Inspection on 22/08/06 for 99 Ashley Road

This inspection was carried out on 22nd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

99 Ashley Road 16/01/06

99 Ashley Road 26/07/05

99 Ashley Road 15/02/05

99 Ashley Road 09/08/04

99 Ashley Road 03/02/04

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

CARE HOME ADULTS 18-65 99 Ashley Road New Milton Hampshire BH25 5BJ Lead Inspector Liz Palmer Unannounced Inspection 22nd August 2006 09:30 99 Ashley Road DS0000012387.V309230.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 99 Ashley Road DS0000012387.V309230.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. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 99 Ashley Road Address New Milton Hampshire BH25 5BJ 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) 01425 628308 Bell House Homes Ltd Nicholas Cook Care Home 10 Category(ies) of Learning disability (10) registration, with number of places 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: 99 Ashley Road is a care home registered to provide personal care and accommodation for 10 service users with a learning disability. It is also registered to accommodate one person who has an additional physical disability. It is owned by Bell House Homes Ltd, a subsidiary of Allied Care Ltd, which has a number of other registered properties in the area. The home is located on the outskirts of the town of New Milton, with relatively easy access to the shops and other public amenities. The home is a detached, double fronted property with car parking for 6-8 vehicles to the front of the building and a well-maintained and accessible garden to the rear. All bedrooms are occupied on a single basis; none of these have an en-suite facility. There are two bathrooms on the first floor and a shower room on the ground floor. There is one lounge area, which can be subdivided to provide two smaller areas, and a separate dining room. Fees range from £850 - £1779 per week. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included a visit to the service which took six hours. Other information provided by the home prior to the visit was used including, regulation 26 monthly monitoring forms, a pre-inspection questionnaire and a training schedule for staff. During the visit most of the service users were met and four were asked about their views on the home. Three were case tracked. Some service users were unable to give their views and these were observed being supported by staff. Six members of staff were met and three staff were interviewed. The manager was present for most of the visit. The parent of one service user was met and gave her opinion of the home. Care plans and other paperwork including policies and procedures were sampled. What the service does well: What has improved since the last inspection? What they could do better: The way in which some service users are charged for transport must be clear. Service users would all benefit from a Person Centred Plan. This was discussed with the manager who is committed to providing this. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 6 Service users would benefit from a more individual approach to risk assessing with particular regard to promoting an independent lifestyle. 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. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 7 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 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 8 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for prospective service users’ needs to be assessed to ensure they can be met before offering them a place in the home. EVIDENCE: This standard was assessed and met at an inspection on 26/07/05, no new service users have moved into the home since then. The last service user to move had made visits and had the opportunity to meet the other service users and staff. An assessment had been made by the manager before offering a place in the home. A care manager had been involved in the admission process. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 9 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are detailed and regularly reviewed, however service users would benefit from person centred plans and a more individual approach to risk assessments. EVIDENCE: Three care plans were sampled. These were clear, detailed and kept under regular review. There was evidence that service users are involved in drawing up and reviewing their plans. Information such as important relationships, likes and dislikes, how to communicate with individuals and how to interpret their actions were written in the plans. There was evidence that annual reviews take place with input from care managers and day services, where appropriate. Service users would benefit from person centred plans produced in a format accessible to them. The manager said he was committed to achieving this and relevant training for care staff would take place within the next six months. A key worker system was in place, service users spoke about their key workers and gave examples of how they are supported by them. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 10 Through observation it was evident that service users are able to make decisions about their lives. Staff were seen asking service users what they would like to do that day. Weekly house meetings are held and a record is kept of what service users discussed. Activities and trips are requested, items of furniture and favourite foods are also asked for. Service users said they are able to choose how they spend their time, when they get up and go to bed. Staff confirmed that there are no rules about this but encouragement is given if needed for someone to keep an appointment or engage in a planned activity. During the inspection people were observed getting up at different times and helping them selves to drinks and breakfast. Service users are supported to take risks and risk assessments are in place and regularly reviewed. Some risk assessments appeared to be the same for all service users, for example, no one has access to the laundry and the risk assessments state no interest in doing their own laundry has been expressed by service users. Some service users may benefit from the opportunity to be involved in such activities as part of a more independent lifestyle. This was discussed with the manager and a recommendation has been made for consideration to be given to this on an individual basis. Another risk assessment seen stated a risk to a service user of violence from other services. Through discussion it became apparent that the risk was actually low making the risk assessment inaccurate. The manager removed the risk assessment. A recommendation has been made for all such risk assessments to be reviewed and again looked at on an individual basis. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 11 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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from the arrangements for opportunities for educational and social activities, community access and support with relationships. Healthy and varied meals are offered with involvement from service users. EVIDENCE: Service users are supported to attend day services, college courses and leisure activities on an individual basis and in groups. Planned activities which took place during the visit included a trip to Beaulieu Motor Museum and a picnic in the New Forest. The trip to Beaulieu had been requested at a recent house meeting. Service users said they had enough to do and evidence of their hobbies and interests being promoted was seen, for example, one service user is keen on football and this was reflected in the décor of his bedroom, the choices of activities offered to him and his clothing. Service users are supported to access the local community and some talked about going out for coffee and using the local shops. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 12 A quality assurance questionnaire sent out to relatives showed that they feel welcome in the home and that service users are supported to maintain links with them. One parent said it was like ‘home from home’. Another thanked the home for regularly driving his son for visits as he is unable to make the journey. Other evidence showed that service users are helped to telephone friends and relatives. One service user talked about his friends coming over for a meal later that week. One relative was met and she said she was always made welcome in the home and that it was like a ‘family’. The home aims to strike a balance between giving service users what the want to eat and promoting healthy eating. Special diets are catered for and one service user showed the inspector his menu for the week which is designed with his health requirements in mind. Evidence of service users stating their preferences for meals was seen. Pictures are used to support those who cannot make their choices verbally. One service user is on a reducing diet which has been recommended by their doctor. A referral has been made to a dietician to support the home with this. A cook is employed by the home, one service user said he occasionally helps with the cooking and is able to make himself drinks whenever he wants. Service users said they have a choice of where they eat but mostly they eat in the dining room. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 13 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to maintain their health and receive personal support in a way that meets their needs and preferences. EVIDENCE: Personal care needs were recorded in care plans. Service users spoken to said they got the care they needed and staff ‘help’ them. Records of visits to General Practitioners (GPs) and outpatient appointments were seen. Systems for following up health matters seem to be suitable. Some service users have specific health needs, systems are in place to monitor and review these. Specialists are involved where necessary and service users are supported to keep appointments. One service user with specific health needs told the inspector about his regular visits to hospital and how he is supported by staff to maintain his well being in between visits. Another service user returned home from an over night stay in hospital where she said a member of staff had stayed with her during the night. Staff said they felt service users health needs are met in the home and any concerns are followed up. Service users are supported to maintain emotional wellbeing. Two service users told the inspector how staff help them when they ‘feel angry’. A strategy 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 14 for helping one person deal with his anger was seen. Some service users have ‘behavioural intervention plans’ which involve de-escalating techniques which staff have been trained in. Staff spoke positively about the training and how it has helped them support individuals in the home. No physical intervention is used in the home. Records relating to administering medication were sampled. All records seen were accurate and up to date. Some service users were prescribed ‘as required’ medication and clear protocols for administering these were in place and agreed by the GP. The procedure for administering medication was seen. Staff spoken to were aware of the procedure and said that only trained staff administer medication. 99 Ashley Road DS0000012387.V309230.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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to air their concerns and make complaints. Procedures are in place to protect service users from abuse, however, the system for charging people for transport must be made clear. EVIDENCE: One complaint has been made to the home since the last inspection. It was made by a service user and has been addressed by the home in line with its complaints procedure. Service users were asked about how they complained and made their concerns known. Some said they could ‘talk to staff’ if they were unhappy. One service user gave two examples of how they had raised concerns to staff and had them resolved. It was not possible to fully assess how some service users would express their concerns, however, guidelines in care plans described indicators to people’s moods and in some cases stated the sorts of things that make them unhappy. The relative spoken to on the day said she would have no hesitation in complaining on her relative’s behalf. She said she has complained in the past and had a satisfactory response. The quality assurance questionnaire sent to relatives showed that those who responded would feel comfortable in discussing any concerns with the home. Staff spoken to said they could raise issues on behalf of service users and expect to have them addressed by the manager. Service users are protected by the homes procedures for supporting them with their finances. The manager is an appointee for eight service users. Records 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 