Inspection on 07/06/07 for Ashchurch House

This inspection was carried out on 7th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashchurch House 19/05/08

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 7th June 2007 08:30 Ashchurch House DS0000027831.V341783.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.V341783.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.V341783.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.V341783.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 26th February 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. Aschurch 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.V341783.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place on the 7th June, 2007 from 08.30hours. The manager was present during the inspection, and was available for the feedback at the end of the inspection. Questionnaires were not sent to the residents in view of their high level of learning disability, and they would not have been able to complete the pictorial questionnaires which have recently been designed by the Commission. The visit therefore, included observing residents and staff, talking to staff, the manager, inspecting maintenance records, staff files, training schedules and case tracking. Some judgements about quality of life within the home were taken from direct conversation with and observation of staff and residents. In addition a tour of the premises was undertaken. At this inspection no visitors were present. The residents appeared to accept the presence of the inspector in their home, and made her feel welcome. Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment (AQAA), monthly Regulation 26 reports and regulation 37 notifications. During the inspection, the inspector also had a conversation with the Service Manager around staffing issues and the control of residents’ finances. The inspector had a discussion with the manager on the broad spectrum of equality and diversity issues, and he was able to demonstrate a good understanding of the varied needs around religion, sexuality, culture, disability and gender. The manager said 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 Annual Quality Assurance Assessment indicated that pre-admission assessments are comprehensive, and that prospective residents are enabled to visit the home prior to making a decision to move in. This was evidenced through the case tracking process, and the assessment process is robust. All residents have a comprehensive care plan together with any necessary risk assessments and strategies are compiled with the service user, relatives if appropriate, the manager and other professionals. The service user guide has been produced in a pictorial format which will benefit some residents. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 6 At the time of this inspection 100 of the staff team were qualified to NVQ level 2 and some to NVQ level 3. All residents participate in small group holidays organised by the management and staff team. The activities co-ordinator, who works 4 days per week from 9a.m. to 2p.m., is providing very intense 1:1 activities with each of the residents, and it was apparent from observations, from discussions with the activities co-ordinator and other staff, and from comparisons made with the previous inspection visit, that some of the residents have really benefited from the 1:1 activity input. A member of staff, referring to a resident, told the inspector “she is much calmer and screams less often, and seems to enjoy the touchy feely toys.” It was evident that residents can choose when to get up in the mornings, as on arrival at the home the inspector observed that some of the residents were up and about, and others were still in bed. Breakfast is flexible depending upon the choices and wishes of the individual residents. Although the current arrangements for the appointeeship around the finances for some of the residents must be reviewed, the administration of these finances is currently robust. All of the bedrooms currently occupied have been decorated and furnished according to the wishes and needs of the individual residents, and they are very personalised. What has improved since the last inspection? The complaints procedure has been produced in a pictorial format, and hopefully this will be of benefit to some of the residents. Staff appeared better informed on issues of equality and diversity, and some staff have undertaken training in this important area. A minister of religion now visits the residents on a regular basis, changes have been made to the menus so that the meals are now more reflective of the needs/choices of the residents. There were several safeguarding adults issues which resulted in local press activity, and this had an affect on staff morale. However, the issues have now been resolved with no referrals being made to the Protection of Adults list. As a result, and because of support given to staff at this difficult time, staff morale at this inspection visit was much higher. One member of staff told the inspector “we all seem to gradually be getting our confidence back.” Training in safe guarding adults has also been undertaken by some staff, with other staff booked for such training. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 7 What they could do better: As the majority of residents are not able to actually participate in cooking, cleaning and undertaking other activities of daily living such as hoovering and laundry, it is essential that the organisation employs additional staff to undertake the ancillary functions at the home. Staffing levels must be reviewed to ensure that care support staff are more actively engaged in interacting with, and engaging in activities with residents who have extremely high and complex needs and require this input for stimulation and motivation. Although the rotas indicate 4 care support staff and the manager on the early shift, and part of the late shift, for a greater part of the time it is actually only 3 care support staff because a member of staff is engaged in either cooking and/or cleaning activities. Residents should be given more choices as to where they spend their day. The bedrooms are very personalised, but it was evident that certainly several of the residents are not able to spend time in their bedrooms, other than for sleeping. Care support staff must ensure that residents are offered choices in all areas of daily life, and enabled to put such choices into operation. The home is that of the residents, and not that of the staff nor the organisation. The organisation must review the current arrangements whereby the manager is an appointee for 5 residents. The Care Home Regulations 2001 require that the registered person shall ensure so far as practicable that persons working at the care home do not act as the agency of a service user. This should be done in consultation with the resident, relatives, commissioners of the service for the individual resident and his/her social worker. With the introduction of the Mental Capacity Act 2005 on the 1st April, 2007 for those people who lack capacity and do not have an independent person to act on their behalf, and from the 1st October, 2007 for all other adults, it is important that the issue of appointeeship are resolved. Although the care plans are comprehensive, they remain in a format which would make it extremely difficult for residents to understand and be able to positively participate in the monthly reviews. The manager is aware of the need to make the care plans more user friendly and this is an area that he has identified for improvement in the AQAA. