Inspection on 19/05/08 for Ashchurch House

This inspection was carried out on 19th May 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashchurch House 07/06/07

Ashchurch House 26/02/07

Ashchurch House 27/10/05

Ashchurch House 24/03/05

Ashchurch House 20/01/05

Ashchurch House 12/02/04

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 Ashchurch House 6 Chase House Gardens Emerson Park Hornchurch RM11 2PJ Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 19th May 2008 08:20a Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashchurch House Address 6 Chase House Gardens Emerson Park Hornchurch RM11 2PJ 01708 473202 01708 456559 ashchurchhouse@aol.com 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) Ashchurch House Limited Freddie Ringor Acosta Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 10 7th June 2007 Date of last inspection Brief Description of the Service: Ashchurch House is a care home registered to provide care, support and accommodation to 10 adults of both sexes aged between 18-65 with physical and learning disabilities. Ashchurch House Ltd. is the registered provider, but this company is part of the Allied Care Ltd. group of companies. Ashchurch House is a detached three-storey house, with five ground floor bedrooms and five on the first floor. There is a kitchen/diner and large lounge on the ground floor and a kitchen/diner on the first floor. The home does not have a lift and, therefore, residents would need to be able to negotiate stairs if their bedrooms are located on the first floor. The second floor is used for staff training and the manager’s office. There are car-parking facilities to the front of the building. The home is located in a residential area of Emerson Park, (off Wingletye Lane) close to shops, public transport and the M25, A127 and the A12. The statement of purpose and last inspection report was available at the home on the day of the inspection, and a copy of the statement of purpose can be obtained by applying to the manager. At the time of this inspection the fees range from £800. to £1500. per week. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 5 Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection undertaken by the lead inspector Mrs. Sandra Parnell-Hopkinson. The inspection took place on the 19th May 2008 between 08.20 hours and 13.40 hours. The manager of the care home was available throughout the time to aid the inspection process. At the end of the inspection the inspector was able to provide feedback to the manager. The inspection process included information contained in the annual quality assurance assessment (AQAA), previous regulation 37 notifications and regulation 26 reports, a tour of the home, questionnaires returned from residents, relatives and staff. We were also able to communicate with some of the residents and were able to talk to staff members during the visit. We case tracked 3 people who use the service, together with viewing staff rotas, training schedules, activity programmes, maintenance records, accident records and menus. Telephone calls were also made to interested health and social care professionals to gain their views on the service at Ashchurch House. We did not look at staff recruitment, safeguarding and complaints on this visit as these areas were the focus of a previous inspection which had taken place in April, and this specifically looked at safeguarding. A separate report will be published on safeguarding, but the findings of that visit have been incorporated in the overall quality rating of this inspection. We have been told previously by the manager that the people using this service would prefer to be called ‘residents’ and, therefore, this term is used in this report. What the service does well: The statement of purpose and service user guide have been reviewed and updated. We were pleased to find that each resident has his/her own copy of the service user guide and that this has been produced in a pictorial format. Also each resident has a pictorial copy of the complaints procedure, which has been produced in an effort to enable residents to communicate any concerns that they may have more easily. We found that the home was very clean and that there were no offensive odours. Bedrooms were very personalised to each resident, and some bedrooms had been fitted with sensory equipment for the benefit of the individual person. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 7 Routines within the home were flexible and when we arrived some residents were having breakfast, and some were still asleep in their bedrooms. Care plans were very person centred and reflected the special needs of each person, and these are being reviewed on a monthly basis, or more frequently if necessary. Each resident had an individual activities programme in addition to a programme for all residents. We were told that residents are being encouraged to take part in activities outside of the home, and also that all of the residents will be going on holiday at the end of May. We observed that a therapist visits the home every Monday morning so that residents can benefit from hand/foot massages. We were told by a professional “I really enjoy coming here because I find the home warm and welcoming. The staff are very supportive of the residents and they are excellent with them.” In addition an activities co-ordinator is employed at the home from Tuesday to Friday and undertakes both individual and group activities with the residents. Where changing needs indicate the need for the use of some assisted technology then this is pursued by the manager, for the benefit and safety of residents. We were satisfied that the health care needs of all residents are given a