Inspection on 22/09/05 for Ashbridge Lodge

This inspection was carried out on 22nd September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 36 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashbridge Lodge 19/11/07

Ashbridge Lodge 14/09/06

Ashbridge Lodge 10/05/06

Ashbridge Lodge 19/05/05

Ashbridge Lodge 31/03/05

Ashbridge Lodge 18/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Ashbridge Lodge 5 Ashbridge Road Leytonstone London E11 1NH Lead Inspector Vivienne Patchett Unannounced Inspection 22nd September 2005 5.00 Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 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 Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 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. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashbridge Lodge Address 5 Ashbridge Road Leytonstone London E11 1NH 020 8989 7767 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) Mr Siddicq Yadallee ****Post Vacant**** Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can provide care for one named service user with a mental health needs. 19th May 2005 Date of last inspection Brief Description of the Service: Ashbridge Lodge is a residential home for five persons (currently 3 women and 2 men) with learning disabilities. Four of the residents, whose ages range from 32 to 62 years, have lived there for 9 years. The most recent resident was admitted in February 2004. Residents have a pet cat. The house is located in a residential area of Leytonstone within the London Borough of Waltham Forest. The home is situated close to local amenities; a post office and mini convenience store are a road away and other facilities, which include places of worship, public transport, leisure centre, public library, shopping centre and restaurants are within walking distance for staff although too far for most of the residents to manage. All service users have their own bedrooms; two of which are on the ground floor. There is no lift. Three of the rooms have en suite toilets; the other two have wash handbasins in the room. There is a communal lounge/diner, a kitchen and a good size back garden accessible by steps. The office is on the first floor. A small room downstairs has been made into a separate seating area and smoking room. Current charges are from £600 to £800 per week. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a Thursday evening in September from 5.00pm to 7.45 pm and found a clean, bright and welcoming environment. Two members of staff were on duty. All five residents were in the home and the inspector spoke to four of them. They were happy with the care they were receiving. The deputy manager assisted at the inspection, the main focus of which was to review implementation of the requirements of the last inspection report of 19.5.05. Some had not yet reached the dates for compliance and have been repeated for information. The inspector spoke to residents and staff, looked at parts of the building, and examined documents, such as care plans, staff records, financial records etc. What the service does well: What has improved since the last inspection? What they could do better: The inspector was satisfied that the basic day-to-day personal care needs of the residents were being met. However, more could be done to introduce modern ideas of good practice relating to the care of people with learning disability or mental health history e.g. increasing choice, independence, decision-making, individual fulfilment etc. The choice of décor, equipment and furnishings could be more linked to the individual needs and wishes of residents, with crockery in sufficient amounts and furniture of suitable size and design to meet residents needs. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 6 Many of the requirements from the last report had not yet been met and need to be addressed by the new manager. There has been no registered manager in post for some years and an application for registration of the new manager needs to be submitted to the Commission by the proprietor as a matter of urgency. 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. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 The lack of clarity in the homes Statement of Purpose, Service Users Guide and contract may make it difficult for perspective service users, their relatives or potential purchasers to know what services the home is able to offer or the costs involved. The Service Users Guide is not currently available in a format suitable for the residents to understand. More fully documented assessments of residents needs are required to form the basis of effective care plans. EVIDENCE: At the last inspection, the Statement of Purpose and the Service Users Guide and conditions/contract required some amendments e.g. for clarification and accuracy and to take account of the changes to the National Minimum Standards made in February 2003 regarding the environment. See also standard 28 regarding a clear smoking policy. The new manager is working on the alterations and the requirements of the last report are therefore repeated. The necessity for more fully documented assessments of residents needs has been identified in previous reports. The deputy manager has been gathering information about the longer-standing residents e.g. assessments carried out prior to placement, their disability, their life histories etc in order to better understand and assess their current needs and how these can be met. She was in the process of incorporating this information into the care plans. There was limited evidence as to how the needs and preferences of residents from specific ethnic or religious groups were being met. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 There has been no major change in these outcomes since the last inspection and this is an area for urgent development. Care plans need further work to ensure they are based on a full assessment of the service users’ abilities, disabilities and needs. The introduction earlier in the year of an independent advocate has been a good start but appears to have had little obvious impact. More should be done to introduce modern ideas of good practice relating to the care of people with learning disability or mental health history e.g. increasing choice, independence, decision-making, risk-taking etc. EVIDENCE: Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 10 The Care plans in place were fairly detailed with a helpful structure. The acting manager had made improvements to the care plans but they need further development to include a full assessment. They would benefit from objectives being set, goals defined and agreed with residents and individual programmes instituted to guide staff and assess progress. Risk assessments were being reviewed and should differentiate more clearly between health and safety and care practice issues and describe how the staff can maximise independence within a safe framework. The last residents meeting with the manager or staff was on 18 April 2005. The advocate has been involved in group discussions with residents and on an individual basis with one resident. At the May 2005 inspection, two residents had indicated in their comment cards that they would like to be more involved in decision-making and the running of the home. The manager and advocate need to agree how the advocates role can contribute to this. Currently none of the service users manage their own finances independently. The proprietor acts as appointee for one resident and others are assisted by relatives. Care plans did not identify how much of which benefit each resident was due, how this was paid to the resident or how they would be assisted to manage their finances within their capabilities. Residents were paying a contribution to the home and details of this should be included in the Service Users Guide and contract. The residents’ contributions were being paid into the petty cash and used for shopping and the day-to-day running of the home. In order to safeguard the interests of the residents, monies handled on behalf of the residents should be kept separate from the day-to-day accounts of the home with separate systems and budgets and clear written procedures for the operation of petty cash. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 16 The atmosphere in the house is relaxed and friendly and residents are able to choose to be alone or in company. Family members are welcomed to visit the home. There has been no change in the Lifestyle outcomes since the last inspection when the report concluded that more could be done to ensure that residents are able to take part in appropriate activities within the home and as part of the local community. EVIDENCE: All but one of the residents attends a work centre but it was not clear what service was being offered and how this met residents‘ needs. Feedback indicated that residents have not been going out as much as they would like and residents wish to take part in a wider range of fulfilling social and educational activities. The acting deputy manager has registered the residents with dial-a-ride but had not yet taken advantage of this service. At present they are using mini cabs. Residents had had a group holiday but no photos were available. Telephone points have been fitted in the bedrooms and a portable phone is also available for residents use to ensure privacy. Residents have been Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 12 offered keys to their bedroom door but only one uses this. There are no lockable facilities in the bedrooms. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 Residents are assisted appropriately with personal care. Arrangements were in place for meeting the health and personal care needs of the service users. However, more detail needs to be obtained of the residents’ health problems and disabilities to enable staff to understand these and respond appropriately. EVIDENCE: The current residents are mostly self-caring with regard to personal care. Prompting, guidance and support are offered as required. Residents are able to choose their own clothes. See also the section on ‘Individual Needs and Choices’ above regarding information on residents’ needs and care planning. The shower had been retiled and a handrail, which one of the residents said he needed, has not been replaced. A referral has been made for an occupational therapist to give advice but there is a waiting list. A handrail has also not been replaced at the top of the stairs and residents had been using the wall for support. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Good personal relationships between the residents and deputy indicated that residents felt able to voice their worries. More could be done, however, to ensure that all of the relatives know of the complaints procedure and that this is written in such a way to assist residents and relatives in understanding the process and staff in responding appropriately to any complaints. The requirement from the last report remained outstanding and has been repeated. EVIDENCE: The residents were clear that they would speak to the acting deputy manager if they had any concerns. A written procedure for dealing with complaints was in place. Although comment cards at the previous inspection indicated that not all relatives knew of the complaint procedure, copies had not been sent to them. The complaints procedure had not yet been amended as required. No complaints were recorded since the last inspection so part of the requirement from the last report could not be checked. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 The home was clean and generally homely, comfortable and safe, with residents’ bedrooms personalised according to their taste and interests. However, attention is required in some areas to ensure that the homes premises are suitable to meet residents individual and collective needs and ensure they have full and safe use of all of the facilities of the home. As a “pre-existing home” the premises meet the minimum standards for the physical environment with regard to bedroom sizes and sufficient sitting/dining rooms, bathrooms and lavatories to meet residents needs. EVIDENCE: Most of the residents are independently mobile although some are unsteady on their feet or of small stature. One of the residents uses a frame in the home and a wheelchair outside. Although a referral has been made for one resident, advice should be sought from an occupational therapist to ensure that suitable aids and adaptations are available to meet the needs of all service users within the house and to provide access to the garden. See also standard 18. New armchairs and settees had been provided in the sitting room at the time of the last inspection but these were too high for the comfort of the residents, staff or visitors. The armchairs in the small sitting room were rather low for Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 16 one resident. The requirement of the last report, for seating suitable to the individual needs of residents to be supplied, had not been addressed. All service users have their own bedrooms; two of which are on the ground floor. One of the bedrooms is 9 square metres plus ensuite toilet, 2 other rooms measure 10m2 plus ensuite. The other two rooms are larger and have wash handbasins but no ensuite toilets. Pre-existing care homes must set out in their Statement of Purpose and Service Users Guide information about the size of rooms. There is a shower room and toilet on the ground floor and a bathroom and toilet on the first floor, giving residents a choice of facilities. There is a communal lounge/diner, a kitchen and a good size back garden, which would benefit from the planting of flowers and shrubs etc. At present access to the garden is limited so cannot be used safely or independently by all residents. There are several steps down to the garden and the pathway is not suitable for the resident using a frame. There is currently no garden furniture. New crockery had been supplied but only 6 plates and bowls so that not all residents and staff or visitors could eat together. Arrangements for Infection control within the home were not inspected on this occasion. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The significant loss of staff since the last inspection, including those with experience and qualification in working with people with learning difficulty and mental health histories has had an impact on the home, with remaining staff working excessive hours for a considerable period. Recruitment procedures are not robust in order to protect residents. Although 50 of staff had achieved an NVQ 2 qualification, suitable arrangements for the induction, training and supervision of staff require urgent implementation. EVIDENCE: Three of the five members of staff left in the same week. New staff had been recruited although one proved unsatisfactory. Records showed staff had been employed in the home without appropriate references and CRB/POVA checks being received. The recruitment procedures and documents e.g. application form, request for reference letter, were not detailed enough to obtain sufficient information and thereby ensure that residents are protected. References had not been verified and gaps in employment history were not explained. There was no evidence of newly appointed staff having had structured induction training or being supervised during the period of induction by named staff member/s. There was no current system for the formal supervision of staff. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 18 Three staff had NVQ level 2 and two were undertaking NVQ level 3. Some ongoing, in-house training had been supplied to staff but there was no planned programme to ensure that staff had all the training required to enable them to fully meet the needs of residents. Some staff had had mental health awareness training but staff had not received any training in learning disability or associated current good practice. Further information and advice can be gained from Skills for Care and BILD. The rota showed an increase in staffing levels to have 2 care workers on duty through the day although staff were still regularly working 13-hour shifts during the day or at night with no break. No ancillary staff are employed so staff do cooking and cleaning as well as care tasks. The rota showed that the deputy had worked 7 days per week for 3 weeks from 1/8/05 to 21/8/05 without a break. A staff meeting had been held on 8 July 2005, following the appointment of the new manager. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41, 42, 43 The service has generally suffered from the lack of a qualified, competent, registered manager, experienced and skilled in the care of people with a learning disability and a mental health history and knowledgeable about current good practice. Urgent attention is required to several areas of management within the home to ensure that the home promotes the welfare of the residents and meets their needs according to best practice. A new manager has been appointed but it is early days for her to make an impact on improving outcomes for residents. EVIDENCE: See previous sections regarding care planning, promoting choice and independence, staff recruitment, training and supervision etc. The previous manager had been in post for two years but had not been put forward by the proprietor for registration by the Commission until required to do so a year ago. The inspector was concerned that the proprietor had allowed this situation to continue for such a long period. This manager retired on 4th Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 20 March, replaced by the deputy manager until the new manager started in July 2005. This manger must apply for registration. Reports of the proprietors monthly visits to report on the conduct of the home were available for 7/12/04, 4/5/05 and 18/6/05 but these quality monitoring visits did not appear to have taken place since then and no further reports had been received by CSCI. Several fire doors, including bedrooms and the laundry room were not effectively self-closing, leading to a possible danger to staff and residents in the event of a fire. This was a requirement of the August 2004& May 2005 CSCI reports and the July 2004 report of the Environmental Health Officer (EHO). An Immediate requirement Notice was issued for this to be remedied urgently. Gas and electricity certificates were current and fire equipment had been tested. Annual testing of electrical appliances and servicing of the fire alarm system were overdue. There was no business plan or financial plan for the home available for inspection. There was no record of accounts kept in the home as required by regulation 17 and no evidence of the systems in place to ensure the financial planning, budget monitoring and financial control of the home. The deputy manager did not have knowledge of any budgets relating to the home. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X 2 X 2 Standard No 22 23 Score 2 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 2 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 3 2 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 2 2 1 2 1 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashbridge Lodge Score 2 2 X X Standard No 37 38 39 40 41 42 43 Score 2 X 1 2 2 1 2 DS0000007276.V253345.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 Requirement Timescale for action 01/12/05 2 YA1 5 3 YA5 5(b) The Statement of Purpose to be amended to include all of the information listed in schedule 1 and take into account the changes in the National Minimum Standards (NMS) made in February 2003. A copy to be sent to the Commission. (Outstanding since 18 August 2004, previous dates for compliance of 1 December 2004 and 1 July 2005 not met. The service users guide to be 01/12/05 amended to meet regulation 5, to include contributions payable to the home by the resident and take into account the changes in the National Minimum Standards made in February 2003. A copy to be sent to the Commission. (Outstanding since 18 August 2004, previous dates for compliance of 1 December 2004 and 1 July 2005 not met.) The terms and conditions/ 01/12/05 contract to be amended to DS0000007276.V253345.R01.S.doc Version 5.0 Ashbridge Lodge Page 23 4 YA3YA6YA19 15 5 YA7YA8 12 include the amount charged, the method of payment and any extras payable. (Outstanding from 31.3.05 report. Previous date for compliance of 1 July 2005 not met. Development of care plans to continue to ensure that goals are set, all care needs are addressed and to indicate, in detail, how the manager and staff will meet these. Care plans to be: based on a full written assessment; describe the services and facilities to be provided in the home and how these services will meet current and changing needs and aspirations and achieve goals; to include service users wishes on ageing, illness, death, religious and cultural customs. The daily recording to be more detailed and link to the care plans and how staff have been addressing these in their day to day work with residents. (From the 31.3.05 & 19.5.05 reports) The registered person to demonstrate how service users are enabled to make decisions with respect to the care they receive and their health and welfare. The staff to provide service users with information, assistance, support and