Inspection on 15/12/08 for Ashclyst

This inspection was carried out on 15th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashclyst 23/06/08

Ashclyst 25/06/07

Ashclyst 03/05/06

Ashclyst 16/11/05

Ashclyst 04/05/05

Ashclyst 25/10/04

Ashclyst 22/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ashclyst 23 Park Lane Winterbourne South Glos BS36 1AT zero star poor service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kath Houson Date: 1 7 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Ashclyst 23 Park Lane Winterbourne South Glos BS36 1AT 01454250946 01179709301 samrv2003@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Aspects and Milestones Trust Name of registered manager (if applicable) Mr Ian John Knowles Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: May accommodate up to 4 residents aged 19 - 64 years Date of last inspection A bit about the care home Ashclyst is a extended semi detached bungalow which provides accommodation for 4 people with learning disabilities and mental health. The house has domestic style facilities such as kitchen diner, lounge, bathroom and toilets and a large garden. The home is situated on the borders of Winterbourne and Frampton Cotterell in the district of South Gloucestershire. The nearest surrounding areas are Thornbury, Iron Acton, Winterbourne where local shops and pubs can be found, Chipping Sodbury where a small shopping village exisit and Yate which has a number of shops pubs, libraries, churches and other social facilities. The home has its own minibus which provides transport to the neighbouring areas and the local community. Each placement cost £1200 per week. The home is staffed with 24 hour care. The house is maintained by John Dean who is repsonsible for all maintainance and decoration of the home and the registered providers are Aspects and Milestones Trust. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We looked at information we have received since the last inspection visit. How the service dealt with any complaints & concerns since the last inspection visit. Any changes to how the home is managed and how well they care for people living at the home. The visit: An unannounced visit which was made on Monday 15th and Wednesday 17th December 2008 to provide feedback to the manager and team leader. The home was also visited by an Expert by Experience from the organization, People First who made an arranged visit to the home on Tuesday 16th December 2008; their comments have been added to this report. During the visit we: Talked to people who use the service, staff and the manager. A telephone interview with the local Community Learning Disability Team (CLDT) for South Gloucestershire also took place to obtain more information on how peoples needs are being met. Looked at information about the people who use the service and how well their needs are being met. Looked at other records such as their policies and procedures, staff rotas and the medication procedure. Discussed, the staff team had the skills and knowledge and training to meet the needs of the people who use the service. A tour of the premises to make sure that the home is clean, safe and comfortable. What the care home does well What has got better from the last inspection A number of requirements were given at the previous inspection and some of the requirements has been met. There is a care plan in the home which sets out why physical restraint is the best option for the safety of the people and staff. There is evidence of the homes quality monitoring system in place based on reviewing and improving the overall quality of care in the home. The staff team have attended planned training in the subject of protection of vulnerable adults. This is to increase the staff teams understanding of abuse and to protect people who use the service from potential harm. All the care files now contain information relating to the Mental Capacity Act and how this affects each individual person. What the care home could do better The homes Statement of Purpose fails to include information about their aims and objectives and it was difficult to understand what the home is trying to achieve for the people who use the service. There is a failure to communicate information and to follow procedure relating to visitors who come to the home and the risk that residents may inappropriately touch them. The role of an advocate would be beneficial to the people who use the service which would provide them with an objective assistance with decision making. Management need to understand the role the complaints procedure plays in the home and to act on any concerns made. Communication between management and the local CLDT team could be improved which would ensure that any information shared is helpful to the people who use the service. The homes quality assurance monitoring system could be more regular due to the nature and standard of care management currently provides. This would ensure that any information obtained from its stakeholders would assist in improvements being made. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Kath Houson 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Prospective residents and their families have limited access of information in which to make an informed choice about their place of residence. The Statement of Purpose and the Service User Guide fails to meet equalities and diverse needs of the residents and their families. Admissions process maybe thorough but the existing residents would need protecting from inappropriate admissions. Evidence: There has been one admission into the home since the last inspection. Numerous correspondence from other agencies concerning the admission was available and seen on file. The admissions process was lengthy which consist of several overnight stays and involved other health professionals. The homes Statement of Purpose was looked at and found to be lacking in information about the background of the home. Historically, there has been requests made several times to reproduce the homes Statement of Purpose. During the previous inspection there was a requirement made for the