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 8 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.V341783.R01.S.doc Version 5.2 Page 9 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.V341783.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 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. Prospective residents have an individual needs assessment, are given the opportunity to visit the home and are provided with a written contract or statement of terms and conditions, so that they are able to make an informed choice about where to live. Some residents benefit from information being provided in a pictorial format. EVIDENCE: The files of 4 residents were viewed and all showed evidence of a comprehensive pre-admission assessment and a statement of terms and conditions, together with a service user guide. The service user guide has been produced in a pictorial format for the benefit of some residents. Clearly several of the residents would not be able to benefit from even the pictorial service user guide due to their level of disability. From the Annual Quality Assurance Assessment the manager has indicated that the service could do better by providing information in audio and video/compact disc formats. It is recommended that the organisation pursues the development of information in such formats for the benefit of future and current residents at the home. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 11 The statement of purpose sets out the admission criteria, the needs that can be met and the support that can be offered, but some amendments are needed to this document as discussed with the manager during the inspection. The manager has agreed to forward an amended copy of the statement of purpose to the Commission when this has been amended. Trial visits to the home are encouraged for potential residents and their family to identify how appropriate the home is for them in meeting their needs. This also gives an opportunity for the prospective resident to meet the current residents, and to become familiar with the environment. The admissions procedures are tailored to the needs of the prospective resident. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 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. The assessed and changing needs and goals of service users are reflected in their individual plans. Although generally residents are enabled to make decisions about their lives with the necessary assistance, this could be improved upon with a review of the staffing structure. Service users are consulted on, and can participate in some aspects of life in the home, but with more staff assistance, and user friendly information formats, could be better supported to take risks as part of their independent lifestyle. EVIDENCE: Currently there are 7 residents accommodated at the home and the care of 4 residents was case tracked. All of the files inspected showed clear evidence of a comprehensive assessment of need and personal goals for each of the residents had been reflected in their individual plan. Sometimes evidence was difficult to triangulate because of the many files which each residents has, and often there was repetition. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 13 Care plans are not in a pictorial format nor in any other format which could be understood by any of the residents. All of the residents have very diverse and complex needs around communication, and the organisation must make more effort in producing care plans and other associated information in differing formats so that the residents can have a greater influence on their care. This area was highlighted in the previous inspection report but no improvements have been made. With regard to getting up, going to bed, personal care and choice of clothes the inspector is satisfied that residents are able to, and do make, choices. However, with regard to other aspects of daily living, residents would benefit more if care support staff were more engaged with them than with having to undertake cleaning/cooking duties. The inspector again discussed with the manager, and the service manager (during a telephone conversation during the inspection), the introduction of the Mental Capacity Act 2005 on the 1st April, 2007 for some adults, and for all adults from the 1st October, 2007. This Act will greatly impact on the methods of recording, of care delivery, and how residents are involved and enabled to make decisions around their daily living activities. It is essential therefore, that the issues around care staff undertaking ancillary duties are resolved. The organisation enables residents to access advocacy services through Mencap. The matter of residents being involved in the review/development of policies and procedures and such was again discussed with the manager. He is giving consideration to one or two of the residents being involved in the interview process for new staff, but this will take time to engage with the residents and for the manager to be sure that they really want to do this. Risks are assessed prior to admission according to health and social services protocols and in discussions with residents where able, family and other agencies. Risk management strategies are agreed and recorded in the individual care plans and such risk assessments/strategies are regularly reviewed. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 15, 16 and 17 People using the service experience adequate 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. People are encouraged to maintain personal and family relationships with their rights being respected, and all are offered a healthy diet in pleasant surroundings. Generally people using this service benefit from the provision, but more could be done if the duties of the care staff were reviewed. EVIDENCE: On arrival at the home the inspector was pleased to observe that the activities co-ordinator was engaged in one to one activities with two residents. It was apparent that a lot of work had been done around identifying individual Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 15 activities for these residents. Because of the very high dependency levels around communication the identification of meaningful and positive activities for residents is very time consuming. The activities co-ordinator has a daily programme of one to one activities with each of the seven residents. However, it was also apparent that these activities are not normally continued at other times by the care support staff. For example one resident enjoyed a foot spa, and the activities co-ordinator endeavoured to organise this at least 2/3 times each week. However, there is absolutely no reason why this resident could not enjoy a foot spa on a daily basis if the duties of the care support staff were reviewed. Another resident obviously enjoyed having his back rubbed with a hand massager, but again this was only generally done during his one to one activities with the co-ordinator. Outside of the programmes organised for each resident by the activities coordinator, there is another individual activity programme. There are sessions of ‘freetime’ which really have no meaning for the current residents, other than that they are left to organise their own activity. In reality this means that residents are just left sitting in the lounge. There is also a sensory room which is well equipped and appear to be well used by the activities co-ordinator in the one to one activities with residents. Residents rooms have been very personalised and are very welcoming but residents are not generally encouraged to make more use of their bedrooms. One particular resident who likes to be quiet, and at such times engages more positively in one to one activities, only goes to her bedroom to sleep. Yet her room has been personalised and has a music centre, but is not used to its’ full potential for her benefit, because staff leave her sitting in the lounge. This bedroom is also situated on the first floor which means that the resident would definitely require staff assistance to access it, and also staff encouragement to make better use of it. With greater input from care support staff, residents could enjoy more one to one activities which would greatly benefit them, and in surroundings other than the lounge, dining area or the sensory room. Many of the residents have already been on holiday and two are due to go during the next week or so. It was also evident from case tracking and from discussions with some staff that residents are encouraged to visit shops, restaurants and other community facilities. Arrangements have now been made for a minister of religion to visit the residents on a regular basis, and some of the residents do appear to enjoy these visits. Family and friends are encouraged to visit the home, and the day before the inspection a resident had a visit from a ‘social aunt’. Changes have been made to the menus and these are now more reflective of the dietary and cultural needs of the individual residents, and staff have Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 16 undertaken training in equality and diversity issues. The health and wellbeing of residents is promoted by the supply of nutritious, varied, balanced and attractively presented meals. Residents have at least two cooked meals daily, and there is always a range of drinks and snacks available. On several occasions the inspector overheard staff asking residents if they wanted a ‘cup of tea’ and it was no problem to make this at any time. The home’s statement of purpose states that the service “aims to provide a homely environment which enables each person to reach their own individual maximum potential at a pace and level that is appropriate for each individual’s ability and needs.” The daily routines endeavour to promote as much independence, choice and freedom of movement, but again improvements could be made with the review of the staffing levels and duties, and the service would be better able to demonstrate that it is complying with its’ statement of purpose. This was discussed with the manager, who also identifies this as an area for improvement in the AQAA, and also with the service manager. The garden areas are well maintained, and on the day of the inspection a resident was using a swing in the garden and appeared to be enjoying himself. However, this activity appeared to be without an appropriate level of supervision, and it was by chance that the inspector was being shown the garden by the manager so was able to observe this. There did not appear to be a risk assessment in place for this activity. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 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 would protect people using the service to retain, administer and control their own medication, where they have the capacity to do so. EVIDENCE: It was evident from inspecting residents’ files that they have a detailed care plan which includes details of health and personal care needs. From observation and discussions with staff members it was evident that the routines for daily living are flexible according to the wishes and needs of the residents. Care plans are reviewed every six months, or more frequently if necessary. Residents are supported in choosing their own clothes and personal care is provided in a respectful manner. Staff showed in discussions that they were now more aware of the need to ensure that the various cultural, social, Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 18 religious and sexual needs of residents are recognised and met within their care practices. Due to the high level of need of some of the residents, they are not able to use the conventional emergency alarm system. This was highlighted in the previous inspection report and as a consequence, an individual alarm system has been put into place for one of the residents. The manager has now made arrangements for a hairdresser to visit the home on a regular basis. From viewing the files and from discussions with the staff and manager, it was evident that residents receive additional specialist support and advice as needed from health professionals. The manager felt that one resident, who was receiving antibiotic treatment through the GP, was not progressing as well as he should and had concerns. He, therefore, sent the resident to hospital where he was kept in and has since had his treatment changed and is now improving. It was evident that the manager and the staff team are very observant and aware of the changing needs of the residents, and do not hesitate to arrange for health input from the various professionals. This was also indicated on the AQAA and confirmed during the site visit. It was evident from the files that residents are seen regularly by the chiropodist, dentist, optician and the GP, where necessary. The weight of each of the residents is monitored on a monthly basis, and actions taken where concerns are indicated. 