Inspection on 12/02/07 for Ascot House

This inspection was carried out on 12th February 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Polesworth Group Pooley Heights

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

CARE HOME ADULTS 18-65 Ascot House 23 Joinings Bank Oldbury West Midlands B68 8QT Lead Inspector Lesley Webb Key Unannounced Inspection 12th February 2007 12:30p Ascot House DS0000067169.V326490.R02.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 Ascot House DS0000067169.V326490.R02.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. Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ascot House Address 23 Joinings Bank Oldbury West Midlands B68 8QT 01384 872804 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) Edge View Homes Ltd *** Post Vacant *** Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6) of places Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Not applicable, first inspection. Brief Description of the Service: Ascot House is situated in the busy residential area of Oldbury in Sandwell. This detached house has been specially converted and refurbished; it is a large three-storey house within easy walking distance of all local amenities. The house provides a warm, comfortable and caring environment. Bedrooms are situated on the two upper floors with four bedrooms and a hydrotherapy pool on the first floor, and two bedrooms on the second floor. Each bedroom has its own en suite bathroom providing a shower, toilet and sink. The bedroom sizes vary but all are in excess of the National Minimum Standards, being larger in size than 12 square meters. Residents are encouraged to choose a colour scheme for their room and may assist in redecoration if they so wish. All necessary furniture is provided, however residents are welcome to personalise their rooms. All bedroom doors are alarmed to ensure the safety and security of the service user and his personal effects. Ground floor accommodation comprises of a large lounge with sky TV, dining room, a main kitchen where resident’s meals are prepared, the manager’s office, laundry room and therapy room. On the ground floor there is also another kitchen for residents to make drinks and if they so desire prepare their own meals. Outside in the garden area there is a conservatory and a patio area. Access to the conservatory is via a covered walk way. Ascot House provides 24-hour residential care for people with learning disabilities, mental health problems and autistic spectrum disorders. These may be complicated by the presentation of behaviour, which challenges services. Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a three-day period, by one inspector, with the home being given no notice of the visit. Time was spent examining records, talking to service users and staff and observing care practices, before giving feed back on the findings of the inspection to the proprietor and members of the management team. Prior to the inspection information was supplied to the Commission for Social Care Inspection. This was also used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. This was taken into consideration by the inspector when case tracking three individuals care provided at the home. No relatives of service users were present during the inspection. However twelve comment cards were received, all praised the service, paying particular attention to staff and management. Fees charged for living at this home range from £2,400.00 to £4,400.00. This was the first inspection of Ascot House since its initial registration in 2006. The atmosphere within the home is inviting and warm and the inspector would like to thank everyone for his or her co-operation and assistance. What the service does well: Assessment processes are good, enabling the home to be confident it can meet the needs of people. Evidence obtained through examination of documentation, talking to service users, observation of practices and interviewing of staff demonstrates the homes capacity to meet the assessed needs of people living at the home. This was also confirmed in all of the twelve comment cards received by the Commission For Social Care Inspection (CSCI). For example one person wrote, ‘I am satisfied at long last my son is at a home that has his interests at heart and caters for his specific needs. Thank you staff at Ascot House’. Staff have good understanding of the support needs of individuals living at the home. All staff that were interviewed demonstrated knowledge of the contents of care plans and their importance, with responses including, “To know boundaries, what clients can do, educational needs, medication. The client’s history, risk assessments, person’s likes, moods and attitudes. They are important so that staff know what support someone needs”. People living at this home are able to make choices about their life style, and supported to develop their life skills. Five service user comment cards received by the CSCI all praise the home for the choice of activities they are supported to participate in. A comment card received by CSCI from a general practitioner also praised the home in this area stating ‘I find the service as proactive and service users lead a full life in the community, participating in the local community effectively, service users enjoy living at Ascot House’. Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 6 Privacy and dignity is respected at this home within a risk-managed framework. All of the people who live here require as a minimum at least one to one staffing, however the inspector observed that attempts are still made by staff to ensure privacy and dignity is respected. For example staff only entered bedrooms upon approval of service users and wishes in relation to times of rising, bathing and mealtimes were seen to be respected. People who live at this home are able to express their concerns, and have access to an effective complaints procedure. All service users that the inspector spoke to stated they feel happy to raise concerns and named various members of staff they would approach if unhappy. Comments include, “Key workers are there if worried, have questions, they help you” and “would go to staff or manager, happy to do this, they would help me. There to help, not judge what you have done in past, none of us are angels or perfect. Staff are good, can have a laugh and joke with them, you can talk to them about your problems”. The physical design and layout of the home enables people who reside there to live in a safe, well-maintained and comfortable environment, which encourages independence. A tour of the building was undertaken, with no issues identified. Relationships between staff and service users appear good, with many compliments made about the staff working at the home. As a service user explained, “Staff here help us to control our feelings, anger. They are good at that and you can still have a laugh or talk to them” and another, “they are here to talk to, if you fall down, they are here to pick up the pieces”. Everyone that the inspector spoke to praised the acting manager, confirming his management style creates an open, positive and inclusive atmosphere within the home. For example one person stated, “he’s fair, treats everyone equal” and another “He is good. Really helpful and active, supports, give you time.” What has improved since the last inspection? What they could do better: Further work is required to ensure prospective people considering to move into this home have up to date and comprehensive information in order to decide if the home will meet their needs. Both the statement of purpose and service user guide requiring amending. When talking to service users one person confirmed they were aware of the service user guide stating, “its about complaints, about staff, food, what could be better. I was reading it the other day” but everyone else stated they had not received a copy of this document. Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 7 People’s rights are not protected by the lack of comprehensive contracts. There are currently no contracts of residency in place between service users and the home. The proprietor confirmed that contracts are in place between the home and the various placing authorities but examination of these leads to the conclusion that they do not offer enough protection to service users. Also, further improvements to some assessments of risk will offer greater protection. Currently these are not in place for all identified needs as detailed in plans of care. Work is required to improve some aspects of meal provision and diet/nutrition. Despite menus appearing varied, four of the six service users and some staff commented that further improvements could be made. These comments include, “it’s the same, sandwiches, sandwiches, sandwiches, even sandwiches at night time” and “its alright, could be improved, more variety, more vegetables”. Improvements to some medication practices will offer further protection to people living at this home. The home must review stock maintained, remove excess and investigate why high amounts of some medication are in place. Some of the medication policies also require reviewing as they were found to refer to nursing home procedures and self-medication assessments and care plans based on individual needs and capabilities must be introduced. Further improvements to recruitments practices must take place to ensure people are protected in full. Six staff files were examined, with missing items on some including a reference, photograph, full employment history, enhanced criminal records bureau disclosure and initial dates of employment. It was also noted that in some instances application forms have not been completed in full, gaps in employment have not been explored and full employment histories have not been obtained. Finally, improvements to quality monitoring and some management of health and safety are required in order that the home can demonstrate it is meeting its aims and objectives in full. Presently the homes formal quality assurance system has not been implemented as per its written policy and procedure. The home has two vehicles, which are used to transport service users to appointments and activities. The current systems for monitoring staff are suitably qualified for driving needs improving. Greater numbers of staff require first aid, risk assessment, food hygiene, health and safety and fire training. 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. Ascot House DS0000067169.V326490.R02.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 Ascot House DS0000067169.V326490.R02.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): 1,2,3,4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further work is required to ensure prospective people considering to move into this home have up to date and comprehensive information in order to decide if the home will meet their needs. Assessment processes are good, enabling the home to be confident it can meet the needs of people. People’s rights are not protected by the lack of comprehensive contracts. EVIDENCE: The home has produced a statement of purpose and service user guide that give details of the environment, criteria for admission, staffing ratios and qualifications, visiting times, activities, care planning, the fire and complaints procedure. It is recommended that the service user guide be reviewed to ensure it contains all information relating to amendments to the Care Home Regulations 2001. When talking to service users one person confirmed they were aware of the service user guide stating, “its about complaints, about staff, food, what could be better. I was reading it the other day” but everyone else stated they had not received a copy of this document. This was discussed with the proprietor and management team who confirmed everyone had been given a copy but that some might have forgot or destroyed it. It is recommended that a copy be prominently displayed within the home and the contents discussed within a residents meeting. Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 10 Pre-admission processes are good within this home. All service user files sampled contained detailed information gathered from various sources detailing needs including challenging behaviour, learning disabilities, health and psychology. Information includes risk assessments completed by a community nurse, care plans from previous establishments, psychology reports and assessments of needs from placing authorities. Evidence obtained through examination of documentation, talking to service users, observation of practices and interviewing of staff demonstrates the homes capacity to meet the assessed needs of people living at the home. This was also confirmed in all of the twelve comment cards received by the Commission For Social Care Inspection (CSCI). For example one person wrote, ‘I am satisfied at long last my son is at a home that has his interests at heart and caters for his specific needs. Thank you staff at Ascot House’. All but one person that the inspector spoke to confirmed that they had visited the home before residing there permanently. For example one person explained, “I stayed overnight, better here than where I was before, we go out more. I visited with staff to have a look round, stayed for one night. Had a meeting and now here for good”. Records examined confirm that people are offered the opportunity to visit the home prior to moving in (in some instances these include five night stays), meet other service users and staff and participate in activities and meals. There are currently no contracts of residency in place between service users and the home. The proprietor confirmed that contracts are in place between the home and the various placing authorities and that these are maintained at the company’s head office. During the inspection these were brought to the home and examined by the inspector. These were found to vary in detail, with none detailing all information as required by legislation. The home was instructed to devise and implement contracts of residency for each service user, ensuring they contain information as detailed in the Care Home Regulations 2001. It is also strongly recommended that these also include information as detailed in standard 5 of the National Minimum Standards for Younger Adults. Ascot House DS0000067169.V326490.R02.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): 6,7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive, within a risk-managed framework. Further improvements to some assessments of risk will offer greater protection. EVIDENCE: Three service users files were examined and found to contain care plans including aims and goals for identified needs including guardianship, learning disability/associated mental health issues, challenging behaviour, interpersonal skills/family contact, daily living skills, communication issues, choice/decision making/ independence, finances, social and educational, general hygiene and diet/fluid. When giving feedback on the inspection to the proprietor and management team the inspector recommended that the wording at the bottom of care plans be altered as these are currently recorded as ‘problem 1,2,3 ect’. This could indicate that all identified needs are seen as a negative. It was also noted that on the three files sampled the care plans for choices and decision Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 12 making contain basic information compared to other care plans. For example instructions for staff include ‘ give information, reassurance, assistance and guidance’. These would be improved if specific instructions or examples were included. Staff complete daily records which are stored alongside the corresponding care plans in addition to completing monthly key worker notes in order that monitoring of the contents of care plans can take place. The inspector recommends that this system is reviewed with staff given guidance, as in some instances the amount of detail recorded varied, contents did not always reflect events that have taken place and do not evidence action taken to address previous issues. The form used for recording the key worker findings asks for any issues since last report, changes to medication, changes in support needed and any other comments. It is recommended that the form be reviewed to encompass other important areas such as complaints and care plans. It was also noted that in some instances meetings have not occurred monthly as required. Staff have good understanding of the support needs of individuals living at the home. All staff that were interviewed demonstrated knowledge of the contents of care plans and their importance, with responses including, “To know boundaries, what clients can do, educational needs, medication. The client’s history, risk assessments, person’s likes, moods and attitudes. They are important so that staff know what support someone needs”. Work should now be undertaken to ensure staff receive training and guidance on the principles and values associated with person centred planning, as none who were spoken to were able to explain this form of care planning. All service users spoken to confirmed that they are supported to made decisions relating to their care. As one person explained, “we had our first residents meeting and talked about holidays, going out, loads of things and I have key worker meetings and talk about home visits”. It is strongly recommended that the frequency of residents meetings increases and that the subjects of issues, complaints, policies and procedures relevant to service users are set as permanent items for discussion on the agenda to further enhance systems already in place at the home. Some of the people living at this home have specific needs in relation to the management of finances which result in them having restricted access to information and monies. Care plans were found to be in place relating to finance but these require expanding to encompass practices currently in place including the withholding of information. As with care planning staff demonstrated good understanding of their roles to support people in decision-making processes. Responses include, “We try to encourage them to make choices as far as education, courses they want to do. If they don’t want to go that’s their choice, but if they do we are here to support them in whatever way they need but still helping them to increase their independence”. Further work required to ensure all areas of risk are assessed and recorded. All files sampled have challenging behaviour and lone working assessments Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 13 (also a smoking risk assessment was in place for one particular person) but assessments for other identified needs as detailed in care plans are not in place. For example one person has care plans for family contact/interpersonal skills that indicates this person has specific needs in this area requiring support, but no risk assessment could be found that details how these needs will be managed. It was also noted that all risk assessments examined state to review period annually/review period could change due to an incident or change in circumstances. It is recommended that this be reviewed and assessments reviewed according to the level of risk identified. Practices observed and examination of records confirm that the home is meeting its legal obligations in relation to confidentiality. Ascot House DS0000067169.V326490.R02.