Inspection on 31/07/07 for Ardsley House

This inspection was carried out on 31st July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ardsley House 12/06/08

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 08/07/2008.

CARE HOME ADULTS 18-65 Ardsley House 55a Royston Hill East Ardsley Wakefield West Yorkshire WF3 2HG Lead Inspector Dawn Navesey Key Unannounced Inspection 31st July 2007 09:25 Ardsley House DS0000001413.V345798.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.V345798.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.V345798.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 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) www.craegmoor.co.uk J C Care Ltd Mrs Robina Richmond Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th August 2006 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. There is a single storey detached building in the back garden. This is used as a day centre. An activity organiser, who is employed for thirty hours a week, works with people who use the service in the centre and uses the building as a base. A support worker assists when necessary. 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 weekly charge for living at the home ranges from £383.69 to £1090.09 per week. Additional charges are made for chiropody, hairdresser, toiletries, horse riding, gym, magazines and holidays. Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced and was carried out by one inspector who was at the home from 9-25am to 6-30pm on the 31 July 2007. For some part of the visit, the inspector was joined by an ‘expert by experience’. An expert by experience is someone who has expert knowledge of care services through their own experience of using services. They join the inspector to help them get a good picture of the service from the viewpoint of the people who use it. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people living there. And also to monitor progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home before the visit to provide additional information. Survey forms were sent out to people living at the home, their relatives and health and social care professionals. A number of these have been returned and information from them is reflected in this report. During the visit a number of documents and records were looked at and some areas of the home used by the people living there were visited. A good proportion of time was spent talking with the people who live at the home as well as with the manager and staff. Feedback at the end of the visit was given to the manager and area manager. I would like to thank everyone who contributed to the inspection process and to the home for their hospitality. What the service does well: The atmosphere in the home is friendly and relaxed. Staff interact well with people who use the service and assist them with their independence skills. A number of people who use the service have been assisted to find paid jobs and voluntary work. A relative who returned a survey said, “Our relative is a lot happier here than he has been anywhere else.” People who use the service made comments such as, “I love it here”, “It’s the best placement I have ever had” and “I like it here”. The organisation has produced care planning information, the service user guide and the complaints procedure in easy words and picture formats. This makes them more easily understood by people who have a learning disability. Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 6 The expert by experience said, “The person centred care plans had a lot of pages, and they were very clear and easy to understand with lots of signs and symbols”. What has improved since the last inspection? What they could do better: People who use the service must have a detailed care plan, which includes their specific health needs. This will make sure they receive person centred, safe support that meets their needs. Also staff must be trained in the specialist needs of people who use the service. This will also make sure the needs of people living at the home are properly met. All identified risks for people who use the service must have a detailed action plan in place in order to minimise or prevent the risk. Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 7 Safeguarding adults procedures must be followed properly in the event of allegations of abuse being made. This will make sure that people who use the service are properly protected. All staff must receive regular supervision so that they are clear on their responsibilities and are properly supported. The manager should make sure that daily notes are accurately completed to give a proper account of behaviours and moods of people who use the service. The manager should also make sure that people who use the service who have shown a desire to move on are given the support to do this. Staffing levels should be reviewed to make sure the needs of the people who use the service are being properly met. Some people who use the service expressed concern at the staffing levels during the day. The manager should obtain references from the last employers of staff. This will make sure recruitment procedures are robust and protect people who use the service from any potential abuse. The organisation should review availability of training in order that staff are trained in meeting the needs of the people who use the service. 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.V345798.R01.S.doc Version 5.2 Page 8 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.V345798.