Inspection on 12/06/08 for Ardsley House

This inspection was carried out on 12th June 2008.

CSCI found this care home to be providing an Adequate 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

Ardsley House 31/07/07

Ardsley House 14/08/06

Ardsley House 12/01/06

Ardsley House 21/09/05

Ardsley House 01/11/04

Ardsley House 02/06/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Ardsley House 55a Royston Hill East Ardsley Wakefield West Yorkshire WF3 2HG Lead Inspector Dawn Navesey Key Unannounced Inspection 12th June 2008 10:00 Ardsley House DS0000001413.V366167.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 Ardsley House DS0000001413.V366167.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. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ardsley House Address 55a Royston Hill East Ardsley Wakefield West Yorkshire WF3 2HG 01924 835220 01924 872618 ardsley.house@craegmoor.co.uk www.craegmoor.co.uk J C Care Ltd 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) Mrs Robina Richmond Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD, maximum number of places: 16 The maximum number of service users who can be accommodated is: 16 31st July 2007 Date of last inspection Brief Description of the Service: Ardsley House is owned by J C Care, which is a subsidiary of Craegmoor Health Care. The care home is registered to provide accommodation and care services for up to sixteen people who have a learning disability. However, two double bedrooms are being used for single occupancy, therefore fourteen people can live at Ardsley House at present. Two of the bedrooms have en-suite facilities, comprising of a toilet, hand washbasin and a shower. There are two communal bathrooms. Ardsley House is situated on a busy main road. It is set back with gardens to three sides. There is a good range of local amenities and shops and the area is well served by public transport. The home is within easy reach of major motorway links. There is ample parking available to the front and the rear of the house. The home is spread over two floors. There is no passenger lift or level access to the home, however some ground floor bedrooms are available. Respite care is not provided in the home. The fees for living at the home ranges from £392.90 to £1090.09 per week. Additional charges are made for chiropody, hairdresser, toiletries, horse riding, gym, magazines and holidays. This information was gained from the senior support worker on 12 June 2008. Ardsley House DS0000001413.V366167.R01.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 1 star. This means the people who use this service experience adequate quality outcomes. The Commission for Social Care Inspection (CSCI) inspects services at a frequency determined by how the service has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk This unannounced visit was carried out by one inspector who was at the home from 10am until 5.30pm on 12 June 2008. The purpose of the inspection was to make sure the home was providing a good standard of care for the people who use the service. Before the inspection, evidence about the home was reviewed. This included looking at any reported incidents, accidents or complaints. This information was used to plan the visit. The manager of the home completed an Annual Quality Assurance Assessment (AQAA) before the visit to provide additional information. We looked at a number of documents during the visit and visited all areas of the home used by the people who live there. We spent a good proportion of time talking with the people at the home, staff and the senior support worker who was in charge on the day of the visit. Comments made to us during the day appear in the body of the report. Survey forms were sent to people living at the home, their relatives and staff. Information from those returned is reflected in this report. Feedback at the end of the visit was given to the senior support worker. What the service does well: Overall people who use the service or their relatives spoke well of the home. These are some of the things they said: • • • • • • I like it here people are nice. He’s never had a better place to live, he’s well looked after. There are some dedicated members of staff at the home. I trust some of the staff they help a lot. I like all the staff. I get on well with the staff and my key worker. DS0000001413.V366167.R01.S.doc Version 5.2 Page 6 Ardsley House • The manager is very approachable. • We’re pleased with the way things are going. • Overall I am very pleased with the standard of care and the friendly and helpful attitude of the staff. Staff have good knowledge on people’s care needs. They are keen to support people to gain more independence. There is a good attitude to responsible risk taking. Some people have started to travel on public transport on their own, others have gained paid employment. The new person centred care planning has involved people who live at the home in drawing up the plans and feeling in control of them. One person said, “I did the plans with my key worker, happy how they have turned out, felt it was what I wanted that got written down”. What has improved since the last inspection? Work has continued on the care plans and risk management plans of the people who use the service. They have improved in the level of detail and give staff good direction on people’s care needs. People who live at the home say they now have more choices of foods and meals available to them. People who use the service have now got health action plans. These clearly show people’s health support needs and make sure those needs are met. Safeguarding matters are now dealt with properly and promptly by the home and organisation. This means people are better protected. Some areas of the home have been re-decorated. Some new flooring has been laid in the kitchen and bathrooms. This has made the home more comfortable for people. Staff and the manager are now receiving regular supervision. This makes sure that staff are properly aware of their job role and responsibilities and given clear guidance on what is expected of them. Staff have also received service specific training. This means they are more aware of people’s individual needs. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 7 What they could do better: It was clear from talking to people who use the service that there are tensions in the home between some people who live there. One person said, “It has been alright here, but now I need to move on. There are too many arguments; I try to keep out of them.” Another said, “I have had enough of here.” People’s needs must be kept under review and action must be taken, to make sure the home is providing the right support. As mentioned in the section above, care plans and risk management plans have improved. These should now be kept under review to make sure they are kept updated and maintained to a good standard. Menus at the home should also be kept under review to make sure the current choices and variety available is maintained. People who live at the home must be given their own copy of the complaints procedure. This will make sure they are fully aware of how to complain and how to take their complaint outside the home or organisation. They must also be informed of the outcome of any investigation to a complaint they make. This will make sure people feel they have been listened to. Any improvements made to the service as a result of a complaint, should be kept under review. This should make sure that improvements are sustained. A relative said, “We have raised issues repeatedly about the care of X which are addressed in the short time, but then slip back. We have felt disheartened by the lack of sustained improvement”. Staffing levels and staff routines must be reviewed to make sure the needs of the people who use the service are being fully met. Some concerns were raised about the management of the home. Some people who use the service said they didn’t feel listened to. One person said, “She is always busy in the office”. Another said, “Not always happy with how the manager speaks to me”. A relative also said, “A change of management at the home could possibly encourage a more consistent proactive service” and “Have found the present management of the home to lack consistent positive leadership and an inability to maintain good practice.” Management systems must be reviewed to make sure people who use the service are feeling properly supported and listened to. There is a stale odour in the lounge and dining area of the home. Action should be taken to identify and remove the source of this. This will make it more pleasant and comfortable for everyone. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 8 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 be made available in other formats on request. Ardsley House DS0000001413.V366167.R01.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 Ardsley House DS0000001413.V366167.R01.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): 2 and 3 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall, people who use the service can be sure that the home will meet their needs following assessment. However, more support is needed to make sure any changes in people’s needs are fully met. EVIDENCE: There have been no new admissions to the home since the last inspection. However, the organisation has introduced person centred care planning. This means that people who live at the home have had their needs re-assessed in the last year and new care plans have been developed from this. The assessment is detailed and in the main, covers all aspects of people’s lives. People made the following comments about the service: • • • • It has been alright here, but now I need to move on. There are too many arguments; I try to keep out of them. I like it here people are nice. I have had enough of here. We have a good time here. DS0000001413.V366167.R01.S.doc Version 5.2 Page 11 Ardsley House Some people have said they want to move on from the service. This was not clearly written in their assessments. There was no structured plan in place for some people to show how this was going to happen for them. This could lead to delays and mean that people’s needs are not properly met. One person has been supported to find an external advocate and external facilitator of person centred planning to assist with the process of moving on. However, on the day of the visit, due to staff sickness, staff were not available to support this person in a planning meeting. This could now lead to further delays in finding an alternative placement for this person. In the AQAA, the manager said they wanted to improve the service and said they wanted ‘To work with transition teams to support individuals to move on into supported living placements where the needs or choice has been identified.’ It was clear they had been trying to do this through reviews with social workers and other professionals. Staff said things seemed to be moving slowly for people and a lack of suitable placements was causing the delays. People’s needs must be kept under review and action must be taken, to make sure the home is providing the right support. It was clear from talking to people who use the service that there are tensions in the home between some people who live there. This is having a negative effect on some people. One person said she was afraid of another person. Staff said there had recently been an increase in the number of incidents of behaviour that challenges others. Ardsley House DS0000001413.V366167.R01.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): 6,7,8 and 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are encouraged to make decisions about their lives and are involved in planning their care and support. EVIDENCE: Further progress has been made in improving the standard of care plans and risk assessments for the people who use the service. A new ‘person centred’ care planning process has been introduced. Key workers have spent time with people to identify how their care needs should be met. A number of people said they had been involved in drawing up their plans. One person said, “I did the plans with my key worker, happy how they have turned out, felt it was what I wanted that got written down”. People who use the service had signed their plans. Or some had been discussed with people’s relatives who had then signed them to show they were in agreement with the care to be provided. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 13 Staff showed a good understanding of person centred care. One said, “The plans are really useful, helps you know someone as an individual, especially their history”. A relative said, “Always meets needs well”. Most of the plans seen gave some clear and detailed instruction on how the needs of people who use the service are to be met. They had good information about how people should be supported with personal care, and when out in the community. There were some minor shortfalls with the care plans and risk assessments. Some plans did not give the detail of how care needs are carried out. Terms such as “Help” do not tell staff how much support a person needs and could lead to needs being overlooked. However, staff were familiar with what was written in people’s care plans and could talk confidently about the support they give. Key workers carry out a monthly evaluation of support plans. This is then written down in people’s daily notes. It is recommended that these are kept with the care plans to show when changes have been made. This will make sure that staff do not miss any changes in people’s support needs. There is a good attitude to responsible risk taking for people in the home. Staff gave good examples of how people have been supported to gain more independence through good risk management. Some people have been working on traveling independently on public transport. Others have been supported to go out shopping in the local area on their own. People are restricted at times by the homes kitchen being locked if staff are not around to supervise its use. Risk assessments are in place to show why this is managed like this. It would be good practice to show how this has been agreed by people who use the service. In the AQAA, the manager said they felt they could improve the service by making sure that ‘all service users are encouraged to be involved in changes making choices and changes within the service.’ People said they had regular meetings in the home to discuss holidays, the menus, staff recruitment and anything that was bothering them. Some people said they had recently been involved in interviewing for new staff for the home. The organisation has also set up a national group called “Your Voice”, where representatives from homes go to a national meeting to discuss ideas, change and improvements to the service. The area manager always speaks to people who live at the home during her visits. People said they enjoyed this and spoke highly of responses they had received to any suggestions they had raised. One person said, “She is good, I think she listens”. Ardsley House DS0000001413.V366167.R01.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): 12,13,14,15,16 and 17 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service are able to make some choices about their lifestyle. Overall, social, educational, cultural and recreational activities meet most people’s expectations. They also benefit from a good, healthy and in the main, varied diet. EVIDENCE: Most people said that in the main they had enough to do at the home. A number of people go to day centres in the community. Some people have paid employment or have set up a business from the home. Other activity on offer to people includes, bike riding, horse riding, shopping, out for meals, going to the gym, walking, looking after a pet dog and swimming. On the day of the visit, an activity had to be cancelled due to staff shortages. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 15 People’s person centred care plans include sections on social interaction and activities. These showed that thought had been given to meeting people’s diverse and different needs. Staff had considered people’s age and ability when helping them plan their activities. This also included risk assessment where needed. This showed staff’s awareness of people’s vulnerability when out in the community and how plans have been put in place to address this. People are also involved in some activity within the home. People said they enjoyed baking, dancing, artwork and gardening. On the day of the visit, most people who stayed in the home were watching television or listening to music. Some people went out in the local community and another person was out gardening all day. In a questionnaire returned to the home from a person living there, they had made a suggestion that more activity was organised in the home. Overall, staff said they felt there were enough staff to make sure people who use the service get a reasonable level of activity. Some staff said it could be more difficult to get people out on occasions when they have staff shortages. A relative said, “Overall the home meets X’s needs but doesn’t appear to offer stimulating activities”. Staff said people are given support to help them keep in touch with their family and friends. Staff said they assist people to make regular phone calls to their family and arrange visits for them. However, a relative said, “ We have asked if our relative can be supported to ring his family this has happened on rare occasions but isn’t a regular occurrence”. People said they regularly go out in the community to local shops and markets. It was clear from talking to people that they have made good links with people and are known in the area. Menus are developed in the home from meetings with people who use the service. People have, in the last year raised a number of concerns about food choices. The area manager has looked at these concerns and worked with the home manager to develop a new menu giving two choices at every meal. On the day of the visit, the lunchtime meal was choice of sausage roll or sandwich. The teatime meal was a choice of sausage and mash or toad in the hole with a selection of vegetables. People who use the service said they had chosen to have sausages as a lunchtime and teatime choice. One person said, “I love sausages”. One person said they were not happy about the food choices and said they often bought their own food. It is recommended that the menus are kept under review to make sure there is a good variety available for everyone. Some people were very positive about the food in the home. They said, “We had a lovely tea last night, treacle pudding and custard, pork chops and veg, lovely it was” and “It’s very good and there’s plenty of it”. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 16 One person said they were disappointed that breakfast was only served until 8:30am, as they preferred to have a lie in. The senior support worker said this was only used as a guide for people and they could have breakfast whenever they wanted. She said that staff had in the past been held up preparing breakfasts and this had meant that some activities had been cancelled. This should be kept under review to make sure there are enough staff at all times to meet all the needs of people who use the service. Other people said they could get drinks and snacks whenever they wanted one. The kitchen is kept locked at times when staff cannot supervise its use. All the people we spoke to said they had agreed to this to make sure everyone is kept safe from hazards in the kitchen. Advice on healthy eating has been taken on an individual basis for people from practice nurses or community nurses. In the AQAA, the manager said, ‘Service users are involved in all aspects of weekly shopping to make choices about the meals they take with advice/support regarding healthy eating.’ Most people who live at the home appeared to enjoy their lifestyle. However, a number of people said they were not happy with the bickering and arguments that take place between people who live there and this was getting them down. As mentioned in the Choice of Home section of this report, people’s needs must be reviewed to make sure the service is meeting them properly. Ardsley House DS0000001413.V366167.R01.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s general healthcare needs are well met and based upon their individual needs. EVIDENCE: In the AQAA, the manager said, ‘Service users have a Health Action Plan implemented in the new person centred planning documentation.’ We saw that these had clear, detailed information in them. They also included people’s family medical history which could be important for them in the future. Good records are kept of health appointments and their outcomes. Staff had good knowledge on people’s personal support needs. They showed a good understanding of how people’s support needs may differ on a daily basis due to their medical diagnosis. One said “We take things at (the person’s name) pace, go with the flow of the day”. Staff were courteous, polite and respectful of people’s dignity when attending to any personal care needs. A relative said, “He’s never had a better place to live, he’s well looked after”. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 18 Staff’s training on specific medical conditions has improved since the last inspection. Records showed that staff have completed training in dementia awareness, personality disorder and bi-polar disorder. Staff spoke of how the training had increased their awarness of these conditions. They were able to describe how they provide care and support to people bearing in mind the effects of these conditions. A health professional expressed some concern that the manager and staff do not always notice people who may be going in to a depressed or anxious state. Staff we spoke to gave examples of what they thought was causing people current anxiety or concerns. They also acted on these during the visit and were arranging review meetings. In the AQAA, the manager said, ‘All staff who administer medication are trained and certificated. We carry out medication competency assessments and these are audited throughout the year.’ The home uses a monitored dosage pre-packed system for medicines. All staff take responsibility for the administration of medication once they have been trained. There are good ordering and checking systems in place, with a clear audit trail for any unused medication returned to the pharmacy. The medication administration record (MAR) sheets were checked and showed no errors in administration. However, one person had refused their medication and the explanatory code had not been used on every occasion. The senior support worker said this was an oversight and she would address the matter. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 19 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Overall people are protected. However, people are not always confident that they will be listened to and that action will be taken when necessary. EVIDENCE: The home has a detailed complaints procedure and an easy read procedure with pictures and symbols. A copy of this is kept in each person’s personal file. It is recommended that each person is given their own copy of this. One person who lives at the home said they did not know how to complain to someone outside of the home or organisation. Most people we spoke to said they were aware of who to complain to in the home. They said, “Oh yeah, I know how to complain, go to staff or manager” and “would go to manager or senior support worker”. Some people spoke of some recent complaints they had made to the organisation’s area manager. Records showed that these had been raised on her visits to the home. One person felt their concerns had been listened to. However, another person didn’t feel they had had enough feedback on the matter and felt both the manager and area manager had not acted on their concerns. We looked at the records concerning this matter. They showed that the area manager had investigated them. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 20 We also looked at the records of other complaints made since our last inspection of the home. Most had been properly investigated. However, it was clear that when people who live at the home had made a complaint, there were sometimes no records to show they had received any information on the outcome of any investigation. Information on the outcome of complaints or concerns raised must be given to people after any investigation. This will make sure they feel supported and listened to. Relatives said they knew how to complain. However, one said, “We have raised issues repeatedly about the care of X which are addressed in the short time, but then slip back. We have felt disheartened by the lack of sustained improvement”. It is recommended that any improvements made as a result of a complaint are kept under review to make sure they are sustained. There have been a number of adult safeguarding issues since the last inspection. These have been dealt with promptly and reported properly by the organisation. People have been protected further by referral to external advocates, community nurses and by having capacity assessments. Strategy meetings have been held and protection plans put in place for people who have been seen to be vulnerable. Most staff have received training in safeguarding adults. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. The organisation has a detailed adult protection policy and a whistle blowing policy, which encourages staff and people who use the service to report concerns. We looked at personal allowance records. All financial transactions were recorded properly. Receipts are kept for purchases made and the manager or senior support worker checks these weekly. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 21 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 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a comfortable environment that is generally well maintained. EVIDENCE: The home is spacious and homely. The lounge has recently been re-decorated and set out differently to make smaller group sitting areas. People said they liked this better. The home looks clean. However, a stale type of odour is apparent in the lounge and dining room area. We noticed that some of the carpet in the lounge area has stains on it. The senior support worker said she would investigate where the odour was coming from. This should make the home more comfortable for people. Several people were happy for us to look at their bedroom. They said they liked their rooms and could have what they wanted in them. Rooms have been Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 22 personalised to show people’s interests and personality. One person’s room has been re-furbished completely since the last inspection. A maintenance person is employed by the home. He makes sure any maintenance work is attended to promptly and has a programme of regular redecoration for the home. The kitchen and some bathroom flooring has been replaced since our last inspection. The home has an attractive garden area which people who use the service are encouraged to get involved with. One person spoke of their plans for future planting in the garden. Another person said they had planted tubs up to go in the garden as a memorial to a family member. Care staff and people who live at the home take responsibility for the cleaning at the home. Most people said they were happy with this arrangement. One person said, “I like to keep busy”. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who live at the home. Staff have received training in infection control as part of their induction and were able to say what infection control measures are in place. However, hand washing and hand drying facilities were not available in all areas of the home. Some areas did not have any liquid soap or paper towels available. This could lead to the spread of infection from poor hygiene practices. The senior support worker felt this was an oversight and agreed to remedy the situation. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35 and 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are trained and competent to meet the needs of the people who use the service but there are not enough staff at times to meet people’s needs properly. People are protected by the home’s recruitment procedures. EVIDENCE: In the AQAA, the manager said the service had improved and they had, ‘Revised shift patterns for working within the home.’ And ‘Ensured staffing levels remain on safe levels to meet the needs of service users.’ There are usually three staff on duty throughout the day and evening, with the manager or senior support worker being available office hours during the week. Records showed that on a number of occasions, the manager or senior support worker is working as one of the three staff on duty. Staff and people who live at the home said this is when someone is off sick or on holiday. On the day of the visit, there were only three staff (including the senior support Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 24 worker) on duty during the day. However, extra staff were called in to cover the shift for the afternoon and evening. Staff said that when fully staffed they felt they met people’s needs properly. However they said it was always activities that got cancelled when they were short. Staffing levels must be reviewed again to make sure people’s needs are being fully met. People who use the service said that sometimes it was all male staff working at the home and that some people had personal care needs that they preferred a female staff member to attend to. The records showed a number of occasions where this was the case. This issue has been brought up at the home before and been the subject of a safeguarding matter. The rota must be planned to make sure a mixed gender of staff are available to meet people’s needs. There are a number of new staff at the home since our last inspection. The senior support worker said the home is now fully staffed. People have been recruited from advertising locally and through the use of an overseas recruitment agency. We looked at the recruitment process for three people that had started working at the home since the last inspection. The files had all the relevant information to confirm these recruitment processes were properly managed. This included application forms, interview notes, references and CRB (criminal records bureau) checks. We received some comments on staff from people who use the service and their relatives. These are some of the things they said: • • • • • • • There’s such a quick turnaround of staff, we don’t get to know them well enough. There are some dedicated members of staff at the home. We have noted that there appears to be regular changes in staff at the home which can make it difficult to build relationships and continuity. I trust some of the staff they help a lot. I like all the staff. I get on well with the staff and my key worker. Some treat us better than others, not always happy with how the manager speaks to me. Staff follow an induction programme based on the “Skills for Care” common induction standards. Most staff said they found this useful and it prepared them well for their job. One other said, “ For someone who has never worked as a carer it’s a bit difficult to understand this job from the beginning”. Records showed that staff had been supported to complete induction workbooks following their training. Records also showed that most staff were up to date with their mandatory training. Topics include, safe moving and handling, food hygiene, first aid and health and safety training. Training has also been given to cover the specialist needs of people who live at the home. Staff said they had found this useful Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 25 and it had helped them to care for and support people better. One person said it had helped them to see the individual more. Another said, “Regular courses keep us up to date with any changes or questions there is”. Four out of the thirteen staff in the home have achieved an NVQ (National Vocational Qualification) in level 2 or above. Three other staff are also working towards this. Staff said they felt they had a good team and that communication in the home is good. They said they receive regular supervision now and that they find it useful and good support. Some staff said there had recently been some teamwork issues and staff had not been ‘pulling together’. The senior support worker said measures have now been put in place to improve teamwork in the home and share workloads properly. One staff said, “We are still struggling with all the staff changes, we need some stability now”. Another said, “The manager is open and approachable, we get good supervision”. Ardsley House DS0000001413.V366167.R01.