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at this home are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: Service users lead full and active lives based on their individual needs and choices. Five service user comment cards received by the CSCI all praise the home for the choice of activities they are supported to participate in. A comment card received by CSCI from a general practitioner also praised the home in this area stating ‘I find the service as proactive and service users lead a full life in the community, participating in the local community effectively, service users enjoy living at Ascot House’. The inspector sat in the dining room with two service users where they both gave details of activities they participate in including swimming, gym, gardening, modelling and fishing, with one person stating, “its one of the best things about living here, I do lots more Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 15 here that where I lived before”. In addition to this records confirm that activities undertaken include art, cinema, bowling, snooker, football, sensory room, IT skills and visits to a public house. Due to the specific needs of people living at the home the majority of activities are undertaken on a one to one basis, resulting care packages and activities being specific to the needs and wishes of each individual. The home should be congratulated for the efforts it makes in this area. Pre-inspection documentation supplied to the CSCI states that holidays are funded by service users and are not included as part of the fee for living at the home. This was discussed with the proprietor and management of the home, who explained that transport, meals and activities are funded for holidays but that the cost of staffing is not included as part of the fees charged to the various placing authorities. Legal advice must be sought regarding this situation. Service users confirmed that they are supported to maintain contact with relatives as per their plans of care. As one person explained, “my dads coming to see me this week and I see my sister. I don’t see them at their house, they come here, I will ring later to see what time. They have to leave by 10.15, that’s latest visitor can stay”. As well as relationships with families the home proactively supports relationships between individuals living within the home. For example all six people living at the home are male and support various football teams. This has caused issues to arise and potential conflict, however records confirm this has been discussed as a group and agreements obtained to respect peoples different preferences. Further work is required to improve some aspects of meal provision and diet/nutrition. Menus were supplied to the CSCI prior to the inspection that detail choices of a lunchtime light meals including sandwiches, jacket potatoes and egg/beans on toast. Evening meals include two choices of a hot meal. Menus appear varied and nutritious and include fruit, vegetables, yogurts, salad, rice and pasta. Despite menus appearing varied four of the six service users and some staff commented that further improvements could be made. These comments include, “it’s the same, sandwiches, sandwiches, sandwiches, even sandwiches at night time” and “its alright, could be improved, more variety, more vegetables”. Improvement must also be made to records of meals eaten by service users. Currently a record of lunch and the evening meal is maintained (however these were found to be accurate in all instances) and no records are maintained of breakfast and supper. Detailed and comprehensive records must be maintained in such a way that nutrition and diet can be effectively monitored. The inspector was allowed to sit and participate in two meals during the inspection. The atmosphere was very relaxed, with service users and staff sitting eating lunch together, chatting and enjoying one another’s company. It is also recommended that the home seek professional advice in relation to nutrition and diet and introduce an Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 16 assessment and screening tool, such as the Sandwell NHS Priority Screening Tool in order that service users needs are appropriately managed in this area. Ascot House DS0000067169.V326490.R02.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): 18,19,20 and 21. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Improvements to some medication practices will offer further protection to people living at this home. EVIDENCE: Privacy and dignity is respected at this home within a risk-managed framework. All of the people who live here require as a minimum at least one to one staffing, however the inspector observed that attempts are still made by staff to ensure privacy and dignity is respected. For example staff only entered bedrooms upon approval of service users and wishes in relation to times of rising, bathing and mealtimes were seen to be respected. Generally health care is appropriately managed. All files sampled contained evidence that people receive appropriate intervention for professionals including general practitioners, community psychiatrist nurses and psychiatrists, but greater care must be undertaken to ensure records reflect appointments. For example the home uses a health care appointment matrix Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 