CARE HOME ADULTS 18-65
Ashbrook House 20 St Hellier Avenue Morden Surrey SM4 6LF Lead Inspector
Liz O`Reilly Unannounced Inspection 13th July & 1 September 2006 11:00
st Ashbrook House DS0000027206.V303839.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 Ashbrook House DS0000027206.V303839.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. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ashbrook House Address 20 St Hellier Avenue Morden Surrey SM4 6LF 0208 646 3096 0208 646 3096 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) Ashbrook House Limited Care Home 9 Category(ies) of Learning disability (9), Physical disability (4) registration, with number of places Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: Ashbrook House is owned and managed by Allied Care, a private organisation. The home is situated on a busy road in Morden close to local shopping, entertainment and public transport amenities. The home opened in 1999 and provides care and accommodation for up to nine residents with learning disabilities, some of whom also have physical disabilities. The home is staffed twenty four hours a day with staff awake in the home throughout the night. Allied Care own a significant number of care homes across the South East of England. Fees for this home range from £717.80 to £1519.04 per week. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one regulation inspector and consisted of two fieldwork visits to the home, discussions with residents and staff, observations and feedback from questionnaires sent to residents, staff and other people connected to the home. At the time of this inspection nine people were making Ashbrook House their home. Staff within the home work hard to meet any requirements or recommendations made following inspections. It is of concern that requirements made which need to be actioned by the organisation are not met. This lack of action on behalf of the organisation may impact on the overall assessment of the service in the future. What the service does well:
Ashbrook House provides a comfortable, homely environment. Feedback on the service provided from residents, relatives, staff and other professionals was good. Comments from residents about the home included; “there is a good atmosphere here”, “we get on well with the other people who live here and the staff”, “I can speak to any of the staff if I have a problem”, “We get to make our own choices”, “I like the food here most of the staff are good cooks”. Residents also commented that “I would not change anything here”, “I like living at Ashbrook”, “I can talk to the manager at any time” and “ it feels like home”. Residents benefit from a stable staff group who have a good knowledge of the strengths and needs of individuals. Staff spoken to and feedback from questionnaires indicated good levels of staff job satisfaction. Generally staff said that they work well as a group and feel well supported by the manager. There are good training opportunities and all of the staff have completed or are in the process of completing NVQ level two or three. Staff were described by relatives and visitors to the home as “very friendly” and that “staff work hard to keep people involved and happy”, “the daily service is excellent” and that “there are always sufficient staff who have created a quiet and pleasant environment”. Residents were very happy with the range of activities on offer in and outside the home. The manager and staff group work hard to meet any requirements set following inspections. Feedback from other professionals involved with the home was overall good. The general level of care was described as “excellent” and that staff have made a “good start in relation to communication work with residents”. Staff were described as “receptive to ideas for improvement in the home”.
Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 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 Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 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): 2 Quality in this outcome area is good. A full assessment of needs is carried out for each individual before they are admitted to the home. EVIDENCE: To make sure that staff are able to meet the needs and aspirations of each resident a full assessment is carried out before they are admitted to the home. All of the present resident group have been placed via a local authority who carry out the assessment. The home is provided with a copy of the documents which are used to produce an initial care plan for the resident. Staff from the home also visit any prospective resident before any decision is made about moving in. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 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 & 9 Quality in this outcome are is good. Each resident is provided with a care plan which has been agreed with them. Care planning follows person centred planning principles. Residents and if appropriate their family are involved in setting up and reviewing care plans. Individual risk assessments are carried out. Residents felt they made their own decisions about their lives. Work should continue on making care planning documentation more accessible to individual residents. Further work could be done to support residents in the running of the home. EVIDENCE: The staff continue to make improvements in the care planning. Each resident is supported to compile a Lifestyle Plan which gives comprehensive information on their individual strengths and aspirations. Documentation provides staff with good information on the needs, likes, dislikes and aspirations of individual residents. Care planning was seen to be reviewed regularly involving the resident, relatives and other professionals. Staff were found to have a clear understanding of the care planning systems and to use these documents to
Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 10 support residents in day to day activities and achieving goals. Daily recording was seen to be of a good standard. Risk assessments are in place which take into account the individual strengths and needs of each resident. These also assist staff in providing the appropriate levels of support or supervision for each individual. Any limitations placed on an individual are agreed as part of the care planning process with the resident, relatives and other professionals. Residents informed the inspector that they make their own decisions on day to day activities and were consulted through residents meetings about group activities they may wish to join. Residents said that they chose the times they get up, go to bed, what they eat and what they do during the day. Residents participate in some domestic activities. Residents said they were assisted by staff to do their laundry. The kitchen is open at all times but residents said they did not help with the cooking in the home. This is one area where staff could investigate how residents can become more involved in the day to day running of their home. All residents now have access to an advocate from outside the home. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 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, 15, 16 & 17 Quality in this outcome area is good. Good progress has been made to make sure that all residents have opportunities to take part in education and or leisure activities outside the home. Individuals are supported to identify their own goals and work to achieve these. Staff have also made progress in involving other professionals in order to improve communication with residents. Residents can access local community facilities. The home has good relationships with neighbours and others in the local community. Appropriate transport must be available. EVIDENCE: All residents have the opportunity to attend colleges and day centres. Individuals take part in a variety of activities outside the home including Drama Therapy, Tai Chi, Salsa Club, Rock and Roll dancing, shopping, trips to the cinema, bowling, nightclubs, concerts and discos. Within the home residents take part in sessions of arts and crafts, pottery and music. Residents were happy with the activities on offer and said they made their own choices about joining in with group activities. Those residents who were unable to verbally communicate were observed to join in with the activities voluntarily.
Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 12 Residents confirmed that they are free to go to their rooms whenever they wished. One resident said they liked to spend time in their room listening to their own music. An outbuilding to the rear of the garden has been converted into an activities area. Residents said that they can have visitors at any time. The home has a policy on personal relationships. One resident said they did have a girl/boyfriend but they did not wish to invite them to the home. Staff should ensure that residents are aware that they can invite friends to the home and how this would be handled. All residents had recently taken a holiday at Butlins. Two residents spoken to said they would like to take a holiday abroad. Staff should investigate how holidays can be tailored to meet the needs and wishes of residents. Residents told the inspector that they enjoyed the meals on offer and that the food provided was generally what they would normally eat. One resident takes part in cookery classes at college and shares what has been made with some of the other residents. Residents said that staff were mostly good cooks. All residents are registered with the Dial a Ride service. Residents are supported to use public transport. At the time of the last inspection a requirement was made for the home’s own vehicle to be repaired. The inspector was informed that this had not been met. Action must be taken to ensure that the home has access to appropriate transport at all times to make sure that residents have access to community facilities. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 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 & 20 Quality in this outcome area is good. Care plans provide detailed information on the personal care needs of each resident. Where possible residents are supported to be independent and responsible for their own personal hygiene and personal care. The health care needs of residents are met with referrals made to other professionals to improve the service. Medication records are well maintained. However staff must ensure that any changes in medication are implemented without delay. Staff also take care to support residents if they are admitted to hospital. EVIDENCE: Staff have made progress in ensuring that professional assessments are being carried out for residents to improve health, communication and daily living activities. An Occupational Therapist was requested and will be visiting the home to assess three residents. A Physiotherapist is visiting on a weekly basis working with staff and residents. A speech therapist is working with staff and residents to improve communication. The inspector was informed by staff that a Dietician would be visiting the home to provide advice. Assessments are also being carried out by Psychologists for two residents . Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 14 All residents are registered with a local GP practice. Where possible residents are supported to attend the GP surgery if needed. District nurses visit the home as required. The home has good links with the community learning disabilities teams. Residents are supported and encouraged to have regular dental and optical tests. Arrangements are made for these checks to be carried out in the community or in specialist centres according to individual needs. Guidelines are in place for giving “as required” medication which includes instructions that all appropriate avenues have been explored before giving medication for challenging behaviours. The guidance also includes instructions that a unified decision must be taken before administration. It was noted that this type of medication was rarely used. Medication is reviewed on a regular basis with the GP or consultant. Medication records were found to be up to date and accurate. Two staff sign to indicate that medication has been given. Medication was seen to be stored safely. Four staff have completed accredited training on the management of medication with four more staff in the process of completing this training. Feedback from other professionals indicated that there have been delays in implementing changes in medication. This needs to be addressed by the home manager. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. The home has a clear complaints procedure which is on display in the home. Staff are provided with training on the protection of vulnerable adults. EVIDENCE: Staff have produced a more accessible version of the complaints procedure which was seen to be available to residents in the home. Residents who were able to give verbal feedback were aware of their right to make a complaint and who they should approach. Systems are in place for all complaints to be recorded along with actions taken and outcomes. All staff have received training in the protection of vulnerable adults. Policies and procedures are in place and the home has a copy of the local authority procedure on the protection of adults. Staff are aware of their individual responsibilities to report any suspicions or allegations of abuse. Facilities are available for residents to deposit cash with the home for safekeeping. Good records are maintained of any deposits or expenditure. Over the last two inspections it was noted that residents who have money held at the organisation head office are not supplied with a clear, easily understandable statement of the money available to them. This remains the case. The registered persons must make sure that a clear, easily understood statement of the money available at head office is supplied to residents on a regular basis. This will enable residents to plan their spending and keep up to date on what funds they have available to them. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 29 & 30 Quality in this outcome area is good. The home is comfortable and well maintained. Improvements have been made in the furnishings provided. Bedrooms are individualised. A copy of the assessment of the premises needs to be provided to the CSCI. The home is clean and tidy. EVIDENCE: All residents are provided with their own single bedroom accommodation. Residents also have access to a domestic style kitchen, dining room and lounge. Since the last inspection of the home new, more suitable, furniture has been provided in the lounge area. Bedrooms have been individualised and reflect the interests of residents in the décor and furnishings. Residents spoken to at the time of the visits to the home said they were very happy with their bedrooms. A number of rooms have been redecorated with residents choosing and buying the paint. The inspector was informed that an assessment of the environment had been carried out by a qualified Occupational Therapist. A copy of the report produced following this assessment must be sent to the CSCI.
Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 17 All areas of the home seen at the time of these visits were clean and tidy. Arrangements are in place for the safe disposal of clinical waste. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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, 34 & 35 Quality in this outcome area is good. Residents expressed confidence in the staff that care for them. Staffing levels are sufficient to meet the individual needs of the residents. Good training opportunities are available. Care needs to be taken to ensure the recruitment procedures are up to date. EVIDENCE: Residents benefit from a stable staff permanent staff group who have a good knowledge of the individual strengths and needs of residents. There have been no changes in the staff group since the last inspection. Four staff are available on each shift during the day with two staff on the premises awake at night. These staffing levels are adequate to meet the present needs of the resident group. Staff have good opportunities for training to make sure they develop their skills and knowledge. All staff are in the process or have completed NVQ level 2 or 3. In addition staff attend training provided by the local authority and in house. Staff have completed fire, epilepsy, bereavement, risk assessment and health and safety training over the last year. The manager maintains a training matrix to make sure that all staff are up to date on their training. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 19 Care must be taken to ensure that the staff recruitment process is up to date to take in new regulations relating to the record of education and employment. A full education and employment history must be sought for all new applicants. It was noted that previously “to whom it may concern” references had been accepted. The registered persons must ensure that references are requested by the organisation and confirmed. Enhanced Criminal Records Bureau checks were seen to have been sought for staff. Staff did not have any concerns about the service, felt they worked well as a team and supported by colleagues and the management. The staff group contains individuals from a number of different cultures and staff felt this was a positive thing as they could meet the differing cultural needs of residents. Comments received from residents and relatives were positive about the staff group and their approach. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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 & 42 Quality in this outcome area is good. The manager needs to apply for registration with the CSCI. Residents felt they were listened to and had the opportunity to give their opinions on the home. The manger has implemented a quality assurance and monitoring system. EVIDENCE: The home was found to be well managed. Residents and staff gave positive comments on the home manager. Significant improvements have been made in the service to individual residents since the manager took up this post. It was noted that the manager has yet to apply to the CSCI for registration. An application for registration of the manager should be made without delay. The manager has completed NVQ level 4 training and will be starting the Registered Manager Award course in September of this year. Residents meetings are held on a regular basis and residents said that they could talk to the staff and manager if they had any concerns about the way the home is being run.
Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 21 Staff carry out regular checks on the home and equipment to ensure the health and safety of residents, staff and visitors to the home. A sample of records were examined during these visits and were found to be up to date and well maintained. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x 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 x 27 x 28 x 29 2 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 3 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 x x 3 x Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(2) Requirement The Registered Persons must ensure that any review of the care plan is signed by staff and all those involved. The Registered Persons must ensure that the vehicle for the home is maintained in full working order or replaced. Timescale for action 01/12/06 2. YA13 23(2)(c) 01/12/06 3. YA20 13(2) 4. YA23 17(2)Sch 4(9)4(3) Previous timescale of 01/04/06 not met. The Registered Persons must 01/12/06 ensure that any changes in medication are implemented without delay. The Registered Persons must 01/12/06 ensure that residents are supplied with regular clearly understandable information on the amount of money held on their behalf at the company head office. Previous timescale of 01/04/06 not met. The Registered Persons must supply to the CSCI a copy of the assessment of the premises carried out by a qualified occupational
DS0000027206.V303839.R02.S.doc 5. YA29 23(1) 01/12/06 Ashbrook House Version 5.2 Page 24 therapist. Previous timescale of 01/04/06 not met. 19 The Registered Persons must Schedule 2 review the recruitment (Amendments procedures to ensure that all 2004) prospective staff provide a full employment history. Care Standards Act Part II Section 11 The Registered Persons must ensure that an application is made for the registration of the manager. 6. YA34 01/12/06 7. YA37 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA7 YA15 Good Practice Recommendations The Registered Persons should continue working on making documentation including care planning more accessible to individual residents. The Registered Persons should look at ways in which residents can become more involved in the day to day running of their home. The Registered Persons should ensure that residents are aware that they can invite friends to the home. Ashbrook House DS0000027206.V303839.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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