high priority and that residents are enabled to access advice and keep appointments with the assistance of staff. The home operates a key worker system and this appears to be very successful at the present time. Staff were very knowledgeable about the individual residents, and were seen to be interacting well with them. We saw that menus were in place and that residents are given a choice at mealtimes, and that records are maintained as to nutritional intake and that weights are monitored on a regular basis. Where a referral to a dietician or nutritionist is required then such a referral is made. However, we were told by the manager that a dietician visits the home every 3 months. Training for staff is given a high priority and over 70 of the support staff have been trained to NVQ level 3 with particular emphasise on people with a learning disability. All staff receive regular supervision with appropriate records being kept. Medication records are kept in good order and there are very good protocols in place for PRN medication. What has improved since the last inspection? Staffing resources have been reviewed and a new system has been put into place whereby a designated member of staff (referred to by the manager as super staff) is assigned to cooking, cleaning and laundry duties each day. This does appear to have been beneficial to the residents since more support staff time is now given over to them. However, currently this is a pilot within the home and from discussions with staff there are some anxieties as to the amount of work to be undertaken by the designated super staff. Therefore, Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 8 this does need to be kept under review as discussed with the manager during the visit. Care plans have been improved upon and the home is now doing this well, with the plans being more person centred. Some bedrooms and corridors have been redecorated and doors now have indicators as to the type of room, such as a sponge for a bathroom and a wooden spoon for the kitchen. Bedrooms doors have photographs or pictures which can be recognised by the occupant which enables them to find their room more easily. The sensory room was seen to be more frequently used for several of the residents who appeared to enjoy the music and lighting effects. The manager is continuing to progress the appointeeship for several of the residents, and this area will be taken over by the organisation’s head office in the absence of appropriate support being forthcoming from the various commissioning authorities. The minibus has now been repaired and is being used more frequently for trips for the residents, and the garden area has been made more accessible with some additional equipment. What they could do better: Daily recordings could be more reflective of the needs identified in the care plans, so that outcomes can be more easily measured and monitored. Also consideration should be given to reflecting end of life wishes in the care plans. Both of these areas were discussed with the manager during the inspection, and he has undertaken to review these. There is no lift at Ashchurch House and the future installation of this equipment should be given serious consideration by the organisation. Currently residents are still able to use the stairs, with assistance from staff members, but as residents become older and frailer this could pose a problem resulting in some having to move to other care homes. This would possibly be to the detriment of the individual resident. A requirement made following the focused inspection undertaken on the 28th April 2008 is that the safeguarding policies and procedures are reviewed and rewritten to be line with current legislation and guidance. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 10 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 Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Prospective residents and their relatives are given information by the care home, together with an invitation to visit the home at any time to enable them to decide if they want to live at Ashchurch House. A comprehensive assessment of their needs is undertaken before moving in and all current residents have a contract stating the terms and conditions of residency at the home. This should ensure that people moving into the home know that their needs will be met. EVIDENCE: We looked at the files for 3 residents and were satisfied that a comprehensive pre-admission assessment had been undertaken before they moved into the home, and that each resident had been given a copy of the terms and conditions of living at the home. It was not possible to gather this information from the residents themselves because of their profound disabilities and communication needs. However, several surveys returned from relatives indicated that sufficient information was given to help make a decision. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 12 We saw that the statement of purpose had been reviewed and updated, and that each resident had a copy of the service user guide in pictorial format in his/her bedroom. We were told by the manager that he is still pursuing the production of a service user guide in audio format, and this was also stated in the AQAA (annual quality assurance assessment). Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People can be sure that their assessed and changing needs and goals are reflected in their individual care plans, and that they will be involved in the setting up of their care plan. This means that the service is more person centred and reflective of the lifestyle chosen by the individual. People are being enabled to make decisions about their lives with the necessary assistance from staff, and are able to take risks within a positive framework which considers safety issues while aiming to improve outcomes for residents. EVIDENCE: We case tracked the care of 3 residents and each of the care plans reflected their special communication needs. We were satisfied that the service involves each individual in the planning of their care, wherever possible, and staff confirmed this in discussions. This was also supported in a comment made by a relative on a returned survey who stated “X has high dependency needs, Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 14 but the staff seem to be able to allow X to make the choices which means X is happy, safe, clean and looked after.” Another comment was “I would suggest the staff are aware that the clients have high dependency needs and do their best in responding to the clients with kindness, and allow them to be as independent as possible.” Comments made by a health care professional and by a social care professional were very positive about the choice of lifestyle at the home. A social care professional told the inspector “when I visit to do a review Y is always asked to join us, sometimes Y does but often after a little while Y wants to leave.” Work has been undertaken to make the care plans more person centred, and the service continues to work on the production of pictorial care plans as stated in the annual quality assurance assessment (AQAA). Care plans indicated religious needs, cultural needs, same gender care and sexuality. In discussions with staff it was evident that religious and cultural needs were understood and that every effort is made to ensure that these are being met. Same gender care is met whenever possible, and it is only in exceptional circumstances due to staff sickness that this may not be met. However, staff were able to show a positive understanding of the importance of this and would deal appropriately with a situation if a resident objected to the provision of different gender care. A comment by a relative on a returned questionnaire was “I have at times queried the ratio of males/females staff to client, however, on my last visit December 2007 there seems to have been a marked difference. Under previous management there was a higher ratio of males and now there seems to be a balance of males/females.” When looking at the care plans we saw that appropriate risk assessments were in place, and in discussions with staff they were able to confirm that specific risk assessments were in place for individual residents. For example when a particular resident goes out in a wheelchair there is a need for leg restraints so that the individual does not slide down in the chair and hurt his feet/legs on the pavement. We saw that care plans are being reviewed monthly and that daily recordings are being maintained. However, the daily recordings should be more reflective of the needs identified in the care plans as this would have a greater influence on the review process, because it would help to focus on evidencing what has worked for the individual and what has not. We talked to the manager around the involvement of residents in the development and review of the service. Whilst we acknowledge that this may be difficult due to the profound disabilities of some residents, it is an avenue to be pursued because it is the home of the residents, and they should have as much involvement as is possible. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People using the service are able to take part in age, peer and culturally appropriate activities and are encouraged to participate in community and leisure activities, and to maintain personal and family relationships, which enable them to enjoy a meaningful life with all the rights and responsibilities of citizenship. They can enjoy well balanced meals in pleasant surroundings, and this means that their nutritional needs can be met. EVIDENCE: We were satisfied from talking to staff and a visitor to the home that residents are encouraged to be part of the local community. We saw evidence on the files, and from discussions with staff, that residents visit local shops, visit restaurants and have holidays. A resident who had previously refused to leave the home, now visits local shops, restaurants and has had a weekend away. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 16 He will also be joining the other residents in a 3 night holiday at the end of May. This has been due to positive work being undertaken by his key worker and the activities co-ordinator. The manager had previously managed to involve a local priest in visiting the home, but this priest has now left the parish. The manager does intend to pursue these visits with the replacement priest when appointed. We were satisfied from viewing documentation and observation that each resident has an individual activities programme, as well as there being a group programme. The activities co-ordinator visits the home on Tuesday through to Friday and has designed very individual 1:1 programmes for each of the residents. Several of the residents have their own ‘box’ which is filled with items which they enjoy touching, holding and looking at. On the day of the visit a therapist was visiting and residents were enjoying hand/foot massages. It was also evident that the therapist was very well aware of the individual needs of each resident, and also of their methods of communication. For example we were told “X lets me know when she has had enough because she will gently push me away. With Y he likes people to gently blow in his ear, and he will lean forward when he wants this done.” We were also satisfied that support staff were more visible in the lounge and interacting well with