Statement of Purpose to include information on the use of physical restraint on people who may display challenging behavior or be in a state of crisis; this has not been included. There is a lack of information about the background of the home for example, the type of home and its mission statement and its aim and objectives. This would provide people with enough information about the type of home they would be entering. The homes Service User Guide however is much more detailed but the home only has one copy available. For instance if a potential relative wished to take away information about the home this would not be possible as the home only had one copy of their Evidence: Statement of Purpose and Service User Guide. This was discussed with the manager at the time of the inspection and his response was oh I guess youre right. The Statement of Purpose was also not available in a variety of formats which means that it fails to meet a diverse range of people who may be interested in using the service. The homes Service Use Guide is a little better but could do with up dating as the existing copy looks shabby and dirty with corrections replaced using stickers. For example this years date placed on a sticker and then put onto the front cover of the Service User Guide. The document contains pictures and sufficient information for people to read. It would be useful to have the Statement of Purpose in a similar format. The admission showed that people would have their needs assessed. However, there was concern that inappropriate admissions could potentially put the existing people at risk and staff would have to put measures in place to maintain peoples safety. Therefore it is important to review the admissions process to take into account the needs of the existing people already living at the home. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Care plans contain some information on peoples care provision and their involvement. Lack of inequality in the provision of care show that those able to communicate have their needs met which affects the maximum potential of other people using the service. Evidence: All care plans were looked at and found to be documented with individualized personal information relating to each resident. The care plans showed people have been involved in the planning of their care. People who are able to communicate have an understanding about their care plans their signature was seen in the documents and confirm they were involved. However those who have complex communication difficulties needed more personalized input and inclusion into the decision making and planning of their care. It was discussed the residents would benefit from the use of advocates which would assist in their understanding of their care provision. Care plans are reviewed regularly. Information relating to the use of physical restraint was also present and contained input from other health care professionals. All the care plans also show peoples likes and dislikes and contained photographs of each person living at the home. Several correspondence from other health professionals were also available and showed input from other multidisciplinary teams. Recent conversations with the health professionals were not so complimentary about the care people receive in the home. A health professional said there had only been small changes in the service since September 2008. Response in a survey from Evidence: another health professional said It can take the home longer than expected to make a referral and carry out recommendations. Continual concerns are also voiced by the local Community Learning Disability Team (CLDT). Who said people with complex communication abilities have difficulties in getting their needs met. This would show that there is a lack of equality in how the provision of service is provided. There was a lengthy discussion with the manager at the time of the inspection about the need to involve advocates and to arrange a robust system of communication for those residents to ensure their inclusion in the home. This would show all people living in the home are given an equal chance to take part in their home life. Comments in the form of a mini report from an Expert by Experience has been included in this section. CSCI Inspection Report 16th December 2008 Ashclyst 23 Park Lane Winterbourne Expert by Experience Jeffery Osborne When I arrived there were no residents to talk to. I spoke to the home manager. A time could have been sorted out with me when there were residents there to talk to. I would have wanted them to have their say. I shook hands with one resident they were getting ready to go out shopping. They had come back from skittles had an early lunch then going shopping. The residents have personalized activities. One resident goes to Chipping Sodbury Day Center three days a week. He also likes to go out for car journeys. He enjoys being in the car and listening to classical music it makes them feel calm. He has intensive interaction with one-one support. To help him choose he has to see or touch an object then he understands. Two of the residents communicate using makaton and pictures. Theres is always a staff member on duty who knows the residents very well and can understand what each resident wants to say. The residents personal needs healthwise are met. The residents have health action plans. The residents are having Essential Lifestyle plans and Person Centered plans done at present. One of the residents earlier this year become very agitated and stressed. Staff felt for the residents own safety and the safety of other people at the home, he should be restrained. Apparently this was because he is a heavy smoker and staff were trying to control his smoking. I think this was wrong and the Manager agreed. I was told by the manager all the staff have been trained in positive handling and adult protection. The residents can choose what they want to eat. The home has an accessible menu with pictures. Evidence: All the residents are going to have a Christmas meal and party. Early in the new year they will be going to a pantomime. As for holidays the residents