18 for recording visits to specialists but these have not been completed to reflect appointments undertaken as detailed in care plan evaluation notes. It was also noted that one persons weight has not been recorded monthly on the homes ‘monthly weight chart’ (with no written explanation to justify this omission). It is strongly recommended that attempts be made by the home to introduce proactive, holistic approaches to healthcare management, with arrangements made for people living at the home to attend ‘Well Man’ clinics and to introduce screening tools such as the ‘Sandwell Priority Health Screening’ tool. Medication was observed being administered, records viewed and stock examined. The home must review stock maintained, remove excess and investigate why high amounts of some medication are in place. One service user prescribed Lactulose had 1500ml in stock but the medication administration record stated 1000mls received, another person prescribed Olanzapine had 54 tablets in stock but 28 recorded and another person prescribed Quetiapine had 239 tablets in stock but 56 recorded. As the home uses a monitored dosage system a maximum of 28 days supply of medication should be maintained at any one time. Photographs must be obtained of service users and retained with their medication records. A member of the management team explained that medication assessments are completed as part of the pre-admissions assessment but examination of this found the assessment to be very basic and not an assessment of needs and capabilities. She agreed a separate comprehensive assessment would promote independence “as many want or hope to move to independent living”. The home has been registered for less than twelve months, with many service users only moving to the home recently. The proprietor explained that wishes in relation to illness and death will be obtained once people have settled into the home and feel comfortable to discuss this. As many of the people living at the home have complex care and mental health needs priority is being given by the home to ensuring these are managed and met appropriately, with the inspector confident action will be taken to address the issue of death and dying at a later date. Ascot House DS0000067169.V326490.R02.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at this home are able to express their concerns, and have access to an effective complaints procedure. Staff have a good knowledge of protecting people from abuse, however further improvements to some policies and practices will offer greater protection and ensure peoples rights are protected in full. EVIDENCE: All service users that the inspector spoke to stated they feel happy to raise concerns and named various members of staff they would approach if unhappy. Comments include, “Key workers are there if worried, have questions, they help you” and “would go to staff or manager, happy to do this, they would help me. There to help, not judge what you have done in past, none of us are angels or perfect. Staff are good, can have a laugh and joke with them, you can talk to them about your problems”. Venues such as residents and key worker meetings are in place, however it is recommended that the frequency of residents meetings increase and the inclusion of issues/complaints as a set item on the agenda be implemented to further enhance systems already in place that encourage and support people to complain. It is also recommended that the complaints procedure be reissued to all service users and relatives as half of the comment cards returned to the CSCI state that people are unaware of the contents of this. All staff that were spoken to demonstrated a good understanding of their role in supporting people to raise concerns. Responses include, “try to talk to them, explain to my senior, arrange meetings to find out why unhappy, if still not resolved go Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 20 to manager, it’s my role to give reassurance and comfort. Its why we do what we do”. Staff also demonstrated good understanding of protecting people from abuse. For example one person explained, “Listen, keep your eyes open to any form of abuse, and report it. If you know abuse is going on don’t be quiet about it, nothing must stop it being reported. Would report anyone even if it’s the manager, we are all equal and that’s what we here for”. A selection of protection policies and procedures were examined with the majority appearing appropriate. The home was instructed to review the adult protection policy as currently it makes no reference to local authority adult protection guidelines, which must be complied with or action the manager must take in the event of an allegation. Many staff have undertaken adult protection training with evidence supplied that others will be completing this in due course. The majority of people living at this home have complex care packages to manage behaviours that can challenge, including physical and verbal aggression. The acting manager is a qualified crisis prevention intervention trainer who instructs staff working at the home in this area. Intervention policies and procedures are in place that appear appropriate, however improvements to training records must take place that evidence all staff working at the home hold up to date certificates in this area as per the homes policy. Financial practices were examined and generally found to be acceptable apart from the need to expand financial care plans (as mentioned earlier in this report) to include management systems currently in place and restrictions on information given to service users. It was also noted that service user inventories require updating on a regular basis, as these have not been reviewed since service users moved to the home. Ascot House DS0000067169.V326490.R02.