residents. Some of the residents have already been on holiday and all are due to go on a group holiday over the Spring Bank Holiday. This was confirmed in discussions with the manager, staff and also from documentation including the AQAA (annual quality assurance assessment). We were also satisfied that residents are encouraged to visit shops, restaurants and other community facilities with support from staff. Family and friends are welcomed into the home and this was confirmed in comments made by some in returned questionnaires. Routines within the home are flexible and are changed to meet the individual needs of each resident. We arrived at breakfast time and saw that some residents were having breakfast and some were still in bed. The lunch time meal is also flexible and again residents are given choices. The main meal of the day is in the evening and menus reflected choices according to the wishes of each person. Drinks and snacks are freely available during the day. A comment made on one returned questionnaire was that “I visit on a Wednesday, and often there does not seem to be enough food in the fridge, and I am always told that ‘we are just going shopping’.” We discussed this with the manager who told us that Wednesday was the main shopping day for the home, but daily staff will visit the local shops and take residents with them if they wish. We looked in the fridge and cupboards and were satisfied that there was sufficient food in the home to meet the needs of the menus and of the residents. We were satisfied from viewing the care plans Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 17 and other records that the dietary and nutritional needs of residents were being met. Due to the disabilities of the residents it would not be possible for them to participate in major cleaning tasks, but they are encouraged to help with minor tasks such as dusting or making a drink with the support of staff. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People using the service can be assured that they will receive personal support according to their wishes, and that their physical, emotional and health needs will be met with the involvement of relevant and appropriate professionals where necessary. The home’s medication policies and procedures ensure that people using the service are safeguarded and would be encouraged to retain, administer and control their own medication, where they have the capacity to do so. EVIDENCE: We case tracked 3 residents and found that each of them had a detailed care plan which was more personalised than had previously been the case. Information included details of health and personal care needs, and also as to how the resident wanted the personal care to be delivered to them. We are satisfied from documentation, talking to staff and observation that the daily routines are flexible according to the needs and wishes of the individual residents. We saw that care plans are reviewed every month, or more frequently if necessary. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 19 We saw that personal support was responsive to the needs and preferences of each person. For example we saw that a resident preferred to have breakfast before washing and dressing, and was then being assisted by a member of staff to go back to her bedroom so that she could be helped with these tasks. Staff showed us in discussions, and through observations that they provided care in a way that respected the privacy and dignity of residents and that care needed to be person centred. Staff were very knowledgeable around the different communication needs and abilities of each resident, and knew what different facial expressions or body language meant for that individual. We discussed with the manager the fact that some residents would not be able to use the normal emergency alarm system, and he told us that assistive technology is being used for one of the residents and that this has proved beneficial. Through case tracking we found that residents receive specialist support and advice as needed from health professionals. We found that care plans were in place for specialist needs of residents. For example one resident is taking warfarin and is monitored by the health clinic, but the care plan showed the changing levels of warfarin and the required visits to the clinic. We saw that because of a change in diet and a higher level of activity that the resident needed to visit the clinic less frequently. Another resident who had had a hospital admission during the past year was also being monitored by both the staff and the health professionals, and currently has had no further hospital admissions. One resident had been referred for a sensory assessment, and another resident is being referred for a similar assessment. Depending upon the outcomes any necessary equipment will be provided. We saw that all residents are being seen by their GP, dentist and chiropodist on a regular basis, and a dietician visits the home every 3 months to monitor the dietary and nutritional needs of each resident. All of the residents attend the GP’s surgery on a regular basis to undergo the necessary health screening, which includes prostate and breast cancer checks. Residents receive effective personal and healthcare support using a person centred approach with support provided by staff who ensure that the rights of dignity, equality, fairness and respect are the focus of all of the care given to the individual resident. It was evident from observation and documentation that staff are very alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond and take action. We did discuss with the manager that in the future some of the residents may need a lift to access their bedrooms on the first floor, due to increasing mobility problems and we were told that the organisation has been, and continues to discuss this issue. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 20 We looked at the medication administration records (MAR) and the medications and were satisfied that the home has an efficient medication policy supported by procedures and practice which staff understood and followed. There are agreed protocols for PRN medication and these are agreed and signed with the GP or consultant and the manager. At the present time there are no residents who are able to retain and administer his/her own medication. There continues to be regular pharmacist input at the home, and arrangements are in place for the return of unused medicines. The home complies with the new regulations on the storage and recording of controlled drugs. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People using the service can be assured that they will be protected from abuse, neglect and self-harm through staff awareness, knowledge and ongoing training. People will be enabled to complain, listened to and complaints acted upon. EVIDENCE: We did not look at these standards at this visit because they were the focus of an inspection around safeguarding which had been undertaken on the 21st April 2008. A separate report will be published around these standards, but a comment received from the inspector who did the focused inspection on safeguarding was “I had a good visit to Ashchurch House. The manager knew what he was talking about and the staff I interviewed were able to answer my questions. They have adult protection and whistle blowing polices in place and the files I examined were in order.” However, the policy and procedure on safeguarding does need to be reviewed and a requirement was made concerning this. This requirement is replicated in this report. The judgement above is also reflective of the findings of the separate focused inspection on safeguarding. The focused inspection also included an expert by experience and again comments were very positive around these standards. There are not any safeguarding issues at this home at the present time, and no complaints had been received by the Commission. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The home is clean and hygienic and provides a homely, comfortable and safe environment for the people living there, and any equipment necessary for the promotion of their independence is provided. EVIDENCE: We did a tour of the home and found that the physical environment currently meets the specific needs of the residents. There is a homely feel at Ashcurch House, and although the bedrooms do not have en suite facilities, they are generally spacious and are well furnished in line with the choices and wishes of the residents. Although the home does have a separate sensory room, some of the bedrooms had been equipped with sensory equipment and mobiles in line with the specific needs of the individual. Bedroom doors had signs/photographs which made the room more easily identified by the resident, and bathrooms could be identified by looking for a Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 23 sponge which had been fixed to the door. Kitchen doors were fixed with a wooden spoon. We found that the lighting throughout the home was in keeping with a homely environment, and the home was clean and tidy and had no offensive odours. The home could be accessed by a person with mobility problems, but within the home access would only be to the ground floor as there is no lift to the first floor. Handrails are in place along the corridors for the benefit of those residents who are registered as blind, or have mobility problems. The communal areas were well furnished, clean and bright. There is an external rear garden that was well maintained and equipped with seating and swings for use by the residents. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. There is a competent and qualified staff team which ensures that people living at the home are supported and assisted to live their lives as independently as is possible. The home’s recruitment policy and procedures are robust so that people can feel protected. EVIDENCE: We did not look at the home’s recruitment policy and procedures during this visit because these areas were the focus of an inspection around safeguarding which had been undertaken on the 21st April 2008. A separate report will be published around these standards, but a comment received from the inspector who did the focused inspection on safeguarding was “I had a good visit to Ashchurch House. The manager knew what he was talking about and the staff I interviewed were able to answer my questions.” The judgement above reflects the outcome of the focused inspection on safeguarding. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 25 We were told by the manager that approximately 75 of staff are now trained to NVQ (National Vocational Qualification) level 3 in Learning Disabilities, and this is an improvement since the last key inspection in 2007. Staff resources have been reviewed and a member of staff is now specifically allocated to undertake cooking, cleaning and laundry tasks. This does seem to have freed up general staff time so that more support can be given to the residents. However, this is currently a pilot project and we were told by the manager that this will be kept under review. We found from talking to staff and from staff records that all staff receive regular supervision which is recorded. This supervision does include direct observation while caring for residents, group meetings and 1:1 sessions. We were pleased to find that staff were interacting well with residents and reassuring them. For example a member of staff was assisting a resident to the bathroom for a shower, but was talking to her as they were walking along the corridor and telling her what was happening. The home operates a key worker system, and in discussions with staff we found that they were very knowledgeable about the residents and their needs as identified in the care plans which we case tracked. Evidence from the annual quality assurance assessment (AQAA) and from looking at training records confirm that staff continue to access training, and staff have recently undertaken training in health/safety, food hygiene, manual handling, safeguarding, epilepsy, infection control and sexual awareness. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 and 43 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The service operates an open, positive and inclusive management style which is to the benefit of the residents. Their rights and best interests are safeguarded by the home’s record keeping, policies and procedures and by the proactive approach taken by the manager. EVIDENCE: We were told by the manager that he has now completed the Registered Manager’s Award and has achieved this qualification, and this was confirmed in the AQAA (annual quality assurance assessment). A deputy manager has also been recruited and is now in post. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 27 We were able to observe that the manager operates an open, positive and inclusive management style, and residents and staff benefit from this which was noticeable from the relaxed and homely atmosphere within the home. The manager has a clear understanding of the principles and focus of the service and works continuously to improve life for the residents. He is proactive in identifying training needs for the staff as evidenced from the training records and comments received from staff members such as “there are always training courses on offer, and the manager is really nice and approachable.” Equal opportunities are promoted throughout the service and all staff spoken to have a good understanding of the importance of person centred care and positive and effective outcomes for residents. The organisation generally has sound policies and procedures and most of these are reviewed as necessary and in line with changes to legislation and good practice. However, it was identified during the recent focused inspection on safeguarding that this policy and procedures needed to be updated in line with recent legislation and guidance. This is a requirement replicated in this report. Health and safety issues are a priority at the home, and recently the local environmental health office for health and safety undertook an inspection at the home. Generally everything was fine with the exception of some paving stones on the front path, and these were repaired very quickly by the organisation. When we were looking at the care plans we found that relevant risk assessments were recorded and that these were reviewed as needs changed. Wherever possible residents are supported to manage their own money and financial records are maintained and kept in good order. There were problems with the manager being the appointee for several of the residents, and this has now been recognised by the organisation as not being good practice. We were pleased to note that rapid progress is now being made for the manager not be the appointee. This has been difficult and time consuming for the manager and the organisation due to the reluctance of the commissioning local authorities to take responsibility. Maintenance records such as those for insurance, fire safety, gas, electric, insurance and water were viewed and these were found to be in good order. Quality monitoring visits required under the Care Homes Regulations, Regulation 26, are undertaken by the responsible individual and copies of these reports were available at the home, and are also sent to the Commission. Regulation 37 notifications of significant events affecting Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 28 residents (again required under the Care Homes Regulations) are being sent to the Commission as necessary. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 3 3 X 3 2 X 3 3 Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 30 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 Standard YA40 Regulation 13 Requirement It is required that the homes safeguarding policies and procedures are reviewed and rewritten to be in line with current legislation and guidance in this area. This is to ensure that residents are safeguarded knowing that staff have the knowledge to do this. Timescale for action 24/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations It is recommended that daily recordings should be more reflective of the needs identified in the care plans so that outcomes for individuals can be more easily measured and monitored. It is recommended that care plans should include end of life wishes and preferred place of care indicators so that staff and other persons will be aware of the wishes of the individual resident at times when they may be unable to make these known. It is recommended that the organisation gives DS0000027831.V364523.R01.S.doc Version 5.2 Page 31 2 YA6 3 YA24 Ashchurch House consideration to the installation of a lift at Ashchurch House for the future benefit of the residents accommodated on the first floor and who, through increasing fraily and physical disabilities may not be able to use the stairs. Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashchurch House DS0000027831.V364523.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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