can choose where they want to go. They look at holiday brochures with the staff and manager. They can choose to go as a group or have oneone support. All the residents have their own money. Staff go with them to help them if they need it. All the residents have good family contact. Their families visit them regularly. They do not go to visit their families. The manager is looking at having the residents start college courses. The residents will be helped to choose the course they want to do. I noticed lots of the residents photos of their daily activities and holiday photos around the home. This makes the home feel personalized. The home is being redecorated when this is done this will make the home feel more homely. The resident who has sensory impairments is having a snooezlum like facility in his bedroom I feel the staff and management are trying to make sure the residents rights, choices and independence are being respected and helping them to have a wide choice of activities. Because I did not get the views of the residents some of the things I put in this report may have been written differently. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Generally staff are aware of the need to support residents to develop their skills, communication and social welfare, some residents are consulted or listened to regarding choice of daily activities the process could be improved to include those with limited communication skills. Peoples dignity and privacy are compromised due to the lack of inconsistency on how their needs can be met. Menus contain healthy options and meet the need of those with complex dietary needs. Evidence: Peoples activity plans and daily dairies were seen and found to be documented well and people are given support in their chosen activities. People were able to take part in their community and join the local college and resource center. Such as, attending Filton College, art and music course and Brandon Trust day care. The home has its own vehicle available to transport residents to their activities. The manager said they would like to organise more in-house activities for the residents. During the inspection this was found to be lacking. For instance there was little evidence to show that residents had access to in house activities and many had been in the home for a long period of time without adequate stimulation. There were photographs of people around the house which made the home more personal. Recent holiday pictures were also seen. Evidence: However, during the inspection it was noted that Christmas parties were arranged for people who live at the home and a number of party invitations were seen in the dairy and on the notice board of the home. It was noted from the homes dairy for the 19th December 2008 that no events were planned for that evening and the manager did not mention a planned pantomime for the Christmas during the inspection. The manager had left the inspection at this point and the homes diary was made available to examine peoples activities over the Christmas period. This was found to be lacking and one staff member had mentioned there are usually a lot more activities arranged for the residents. This was arranged later on in the week. There appears to be a lack of consistency between the staff members and the arrangement of activities may fall to one staff member. If for any reason that staff member is not available then the peoples planned activities would be limited. This shows the failure to provide consistent care in the planning of structured activities especially around the time of Christmas when there would be a number of events could be arranged for the need of the people using the service. During the inspection one of the residents wished to go out for a pub lunch. All the residents were then taken out for lunch. This shows that residents who are able to verbalize well can get their needs met. The staff team spoke to residents respectfully and know the residents well, for instance their body language and gestures. This helps with communication but the system could be more structured and continual. The home promotes contact with peoples family and friends, this was evident in their care plans and comments made by relatives such as every time my relative come to visit they look lovely. There is an issue of equality, dignity and respect being consistent in the home. For instance, the homes contract indicates peoples rights. However this is infrequent, for instance the manager failed to take a resident to their bedroom to be dressed during the inspection. It would be more appropriate for residents to be dressed in their own bedroom to enhance their privacy and dignity. The issue of equality privacy and dignity was frequently discussed during the inspection with the manager. The home has a menu board where people can choose their meal of choice. Although this is a good idea and the team were acknowledged for this attempt the pictures were found to be out of focus and looked less appealing. This was mentioned to the manager and asked how were the residents able to make a choice when the pictures were out of focus, limited in content and not very attractive to look at due to the colours being faded. It was also mentioned to the manager that the range of foodstuff available on the market are vast and that their menu board failed to reflect this amount of choice. The managers response throughout the inspection was I guess youre right Ill get some pictures redone. Residents who have complex dietary needs are met and input has been obtained from the dietician. The home has a rolling 6 weekly menu which contains the same food items only rotated into different weeks. The refrigerated items had no date of opening Evidence: and looked limited. The freezer was the same, a limited amount of food items were available. It would appear that the shopping had not been done in a while. However one staff member said the shopping is likely to be done this week. The shopping was being done during the week of the inspection this was evident on Wednesday 17th December. Member of staff spoken with said the food items are brought from a number of supermarkets. There was a question about the quality of food items as it appeared that only the cheaper brands of foodstuff were brought. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People health care needs are being met, clearly recorded and individualized in their care plans and have access to health service in the home and outside in the community. The homes medication systems show compliance with the administration and safe keeping of peoples medicine. Evidence: All the peoples care files were looked and found to contain information of appointments with other health professionals such as the GPs, Consultant Psychiatrist, Opticians and Chiropody. The information was detailed and included review dates. It was suggested the service consider the use of OK health checks which is a new system of recording residents emotional and physical needs. By making a note of their health needs an action plan can be arranged. Additionally, if residents are rushed into hospital this document would go along with them. All care plans are made available to people who use the service, one resident when asked if his care file can be looked at? he said yes you can read my care plan. However, some sections are not in easy read format. Such as the communication chart, this was very much in textual format, the mental capacity act which was also in poor print which would be a problem for those with visual impairment. Risk assessments were also in text format. The service has an effective medication policy. Peoples medication records were looked at and no omissions were seen. The home uses the Boots monthly medicine system and comply with their administration practices. In some instances the end of life programme had been arranged according to peoples Evidence: wishes in regards to growing older, terminal illness and death. This informs friends and family how people who use the service wish to receive treatment during the time of their changing needs. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People have an accessible complaints procedure; which people can use with support. Any issues are poorly managed with outcomes not always satisfactorily resolved. Evidence: The service has a complaints procedure which is in an accessible format. It contains pictorial and text and meets diverse needs. Each resident has a copy of the complaints procedure in their care files. The home has a complaints log book where concerns are noted and was made available during the inspection. However, the staff team were aware of the complaints procedure. Failure to realise the importance of listening and then resolving the issues are significant; to avoid any repetition and to act when concerns are made by any individuals who enter the home. For example, a concern from a team member of the CLDT was brought to the attention of the staff team in September 2008. The nature of the complaint was logged in the homes complaints book. There was a small note of the complainants reassurance but no mention of whether the issues had been resolved to their satisfaction. On the day of the inspection 15th December 2008, the same issue had occurred which was difficultly in gaining access to a staff member of the home. This would suggest that the complaint of September 08 had not been resolved and the staff team had not fully complied with their own procedure. This issue is significant. Due to the nature of the people who use the service; who can be described as having complex needs which can affect their health in a dramatic manner. For instance, other health care professionals had made 7/8 attempts to gain access to the home in order to see residents with high risk which has serious consequences to their health. The appointment was finally achieved in 14 days of the first referral being made. Due to the nature of this referral this could be considered to be a long time especially with residents whose health needs can be described as high risk. This shows failure to acknowledge the risk involved and lack of poor judgment of the situation concerning people who use this service. One health care professional said Evidence: it takes the home a long time to identify potential health care needs. There has been no complaints from relatives but there has been concerns from the health care professionals. As a result of the concerns addressed during the inspection, the staff team have now started to use the home telephone answer machine which will take calls when the home is empty due to staff and residents being out on trips. A lengthy discussion took place with both the manager and team leader in an attempt to resolve the issue of access to staff members. It was also discussed at length the role of advocates to assist people who use the service to make complaints. The home currently has a safeguarding issues due to residents inappropriately touching visitors and residents attacking each other. There was failure to inform any visitors to the home of residents inappropriately touching them and leaving them alone in certain part of the house. It is important to follow procedures that would keep residents and visitors safe from potential harm. In regard to residents being attacked by each other; this could be the result of the admissions process. Although steps have been taken to protect residents from bullying and harassment it is important to assess the compatibility of all potential admissions to avoid the risk of abuse. Staff spoken with understand the issues around abuse and neglect. Vulnerable adults training have been positively received by the staff team in October 2008. The homes Annual Quality Assurance form (AQAA) confirms up dates had been planned and staff training matrix show attendance from South Gloucestershire Community Services. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home fails to completely meet the needs of the people who live there, slippage in maintaining the property has resulted in a home that needs radical updating. Evidence: Ashclyst is a 4 bedroomed semi detached two storey, domestic house which provides residential accommodation. The communal areas of the house consists of the kitchen diner, lounge and a large garden which is laid mostly to lawn. The drive way has parking for 4-5 vehicles. The home is located on the borders of Winterbourne and Frampton Cottrell where local shops can be found. The other neighboring areas are Yate which has a number of shops and other social facilities to include pubs and libraries. The home has its own transport available for peoples use which is often unplanned due to the location of the home which is remote and with limited access to bus routes. The house is maintained by John Dean who is responsible for decoration of the house and garden. The garden where residents sit to smoke has a number of used cigarettes thrown on the ground and left soggy and grim and had not been cleared up. The manager said the cigarettes have been there for 1 month. It was evident that no one had thought enough to pick them up and dispose of them in a safe and proper manner. This lacks dignity and respect for other users in the home and for the environment where people live. There are two bedrooms on the ground floor and two bedrooms on the second floor. The bedrooms are personalized and in need of updating along with the whole house. Bedrooms on the bottom floor is in need of repairing as the wall has a large crack across the middle. The manager discussed about spot painting this area. It would be useful for this task to be professionally tackled to make the bedroom more homely and comfortable. The kitchen is new and has been recently installed. Evidence: There has been lengthy discussions with the manager about the general condition of the house which is found to be shabby in places and grubby and could do with a good clean. The bedrooms at on the top floor was striped bear with the furniture nailed to the walls. This looked ugly and not homely nor comfortable for residents use. It lacks dignity. There are plans for the room to be decorated and some sensory items are being allocated to residents. Following the inspection a random visit took place on the 17th December 08, the manager had called the contractors John Dean in to start decorating the home and started with the bedrooms upstairs. The toilet on the top floor was taped to the wall and is need of updating. The shower looked worn and could do with a steam clean. The bath tub is in need of updating. The manager said during the inspection that staff have to paint the walls and the tiles in the existing bathroom downstairs. Unless the residents are able to take part in decorating their home, to a good standard, then this task would be better completed by the professionals in order to provide a home that is cosy and comfortable for peoples needs. This would give people who use the service value for their money. The office is also in need of updating throughout. The environment lacks simulation especially for those with limited communication skills. Peoples photographs personalize the house very much and this was seen throughout the home. The home has the potential to be comfortable and homely which would be of benefit to the people who use the service. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service has a recruitment procedure that meets the regulations and the National Minimum Standards; the procedure is followed in practice and there are accurate recording at all stages. People would benefit if the communication between the management, staff team and other health professionals could be more effective, which would ensure that their care is provided in a consistent and timely manner. Evidence: Selected staff files were looked at along with the homes staff training matrix and staff rota and their certificates. The training files were up to date and showed that the staff are fairly competent in the jobs they do and are able to provide support to the people who use the service. The staff team are long standing and staff spoken with said I enjoy working here with the residents. There are enough qualified and competent staff to meet the health needs and welfare of the people using the service. However, there are a number of concerns regarding communication between staff and management and how information is shared with other health care professionals which may have significant consequences to peoples health. Recent comments from the Community Learning Disability Team (CLDT) said residents needs are met according to which member of staff you are talking to. CLDT go on to say communication is not as effective as it could be, if I get conflicting information I approach straight away if I have difficulty obtaining accurate information. Management and staff must work towards maintaining effective communication between themselves and other health professionals. This would ensure people who use the service needs are met in a timely manner and all information relating to residents Evidence: are accurate. This also would result in the correct treatment being given at the right time to the correct person. Comments from the CLDT relating to staff competencies was also concerning. For instance; there are knowledge gaps when asked has this individual lost weight? there is little or no response; I have to ask; well is their clothes looser, are they eating less? lots of questionable prompts were given but often with little response. We also found the staff were slow to go to the GP. For instance, residents showed signs that they were thirsty and was drinking a large amount of fluids in a short space of time I got conflicting reports about the fluid intake, for example residents had a fair amount of fluids at the time they had got up from 07:00hrs and had a further liters at the day center between 011:00/12:00hrs. You would normally expect that amount of fluid to be consumed over a period of time during the day. When asked the manager about residents routine and their fluid intake, based on the residents showing signs that they were thirsty and there could be a sugar imbalance; I then suggested that the residents should be seen by a Doctor. The response from the manager during this conversation was yes youre right. The last time concerns were raised was three years ago which