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): 24,25,26,27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who reside there to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: In relation to the environment the homes statement of purpose states ‘Ascot House is situated in the busy residential area of Oldbury in Sandwell. This detached house has been specially converted and refurbished; it is a large three-storey house within easy walking distance of all local amenities. The house provides a warm, comfortable and caring environment. Bedrooms are situated on the two upper floors with four bedrooms and a hydrotherapy pool on the first floor, and two bedrooms on the second floor. Each bedroom has its own en suite bathroom providing a shower, toilet and sink. The bedroom sizes vary but all are in excess of the National Minimum Standards, being larger in size than 12 square meters. Residents are encouraged to choose a colour scheme for their room and may assist in redecoration if they so wish. Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 22 All necessary furniture is provided, however residents are welcome to personalise their rooms. All bedroom doors are alarmed to ensure the safety and security of the service user and his personal effects. Ground floor accommodation comprises of a large lounge with sky TV, dining room, a main kitchen where resident’s meals are prepared, the manager’s office, laundry room and therapy room. On the ground floor there is also another kitchen for residents to make drinks and if they so desire prepare their own meals. Outside in the garden area there is a conservatory and a patio area. Access to the conservatory is via a covered walk way’. A tour of the building and examination of documentation confirm the above information to be accurate, with no issues identified. Infection practices are good. It is however, recommended that a safe system for storing of mops be introduced and a written procedure for the sanitizing of mop heads introduced. Work must be undertaken to ensure staff receive infection control training, as currently only one of the twenty six staff employed at the home have undertaken this. Ascot House DS0000067169.V326490.R02.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): 31,32,33,34,35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally staff in the home are trained, skilled and in sufficient numbers to support the people who live there. Further improvements to recruitments practices must take place to ensure people are protected in full. EVIDENCE: Relationships between staff and service users appear good, with many compliments made about the staff working at the home. As a service user explained, “Staff here help us to control our feelings, anger. They are good at that and you can still have a laugh or talk to them” and another, “they are here to talk to, if you fall down, they are here to pick up the pieces”. Twelve comment cards were also received by the CSCI, again all praising staff and the support they give service users. Compliments include, ‘all staff are very friendly, professional and helpful’ and ‘the staff are always kind and helpful, they and the residents make the house warm and welcoming. There are always plenty of things for the residents to do, and the carers really work hard in involving them in things in the house and local community’. Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 24 Although practices observed and discussions with service users and staff indicate people working at the home have the appropriate qualities and qualifications to support people living at the home improvements to recording and storage systems are recommended to allow for effective monitoring. Currently training certificates are stored in personnel files and others in a training folder, training lists do not always correspond with certificates on file, some certificates were found to have expired and the person completing medication competency assessments of staff was found to have no certificate for the administration of medication and therefore the inspector was unable to verify if they are suitably qualified to undertake this responsibility. As mentioned earlier in this report is it also noted that no-one working at the home has yet undertaken person centred planning training. It was however pleasing to find that some staff have received training in learning disabilities and other areas in order that they have greater understanding of the needs of people living at the home. Staffing levels appear appropriate to the needs of people living at the home. Pre-inspection documentation supplied to the CSCI prior to the inspection states that 819 care hours are required in order to meet service user needs and that 902.75 are provided. In addition to this 41.5 supernumerary management hours are allocated every week. When discussing the findings of the inspection with the proprietor and management team the inspector recommended that consideration be given to actively recruiting male carers to meet needs of service users and to comply with contents of care plans and assessments. The home was also instructed to expand the staff rotas to detail in what capacity staff undertake work. Records and discussions with staff confirm that one staff meeting has taken place since the home opened in June 2006. It is strongly recommended that the frequency of these increase and that records include agreed actions, by whom and target dates for monitoring purposes. Improvements to recruitment records are required to ensure people living at the home are protected in full. Six staff files were examined, with missing items on some including a reference, photograph, full employment history, enhanced criminal records bureau disclosure and initial dates of employment. It was also noted that in some instances application forms have not been completed in full, gaps in employment have not been explored and full employment histories have not been obtained. When discussing the findings with the proprietor and management team the inspector also instructed that the home seek legal advice regarding staff being instructed that they may have to pay for training if they leave the employment of the home within specified timescales. As the inspector explained under health and safety legislation employers have a legal responsibility to provide training and this must be funded by the employer. There have been three managers in post at the home since in opened in June 2006. This has affected the amount of formal supervision staff have received, Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 25 with no files containing evidence that staff have received as a minimum six sessions (as per the National Minimum Standards for Younger Adults). It was therefore pleasing to find that since the new manager has been in post (8th January 2007) this support has now been reinstated, with all staff having now received one supervision. It is strongly recommended that the frequency of these increase and that annual appraisals be introduced, both as forms of support for people working at the home. Ascot House DS0000067169.V326490.R02.