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. Again from the AQAA it is indicated that the manager is aware that due to the future changing needs of the residents, it may be necessary for equipment such as hoists, zimmer frames and other aids to mobility to be provided. An inspection was undertaken of the medication administration records (MAR) and the medications and these were found to be in good order, and in accordance with the home’s policies and procedures. Currently no resident is 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 issue of the medication storage room being too hot has been addressed and the manager now has a fan available for use when necessary. This room temperature should not be above 25°C, and it is recommended that the manager checks the temperature on a daily basis, especially during hot weather. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 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: Since the previous inspection the manager has worked at producing a more simplified complaints procedure. Although more work has to be done on this document, it is evident that the manager and his staff team are committed to enabling residents to be able to express their concerns or unhappiness at the service. Staff spoken to were aware of the whistle blowing policy, and those spoken said that if they saw any poor care, or possible abuse, they would not hesitate to whistle blow to either the manager or to the service manager. Many of the staff have now undertaken training in safeguarding adults (POVA), and dates are in place for the remainder of the staff team to undertake this training. Within the home there is now a copy of the London Borough of Havering’s adult protection procedures. The adult protection issues referred to in the previous inspection report have been addressed through the appropriate procedures, and there were no Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 20 resultant issues/staff members that needed to be referred to the provisional POVA list. Financial records with regard to those for the residents were inspected and found to be in good order. However, the manager still remains the appointee for several of the residents and as previously indicated this is not good practice. Discussions were had with the manager and the service manager regarding the need to urgently address this matter with the relevant funding authorities. Some of the current residents do not have family/friends who would be willing to take responsibility for their finances, and therefore having regard to the recently introduced Mental Capacity Act 2005 the organisation must pursue the need for an Independent Mental Capacity Advocate to be appointed, or that the funding authority takes back this responsibility. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 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. Residents live in a homely, comfortable and safe environment and bedrooms suit their individual needs. The home was clean and hygienic with no offensive odours and it was apparent that this was to the benefit of residents. EVIDENCE: A tour of the premises was undertaken and the home does provide a physical environment that is currently appropriate to the specific needs of the residents who are living there. All of the bedrooms are single, without en suite facilities, but all have a hand basin and are situated near to a toilet. Bedrooms have been redecorated, and residents were involved in the choosing of colours and furnishings. It was also evident that rooms had been personalised to suit the needs of the individual residents, and some had been equipped with sensory equipment and mobiles. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 22 The lighting throughout the home was in keeping with a homely environment, and the home was clean and tidy and had no offensive odours. Currently the residents are able to use the bathrooms, but if needs change consideration must be given to the installation of appropriate equipment such as hoists. 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 and these aid those residents who are registered as blind. 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. The garden to the side of the home was also well maintained. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35 and 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Residents are generally supported by a competent and qualified staff team, but there are some gaps in training. Residents would greatly benefit from a care staff team who did not have to spend time undertaking cleaning, cooking and other domestic tasks. The home’s recruitment policy and procedures are robust so that residents can feel protected. EVIDENCE: From discussions with the manager and from viewing records it was evident that the recruitment processes for the home are robust and that the necessary references and criminal records bureau disclosures are obtained prior to the employment of a member of staff. Induction training is undertaken by new members of staff but again this must be more robust and undertaken within the first six weeks of appointment. Staff are given a copy of the General Social Care Council’s standards of conduct and practice. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 24 Staff spoken to did appear to be aware of the home’s various policies and procedures, and especially those around safeguarding adults. Currently 60 of the staff team have a qualification at NVQ level 2 or 3, and these skills should be put to better use during each shift for the benefit of all of the residents living at the home. With the allocated ‘freetime’ indicated on the activities schedules for each resident, staff will need to assist and support them so that residents are not just left sitting in the lounge area, but are enabled to make choices as to how they spend this ‘freetime’. All staff receive regular supervision which is recorded. This supervision does include direct observation while caring for residents, group and 1:1 meetings. Generally staff were observed to be interacting well with residents, but there were occasions when a member of staff would approach a resident with just a few words such as ‘come with me’, then take that person by the hand and lead them from the lounge without any other words being spoken. This is not good practice, and must be addressed in training and ongoing supervision so that staff members are made aware of the importance of continual interaction with residents. Staff members should always be talking to residents, letting them know what is happening and reassuring them. Some staff have undertaken training in equality and diversity and are now more able to understand the religious, social, cultural and other needs of the individual residents. Care staff still have to undertake ancillary duties such as cleaning and cooking, and such staff would be better employed in spending more quality time with the residents. The residents have high levels of need and require a lot of 1:1 input. Training needs have been identified by the manager but it does sometimes take some time for the training courses to be identified and organised by the company. This fact is acknowledged by the manager in the AQAA since his plans for improvement during the next 12 months is for staff to attend more training to improve their skills and knowledge. During this inspection there was a noticeable improvement in the morale of the staff team. The manager and the team are to be commended for this and the way that they have moved forward following the recent adult protection issues and the associated press coverage. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 25 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, 42 and 43 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Residents benefit from the open, positive and inclusive management style of the current manager. Although the manager continues to act as the appointee for some residents, their rights and best interests are safeguarded by the home’s record keeping, policies and procedures. However, the organisation must be more proactive in supporting the manager with regard to the appointeeship and staffing issues, in the best interests of the residents. EVIDENCE: Since the last inspection the manager has now achieved registration with the Commission. He is also in the process of finalising his qualification for the Registered Manager’s Award. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 26 The management style is open, positive and inclusive and this creates an atmosphere which is to the benefit of residents and staff. The manager is continually improving and developing systems that monitor practice and compliance, but he is also aware of work that is still required in these areas. Staff spoken to said “the manager is great, he is very supportive and always ready to listen.” He is proactive in identifying training needs for the staff, and this must be supported by the organisation. For instance it is essential that all staff undertake training in the implications and implementation of Mental Capacity Act 2005 which fully comes into operation on the 1st October, 2007. The manager is making efforts to contact the various funding authorities with regards to them taking responsibility for the appointeeship of some of the residents. This is an area for which the organisation should be taking responsibility in the liaising with the funding authorities, and should be ensuring that this area is actively and positively dealt with. This is an area which was identified in the previous inspection report and must be progressed. It was also evident during the inspection, through discussions with the manager that staffing levels need to be reviewed to ensure that the trained care support staff are engaged with residents, and not undertaking ancillary duties which do not involved residents. In discussions with the service manager, the inspector was informed that this practice was that of the organisation in all of its homes. The needs of residents will vary, and therefore, the organisation must ensure that the manager with day to day responsibilities is enabled to take account of the current and changing needs of the residents. In some instances this may entail the employment of ancillary staff to undertake the cleaning, cooking and other household duties, so that trained care support staff are able to spend more quality time with the residents. Maintenance records such as those for fire safety, gas, electric, insurance and water were viewed and these were found to be in good order. It was evident from discussions with the manager, and from viewing the documents that the organisation does review the policies and procedures. Regulation 26 visits are undertaken by the responsible individual and copies of these reports were available at the home. Regulation 37 notifications are being sent to the Commission as necessary. Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 3 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 2 32 2 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 3 X 2 X X 3 2 Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 28 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 YA1 Regulation 6 Requirement The registered persons must review the current statement of purpose and ensure that this complies with the regulations, so that prospective and current residents can benefit from accurate information. The registered persons must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health, welfare and lifestyle of residents. This must take account of the fact that residents are not able to participate in cleaning and other major household tasks. (this is a repeated requirement) The registered persons must ensure that all staff receive training in the implementation of the Mental Capacity Act 2005 to ensure that care is delivered in a manner appropriate to the needs and capacity of the residents. The registered person shall ensure so far as practicable that persons working at the care DS0000027831.V341783.R01.S.doc Timescale for action 31/07/07 2. YA16 YA11 YA18 YA32 18(1)(a) 31/07/07 3 YA35 18 30/09/07 4. YA23 20(3) 30/09/07 Ashchurch House Version 5.2 Page 29 5 YA43 YA39 10(1) home do not act as the agent of a service user. This must ensure that the capacity of residents under the Mental Capacity Act 2005 is taken into account, and where necessary the engagement of an I.M.C.A.. (this is a repeated requirement) The registered provider must carry on the home, with sufficient competence and care, having regard to the statement of purpose and the needs of the residents, so that all residents benefit and enjoy a good quality of life at all times. 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashchurch House DS0000027831.V341783.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. 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