opportunities they need to make decisions about their lives. Staff must be able to demonstrate how individual choices have been made and must record instances when decisions are made by others and why. Clarification to be sought as DS0000007276.V253345.R01.S.doc 01/01/06 01/01/06 Ashbridge Lodge Version 5.0 Page 24 6 YA7YA11YA23 12 & 17 7 YA9 12 & 13 8 YA12YA13YA14 16 to the input and any outcomes from involvement of the advocacy service. (From the 31.3.05 and 19.5.05 reports) All monies handled on behalf 01/12/05 of residents, including their contribution to fees, to be recorded, with details of bank accounts and where monies are held. The manager to ensure that residents receive their personal allowances and any other income to which they are entitled promptly, details of which to be included in the care plans. Appropriate support and tuition for residents to manage their own finances to the best of their ability to be provided in line with their care plan, documented and reviewed. (From the 31.3.05 & 19.5.05 reports. Date for compliance of 1 July 2005 not met) The manager to arrange 01/12/05 appropriate training for service users regarding personal safety and using public and other transport to maximise their independence and ability to attend activities etc within a care planning and risk management framework. (Repeated from the August 2004 and May 2005 reports) The manager to ensure that 01/12/05 residents are given appropriate assistance and encouragement to take the part in fulfilling social, educational and leisure activities in the home and within the community. (Outstanding from 19.5.05. Date for compliance if 1 July 2005 not met). DS0000007276.V253345.R01.S.doc Version 5.0 Page 25 Ashbridge Lodge 9 YA1YA16 5 10 YA18YA29 13, 23 11 YA22 22 12 YA22 22 13 YA24YA26 23 Rules on smoking and alcohol to be clearly stated in the contract and the Statement of Purpose. (Repeated from the August 2004 report, dates for compliance of 1 December 2004 and 1 July 2005 not met) An occupational therapist to assess the suitability of the premises to meet the needs of all residents, to assist them to maintain maximum independence. (from the May 2005 report) The complaint procedure to be readily available in the home, be given to every service user and their representative. All complaints to be recorded whether they made verbally or written. The record of complaints to include a sufficiently detailed record of the complaint, investigation, action taken, the outcome and timescales etc. The complaint procedure to clarify: how a potential complaint of abuse is linked to the adult protection procedure; the procedure if the complaint is about the manager and the role of the proprietor in the complaints process. (From the 31.3.05 & 19/5/05 report. Previous dates for compliance not met.) A copy of the complaints procedure in an appropriate format for service users to understand to be given to every service user and their representative. A range of seating, suitable to the individual needs of DS0000007276.V253345.R01.S.doc 01/12/05 01/12/05 01/11/05 01/04/06 01/12/05 Ashbridge Lodge Version 5.0 Page 26 14 YA33 18 residents, to be supplied in both sitting rooms and the garden. The bedrooms to contain the furniture and fittings included in this standard and listed in the residents contract/ statement of terms and conditions i.e. a table and 2 comfortable chairs, a lockable storage space, bedside tables and lamps. Suitable curtains to be provided in all rooms & the velcroed ones in a bedroom from a previous resident to be removed. (Outstanding from May 2005 report. Date for compliance of 1 August 2005 not met). If the space in bedrooms is not sufficient for provision of recommended facilities, this to be included in the Statement of Purpose, Contract and Service Users Guide, noted on the care plans and reviewed. Sufficient staff must be employed at all times to ensure the health and safety of both residents and staff, fulfil the aims and objectives in the Statement of Purpose and meet the needs of all residents. The rota to specify when management tasks are being carried out and to include any hours worked in the home by the proprietor or any volunteers. The registered person to ensure staff have the breaks specified in the Working Time Regulations. (From the 31.3.05 & 19.5.05 reports. 01/11/05 Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 27 15 YA32 18 16 YA34 19 15 YA34 19 16 YA35 18 (2) (a)(b) 17 YA35 18 & 19 Date for compliance of 1 July 2005 not met.) All staff to have NVQ Level 2 or 3 qualification in care or be working to obtain one by an agreed date Staff must not be employed until CRB and POVA or POVA First checks and adequate, verified references have been obtained. The format of Job application forms and references to be revised to ensure that they provide appropriate information to form a basis for judgements of fitness of applicaants. Newly appointed staff to have structured induction training to Skills for Care (ex TOPSS) specifications, covering all of the areas specified in the National Minimum Standards, within 6 weeks of employment and to be supervised during the period of induction by a designated member of staff on duty at the same time. (Regulations as amended in July 2004). (Outstanding from the August 2004 report, date for compliance of 1 December 2004 not met). The registered person to