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, 38, 39 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall, the home is fairly well managed. The interests of people who use the service are, in the main, seen as important to the manager and staff and are safeguarded and respected. EVIDENCE: In the AQAA, the manager said, ‘We have a Home Manager in post who trained and qualified as a Learning Disability Nurse has seven years management experience and has her RMA (Registered Managers Award). She is supported by a Senior Support worker with many years experience in the Learning Disability field.’ The AQAA also stated, ‘The Home Manager receives Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 27 supervision with the Area Manager, who regularly visits the service along with additional support from the Business Support Manager.’ In the main, people were positive about the management of the home. These are some of the things they said: • • • The manager is very approachable. We’re pleased with the way things are going. I get on well with the manager and his keyworker. Some people raised some concerns. One person said, “A change of management at the home could possibly encourage a more consistent proactive service” and “Have found the present management of the home to lack consistent positive leadership and an inability to maintain good practice.” A health professional said they felt people were not supported as well as they had been in the past in dealing with their emotional and health needs. They also said the manager does not maintain people’s confidentiality well enough and speaks about personal care needs in front of other people who live at the home. A person who uses the service also said they had concerns about their confidentiality being breached by the manager in this way. Another said that they didn’t feel the manager had enough time for them, saying, “She is always busy in the office.” Management systems must be reviewed to make sure people are feeling properly supported and listened to. The area manager visits the home on a monthly basis to carry out regulation 26 visits. This involves talking to people who use the service and staff about the home. A report of these visits is made showing details of any action to be taken to improve the service. People who live at the home spoke highly of these visits and said they found them useful. The home sends out annual questionnaires to people who use the service and their relatives. This means they can get feedback on the service they provide and see where any improvements can be made. We looked at the survey results, which mainly showed satisfaction with the service. Comments included, “Overall I am very pleased with the standard of care and the friendly and helpful attitude of the staff” and “X is very happy here”. It is recommended that the organisation extend the questionnaire to include health or social care professionals who visit the home. This will give them more opportunities to find ways to improve the service. The home has a full range of health and safety policies and procedures in place. Maintenance staff carry out weekly or monthly health and safety checks around the home such as fire alarms, emergency lighting, water temperatures and checks on the house vehicle. Records of these checks were clear and well maintained. We looked at accident records. These were also well kept. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 28 In the AQAA the manager said relevant policies and procedures were in place, and many were reviewed in the last two years. She also said equipment has been serviced or tested as recommended by the manufacturer or regulatory body. The electrical wiring and portable appliance testing was up to date. Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 29 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 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 2 2 X X 3 X Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 30 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 YA3 Regulation 12 Requirement The needs of the people who use the service must be reviewed and re-assessed to make sure the home can meet their needs properly. People who live at the home must be given a copy of the complaints procedure. This will make sure they are fully aware of how to complain and how to take their complaint outside the home or organisation. People must be informed of the outcome of any investigation to a complaint they make. This will make sure people feel they have aired their views and been listened to. Staffing levels and staff routines must be reviewed to make sure the needs of the people who use the service are being fully met. Management systems must be reviewed to make sure people who use the service are feeling properly supported and listened to. DS0000001413.V366167.R01.S.doc Timescale for action 30/09/08 2. YA22 22 30/07/08 3. YA22 22 30/07/08 4. 5. YA33 YA16 YA13 YA14 YA38 18 30/09/08 12 30/09/08 Ardsley House Version 5.2 Page 31 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. 4. 5. Refer to Standard YA6 YA17 YA20 YA22 YA30 Good Practice Recommendations Care plans and risk assessments should be kept under review to make sure they are detailed and give staff good instruction on care and support needs. Menus at the home should be kept under review to make sure the current choices and variety available is maintained. Codes should be used on medication administration record sheets when medication has been refused. This will make sure practice is safer. Any improvements made to the service as a result of a complaint, should be kept under review. This should make sure that improvements are sustained. Action should be taken to identify and remove the source of the stale odour in the lounge and dining room of the home. This will make it more pleasant and comfortable for everyone. Some consideration should be given to extending the quality assurance questionnaire to include health or social care professionals who visit the home. This will give them more opportunities to find ways to improve the service. 6. YA39 Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. Extracts may not be used or reproduced without the express permission of CSCI Ardsley House DS0000001413.V366167.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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