Inspection on 22/07/05 for Ardgowan House

This inspection was carried out on 22nd July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ardgowan House 15/09/08

Ardgowan House 09/10/07

Ardgowan House 12/01/07

Ardgowan House 03/07/06

Ardgowan House 16/01/06

Ardgowan House 28/02/05

Ardgowan House 02/09/04

Ardgowan House 27/02/04

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

CARE HOME ADULTS 18-65 Ardgowan House 4 Middle Street Newsham, Blyth Northumberland NE24 4AB Lead Inspector Karena M. Reed Unannounced 22nd July 2005 2:00 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. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ardgowan House Address 4 Middle Street Newsham Blyth Northumberland NE24 4AB 01670 367072 01670 367072 deborah.jobson1@btinternet.com Mrs A Jobson 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) Mrs A Jobson CRH 13 Category(ies) of LD - Learning Disability (2) registration, with number MD - Mental Disorder (7) of places MD(E) - Mental Disorder - Over 65 (4) Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 28/2/2005 Brief Description of the Service: Ardgowan House is a home registered to provide personal care to thirteen adults, categories of registration include eleven places for adults with mental health problems, four of these places are for people over sixty five years of age and two places are for adults with learning disabilities . The home is situated in a residential area on the outskirts of Blyth. It is close to local facilities and is easily accessible to the town centre and nearby coast.The home does not provide nursing care. The home consists of a large detached house with a small front and very large rear garden. All bedrooms are for single occupancy. There is a diningroom/combined lounge, separate lounge and a quiet room . A passenger lift is not available but some bedrooms are located on the ground floor of the property. There are two bathrooms and sufficient lavatories for the needs of service users. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over four hours. A partial tour of the premises took place and a sample of care records were inspected as well as other records. Records included: 4 care plans, 2 staff files, the fire log record, the accident book, admission/discharge register, complaints record, staffing rotas, daily communication book and service users personal allowance records. The deputy manager and two carers were spoken to during the inspection. The proprietor was not on the premises but she was spoken to on the telephone. Time was also spent with 6 service users during the inspection. What the service does well: What has improved since the last inspection? The standard of training has improved to include developmental training to assist staff to meet the needs of people cared for at the home. The National Vocational Qualification training programme continues and by December 2005 the minimum requirement will have been exceeded with50 of staff having achieved NVQs at level 3. This means staff have a good grounding in the knowledge they need to provide care. The environment is becoming better maintained and there is an on going programme of decoration and refurbishment around the home. It was pleasing to see that the number of shared bedrooms has reduced. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 6 What they could do better: 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. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 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 Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 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) 1,2,3,4,5 There is not enough relevant information provided by the home to ensure that potential service users are supplied with details of all the services the home provides to help them make an informed decision about coming to stay in the home. Comprehensive information is made available from the care manager when a referral is made. The home carries out an assessment prior to agreeing to admit people into the home to ensure that the home can meet their needs. Staff are becoming better equipped with the necessary skills in order to meet the needs of the service users. EVIDENCE: A Statement of Purpose was available within the Home however it should include all the information as required by the Care Standards Act 2000. The document should be made more user friendly and easy to read to inform prospective service users of the services available within the Home. Service users records did not contain written contracts between the home and the service user stating the terms and condition of residency, but they did contain more general contracts between the home and County Council. Inspection of records for four service users showed that full assessments had been carried out prior to their admission. A service user said that they had Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 9 visited the home and received information verbally and in writing about the way it was run before moving in for a trial stay. The service user was also very happy with the care and attention received. Service users have the opportunity to visit the home as many times as they like to decide if they wish to live there. This may involve tea- time visits, day and overnight stays and can be adjusted to the pace of the service user. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 There are some arrangements in place to ensure that residents’ health and social care needs are met. Health needs are not clearly addressed to ensure the staff team are fully informed. Service users are supported by staff but care plans do not reflect the amount of care and support that staff are providing to service users. There was no regular review of service users changing care needs. Service users are encouraged to be involved in decision making and to communicate and make their views known. EVIDENCE: Records showed that an assessment was carried out prior to the admission of service users. Information was also received from the care manager’s assessment of service users’ care needs. The resulting care plans recorded information about the health and medical and social needs of the service user. Two of the care plans however did not reflect the changing needs of the service users and did not record the support and assistance staff needed to provide to meet the needs. One of the service user’s care records contained evidence of a recent review of the person’s care needs by the placing authority Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 11 but the report did not accurately reflect the current situation and changing needs of the person. Although the home had involved other health professionals there was no evidence of their involvement. Other care plans looked at were not up to date and there was no evidence of recent evaluation of care plans by the home to ensure staff provided the appropriate levels of care to service users in case their care and support needs had changed. Meetings are held with service users about the running of the home. Service users spoken to stated that they were involved and consulted about decisions involving themselves. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,16,17 The Home encourages and provides support to enable service users to use and take part in community facilities wherever possible eg leisure, health, spiritual, social, educational needs. Social activities are managed creatively and provide variation for people living in the home. Meals are wholesome and nutritious but no choice is available. Visitors are made welcome or staff support residents to maintain contact with family and friends as they wish. EVIDENCE: Records showed that, service users, whatever their level of need are assisted to enjoy as fulfilled a lifestyle as they may choose. Service users all pursue their own individual hobbies and interests. There was also a range of activities and entertainment available to choose from if service users wished to take part eg parties, day trips, meals out, shopping, cinema, karaoke, dominoes. Service users also enjoy individual or small group holidays eg Blackpool, Cadburys World, mystery weekend, Paris. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 13 The service users spoken to said that they were involved in the running of the home and involved in making decisions about their daily and future living requirements. Records also provided evidence that service users are consulted and asked their opinion and encouraged to make decisions. The care records of one service user highlighted his wishes were not respected with regard to an aspect of his daily living requirements. Advice was given to record all advice taken from health and social care professionals and carry out an appropriate risk assessment to provide evidence of how the home were trying to manage and deal with the changing needs of the service user. The care records of another service user contained an emergency plan of care documenting the care provided by staff and how the home had worked to ensure her wishes were fulfilled of a trip to Paris. They did not however record the involvement of other professionals, but this involvement was recorded in the daily communication book. A four week menu is in operation and on the day of inspection the tea time menu offered pork steak casserole and plums and ice cream. I was informed service users could have something else to eat if they did not want this but no menu with a publicized alternative was available for viewing. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,21 There are basic arrangements in place to ensure that service users’ health care needs are met however there was no evidence other than verbal of how changing needs were met due to incapacity and old age. The home does respect the wishes of the individual when dealing with incapacity, however the home is not prepared for the ageing of service users. EVIDENCE: It was apparent during the inspection that attention was paid to service users dignity and privacy and staff were seen to act respectfully. Care records and other records such as the communication book provided details of the care provided to a service user who had recently died, the staff of the home had worked diligently and compassionately to respect the wishes of the person to remain at the home. The home had received advice and support in this task from the necessary health personnel. Records showed when other service users had seen health professionals eg doctors, community nurses, etc. Care plans did not reflect the changing needs of service users to ensure that the staff team are fully informed and aware of the support they need to provide when dealing with incapacity. ageing and illness. The care records of a service user who was becoming older and possibly incapacitated did not provide evidence that the home had looked for advice or support from outside agencies eg occupational therapist, continence advisor to ensure that the home could meet the needs of the person. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 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) 22,23 There is a suitable complaints procedure. Service users and their relatives have confidence that they can raise any issues and know that they will be dealt with. The home’s management team have a grasp of Protection of Vulnerable procedures. EVIDENCE: The home has a complaints procedure. One complaint has been received about the home since the last inspection. This was about the care provided to a service user and not respecting the rights of an individual. The complaint was not substantiated but other issues became evident during the investigation of the complaint that have been addressed in this report. Service users spoken to stated that they would raise any issues of concern with the staff team. A procedure for responding to allegations of abuse is available. The home’s managers are to receive the multi agency training in Adult Protection this year and this will be cascaded to staff, arrangements should be made for all staff to receive the training direct in the near future. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 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) 24,25,26,27,28,29,30 The building is quite well maintained with better quality furnishings and décor in the communal areas, which creates a pleasant environment for those living there. A more homely environment would be created if a separate office was created. Systems are in place to provide a safe environment for service users and staff. Specialist equipment may be needed around the home. There is a good standard of hygiene around the home. EVIDENCE: A tour of the premises was undertaken and a small number of bedrooms viewed. The home is well maintained and the entrance hall and dining room/lounge has recently been decorated. The smoking lounge required more adequate ventilation as it smelled strongly of smoke. There are two lounges and a dining room/combined sitting room. It was evident during inspection there was no office to discuss subjects of a confidential nature. The dining room and kitchen contain records and office furniture that would be more appropriate out of the service users living space. It was good to see the reduction in double bedrooms so service users could enjoy privacy in their own room. Service users bedrooms are personalized to Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 17 their tastes. There are an adequate number of bathrooms and lavatories around the home but advice must be taken from an occupational therapist to ensure there is specialist equipment to maintain the independence of some older service users. There is a large garden to the rear and a pleasant, protected sitting area at the front where service users enjoy sitting. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35 Usually good staffing levels are maintained which means that there are enough staff on duty to meet the needs of service users. There is a training programme that assists in ensuring the staff have an understanding of the service users support needs. EVIDENCE: The home is staffed as follows: 8.00am- 4.00pm 3 4.00 pm- 10.00pm 2 10.00pm-8.00am 2 These numbers include the management team of manager and one assistant manager. The proprietor lives on the premises four nights of the week. There is a senior staff member on each shift. Staff members carry out food preparation. On examination of the communication book it was evident that staffing levels had not been sufficient during the night to meet the needs of all the service users when one of them had been ill. A sleep in member of staff was on the premises together with the waking night staff but only the waking member of staff was attending to the needs of all the service users. Arrangements should Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 19 be made to ensure that sufficient waking staff are available to ensure the health and safety of service users and staff if the need arises in the future especially as service users become frail or incapacitated when eg moving and handling issues may occur. Two staff files including the most recent starter showed the necessary checks are being carried out prior to workers being appointed. The home carries out its own induction for new staff members but it is not the recommended TOPPS induction training to be completed within the first six weeks of employment and foundation training over six months. The staff files did not provide evidence of the identity of the staff member eg documentation that had been supplied for processing of CRB checks. Staff were observed to be kind, caring and respectful to service users. 6 members of the care staff team are studying for National Vocational Qualifications at level 3 and by December 50 of the staff team will have achieved this qualification. Staff confirmed that they also receive advice and /or training in other areas, such as bereavement and loss, osteoporosis and the necessary statutory training. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 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 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) 37,38,41,42 Systems are being developed to underpin the sound care practice provided by the team of carers. These systems will ensure and provide evidence of a more professional approach to the running of the home, which will ultimately benefit service users. The size of the home contributes to an atmosphere of homeliness with daily consultation with service users. There are adequate health and safety measures in place to ensure the safety of all who live and work in the home EVIDENCE: The manager , Mrs Anne Jobson ,has owned and managed the home on her own since 2004 prior to that she was co owner of the home. She has a background in nursing and is currently studying for a relevant qualification in management and expects to obtain this in 2005. An assistant manger has been appointed this year to join the management team , she is also studying for the Registered Manager’s Award. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 21 The positive comments of service users shows the manager promotes a philosophy of involvement of service users. Discussion with the assistant manager and staff members provided evidence that the staff are supported in their roles through supervision meetings which take place regularly. Service users meetings and staff meetings also take place regularly. There is a system in place to ensure that the staff are given training in moving and handling skills, fire safety, first aid and food hygiene. The fire log book indicated that fire safety checks are carried out routinely. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 2 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 2 2 Standard No 31 32 33 34 35 36 Score x 2 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ardgowan House Score 2 2 x 2 Standard No 37 38 39 40 41 42 43 Score 2 3 x x 3 3 x B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 23 yes 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. 2. Standard 1 5 Regulation 4(1)(a)(b) c 5(b)(c) Requirement The Statement of Purpose must be expanded to make it more user friendly. A contract must be issued to all new service users detailing the services provided by the home and the fees payable. Service users changing needs must be kept under review and accurately reflected in their plan of care. Care records must contain information for service users as detailed in Schedule 3 of the Care Standards Act 2000 Care records must detail the advice and support requested by the home to meet the needs of service users, and as far as possible take account of the wishes of service users. To create an office and remove records and storage equipment and notices from the service users living areas. The smoking lounge imust be adequately ventilated. The environment must be equipped , after taking advice from the necessary people,with the necessary aids and Timescale for action November 1st 2005 August 31st 2005 August 31st 2005 August 31st 2005 August 31st 2005 3. 6,16 14(2)(a)( b) 17(3)(k)( m) 12(1)(3)( 4)(a) 4. 18 5. 19,21 6. 24 23(2)(g) January 1st 2006 August 31st 2005 October 1st 2005 7. 8. 24 29 23(2)(p) 23(2)(n) Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 24 9. 10. 32 18(1)(a) adaptations to meet the needs of service users who are becoming older or incapacitated. Adequate staffing levels must be maintained during the night as service users needs change. To be kept under review 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. 2. 3. Refer to Standard 17 18 37 Good Practice Recommendations To provide an accessible daily menu with a publicized alternative. To ensure all personal recordings about service users care needs are contained in their care records and plan of care. The proprietor, manager to obtain the Registered Managers award in 2005. Ardgowan House B53-B03 S521 Ardgowan House V240546 220705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR 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. 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