ensure: foundation training is provided to staff within 6 months of employment. Such training to cover all of the areas specified in the National Minimum Standards and be to Skills for Care (TOPSS). specifications (Outstanding from the August 2004 report, dates for compliance of 1/ 12/2004 & 1/10/05 not met) 01/01/06 01/10/05 01/12/05 01/11/05 01/03/06 Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 28 18 YA36 18 19 20 YA37 YA37 8&9 10 Staff to have appropriate training in learning disability, mental health and associated current good practice. A schedule of planned and structured supervision sessions to be implemented for all staff - to start as part of the induction process, through the probationary period and then establish a regular pattern of supervision at least six times a year. A supervision contract to form part of the supervision procedure, defining the length and frequency of sessions and the areas to be included. Staff to have a named supervisor, be able to add items to the agenda, the sessions to be minuted and a signed copy given to the supervisee and kept by the supervisor for the staff records. Sessions to cover: all aspects of practice; philosophy of care in the home; career development needs. (Outstanding from previous reports. Timescale for compliance of 1 November 2004 and 1 July 2005 not met) An Application for registration of the manager to be submitted to the CSCI. The manager to have sufficient time and delegated overall responsibility, set out in a job description, to ensure: that she is able to carry out the duties of a registered manager; that written aims and objectives of the home are achieved; policies and procedures are implemented; the homes DS0000007276.V253345.R01.S.doc 01/12/05 01/11/05 01/11/05 Ashbridge Lodge Version 5.0 Page 29 21 YA39 26 22 YA41 17 23 YA42 13 budget is properly managed; certificates and licences are obtained and displayed; the terms of service users contracts are fulfilled; the home complies with the Care Standards Act and Regulations, General social care Council codes of practice and other legal requirements. (Outstanding from the August 2004 report, dates for compliance of 15 October 2004 and 1 July 2005 not met.) The registered provider must 01/11/05 visit the care home at least once a month, unannounced, and: interview service users, representatives and staff in order to form an opinion of the standard of care provided in the home; inspect the premises, its records of events and any complaints and prepare a written report on the conduct of the care home. The registered provider must supply a copy of the report to the Commission and a copy must be kept in the home. The registered person must 01/11/05 ensure that all the records required by regulation are in place within the home, kept in sufficient detail and up-todate. E.g. staff supervision records; accounts of the home; records of the monies handled on behalf of residents by the proprietor or staff; Statement of Purpose and Service Users Guide etc. (from the May 2005 report, date for compliance of 1 July 2005 not met.) The registered person to 07/10/05 DS0000007276.V253345.R01.S.doc Version 5.0 Page 30 Ashbridge Lodge 24 YA43 25 & 17 ensure that fire doors consistently and effectively self-close and are kept closed. (Outstanding from the August 2004 report, date for compliance of 1 May & 1 July 2005 not met). Immediate Requirement Notice issued. A record of accounts to be 01/12/05 kept in the home as required by regulation 17. Clear budgets to be available for the running of the home and petty cash account, separate from residents finances. Appropriate systems to be in place to ensure the financial planning, budget monitoring and financial control of the home, including the manager having access to budgets relating to the home. Lines of accountability within the home to be clarified. (Outstanding from the August report. Dates for compliance of 1 November 2004 & 1 July 2005 not met). 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 Refer to Standard YA1 YA9 Good Practice Recommendations The proprietor and manager to make the Service Users Guide available in a format suitable for the residents to understand. The format for risk assessments to differentiate more clearly between practical health and safety issues and care practice issues and describe how the staff can maximise independence within a safe framework. A clear smoking policy to be developed which defines DS0000007276.V253345.R01.S.doc Version 5.0 Page 31 3 YA28 Ashbridge Lodge 4 5 YA12 YA40 6 7 YA43 YA26 where the one resident who smokes and his visitors can smoke in the building. The smoking area should be separate from communal space used by other residents. The manager to visit the work centre to assess how well this provision is meeting residents’ needs and document how it fits into their care plans. It is recommended that the home have access to the Internet so that vital information, updates and good practice guidance can be downloaded from CSCI, appropriate government and allied web sites. A copy of the home’s business plan and financial plan to be forwarded to the CSCI. Residents should be provided with lockable facilities in their room. Ashbridge Lodge DS0000007276.V253345.R01.S.doc Version 5.0 Page 32 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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