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): 37,38,39,40,41,42 and 43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. Improvements to quality monitoring and some management of health and safety are required in order that the home can demonstrate it is meeting its aims and objectives in full. EVIDENCE: The acting manager has been in post since December 2006. Discussions and observations of practices made during the inspection indicate that the acting manager is dedicated to running the home in the best interests of the service users residing there. When asking the acting manager about his qualifications and experience he explained, “I’ve been qualified as a nurse since October 2002, my first job was working at a nursing home with people with learning disabilities, mental health and other conditions. I’m a qualified crisis Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 27 prevention intervention trainer. Previously when I was a primary nurse I was responsible for supervision of staff, ensuring key workers fulfil their roles. Also responsible for ordering medication while at nursing home”. He also confirmed that it is his intention to enrol on the registered managers award and to submit and application for registration to the CSCI. Everyone that the inspector spoke to praised the acting manager, confirming his management style creates an open, positive and inclusive atmosphere within the home. For example one person stated, “he’s fair, treats everyone equal” and another “He is good. Really helpful and active, supports, give you time.” Presently the homes formal quality assurance system has not been implemented as per its written policy and procedure. The records of two visits undertaken in line with Regulation 26 of the Care Home Regulations 2001 were found to be in place that appear to be very detailed and based on the views of people living at the home. Further work must be undertaken to ensure they occur monthly, again in line with regulation. The inspector also recommended that staff received guidance to understand quality assurance, the processes and its importance as non that were questioned about this demonstrated sufficient knowledge and understanding. As mentioned in other areas of this report some policies and procedures require reviewing to ensure they comply with legislation, practices within the home and are up to date. It was noted that two complaints policies were on file, both containing different information, the policy for absconding gives the CSCI Stafford address and telephone number when the home is regulated by the Halesowen area office. It is also recommended that policies relevant to service users be included as set item on service users meeting agenda, to encourage and involve them in decision making processes. In the main service users rights and interests are safeguarded by the homes record keeping practices. Service user files were found to be in good order and to contain the majority of information as required by regulation. As mentioned earlier in this report priority must be given to ensuring full and comprehensive recruitment records are in place, so that service users are protected in full. When examining other documents the inspector found that notifications to the CSCI in line with Regulation 37 of the Care Home Regulations 2001 have not been completed. This was discussed with the acting manager, who confirmed his commitment to ensure this does not continue. It is recommended that computer and Internet access be made available within the home to ensure that the acting manager and staff have access to up to date information relevant to their roles. Pre-inspection documentation supplied to the CSCI prior to the inspection states that fire equipment was checked April 2006, the last fire drill took place on the 19th January 2007, fire alarms are tested weekly, the central heating was serviced on the 6th June 2006, a Legionella assessment was undertaken 15th June 2006 and a electrical wiring certificate issued 10th July 2007. When Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 28 assessing the management of health and safety within the home the inspector recommends that risk assessments be completed for all subjects listed in 42.2 and 42.3 of National Minimum Standards for Younger Adults and that the records of fire drills be expanded to include the time of the drill as currently this is not recorded and the home cannot confirm night evacuations as per its written policy. Greater numbers of staff require first aid, risk assessment, food hygiene, health and safety and fire training. The homes fire risk assessment states ‘all staff are trained in fire prevention and evacuation’, records indicate this not so. Ascot House DS0000067169.V326490.R02.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 2 2 3 3 3 4 3 5 2 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 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 2 3 2 2 2 2 3 Ascot House DS0000067169.V326490.R02.