resulted in a change of the staff team. The health care professional said there are a good team providing support and some staff members are on the ball about individual needs. These comments were shared during a telephone interview at the time of the inspection. When the health professionals were asked are the residents well care for? The response was unsure some things are managed well and other things unsure about. This raises concerns about the standard of care this service provides to the people who currently live at Ashclyst. In relation to the training of the staff team We the CLDT had to start some training with the staff in the home. Such as the dietician from the CLDT in South Gloucestershire completed training on specialised diets and the needs to liquidize food for those with a high risk of choking and other problems with eating and drinking. The health professionals said the training was positively received although they did not like the risk assessments and it took a while for it to cement in. There is a gender imbalance to the staff team which causes no problem to the member of staff who enjoys working with the guys. Selected staff files were looked. These were found to contain fully completed application forms, job description, two references which also coincide with the named referee on the application forms, Criminal Record Bureau (CRB) and email notification from Protection of Vulnerable Adults (POVA). The manager said that some references are kept in the home and others are held at the Trust Head Quarters. Staff induction notes were seen and regular supervision folder was made available. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People would benefit from a service that is well managed; the home is drifting and lacks purpose and direction; improvements are needed to be made to raise standards of care to a good level which would provide people who use the service value for money. Evidence: The current manager is a qualified registered mental health nurse and has been in the care industry for several years. He has also completed the Registered Managers Award (RMA) level 4. This would demonstrate that he has the qualification and the necessary experience to manage this service; which is based on his previous employment in the community working with people with learning disability. The manager assisted with the inspection but had to leave early as he had done so on two other occasions. Therefore, feedback for this inspection was conducted on Wednesday 17th December 2008. Throughout the inspection there was great deal of discussion and suggestions being made to the point where instruction was given on ways to improve the service. The frequent response from the manager was youre right. It was difficult to ascertain whether this is a laid back attitude of the manager or if there is a question that he may not know and there is a gap in his knowledge. This was also confirmed by another health professional who said it is difficult to know if this a laid back attitude of the manager or not able to do anything about it. This is concerning for instance, people who use the service would greatly benefit from a manager who is able to act on complaints and learn by them; deal with issues concerning peoples needs; has the ability to provide accurate information in regards to peoples healthcare; communicate with other health professionals; demonstrate and Evidence: understand equality and diversity issues; exercise and practice dignity; build the staff team and instill cohesion; admit limitations; demonstrate that this service can be managed to a high standard and give the people who use the service value for money. For instance: The complaint; there was no indication of the time scale and whether the concern was dealt in a timely manner and if the complainant was satisfied with the outcome. The issue was no one being at the home to take phone calls following a urgent referral. On the day of the inspection, it was difficult to contact the manager or any other member of staff. The answer machine was not on and there was no call diversion to the homes mobile phone. Aspects and Milestones head office had to be contacted who then had to locate the manager. The health professional said there has been little change since September to December 2008 and was not surprised that the service has been given a poor rating. The conflicting communication in regards to peoples health needs can cause potential risk to how their care is provided and this was evident during the inspection. There is a consistent lack of equality in the home and those residents who are able to communicate have their needs met. This would suggest that those residents would gain more from the service than those who have difficulties with communication. This was also confirmed by the health professional who said when asked do they meet every bodies communication needs? the response was no they meet people needs who are more verbal but others then no. This was also observed during the inspection. People who can voice their wishes were seen to have their needs met in a timely fashion. During the inspection the manager proceeded to dress residents in the staff office. It would be more appropriate to encourage the residents to go their room and dress them in their own private space. There is a gender imbalance in the staff team and although this does not cause any problems to the female staff member. The tasks such as food shopping seems to be her responsibility. For instance, on the day of the inspection the cupboard and fridge/freezer had limited stock of food. The staff member said I stocked those cupboards and fridge/freezer six weeks ago and no shopping had been done since then. Another example, during the inspection; it was noted that week of the 15th December a number of Christmas parties had been arranged. However, there is the expectation that there would be more Christmas activities arranged over the Christmas period. The manager was asked what activities were arranged and he replied there are a few parties for the residents. The homes diary was available during the inspection and Christmas parties