Inspection on 27/06/05 for Ashby House

This inspection was carried out on 27th June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashby House 27/06/06

Ashby House 17/10/05

Ashby House 03/02/05

Ashby House 04/06/04

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Insight - Eastchurch

Southfields

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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 Ashby House 40 Richmond Avenue Bognor Regis West Sussex PO21 2YE Lead Inspector Ms V Khan Announced Monday, 27 June 2005 V226195 th 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 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 Stationary 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. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashby House Address 40 Richmond Road, Bognor Regis, West Sussex, PO21 2YE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01243 822145 Emeraldpoint Limitid Mr Alan Shephard Care home only (PC) 6 places 6 places Category(ies) of Learning Disability (LD) registration, with number of places Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3rd February 2005 Brief Description of the Service: Ashby House is a spacious semi-detached house located in a quiet residential road on the Western outskirts of Bognor Regis. The home has a secluded rear garden for clients to enjoy. There are local shops, other amenities and the seafront close by. The town centre of Bognor Regis is approximately fifteen minutues walk away. There are cinemas, a theatre, pubs, cafes, restaurants and amusements within the town centre. There are several parks adjacent, some with leisure facilities. There is a railway station in the centre of Bognor and main bus routes pass by. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this announced inspection, which started at 10 am and lasted for four hours. Three clients were at home for most of the inspection and three were out at day centres. As preparation for the inspection, the inspector read the last inspection report and the pre-inspection questionnaire that the manager had completed. Comment cards were sent out to placing authorities, but none have been returned. The inspector spoke with residents, staff and the manager, observed staff and residents interacting, walked around the home and garden, and read some paperwork. What the service does well: What has improved since the last inspection? What they could do better: Incorporate information about POVA into the adult protection policy. Ensure there is written evidence as proof of making any referrals to POVA. Ensure all staff have Enhanced CRB checks, rather than Standard checks. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 6 Continue with the NVQ training programme for staff. Two members of staff have Standard level CRB checks, rather than Enhanced level checks. The manager needs to obtain the NVQ Level 4 qualification in care. All staff need to receive training in moving and handling. 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. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3 Comprehensive information is provided to prospective clients, families and supporters. Prior to moving in, prospective clients are thoroughly assessed to make sure they are right for the home. EVIDENCE: The Statement of Purpose and Service User Guide provide details about the home to assist people in making choices about moving in. The Service User Guide and Complaints Procedure have been produced in pictorial formats for ease of use. Clients are visited in their own homes or previous placements if at all possible as part of the pre-admission assessment. The manager also obtains information from the previous placement, families and supporters. The health and social services care management assessment is used to inform the home’s initial assessment of need. A clear plan of care is then developed by the home. Staff individually and collectively have the skills required to work with the clients living at Ashby House. Advocacy schemes can be approached on behalf of clients as necessary. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 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 standard(s) 6, 7, 8, 9 Clients’ needs are assessed which include risk assessments; care plans formulated and regular reviews held. Clients can make appropriate choices about how they lead their lives. Clients are consulted about, and contribute to the day-to-day running of the home. EVIDENCE: Individual care plans were read and contained all aspects of the client’s needs. Care plans incorporate risk assessments, health records, behavioural guidelines, daily living work schedule and goals. The manager showed the inspector that the format of the care plans was in the process of being changed, in order to make them clearer and easier to read. All staff have signed paperwork, to confirm they have read and understood clients guidelines. All clients have allocated key workers who are people who can communicate with the individual clients. All care plans are kept under review. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 10 Clients manage their own finances if possible, managing their own bank account, or with staff support if needed. Two residents have their families acting as appointees. Advocates can be arranged for residents if there are no family representatives, via a local advocacy arrangement. Weekly house meetings are held with clients to ensure they are involved in the day to day running of the home and allow them to make choices and decisions. Clients all have risk assessments in place. Risks are assessed before clients move in to the home, put into the care plans and kept under review. Clients were consulted about their choices throughout the inspection. Guidelines are in place to follow should any clients go missing. The manager needs to ensure that photographs of clients are held, in case the missing person’s procedure needs to be used. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 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 standard(s) 13, 14, 15, 17 Clients are supported to make full use of the local community facilities. Contact with family and friends is promoted. Clients enjoy a healthy diet. EVIDENCE: For about an hour during the inspection, three clients went for a walk with staff to the seafront and enjoyed a drink in a local cafe. Staff said that clients were supported in going out for short walks most days. Care is taken to ensure that clients are integrated into the local community. Bognor Regis has plenty of amenities, and clients are supported to visit pubs, bowling, cinema, theatre, shops, and leisure centre. There is a company vehicle available, which can be used to take clients further a field. Staff members assist clients to obtain any benefits they might be entitled to. Clients have days out to places of their choice. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 12 Within the home, there is a television and video player, videos and board games. Contact with Families and friends is encouraged, providing it is in the best interests of the clients and they are in agreement. The manager said that most contact tends to take place out of the home. Family are welcomed into the home and are also invited to the home for celebrations. The inspector sat with clients in the back garden at lunchtime. Lunch was jacket potato with tuna and red onion, with mixed salad. They all ate plenty of lunch and enjoyed the food provided. They are involved in the menu planning for the home and shopping. After lunch, one client wanted to go in the paddling pool, so staff arranged this and joined in with the fun and games. No risk assessments have been done on this, but the manager and staff confirmed that any use of the paddling pool is always supervised. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 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 standard(s) 18, 19 Staff support clients appropriately according to their care plans. Clients’ individual physical and emotional needs are met at Ashby House. EVIDENCE: Staff follow guidelines in the care plans on how to support clients. Daytimes during the week sees clients follow structured day care. Weekends are more flexible and relaxed. Clients are supported to shop for their clothes and personal belongings. All clients are registered with G.P.’s and see the community dentist and chiropodist. Help and advice would be requested from appropriate professionals as necessary e.g. the community team for people with learning disabilities, occupational therapists and speech therapists. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 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 standard(s) Clients are protected from abuse in the home. EVIDENCE: Policies and procedures are held regarding the protection of clients. Training is also held on this matter. However, the abuse guidance policy needs to be updated to include the Protection Of Vulnerable Adults (POVA). All staff receive in-house training in conflict management, gentle restraint and breakaway techniques. The manager confirmed that no restraints have been used on any of the current clients. Care plans indicate how to respond to any changes in behaviour. The recent adult protection investigation has been concluded. At the adult protection meeting in April 2005, the manager confirmed that the member of staff in question had been referred to POVA, but there was no evidence to support this. In view of the seriousness of the recent adult protection issues, the inspector told the manager that written evidence of referring the staff member to POVA is obtained. This will be checked at the next inspection. 23 Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 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 standard(s) 24, 28 The home is comfortable, homely and safe. EVIDENCE: The home is well decorated and comfortably furnished. The house is in keeping with the neighbourhood and is close to the seafront and town. One bedroom is on the ground floor and the five other bedrooms are accessible by stairs. There is no lift in the home. There is a large lounge, a dining area and a sun lounge, which is used as a second lounge. A replacement modern sofa and two armchairs have recently been put into the main spacious and bright lounge. New carpets have been laid in communal areas of the home. The house has a secluded back garden with patio area, flowerbeds and lawn for clients to enjoy. Clients are supported in using the kitchen and in helping to prepare meals. For example, during the inspection, one client went to help prepare the tuna for lunch. The manager confirmed that funding has been agreed by the company to purchase a new cooker. No smoking is allowed in the house. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34 The manager and staff team are committed to achieving the best outcomes for clients. Care needs to be taken about obtaining the correct level of CRB check to ensure clients are protected. EVIDENCE: Staff and the manager interacted well with clients. All had a good understanding of their needs and were able to communicate appropriately with them. Of the current staff tem, excluding the manager, only two care staff have obtained the NVQ in Care Level 2, and one of these has also gone on to complete the NVQ 3. The manager confirmed that some staff were currently doing NVQ training and others would be starting training in the near future. The staff worked well as a team, and were aware of each other’s particular strengths. Staff rotas indicated that there were enough staff working during the day and at night to meet the needs of clients. The manager was unsure how to work out the staffing levels as per the Department of Health guidance. The inspector provided him with a contact telephone number and website address, in order to research this. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 17 The small staff team meet regularly to update their information regarding clients’ needs and in-depth discussions take place at shift handovers. All staff files were read at the inspection. The manager needs to ensure that all staff have Enhanced level CRB checks to include POVA checks, as two members of staff were noted to only have Standard CRB checks carried out. The inspector felt the home has a close staff team who enjoy coming to work. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 42 The manager is committed to being involved with clients on a daily basis, but also in running the home effectively. Staff would benefit from attending moving and handling training to ensure the protection of clients continues to be promoted. EVIDENCE: Mr Shepherd has been the manager at Ashby House for several years. He very much enjoys being hands on and working with clients, so makes a point of including himself in the staff shift rota. Mr Shepherd said that he has achieved the Register’s Manager’s Award. However, he also needs to obtain the NVQ Level 4 qualification in care. The company operation’s manager supervises Mr Shepherd. He said that he found the supervision and support provided extremely useful. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 19 Reports have been completed about the home by someone external to the home and sent to the Commission monthly in accordance with the regulations. Excellent interaction was observed between the manager and three clients who were at the home during the inspection. In particular, one male client’s face lit up every time he saw the manager. Staff spoken with praised the manager, saying, “He has a good rapport with everyone”. Staff confirmed they were well supported by the manager. Clear health and safety policies are in place. Moving and handling training was due to take place at the start of the year, but this did not take place. The manager said this would be done as soon as possible. One new staff member confirmed she was receiving comprehensive induction training. Staff training will be examined in detail at the next inspection. Ashby House H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 20 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 3 3 3 x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 3 x x Standard No 11 12 13 14 15 16 17 x x 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 2 3 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashby House Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x H60 H11 S14370 Ashby House V226195 270605 Stage 4.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? No 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. 2. Standard 34 42 Regulation 19 19 Requirement All staff should be CRB checked at the Enhanced Level. All staff need to receive training appropriate to the work they are to perform, e.g. training on moving and handling. Timescale for action 27/7/05 27/9/05 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 23 32 37 Good Practice Recommendations Include details about POVA in the adult abuse policies and procedures. Continue with the NVQ staff training programme. The manager is advised to undertake the NVQ level 4 training course in care. 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