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 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 who use the service can be sure that the home will meet their needs following assessment. Also written and verbal information that is available provides enough information for them to decide whether the home will meet their needs. EVIDENCE: The Statement of Purpose, which provides information on the services provided by the home, has recently been updated. This is kept on display in the entrance hall of the home where families and visitors can have access to it. There is also a Service User Guide to the home, which each person using the service has a copy of. This has been produced in an easy read format using pictures and symbols alongside the words. It gives good information about what the service can offer. All people who returned a survey said they had been given enough information about the service before they moved in. A relative who returned a survey said, “Our relative is a lot happier here than he has been anywhere else.” People who use the service made comments such as, “I love it here”, “It’s the best placement I have ever had” and “I like it here”. One person who uses the Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 10 service said they would like to move on to something more suitable to their needs. There have been no new admissions to the home for some time. However, the manager is currently introducing new person centred care planning documents. This means that people who use the service are having their needs re-assessed to make sure all their needs are being met. This new document should make sure that care and support plans are developed from assessments of people’s current needs. People who use the service have a contract with the organisation. This shows the cost for their placement and is signed by people who use the service or by their representative. The contracts are slightly out of date and are due for annual renewal. The manager said the organisation is aware of the need to update them. Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 11 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. This judgement has been made using available evidence including a visit to this service. Despite some gaps in care planning and risk assessment documentation, staff are, in the main, aware of the individual needs of people who use the service. The lack of detail in some care plans and risk management plans could however, lead to the needs of the people who use the service not being properly met. People who use the service are involved in decisions about their lives and play a role in planning the care and support they receive. EVIDENCE: Progress has been made in improving the standard of care plans and risk assessments for the people who use the service. 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. Some of the information is person centred and gives good information on how people like to be supported. This includes detailed information on types of toiletries people like and whether they like to wear Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 12 perfume, use body lotion and have their nails painted. There is also information on how their dignity is maintained during personal care. Support plans around people’s last wishes have also now been included. People who use the service or their relatives have signed the care plans to show they are in agreement with them. The expert by experience said, “The person centred care plans had a lot of pages, and they were very clear and easy to understand with lots of signs and symbols”. Some of the care and support plans need more detailed information in them to make sure they give staff enough detail on how care tasks are to be carried out. Instructions such as “assist” and “prompt” do not give clear and specific guidance and could lead to important care needs being overlooked. A good support plan should give clear and detailed information on how and when care is given, taking particular notice of the peoples’ preferences and choices. Some behaviour support plans did not have enough detail on how behaviour that challenges others is to be managed. This could lead to inconsistency from staff in their responses to people who use the service. Risk assessments are, in the main, supported by risk management plans. A person with epilepsy had no plan in place for emergencies and at what point they would require hospitalisation. Staff could however, describe when this would be needed and gave assurances they would act promptly in the event of an emergency. Staff have good knowledge on some of the care and support needs of the people who use the service. Some were able to accurately describe the care they give and talk about the detail of how people like to be supported in their daily routines. Key workers carry out a monthly review of support plans. It is not clear if people who use the service have been involved in this too as they are only signed by staff. Staff complete notes for people who use the service on a daily basis. One person is regularly noted to be “demanding” or “very demanding”. This does not accurately describe the person’s behaviour or activity and is not showing a positive regard for this person. In surveys returned by health and social care professionals, concern was expressed that some staff do not recognise people who use the service as individuals who all have different needs. One professional said, “They need to recognise people as individuals, develop a professional manner to all individuals living there, whether they like the client or not”. People who use the service were offered choices throughout the day, for example, what to do, where to go, what to eat, whether to have the radio or the television on, whether to spend time in the lounge or in their own room. Staff respected their choices and responded well to their requests. People who Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 13 use the service have chosen to be involved in shopping, cleaning and washing up at the home. All people who were asked said they enjoyed this level of involvement as long as everyone took their turn. Some people who use the service have said they would like to move on. The support plans do not give information on how or whether they are being assisted to do this. The manager said reviews would be arranged to try and start this process. People who use the service arrange their own meetings about two or three times per year. Issues discussed are holidays, activities, menus and any dissatisfaction people may be feeling. 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 home has also introduced a suggestions box. This is kept in the entrance hall of the home and people can post their suggestions. One person who uses the service said they had been very satisfied with responses to suggestions made about activities and handicrafts to be done in the home. The manager shows how the home has responded to suggestions by keeping a poster available with details of changes made in response to suggestions made. Ardsley House DS0000001413.V345798.