were planned but no other activities were arranged. This task was left to the female member of staff who had not been available to arrange any Christmas activities. This shows there is an inequality of staff responsibility and peoples activities are arranged according to which staff member is on shift. A Christmas pantomime was arranged later on in the week on the 19th December 08. Evidence: The homes quality assurance system was looked at and was discussed with the manager. The manager said questionnaires are sent out every 6 months. The questions were seen and a number of issues caused concern, they were not dated and was difficult to determine when the questionnaires had been sent out. The questions were leading and very closed; leaving very little prompts for relatives and stake holders to make useful comments and suggestions. This was discussed in detail and was suggested since this is a level one service it maybe useful to send out questionnaires sooner with the aim to identify gaps for improvements. The managers response was your right. A lack of understanding the homes aims and objectives and how this could be achieved was evident during the inspection. There is a failure to provide a clear sense of direction and leadership which relates to the aims and purpose of the home which would have positive outcomes for the people who use the service. The homes completed Annual Quality Assurance Assessment form (AQAA); in some sections were incomplete for example, in the section Individual needs and choices the section asks what we could do better. This was left blank and would suggest the home is unaware of how to improve its standards of care. This was consistent throughout the form and in some places no response was given on plans for the next 12 months. It is important to identify gaps in service improvement and where enhancements to the service can be made. This would result in raising the standards of care for the people who use the service and provide them with positive outcomes. The health care professionals response to how do you think the care service can improve? detailed a number of issues; such as, increased knowledge and awareness of eating and drinking problems of residents, planned training, increased working with other health care professionals, increased awareness and knowledge of communication needs of people they care for and seek out appropriate strategies and assistance to help meet those needs, improved recording of information. The homes safety checks were seen and kept up to date the fire log book showed regular checks and recent portable appliance checks were also maintained. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 1 4 The statement of purpose must set clearly the reasons for the use of physical restraints in the Home, and how this will be reviewed, and why this is in the residents best interests. Requirement partially met. 23/07/2008 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 1 4 The registered person shall 30/05/2009 compile in relation to the care home a written Statement of Purpose which shall consist of a statement of the aims and objectives of the home, its philosophy and any strategies for communicating with the residents. This would ensure that potential residents would have sufficient information to make an informed choice about their place of residence. 2 7 12 The registered person shall 30/05/2009 make proper provision for the health and welfare of the residents in regards to decision making with the help of an advocate. This to ensure that residents independence are promoted. 3 16 12 The registered person shall 30/05/2009 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of the residents. This is to promote dignity and respect in a consistent manner. 4 22 22 The registered person shall ensure that any complaints made under the complaints procedure is fully investigated. 30/05/2009 This show that this service listens and act on the views and concerns of all persons who live and enters the home. 5 23 13 Registered person shall make 30/05/2009 suitable arrangements to prevent visitors from being harmed or placed at risk of harm or abuse. This is to ensure that both visitors and residents can have a positive outcome when visits take place at the home. 6 24 23 The registered person shall 30/05/2009 ensure that the premises to be used as a care home are of sound construction and kept in a good state of repair externally and internally. This is ensure that the home is comfortable for the people who live in the property. 7 30 23 The registered person shall 30/05/2009 maintain all parts of the care home are kept clean and reasonably decorated. To ensure that the home is clean and comfortable for the people who live in the property. 8 32 12 The registered person shall 30/05/2009 ensure that the home is conducted in a manner that proper provision for the care, treatment education and supervision of the people who use the service. This is to ensure that their needs are met in a timely and consistent manner which has positive outcomes for their health. 9 35 12 The registered person shall 30/05/2009 maintain good personal and professional relationships with each other and other health professionals with regard to improving communication channels and the sharing of information which would affect the people who use the service. People who use the service would benefit from having their needs appropriately met. 10 37 26 Where the provider is an 30/05/2009 registered organisation the care home shall be visited by the responsible individual who may visit the home on a monthly basis and to notify the Commission of those visits. This to ensure that the service is meeting the needs of the people who live at the property. 11 39 24 The registered person shall establish and maintain a system for reviewing at appropriate intervals a quality assurance for improving the standard of care currently provided at this service. 30/05/2009 To identify gaps for improvements which would have positive outcomes for the people who use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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