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 YA5 Regulation 5, 5(b) Sch4(8) Requirement The registered person must develop and agree with each service users a written and costed contract/statement of terms and conditions between the home and the service user. The registered person must expand financial care plans to encompass practices in place, including the withholding of information. The registered person must ensure all areas of risk for each service user is assessed and recorded for all identified needs. The registered person must seek legal advice regarding who is responsible for funding service users holidays. The outcome of this must be forwarded to CSCI, Halesowen. The registered person must ensure an accurate record is maintained of all meals eaten by service users. The registered person must review medication stock maintained within the home, remove excess and investigate why high amounts of some DS0000067169.V326490.R02.S.doc Timescale for action 30/05/07 2 YA7 15 Sch 3(q) Sch 4(9) 13(4)(6) 30/05/07 3 YA9 30/05/07 4 YA14 5(b) 13(4)(6) 30/05/07 5 YA17 Sch4(13) 31/03/07 6 YA20 13(2) 30/04/07 Ascot House Version 5.2 Page 31 medication are in place. The registered person must ensure a photograph of each service user is retained with their medication records. The registered person must 30/04/07 review the adult protection policy, ensuring it makes reference to local adult protection guidelines and actions that must be taken by the manager should an allegation be made. The registered person must ensure all staff working at the home hold up to date certificates in crisis intervention prevention as per the homes policy. The registered person must make arrangements for all staff to undertake infection control training, with certificates maintained within the home for inspection. The registered person must ensure all recruitment records as detailed in the Care Home Regulations 2001 are in place prior to anyone undertaking shifts and that these are maintained within the home. 7 YA23 13(4)(6) 8 YA30 13(3) 31/05/07 9 YA34 19 18(1) Sch 2,4. 31/03/07 10 YA39 24 The registered person must seek legal advice regarding staff being instructed that they may have to pay for health and safety training if they leave the employment of the home within specified timescales. The outcome of this must be forwarded to CSCI, Halesowen. The registered person must 31/03/07 arrange for unannounced visits in line with Regulation 26 of the Care Home Regulations 2001 to take place every month. DS0000067169.V326490.R02.S.doc Version 5.2 Page 32 Ascot House 11 12 YA40 YA41 24 37 Sch2,3,4 The absconding policy must include the CSCI Halesowen address and telephone number. The registered person must ensure all records as listed in schedules 2,3 and 4 of the Care Home Regulations 2001 are maintained within the home. The registered person must ensure notifications in line with Regulation 37 of the Care Home Regulations 2001 are completed. The registered person must ensure all staff receive first aid, risk assessment, food hygiene, health and safety and fire training, with certificates maintained. 31/05/07 30/04/07 13 YA42 18(1)(a) 31/05/07 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 2 3 4 Refer to Standard YA1 YA1 YA5 YA6 Good Practice Recommendations The registered person must produce an up to date service user guide that contains all information as detailed in the Care Home Regulations 2001. That the service user guide be displayed prominently within the home and the contents discussed within a residents meeting. That contracts of residency include all information as detailed in standard 5 of the National Minimum Standards for Younger Adults. That the wording at the bottom of care plans be altered. That care plans for choices and decision making be expanded to include specific instructions or examples for staff. That staff receive guidance on completing daily records and key worker reports. Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 33 That the form used for recording key worker meetings be expanded to encompass all areas of care planning. 5 YA8 That key worker meetings take place monthly. That the frequency of residents meetings increase. That the subjects of issues, complaints and policies and procedures be set as permanent items for discussion on the agenda. That risk assessments are reviewed according to the level of risk identified. That the home explores with service users and staff the provision of meals. That the home seek professional advice in relation to nutrition and diet. That the home introduce a nutritional assessment and screening tool. That service users are weighed monthly as per the homes policy. That arrangements are made for people to attend ‘Well Man’ clinics and to introduce screening tools such as the ‘Sandwell Priority Health Screening’ tool. That the complaints procedure be reissued to all service users and their relatives. That service users inventories of personal items are regularly updated. That a safe system for storing mops be introduced and a written procedure for the sanitizing of mop heads. That improvements are made for the recording, storing and monitoring of staffs training certificates and associated documentation. That anyone completing medication competency assessments is suitably qualified. That all staff undertake person centred planning training. That all staff undertake equal opportunities training. 14 YA34 That all staff undertake autism training. That consideration be given to actively recruiting male care workers. That the frequency of staff meetings increases. That the minutes of staff meetings include agreed actions, by whom and target dates. Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 34 6 7 YA9 YA17 8 YA19 9 10 11 12 13 YA22 YA23 YA30 YA35 YA35 15 YA36 That all staff receive as a minimum, six supervision sessions per year. That annual appraisals be introduced for all staff. That the acting manager enrols on the registered managers award prior to submitting an application for registration to CSCI. That a formal quality assurance system is introduced that includes obtaining the views of service users, their representatives and other stakeholders. That staff receive guidance and training to understand quality assurance, the processes and its importance. That a computer and internet access be made available within the home. That risk assessments are completed for all subjects listed in standards 42.2 and 42.3 of the National Minimum Standards for Younger Adults. That the records of fire drills be expanded to include the time of the drill. The registered person must introduce a system that demonstrates staff are suitably qualified for driving the homes vehicles. 16 17 YA37 YA39 18 19 YA39 YA42 Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Ascot House DS0000067169.V326490.R02.S.doc Version 5.2 Page 36 - 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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