16 were sampled of three service users bank accounts and cash held on their behalf. The procedure for storing bank books and money is robust and records are kept of all transactions and receipts where possible. There are individual arrangements for service users handling their own money which are detailed in care plans. Two large transactions from one account were not known about by the manager and there was no audit trail, this was resolved during the inspection and advice on how to avoid this in the future was given. Some service users are being charged for the use of the home’s transport. A record of how many miles each service user travels is kept. The manager stated that all service users receive more than they are charged for and no one is ever refused a journey based on what they have paid or what journeys they have already done. However, he was unable to say how much each person paid. A requirement has been made for the charges to be clearly set out. The home has an adult protection policy and a copy of The Hampshire County Council policy. Staff receive training in this area and the manager was confident that the home could respond appropriately in this area. There are no current adult protection issues. 99 Ashley Road DS0000012387.V309230.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a clean, hygienic and safe environment. EVIDENCE: A tour of the premises was undertaken with the assistance of one of the service users. The home was found to be comfortable, clean safe. For example, doors marked as needing to be kept locked were locked. A suitable window restrictor was seen to be in place. A maintenance worker is employed by the home and a system is in place to report repairs and improvements needed. Some improvements have been made to the home since the last inspection. These include the redecoration of two service users bedrooms and a new hall carpet. Bedrooms seen were suitably decorated with adequate furniture and personalised to reflect the preferences and needs of the individuals occupying them. A domestic assistant is employed. She was in the process of ‘spring cleaning’ one of the service users bedrooms. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 18 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 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a well trained and supervised staff team. EVIDENCE: A recommendation was made at the last inspection for the manager to take action to ensure sufficient numbers of staff are trained to NVQ level 2. This has been addressed and three staff are now undertaking level 3, three are doing level 2 and the deputy manager is doing level 4. All remaining staff will start level 2 in April 2007. Other training undertaken so far in 2006 includes Adult Protection, Epilepsy, Health and Safety, Fire, Sexual Awareness, Makaton, Mental Health Awareness and training in de-escalation techniques. Training planned for the rest of the year includes Autism, Risk assessment and Equal Opportunities. Allied Care has a rolling programme of training to keep staff updated and new staff suitably trained. Staff spoke highly of the training they had received. Staff were observed working in a positive manner with service users, they were aware of their needs and took time to listen to them. A program for supervision was seen and staff said they receive this monthly and find it useful and supportive. Regular staff meetings take place which one staff member described as ‘an open forum’. Staff said their views are listened to and respected. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 19 Standard 35 was assessed and met at an inspection on 26/07/05, no new staff have been recruited since that inspection. One member of staff had transferred from another local Allied Care home, the manager said she is settling in well and the increase in staff has enabled them to stop using agency staff. The home has four staff during the day, one sleep in and one waking night staff. There is also a part time cook and a part time domestic assistant. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 20 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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and the health and safety of service users is promoted. EVIDENCE: The manager is confident and competent and has the support of his staff and deputy manager. Service users benefit from the office being well organised and paperwork being kept accurate and up to date. Evidence of regulation 26 visits taking place was available. Regulation 37 forms are sent to the commission to inform us of events detrimental to the well being of service users. Staff and service users expressed confidence in the manager and felt able to talk to him and be listened to. Relatives’ confidence in the manager was also stated in the questionnaires returned to the home. Service users continue to be more involved in the decision making process and are consulted about the development of the home. Relatives are consulted and questionnaires from them were seen to be positive overall. A full audit is due to take place in October. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 21 Standard 42 was assessed and met at the last inspection, a pre inspection questionnaire received from the manager by the commission on 31st July confirms that necessary health and safety checks are taking place, for example, weekly fire checks, regular fire training for staff and annual tests of electrical equipment. The fire alarms were tested during the inspection. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 22 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 X 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 23 N/A 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 YA23 Regulation 16 Requirement The registered person must ensure that any charges made to service users outside their terms and conditions, including for transport, are clearly recorded stating the reasons and circumstances under which they will be charged. Timescale for action 22/10/06 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 YA9 Good Practice Recommendations Service users would benefit from risk assessments being more individual and looked at more in terms of independent living as well as keeping safe. 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 99 Ashley Road DS0000012387.V309230.R01.S.doc Version 5.2 Page 25 - 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. 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