Inspection on 26/07/05 for 99 Ashley Road

This inspection was carried out on 26th July 2005.

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

Other inspections for this house

99 Ashley Road 22/08/06

99 Ashley Road 16/01/06

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 Sue Kinch Unannounced 26 July 2005, 9:30 th 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 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 Stationary 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 H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 99 Ashley Road Address New Milton, Hampshire BH25 5BJ Telephone number Fax number Email 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 Limited Mr Nicholas Cook Care Home 10 Category(ies) of Physical Disability (1) registration, with number Learning Disability (10) of places 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Not more than one service user to be admitted in the PD category. Date of last inspection 15/02/05 Brief Description of the Service: 99 Ashley Road is a care home providing personal care and accommodation for 10 service users with a learning disability. It is also registered to provide for one of these persons to have an additional physical disability. It is owned by Bell House Homes 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 comprises 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 is one lounge area, which can be subdivided to provide two smaller areas, and a separate dining room. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on July 26th for 5.5 hours and on 27th July for 2 hours. The inspector met most of the service users during this time and spoke with the manager and three staff. Some of the residents rely mainly on nonverbal communication. This affected the level of consultation available. All comments were positive. Observations were made of contact between staff and service users. Comment cards were received from residents and relatives. Evidence was also taken from a pre inspection questionnaire submitted by the manager. The communal areas and two bedrooms were seen. A selection of records was sampled. What the service does well: What has improved since the last inspection? What they could do better: A quality assurance system is being implemented in the home. However in order to demonstrate that regular monitoring of the home is frequent enough, required regulation 26 visits (by a representative of the organisation) need to 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 6 happen monthly and a report produced. It is advised that care management assessments are obtained before admission. 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 H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 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 standard(s) 2,3 Systems are in place for prospective residents to visit and decide if the home can meet their needs before admission. EVIDENCE: Since the last inspection one resident had been admitted to the home. Prior to this the resident had made visits and had the opportunity to meet the other residents and staff. There was sufficient written evidence that the manager had visited the resident and made a pre admission assessment of needs before the admission. The resident confirmed this. Records had been held of the visits and work to re assess had started when the resident had moved in. This had been followed up by a review in June. Information had been obtained from the previous home to aid assessment and care planning. A care manager had been involved but a care management assessment had yet to be obtained. It is advised that this is obtained before admission. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 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 standard(s) 6,7,8,9 Residents are increasingly involved in planning the support they need and in day-to-day decision-making. Systems are being improved to involve residents in risk assessments. EVIDENCE: Since the last inspection much work had taken place to update and revise the care planning and risk assessment systems in the home. This had been required in the last inspection report. The files seen when case tracking included support plans for a range of needs and were cross-referenced with the risk assessments. From talking to two residents about support and help needed the inspector noted a range of issues that support was needed for. Documentation for this was found in the care plans where needed with a couple of exceptions which needed to be addressed. The two residents were aware of their care plans. Care plans are increasingly including goals. Advice was given to research person centred planning. The range of risk assessments had broadened with increasing evidence of consultation with residents and care managers. Some discussion was held with the manager about some of the details of the risk assessments, which needed 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 10 further consideration. This included being specific about which relevant others are consulted. Another example is to extend staff guidance such as when the kitchen door is locked. The requirement made in the previous two reports about providing more detailed plans for dealing with difficult behaviours and physical intervention plans had been met. Old physical intervention plans that are not needed had been removed and the one that is in place was clearer including specific instructions. There was still no pictorial information about specific holds but this was to be reviewed with new physical intervention training planned for the staff group in the coming months. There is increasing evidence that residents are consulted about life at the home. On the first afternoon of the inspection two residents had decided not to go out and were supported to find things to do. Residents had been consulted in the morning about where to go. Staff confirmed this. Residents have regular staff meetings in which they are consulted. Records were held of this. A member of staff commented that with the increase in staffing they are able to offer people more choice. Discussion was held with staff and residents about a recent holiday that some of the residents had chosen to go on in a small group. Photographs were used to aid discussion. Others had chosen a similar holiday and some people had chosen to have a series of days out instead. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 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 standard(s) 12,13,14,15,16, 17 Service users benefit from opportunities to join in with a range of activities in the home and local community which increasingly take into account personal preferences. Service users are offered a healthy diet with increasing opportunities for choice. EVIDENCE: Through the course of the inspection staff supported residents in a variety of activities in and out of the home. The range of activities available was different to usual because of college courses not running during the summer. However the inspector heard about walking, cooking, cleaning the minibus, going to Hengisbury Head and Fisherman’s Walk, sewing, letter writing, exercises, shopping, and train rides. Staff commented on being more flexible about when activities can take place with more staff available. When talking with residents about the things they do with staff they said they like the activities. A daily activities board was in use in the dining room indicating choices made by service users. The use of photographs will help residents identify activities 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 12 and these were being prepared for use. Conversations were also held about the use of object references, which the manager thought could be useful for some of the residents. Activities may take place locally and further away. Two mini-buses are available for staff to use although the numbers of staff drivers affects use. This was a point made on one of the relative’s feedback cards. However the manager noted that there is increased use of local facilities and public transport, which some residents enjoy and request. Contact with families and friends is supported. Some residents spoke of their relative’s visits or visiting them. One resident was being helped to write a letter during the inspection. All feedback from relatives about visits to the home was positive. There was evidence of rights and responsibilities being increased in the home. Some residents were involved in kitchen and household duties. One resident asked, confirmed to have been offered a key to his room. There was some discussion about when and why the laundry is mainly locked and why the kitchen is also locked sometimes. This is referred to in the Individual Needs and Choices section but must be addressed to maximise freedom of movement around the home. A conversation was held with residents and staff about food provided in the home. The roast lunch had been appreciated by all those asked. In separate individual conversations with residents those asked spoke positively about the food in terms of quantity and quality. Discussion was held about likes and dislikes and there was general agreement that the cook and staff new residents preferences. There was also some discussion about special diets. Those spoken to were in agreement with the weight loss programmes. Staff and residents confirmed that there is choice. The options are discussed weekly. Alternatives were seen by the inspector to be provided. The day’s main menu is posted on the dining room wall. The manager confirmed that photographs are being taken of various meals and these will be included on the menu. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 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 standard(s) 18,19,20 Personal care systems are effective in providing service users with adequate support in personal care and health accessing other professionals when necessary. EVIDENCE: In conversation with some of the residents personal care was discussed. This was reported to be ‘nice’ and the help was ‘alright’. Personal care needs are documented in care plans. One resident said that staff helped with her hair and to get a haircut. Records were sampled for three residents to check that medical monitoring takes place. Records were available to show that various checks are made and frequencies of appointments are monitored. One resident discussed elements of his health needs. He was clear about his needs and the support available to help him. His independence was being promoted when making hospital visits. Staff dispensed medication individually during the inspection. Aspects of the medication system were sampled as a requirement was made in the last inspection report. Medication was stored securely. Checks were made of stocks. These were accurate except in one situation where an admission to the home had affected this. This only related to one drug. The manager agreed 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 14 that it needed to be rectified and it had been over looked. Several medication sheets were observed and no gaps were seen. A medication prescribed since the computerised sheets had been started had been recorded on the sheet and a copy of the prescription retained as required. Medication coming into the home is checked. A reminder was given to ensure that staff sign rather than tick the record for this. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 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 standard(s) 22 A complaints procedure is available in the home and service users feel able to talk to the staff and manager about concerns. EVIDENCE: The home has had one formal complaint since the last inspection and this had been logged in the home complaints file. There was evidence that this had been investigated by the manager and a response given to the complainant within required timescales. No further issues had been raised and there was evidence that the home was already monitoring the issue raised. What to do about complaints or problems was discussed with two of the residents. One felt that complaints could be made to the manager if necessary but this had not been necessary. The other resident would talk to staff or the manager if there were problems. The Commission For Social Care Inspection has not received any complaints about the home since the last inspection. Five relatives sent comment cards to the Commission and one reported to have made a complaint to the home. This had been addressed by the home. Four of the five respondents reported to not be aware of the homes complaints procedure. This was brought to the manager’s attention and he agreed to take action. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 16 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 standard(s) not assessed EVIDENCE: 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34 The revision of staffing levels and careful recruitment procedures offers an increase in staff support to residents to meet individual needs. EVIDENCE: As required the staffing levels have been revised since the last inspection when it was noted that two resident’s needs were under review. Following that inspection the staff levels were reported by the manager to have been reviewed. At this inspection it was noted that staff levels had been increased. Now four staff work on each shift instead of three. Evidence on the rota confirmed this and staff spoke positively about it. The change from three to four staff a shift had involved a temporary increase in agency staff used at the home but further recruitment has reduced the frequency of using them. On the week of the inspection no agency staff were planned to work at the home. During the inspection staff working showed friendly and supportive approaches to the residents. Positive comments were received from residents about the staff. Some residents were asked specifically for their views. Comments such as ‘nice’, ’alright’, ’treat me good’, ’take me out a lot’, were received about staff. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 18 Now the home provides a total of 458.5.care staff hours a week. There is one waking night staff and one person sleeping each night. In addition there 25 hours of cleaning and a cook works 25 hours a week. Following the last inspection a requirement was made regarding staff records that were incomplete. This was re examined and a sample of records were viewed and discussed with the manager. Work had taken place to address the requirement. Records for new staff recruited were sampled and found to be in place. For agency staff a letter from the agency was available confirming the nature of checks that they complete. The manager said that individual details are provided to the home before each person works there. The inspector asked to see six and all could be found except for one person. The manager confirmed that he had received it and agreed to find it. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,42 The registered manager in the home promotes an increasingly consistent service to residents. Residents are protected by a more effective system of regular safety checks and maintenance but overall monitoring needs to improve. EVIDENCE: A quality assurance system was required in the last inspection report. There is increasing evidence that monitoring of practices in the home. A quality audit by Allied Care (the parent company) had begun. Elements of the home had been audited in May 2005 .The manager had been provided with an action plan The manager was in possession of a record of action taken so far. Consultation with service users is increasing. House meetings take place each week and ideas are recorded. Consultation with relatives has not yet taken place formally but the manager stated that the staff and management have regular contact with families offering opportunities for feedback. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 20 There is not enough written evidence that regulation 26 visits are taking place routinely each month. Elements of health and safety precautions and maintenance were checked. In the pre inspection questionnaire received by the Commission in June 2005 routine checks were reported to be taking place. A sample of records was checked during the inspection. Fire records were in place. Checks of water temperatures are taking place as required in the last inspection report and are recorded. The gas safety check was slightly over due and the manager agreed to chase it. Legionalla testing is taking place. The employers liability insurance was valid. A new boiler had been installed in October 2004. The hoist had been checked in May 2005. Records of fire training are variable and recorded inconsistently in the fire log, induction records and staff meeting minutes. They need some attention to demonstrate the duration, nature and frequency of it for all relief, agency and permanent staff working in the home. This will vary depending on the nature of their roles. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 99 Ashley Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 39 Regulation 26 Requirement The home and CSCI must have reports of regulation 26 visits completed each month. Timescale for action 26/9/05 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 2 Good Practice Recommendations It is advised that care management assessments are obtained before admissions to the home. 99 Ashley Road H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Hampshire Area 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 H54 S12387 99 Ashley Road V240581 260705 Stage 4.doc Version 1.40 Page 24 - 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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