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): 11, 12, 13, 14, 15, 16 and 17 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. The home offers opportunities to people who use the service, for personal development in addition to a range of leisure activities. People who use the service are able to make choices about their lifestyle. They also benefit from a good, healthy and varied diet. EVIDENCE: There is a variety of activity on offer for people who use the service. One person has also been employed to develop activity in the home such as handicrafts and games. Activities include horse riding, bike riding, attending the day centre attached to the home, dancing, concerts, meals out, going to a local gym, shopping and going to the pub in the local area. Activities within the home include rug making, card making, painting and sewing. People who use the service said they enjoy getting involved in the activities. Some people have also gained paid employment. A number of people who use the service Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 15 are working together on a gardening project to create a space where people who use the service can plant flowers and trees to remember loved ones who have passed away. They are also hoping to use some land near the home to plant and grow vegetables and fruit. One of the people who use the service was very enthusiastic about becoming self sufficient with this project. It is clear his skills are going to be well utilised. One of the people who use the service keeps a dog. On the day of the visit, a number of people went out to the gym. Others were involved in knitting, watching TV, doing jigsaws, gardening and painting a fence in the garden. On looking at the daily notes of a person who uses the service, it showed that there were periods of ten days or more where it appeared that the person had not been out of the house on any activity. This person’s support plan recommended that they went out daily. The manager said she felt it was an omission in recording of activity and would follow this up with her staff team. In the main, staff said they felt there were enough staff to make sure people who use the service get a good level of activity. Some staff said it could be more difficult to get people out on occasions when they have only two staff on duty. Other staff said that some people who use the service are at times reluctant to go out and prefer to be at home. A person who uses the service said, to the expert by experience, “Some residents just watch TV all day and are very boring”. A person who uses the service said that they felt staff don’t always want to go out with them, they said “They can’t be bothered sometimes.” Another said, “Even when there are enough staff, they don’t always want to take you out”. People who use the service have an annual holiday. Holidays are currently being arranged in small groups of people who use the service and staff. The manager will make sure holiday risk assessments are completed before the holiday and on arrival at holiday destinations. Staff are aware of their responsibilities when on holiday with people who use the service and there is a policy in place to reinforce this. The new document for person centred care planning has sections within it that should make sure people who use the service are given help to keep in touch with family and friends and to remember special occasions such as birthdays and anniversaries. Their cultural needs such as the era of music people like and the religion they follow are also written into these social interaction plans. People who use the service have developed friendships with people in the local community. One person spoke of friends and contacts at the local shops and markets. Staff were seen to support people with courtesy and thought for their dignity. Staff said it was important to make sure people who use the service are as independent as possible for their dignity and self esteem. They said they are Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 16 encouraged to get involved in household tasks such as ironing and to make drinks and cook for themselves. People who use the service said they enjoyed this opportunity to do things for themselves. One person said, “I like to keep busy, keeps us occupied”. Menus are developed based on the likes and dislikes of people who use the service. They are, in the main, well balanced and nutritious. The manager said it can be difficult to encourage healthy eating while also giving people their choices. A good variety of food is available and staff make sure there is plenty of fresh produce such as fruit and vegetables. People who use the service made comments on the food that included, “We get asked our choices, we get what we want”, “It’s all much better now” and “It’s good food”. The lunchtime meal was a choice of cheese on toast or hot dog sausages in a roll. Meal times are an opportunity for people who use the service to sit down together and socialise if they want to. People who use the service assisted with table setting and some of the food preparation. Staff did not appear to have time to sit at the table with people who use the service, as they were busy in the kitchen preparing the food. This meant that an occasion for social interaction with the staff was missed. Ardsley House DS0000001413.V345798.