfactory written explanation of any gaps in employment prior to employing a person to work at the care home and gain a recent photograph ensuring the recruitment procedure is robust. Ensure that persons employed at the home receive training appropriate to the work they are to perform in a timely manner. It would be good practice to obtain a bound hardback book with numbered pages for any controlled drugs and to follow the National Pharmaceutical guidelines around the safe storage, recording and administration for these types of drugs. It is good practice to consider including health and social care professionals who visit the home in the quality review of the service to gain a more ‘rounded picture’ of the service. It is recommended, where service users health and support needs are commissioned from other geographical areas, to gain the relevant interagency safeguarding policy and procedures and keep them in the home for reference. 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. The summary of this inspection report can 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 8 be made available in other formats on request. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 9 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 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. The home provides all prospective and current users of the service with information, in a format suitable to their needs, detailing the service and services it can provide. No one moves into the home before an assessment of needs is undertaken to ensure that both parties are confident that the home can meet their needs appropriately This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection undertaken in 2007, there have been no new admissions to the home. The admission process was discussed and it was ascertained that prior to moving into the home all prospective users of the service undergo an assessment of needs, by a person qualified to undertake such a task, to ensure both parties are confident that their needs can be met in full at 4 Ashley Drive. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 11 A sample of current service users files were examined and contained evidence highlighting that a comprehensive assessment of needs was undertaken prior to them moving into the home. People using the service, health care professionals and the service users’ representatives were involved in the assessment process. Information about the home and the services it offers is provided in a service users’ guide which can be produced in a pictorial format for those who require. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good All service users have an individualised plan of care and support detailing their assessed needs and personal goals and how these needs and goals are to be met. Service users are enabled to make decisions about their lives and are supported to take risks in all aspects of their daily lives promoting their independence and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection the inspector viewed a sample of care plans and found them to be individualised and contain appropriate detailed information on the users individual needs and preferences and how these needs are to be addressed. Each was drawn up from an assessment of needs in which the 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 13 service user, and/or family members and other health and social care professionals had taken part in. Regular reviews of care are undertaken and care plans updated where change in needs have been highlighted. Evidence shows the service has been working to ensure user involvement , although care needs to be taken to ensure all assessments are signed appropriately and user representatives/independent advocate sign where the service user is unable to do so. A requirement has been made to address this. The care plans set out the action, care and support needed, taking into account the service users’ preferences and expectations, detailing how the staff are to meet their assessed needs appropriately. Where any risks had been identified, a risk assessment was in place detailing the risks and how these may be minimised whilst promoting users choices and independence, however in situations in which it is felt that some form of restraint is required, a multidisciplinary assessment should be undertaken, the rationale fully documented and signed by all parties for which a requirement has been made within this report. Service users are encouraged and supported to make decisions about their lives. Regular residents meetings are held to gain service users views on different aspects of their lives, both within and outside of the home, all of which are minuted. A local independent advocacy service is provided regularly to those using the service both in group discussions and on a one to one basis when required. The majority of people using the service have regular contact with family members. The inspector discussed the protection of service users monies held within the home and viewed documentation. The documentation was in good order, with receipts kept for all purchases and provided a clear audit trial. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 14 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): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate People using the service are provided with opportunities to attend local day placements within the community although there is a lack of any meaningful activities being sought and accessed at any other time such as the evenings and weekends. Mealtimes are relaxed, unrushed and flexible to meet peoples individual needs although there is not a system in place to enable the service to track what meals have been provided and to evidence they meet the service users need appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details within the care plans, daily notes and feedback from service users evidenced that all are actively involved within the local community and attend 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 15 day service placements within the local area, however there appears to be a lack of meaningful activities when people are not accessing day services and during the evenings and weekends. This was noted during our last inspection undertaken in August 2007, for which it was recommended that that the service reviews their activity programmes relating to evening and weekends to ensure that the people who use the service are enabled to access the community. One user of the service attends a day centre two days of the week and attends a local church most Sundays, however it was noted that there were few activities noted that this particular user of the service had partaken during the days in which he/she did not attend the day centre. Over the course of 22 days the said service user had spent 6 days at the day centre, of the remaining 16 days he/she spent the days at home. the activities documented for these days that he/she had spent at home were that he/she had accompanied staff in the homes transport to collect fellow service users from their day placements on six occasions, three occasions documented in which he/she had taken a walk, one afternoon in which he/she sat in the garden and a further entry in which he/she had done a puzzle with two fellow service users. Over the course of three weekends there was no evidence of any activities having been undertaken other than that of one 2 hour shopping visit, one entry in which the user ‘watched others cleaning their rooms’ and ‘watched TV with other service users’. Feedback from surveys, which we sent out to staff prior to this visit, indicated that they felt the service could improve upon the provision of activities. One commented that ‘I think a few more organised activities like going out for day trips should be put in place. I feel some of the service users should get out more on the weekends as they seem to spend a lot of time at home” whilst another felt the service could provide “more staff to provide one to one activities”. Information provided to us in the AQAA informs us that the service have improved in the last 12 months in that they have increased the staffing levels at weekends in order that they can begin working on activities with the service users and they plan in the next 12 months, to work towards providing more activities over the weekends for the people using the service. However, there appears to be little evidence of any improvement in the provision of meaningful activities during the evenings/weekends since we last inspected the service and therefore a requirement has been made within this report to ensure that regular and engaging activities, suitable to the needs of those using the service, are provided to provide stimulation and variety to their lives. Arrangements for service users to meet with friends and family members are flexible and support is given to maintain personal relationships where required During the inspection it was noted that staff spend mealtimes with service users and offer assistance where required in a sensitive manner. Mealtimes were observed to be a sociable occasion and were unrushed, relaxed and served at a time to suit those using the service. Training has been provided to 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 16 all permanent staff ensure they are aware of and adhere to the specialist feeding guidelines for one particular service user who is fed by a PEG machine and guidelines are in place in the relevant care plan. People using the service are involved in planning the menus; meal choices are discussed and their ideas are sought in the monthly home meetings. On the day of this inspection, we toured the kitchen and found it to be clean and well stocked. We asked to view records of the meals provided that week as all that was observed was a document pinned to the fridge, which was the homes meal planner and also logged the recorded food temperatures, although these had not been entered for all the foods documented. The said document gave no details as to what had been provided for breakfast or lunch and the evening meal only documented the type of meat. It contained very little detail making it impossible to establish if the users of the service are receiving appropriate well balanced, nutritious meals which meets their needs appropriately. Upon discussion with the manager it was ascertained that this was the only log kept of the meals provided to those using the service. A requirement has been made within this report to ensure that detailed logs of food provided to service users is kept to evidence that appropriate nutritionally balanced meals are provided which meet their health needs appropriately and to allow for tracking purposes 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor Arrangements for managing medication are unsafe and fail to protect and promote the welfare of people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have the necessary disability equipment they require to enable them to maintain their independence and robust risk assessments are in place detailing how the care is to be delivered in a safe manner whilst maintaining and promoting the users independence. Of those service users being case tracked during the inspection it was evident that the carers spoken to were aware of their individual needs and had a good understanding of how to address their needs whilst promoting their independence. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 18 There was evidence in the daily diary detailing people’s appointments. Healthcare records included separate records of contact with various healthcare professionals. People using the service are now supported to visit the surgery wherever possible as opposed to the GP visiting the home to allow for more independence. The records indicated that annual health checks are in the process of being completed for each person living at the home and appropriate one-off consultations are sought where necessary. Monthly recording of people’s weight is being undertaken. Each user of the service has a book entitled ‘Health Passport’ which allows for a detailed record of appointments and healthcare issues pertinent to each individual although these are not yet fully updated we are assured that these are being attended to. The service recognises that improvements need to be made around peoples health care plans and inform us that plans are in place to address this. Feedback from healthcare professionals informs us that the service always seeks advice and act upon it to manage and improve individuals’ health care needs, that the service have responded appropriately if any concerns about people’s care have been raised and that they are confident that people’s healthcare needs are always met. Poor practices around the administration and recording of medications were apparent. Whilst viewing the medication administration records (MAR) evidence highlighted that medication is not always documented appropriately on the users MAR sheets. There were instances in which there were gaps where administered medication had not been signed for to evidence that these had actually been administered. The service must ensure that medication administration record (MAR) sheets are initialled at the time of administering the medication and a record is made on the MAR sheet for the reason of any non administration of medication; One user of the service had been prescribed medication 4 times a day, however records evidence that this particular medication was only being administered twice a day with no reasoning documented as to why the GP’s instructions were not being followed. The registered manager informed us that the change in dosage had been instigated by the GP, however there was no documented evidence to support this and no new prescription had been provided to support this. During the medication round it was noted that the same service user was to be administered a medication, the inspector asked to view the medication prior to this being administered and noted the ointment to be past its expiry date. Appropriate actions were taken and the medication was not administered, the registered manager contacted the out of hours GP and a repeat prescription was to be provided in due course. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 19 Further concerns were highlighted around the recording of schedule 2controlled drugs, namely that of Temazepam. The service documents all controlled drugs separately on a document entitled ‘Controlled Medication Register’, whilst this is not a hardbound book with numbered pages that can be obtained from the pharmacist, it serves the same purpose to enable a clear audit trial. Staff had returned from a vacation with some of the service users, and was seen to be checking medication into the home upon their return. Two staff undertook this task to ensure that a witness partook and to ensure no errors. We looked at the records for the controlled drugs returned into the home and found discrepancies; the balance of the said temazepam tablets did not correlate with that entered in the homes documentation. An immediate requirement was made to undertake an enquiry into the discrepancy and to forward the outcome and any actions taken to CSCI within 48 hours, of which the service did. Furthermore, we were supplied with copies of the homes controlled medication documentation for the said person and note that this type of discrepancy appears to be a regular occurrence, records are incomplete proving very difficult to undertake an audit trial which gives a clear picture of the situation. Poor practices are clearly being undertaken which do not serve the service users’ best interests as may be evidenced in the above findings. The above findings are most concerning, and therefore the inspector will be recommending that the Commission, as a matter of urgency, undertake a pharmacy inspection. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. Effective complaints procedures are in place to ensure that issues raised by service users or their representatives are listened to and acted upon, although outside agencies are not always informed of the progress within the timescales stipulated in the homes policy. Adult protection is appropriately managed to ensure that service users are not placed at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has received six complaints since the last inspection undertaken in August 2007, all of which were logged in the complaints book, detailing the actions taken. It was noted that all had been dealt with in a timely manner and according to the homes robust complaints procedure. The complaints procedure is accessible to all those using the service in a user friendly format and this is explained to those using the service on a regular basis. There is an independent advocate who visits the home regularly, who will support those to speak up about any concerns they may have, if required. The commission has received one complaint, which was sent to the provider to deal with under their complaints procedure, some aspects of the complaint were fed into the inspection process and were followed through within the remit of the key inspection. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 21 The registered manager and services manager confirmed that there has been one safeguarding adults issue since the last inspection undertaken in August 2007. We were notified of the issue as is required under the Care Homes Regulations and an appropriate referral was made to the appropriate bodies. The home followed the local interagency policy and procedures and appropriate actions were taken to address the issue and protect users of the service from any unnecessary harm. Information provided to us prior to undertaking this visit informed us that staff have generally received training in this area, to ensure that they have the skills and knowledge to address any allegations or incidences appropriately. However of the three staff files viewed, one failed to contain any evidence that safeguarding training had been undertaken. A requirement has been made elsewhere in this report to ensure that staff are suitably trained to meet the needs of all those using the service. Whilst the home has a copy of the Buckinghamshire Local interagency policy and procedures around safeguarding, the service needs to ensure that where service users health and support needs are commissioned from other areas, the relevant interagency policy and procedures should be held within the home. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 and 30 Quality in this outcome area is good The home endeavours to provide users of the service with a homely comfortable environment in which to live with appropriate specialist equipment in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a clean, homely environment that is appropriate to the specific needs of the service users who live there. It is well-maintained and provides specialist aids and equipment to meet the needs of those who live there. Bedrooms are located both upstairs and downstairs. The downstairs bedrooms have en-suite facilities, suited to the needs of the people who live there, one person is not able to bath as he has a shower in his room and the baths located upstairs and are inaccessible 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 23 The bedrooms are decorated and furnished to service users own personal tastes containing their own possessions and lockable storage facilities. All users of the services are provided with keys to their own room to ensure privacy. Since the last inspection, the service has purchased new furniture in the lounge and dining room to provide for more comfort for those living there. Likewise new bedding has been purchased and provided for those using the service and some specialist equipment is on order for one user of the service to ensure that their needs be met appropriately. It was noted that wheelchair access to the rear garden is via a ramp, however a large shrub obstructs the ramp, thus restricting them access to this part of the garden. In order to ensure safe access to the rear garden for wheelchair users this needs attending to. The home has the necessary clinical waste bins to prevent cross infection, they wash peoples’ laundry separately and have a robust cross infection policy in place. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate There are effective recruitment procedures in place although these could be further enhanced to ensure they are more robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing levels on the day of this inspection were appropriate to meet the needs of those using the service. Staff spoken with demonstrated a good understanding of their roles and described a supportive environment and a good sense of teamwork. Since the last inspection work has been undertaken to enable users of the service to be involved in the recruiting and selection of staff for the service; this resulted in the organisation holding Service User Recruitment Group meetings and training service users, who wished to take part, in identifying what makes a good staff member and what is required. One service user from Ashley Drive has been involved in this group since it started and has completed 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 25 several staff interviews. The home’s policy around the recruitment and selection of staff serve to protect service users health and welfare. Application forms are completed, references are collected and a face-to-face interview is undertaken. Relevant POVA (protection of vulnerable adults) and CRB (criminal records bureau) checks are undertaken prior to appointment to ensure the persons suitability with working with vulnerable people. However whilst viewing three staff personnel files, it was noted that one did not contain a full employment history there were gaps and no evidence of any documentation was available to explain the gaps in employment and of the three files viewed, two failed to contain an up to date photograph of the said persons. A requirement has been made to address these shortcomings. All newly recruited members of staff receive a structured induction training including shadowing more experienced carers until both parties feel confident and comfortable. Staff are provided with mandatory training in the core subject areas, however this is an area in which the service have highlighted as an area for improvement and inform us that this is an area being addressed; that those staff who have not completed such training have started to complete their mandatory training. Of the three staff personnel files it was noted that two had undertaken all the necessary training whilst the remaining personnel file highlighted gaps in this area, particularly around food hygiene, safeguarding and health and safety. Information provided to us prior to this inspection informs us that of the 10 permanent staff, only two possess their National Vocational Qualification in care at level 2 or above with a further member of staff working towards it. Evidence within the personnel files viewed contained evidence of the provision of staff supervision, however, the service recognises that this has not been as regular as required and plans are in place to ensure more regular staff supervision meetings take place. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is adequate The home is generally well run, the service are aware of where improvements need to be made, although evidence of poor procedures taking place namely around record keeping medication practices do not serve the service users best interests and could compromise the health safety and welfare of those using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new Manager of the service has been appointed to the home since the last inspection undertaken in August 2007and he successfully gained registration with the Commission in March 2008. The manager is very experienced in the 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 27 field of health and social care, has the Registered Managers Award and is currently undertaking the National Vocational Qualification level 4 in care. Service users and staff spoke in complimentary terms about his management ability and the support he gives as did the feedback from surveys sent out prior to the inspection and discussions with family members on our second day of this inspection The manager obtains feedback from residents at residents meetings, staff meetings and family meetings added to these, he has an ‘open door’ policy that encourages people see him without the need to make an appointment. An annual quality assessment of the service is undertaken in which surveys are provided to service users, staff and family members to complete giving feedback on the service and the services they offer. The results are collated and fed back to all who took part and any actions are put into place. A reccommendation has been made to include health and social care professionals who visit the home in the quality review of the service to gain a more ‘rounded picture’ of the service Regular monthly house meetings are held to gain the views of those using the service and through the use of service user questionaires which service users are asked/suported to complete given a variety of topics. Summary reports and Continuous Action plans are produced from these a number of which the inspector viewed., collate the findings and feedback to those taking part. During the visit, we examined a number of health and safety records, which indicated that these undertaken appropriately to ensure the health, safety and welfare of those using the service. All necessary checks and servicing of equipment in relation to fire safety and the maintenance of the water system are routinely undertaken and documented appropriately. Hazardous substances were found to be stored appropriately. Evidence of poor practices taking place namely around medication and poor recording procedures, do not serve the service users best interests and could compromise their health, safety and well being. Improvements are needed in record keeping for some of the key document tools such as risk assessments and medication practices to ensure the health, safety and welfare of those receiving a service. These issues have been identified elsewhere in this report. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 28 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 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 3 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 2 x 2 x 2 2 x 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 29 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 YA6 Regulation 14(a)c Requirement Undertake regular audits of care plans to ensure that all assessments are signed by the person who undertook the assessment and the service user/representative to evidence they have taken part in the process. Timescale for action 05/09/08 2 YA9 13(4)c 3 YA13 16(2)m,n When risk assessments highlight 31/08/08 situations in which it is felt that some form of restraint is required, a multidisciplinary assessment should be undertaken, the rationale fully documented and signed by all parties including that of the service user/their representative. Ensure that regular and 31/08/08 engaging activities, suitable to the needs of those using the service, are provided to provide stimulation and variety to their lives. Ensure that detailed logs of food provided to service users is kept to evidence that appropriate nutritionally balanced meals are provided which meet their health DS0000069095.V365158.R03.S.doc YA17 4 17 and Schedule 4 15/08/08 4 Ashley Drive Version 5.2 Page 30 needs appropriately and to allow for tracking purposes 5 YA24 13(4)a The registered manager must ensure that all users of the service have access to the garden which is accessible, well maintained and free from hazards to their safety The registered manager must ensure to gain a full employment history, together with a satisfactory written explanation of any gaps in employment prior to employing a person to work at the care home. The registered manager must ensure to have a recent photograph contained in each staff personell file. The registered manager must ensure that persons employed at the home receive training appropriate to the work they are to perform in a timely manner. 31/08/08 YA34 6 19 and schedule 2 31/08/08 7 YA34 8 YA35 19(4)b and schedule 2 18 15/08/08 31/08/08 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 YA20 Good Practice Recommendations It is good practice to obtain a bound hardback book with numbered pages for any controlled drugs and to follow the National Pharmaceutical guidelines around the safe storage, recording and administration for these types of drugs. It is good practice to include health and social care professionals who visit the home in the quality review of the service to gain a more ‘rounded picture’ of the service It is good practice, where service users health and support needs are commissioned from other areas, to gain the DS0000069095.V365158.R03.S.doc Version 5.2 Page 31 2 YA39 4 YA23 4 Ashley Drive relevant interagency safeguarding policy and procedures and keep them in the home. 4 Ashley Drive DS0000069095.V365158.R03.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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