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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lack of some written documentation and training for staff could lead to personal and health care support needs being overlooked. People who use the service are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Staff were seen to support people who use the service with their personal care needs in private and with dignity. They have an awareness of people’s personal care likes and dislikes and were seen to follow personal care support plans. The level of detail in some support plans on how personal care and health related tasks are to be carried out is not always detailed enough and could lead to some needs being overlooked. As mentioned in the Individual Needs and Choices section of this report one of the people who use the service has a care plan on epilepsy. However, this does not specify the length of time staff should wait before getting medical assistance in the event of a fit. The Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 18 risk assessment said that staff should call an ambulance if the person had stopped breathing for two minutes. This could have led to dire consequences if staff had followed this instruction. All staff asked, said they would call an ambulance immediately if anyone stopped breathing. The manager changed the care plan immediately it was pointed out to her and agreed to draw up a more detailed epilepsy management plan. The support plans have details of any health professionals that people who use the service see. These include, GP, chiropodist, dentist, specialist nurse, and optician. Records are kept of any health appointments and their outcome. Staff were seen completing these during the visit. Some people who use the service have specialist health needs. These include dementia, stoma care, bi-polar disorder, personality disorder and anxiety. Staff have been trained recently in personality disorder and the manager has now arranged for staff training in dementia, bi-polar disorder and stoma care. Community nursing staff will be providing this training. The manager has tried to access this type of training through the organisation’s training department but there seems to be a lack of availability. A health professional who returned a survey expressed concern about the level of staff’s understanding on these health issues, they said, “Some people have little insight into the needs of people who have a learning disability and associated problems such as bi-polar disorder, autism, anxiety and depression.” Another said, “Concerns/advice given not always followed or addressed.” Care and support plans did not have detailed information on how these needs are met and this could lead to them being overlooked or behaviours being misinterpreted. Some staff showed a good awareness of the needs of people with dementia and the importance of maintaining memory and skills. A relative who returned a survey said they were concerned at the amount of weight their relative had put on recently. In discussion with the manager, she said that people who use the service who have any weight problems are encouraged to eat healthily and attend their GP surgery practice nurse sessions for advice. The home uses a monitored dosage pre-packed system for medicines. All staff take responsibility for the administration of medication and have been trained to do so. 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. Ardsley House DS0000001413.V345798.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. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives have their views listened to, taken seriously and acted upon. There are, in the main, good systems in place to protect people who use the service from abuse, however the organisation must follow procedure at all times when any allegations of abuse are made to make sure people are protected. EVIDENCE: The home has a comprehensive complaints procedure and an easy read procedure with pictures and symbols. A copy of this is kept in the service user guide, which each person who uses the service has a copy of. Any complaints the home has received are documented in the complaints file and the investigation and outcome are documented. It is clear that people who use the service and their relatives or representatives feel confident to use, and have used the complaints procedure. People who use the service said they knew how to complain and relatives who returned surveys said they were aware of the complaints procedure. There have been a number of adult safeguarding issues since the last inspection. In the main, the home and organisation have responded properly to these by referring to adult protection and the police. However, on one occasion, the organisation began its own investigation into an allegation before Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 20 the police were informed. This is poor practice and could have undermined the investigation into the allegation. Most staff have received training in the protection of vulnerable 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. Some staff are still on their induction training and have not yet done this training. It was pleasing that one of these staff was also able to say how they would respond to any suspicions or allegations and was also able to describe what they would consider signs of distress in someone who was suffering abuse. The organisation has a comprehensive adult protection policy and a whistle blowing policy which encourages staff and people who use the service to report concerns. The whistle blowing policy is displayed in the home; staff and people who use the service are given a copy of this too. People who use the service have their own bank account or a company account with monies held on their behalf. There are systems in place to protect their finances and the manager checks transactions on a regular basis. People who use the service now receive statements on money held in company accounts. Ardsley House DS0000001413.V345798.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, 26 and 30 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. The environment in the home is, in the main, homely, clean, safe and hygienic. Staff’s practices control the spread of infection. EVIDENCE: A tour of the building was carried out, accompanied by people who use the service. The home is spacious, homely and well laid out, providing sufficient room for people. Bedrooms have been decorated and furnished to suit individuals and their interests and personality. People who use the service said they had chosen the décor and furnishings themselves. The home is nicely decorated and has furniture and furnishings of a good standard. A maintenance officer is employed by the home. He makes sure any maintenance work is attended to promptly and has a programme of regular re-decoration for the home. The halls, stairs and landings have been re-decorated recently. People who use the service said they knew their rooms were going to be re-done soon and were currently choosing colour schemes. Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 22 One bedroom was in a poor state of cleanliness and repair. The manager was aware of this and has new furnishings and carpet on order. The manager said she would make sure this person gets more support to keep the room in a good state in the future. Staff and people who use the service take responsibility for the cleaning at the home. People who use the service said they enjoyed being involved in this way, as long as everyone took their turn. The manager said she has not employed any domestic staff and has used the hours for care and support instead. Communal areas were clean and fresh and there were no odours noted. Bathrooms have also been re-decorated since the last inspection. They look attractive and homely. Pictures and ornaments have been used to good effect. One of the toilets needs the floor covering replacing. This is on order. The kitchen is domestic in style and food hygiene practice is good. The kitchen floor covering is also in need of replacement and is due to be fitted soon. The kitchen is kept locked when staff are cooking or when they cannot monitor the area. This is to protect the health and safety of some of the people who use the service. Risk assessments have been carried out and all people who use the service have agreed to the times when the kitchen is locked. A number of people were asked if they were in agreement with this practice. All said they thought it was a good idea and showed genuine concern for those people who were at risk from the kitchen being unlocked. One person said, “It’s good, it means no one can take our stuff we put in there”. There is a large garden and patio area. People who use the service enjoy working in the garden. On the day of the visit, two people were taking full advantage of the good weather to get some planting and fence painting done. It was clear from conversations with them that they take a real pride in doing this. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who use the service. Staff have received training in infection control as part of their induction and are able to say what infection control measures are in place. Paper towels are now available at all sinks for hand drying. Ardsley House DS0000001413.V345798.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, in the main, trained and competent to meet the needs of the people who use the service but the manager does not formally supervise them. People who use the service are, in the main, protected by the home’s recruitment procedures. EVIDENCE: Most days there are three staff on duty through the day and evening. However, at times the third person marked on the rota is working at the adjoining home and not in Ardsley house. Staff and people who use the service said they feel there are usually enough staff on duty as long as there is no sickness or absence. As previously mentioned in the Lifestyle section of this report, staff said it can be difficult to get people out on activities in the community when there are only two staff on duty. The expert by experience said that some people who use the service felt there were not enough staff on duty through the day. The manager should review these staffing levels to make sure they are properly meeting the needs of the people who use the service. During the week the manager is also available 8am-4pm. At night Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 24 there is one member of staff who sleeps in and another member of staff who is on a waking duty. An on-call manager is available to support staff out of hours. There has been a high turnover of staff since the last inspection. Relatives who returned surveys said they were concerned at this level of staff turnover. Eight staff have left in the last year. The manager has worked hard to fill the vacant posts. Part of the recruitment drive has included recruiting staff from overseas via an agency. The manager has opportunity to interview staff from the agency and decide whether to offer employment. References are obtained for these staff from the agency. These references are not references from previous employers. It is recommended that references from previous employers are obtained in order that this recruitment process is more robust. Staff from overseas are offered support from the organisation in developing their English language skills. Other than as mentioned above, recruitment is properly managed by the home; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. The manager has now also made sure that there is a photograph of staff on their personal file as recommended at the last inspection. A new induction programme based on the “Skills for Care” common induction standards has been introduced by the organisation. The manager has had difficulty obtaining the work-books for staff to complete, from the organisation’s training department. None of the new staff had started the work-books but the manager has been arranging and delivering their induction training courses in preparation for this. Availability of training has been a problem for the manager as there have been a large number of new staff who have needed the training at the same time. The organisation should make sure the manager is supported in the induction of the new staff and make training courses more readily available. The manager has done an audit of staff’s training needs and is aware of who needs updates in essential training such as food hygiene, moving and handling, protection of vulnerable adults and infection control. She is also aware of the need to provide training specific to the needs of people who use the service. She is currently arranging training in the specific health needs of people who use the service. As mentioned in the Health and Personal Care section of this report, community nurses will provide the training, as the manager cannot access any training of this nature through the organisation. In surveys returned by health and social care professionals, they said, “Training is needed to encompass all areas related to the support of people with a learning disability” and “Staff need specific training to understand different aspects of learning disabilities/conditions such as anxiety, autism and behaviour”. Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 25 Staff said they felt happy with the training they receive from the organisation and that the quality of the training met their needs. Almost 50 of the staff team have achieved an NVQ (National Vocational Qualification) in level 2 or above. Other staff are now waiting for the opportunity to do this. People who use the service were, in the main, positive in their comments about staff. Comments received included, “I like the staff”, “Staff are alright with me”, “The new staff are settling in alright, they are OK” and “Staff can be funny when they want to be, makes me feel like being awkward”. In a returned survey from a health professional they said that some staff have a negative view of some people who use the service. Staff said they felt they had a good team and the manager was very approachable and supportive. Staff said they felt communication and teamwork within the home is good. Regular team meetings take place. Formal supervision has still not been taking place regularly for staff. The manager is aware of this and discussion took place about the importance of good supervision and support for staff, particularly at this time when many of the staff team are new and inexperienced. She agreed to put systems in place to make sure this happens and is planning to delegate some of this responsibility to her senior support worker. Ardsley House DS0000001413.V345798.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, 40 and 42 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. The home is, in the main, well managed and the interests of people who use the service are seen as important to the manager and staff and are safeguarded and respected at all times. EVIDENCE: The home has an experienced manager who has a nursing background and has now completed the NVQ level 4 Registered Managers Award. She has also just completed a Masters degree in Learning Disability. Staff said she is supportive and shows good leadership. One staff said, “She is always there to ask and will help sort any problems out”. People who use the service said they get on well with the manager, comments included, “She treats me alright, I like her” and “She is OK”. Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 27 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. However, the manager has not received supervision from the area manager or had an appraisal for a long time. There are no records in the home of this ever taking place. It would be good practice for the manager to receive support and supervision in her role especially at this time when she has been supporting a lot of new staff in the service. The organisation sends out annual questionnaires to people who use the service and relatives asking for their views of the home. These are then analysed and any changes are made to the service as necessary. It was disappointing that none of this information was available at the home on the day of the visit. 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. Maintenance records are well kept. Environmental risk assessments are completed and up to date. Electrical wiring and gas installation certificates are available and up to date. Accident or incident reports are completed. The manager has a system in place where she can analyse accidents to see if there are patterns, trends or ways of avoiding future accidents. She has also developed a system where any accidents are followed up. This is now recorded. The home has a comprehensive range of health and safety policies and procedures in place. Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 3 3 3 X 3 X Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 YA19 Regulation 15.1 Requirement The manager must make sure that all people who use the service have a detailed care plan, which includes their specific health needs. This will ensure that they receive person centred, safe support that meets their needs. The manager must make sure that all identified risks for people who use the service have a detailed action plan in place in order to minimise or prevent the risk. The manager and the organisation must make sure that safeguarding adults procedures are followed properly in the event of allegations of abuse being made. This will make sure that people who use the service are properly protected. The manager and the organisation must make sure that staff are trained in the specialist needs of people who use the service. This will make sure their needs are met properly. DS0000001413.V345798.R01.S.doc Timescale for action 31/10/07 2. YA9 13.4 31/10/07 3. YA23 13.6 15/09/07 4. YA35 YA32 18 30/12/07 Ardsley House Version 5.2 Page 30 5. YA36 18 The manager must make sure that all staff receives regular supervision so that they are clear on their responsibilities and are properly supported. This requirement is outstanding from 21st September 2005, 12th January 2006 and 14th August 2007. 30/09/07 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 YA6 Good Practice Recommendations The manager should make sure that daily notes are accurately completed to give a proper account of behaviours and moods of people who use the service. The manager should also make sure that people who use the service who have shown a desire to move on are given the support to do this. The manager and the organisation should review staffing levels to make sure the needs of the people who use the service are being met. The manager should obtain references from the last employers of staff. This will make sure recruitment procedures are robust and protect people who use the service from any potential abuse. The organisation should review availability of training in order that staff are trained in meeting the needs of the people who use the service. 2. 3. YA33 YA34 4. YA35 Ardsley House DS0000001413.V345798.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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.V345798.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!