Inspection on 23/06/08 for Ashclyst

This inspection was carried out on 23rd June 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashclyst 15/12/08

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 08/11/2008.

CARE HOME ADULTS 18-65 Ashclyst 23 Park Lane Winterbourne South Glos BS36 1AT Lead Inspector Melanie Edwards Key Unannounced Inspection 23rd June 2008 09:15 Ashclyst DS0000003390.V364995.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 Ashclyst DS0000003390.V364995.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. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashclyst Address 23 Park Lane Winterbourne South Glos BS36 1AT 01454 250946 0117 970 9301 samrv2003@yahoo.co.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust 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) Mr Ian John Knowles Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 4 residents aged 19 - 64 years Date of last inspection 25th June 2007 Brief Description of the Service: Ashclyst is situated in South Gloucestershire in a somewhat remote, almost rural position on the outskirts of Bristol. The home is registered with the Commission for Social Care Inspection to provide accommodation and personal care to four residents with a learning disability aged between 19-65 years of age. It is a modern 4 bedroom detached bungalow. Accommodation is on two floors. Residents have access to two bathrooms. The communal areas consist of a lounge and an open planned dining room and kitchen. Residents have access to a minibus in addition to public transport to enable them to access the local community. The home is managed by Mr Knowles. The fees at the time of publication of this report were £1250. Presently there is no Email address for the home. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. Please note due to their range of needs the majority of the residents are unable to express their views verbally about the Home. We met two of the three residents living at the Home. We spoke to the registered manager Mr Knowles, the assistant team leader, and two support workers. We spoke to them about their roles and responsibilities, training needs, and how they support residents. The registered manager left the Home during the inspection to carry out duties in the other Care Home they also manage. We looked at a selection of records relating to the day-to-day running and management of the Home. The records we saw included two care plans, two assessment records, medication records, staff duty records, supervision records, accident records, fire records, and menus. We saw staff helping residents with their needs. The environment was viewed throughout. The ‘AQAA’ (an annual quality assessment document that all Homes are required to complete) has been used to help form the judgments in the report. The Home was operating within the required conditions of registration set down by us. The conditions of registration set out the type of care and the needs of residents as well as the numbers of residents who may stay at the Home. What the service does well: The Home aims to be a supportive environment for residents who have a range of complex, and challenging care needs. The staff team are committed to the work that they do and aim to provide a safe environment for the residents. Residents are well supported to attend a range of community based services, and activities. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The statement of purpose must set out the reasons for the use of physical restraint in the Home and why this practise is in residents’ best interests. If physical restraint of a resident is to be used, this must only be undertaken following multidisciplinary team decision-making. The practise of restraint needs to be very regularly reviewed. The views and wishes of the residents must also be actively taken into account. If physical restraint of a resident is to be used, the staff need to follow the Trusts own procedure for the use of this practise. This makes a clear reference to the need for the resident to be offered formal support and teaching, to reduce the need for the use of physical restraint. The procedure also refers to the need to assist other residents from the area where the restraint is taking place. There must be a care plan in the Home that sets out the reasons why the use of physical restraint is the best option .We were told that a residents care plan relevant to the reason for the use of restraint was not on the premises. We were told it was with a member of the ‘ Intensive support ’ team. The team offer support to people who have learning disabilities and mental health needs. Visitors must be told if there is a risk that residents may inappropriately touch them. An incident took place where a resident inappropriately touched an inspector. The inspector was not made aware of the risk that this may happen, and there were no staff nearby . Care plans should include up to date information about each residents Mental Capacity. This information is needed to protect and uphold residents’ legal rights, if they cannot give informed consent in their daily lives. There must be evidence of a quality monitoring system in place in the Home This needs to be based on reviewing and improving the overall quality of care in the Home. Staff should understand the principals of advocating on behalf of residents, to help to make complaints for them. Staff must do some relevant training in the principal of ‘ safeguarding ’ of vulnerable residents from abuse. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 7 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. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 8 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 Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 9 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. Quality in this outcome area is adequate. There is information available to residents and their representatives about the Home and the service provided. However the information is not fully up to date. Residents’ needs are assessed by the Home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the service users guide and the statement of purpose to find out about the sort of information there is available about the Home. The service users guide explains the type of care, and service that is provided The statement of purpose and the service users guide contain clearly written information about the service. Both documents are written in an easy to understand style. There is also information about the qualifications of the staff employed, and the accommodation. The philosophy of the Home and how the service aim to meet residents needs is also included. The complaints procedure is in each service users guide so people know how to complain about the service. There are photographs of the Home in the service users guide. The complaints procedure includes the contact information for the Commission if a person wants to contact us directly. However the information is not up to date Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 10 as it includes our old address. This makes it potentially harder for people to contact us if they need to. As already referred to in the report, the Home are using physical restraint on occasions when supporting one of the residents .We advised that if the use of physical restraint is part of the philosophy of care then the statement of purpose must set out the reasons for this . The statement of purpose must also set out how this will be reviewed, and why it is in resident’s best interests. To find out how effectively the Home is meeting residents’ needs we looked at one care plan, (see also standard 6). There was information written for the resident stating how to assist individuals with their needs. We saw a detailed health care needs assessment in place, as well as a social care needs assessment. The staff that we met conveyed in discussion with us and through observations that they had a good understanding of the needs of the residents. Staff demonstrated that they know how to respond when residents exhibit behaviour that may be challenging. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 11 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): 6,7,9.Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed, however care plans fail to fully reflect how needs are met. Residents are supported to make decisions in their lives. However there are failings in care planning and risk management processes, and this potentially puts residents at risk. EVIDENCE: To find out how well residents are being supported to meet their needs we looked at one care plan. We found the care plan to be generally informative and contained relevant information to support the resident to meet their care needs and their social care needs. The care plan included information showing how to support, and communicate with the resident and how to assist them with their care needs. The care plan that we did see had been evaluated and updated regularly. This practise helps to demonstrate residents changing needs are being monitored. However, in discussion with the staff we were told Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 12 that on occasions the staff have used physical restraint to keep the resident and themselves safe .We asked to see the care plan that relates to the reason for the use of physical restraint, but this could not be located. We were told that this part of the care plan had been given to a member of the ‘ Intensive support team ’. The team provides specialist support to residents and the staff in Care Homes for people who have learning disabilities. We advised there must be a care plan in the Home, which sets out the reasons why the use of physical restraint is the best option to protect residents’ safety. If physical restraint is to be used, this should only be after a multidisciplinary decision has been taken and not before it has happened. We refer to the fact that the staff have already used physical restraint, while the residents care plan is not in the Home . We read the Trusts own restraint policy. We discussed the policy with a member of staff on duty. We also reviewed the residents care plans and risk assessment records. Based on the evidence, it is clear the policy is not being fully followed. Specifically there is no evidence of formal support and teaching offered to the resident concerned, to help them find ways to cope when they get very angry. The procedure also refers to the need to assist other residents from the area where the restraint is taking place. We were advised when we asked the staff , that this had not been taking place. We were told residents have been sitting in the lounge during the process of physical restraint involving another resident. We did find written evidence that the residents G.P had expressed approval for the use of physical restraint. However there had not been a multi disciplinary decision taken about the practice. There has also not been regular formal review of this practise, to find out if it is still safe and the most appropriate option. We were advised that staff have different levels of confidence about the ability to use physical restraint techniques. We saw in the resident’s records letters from a psychiatrist who will see resident when required at the Home. We saw a physical health care needs record in the resident’s records. This recorded when the resident had last had routine optician, chiropody and dental appointments. The staff keep daily records that they write to demonstrate they are monitoring residents wellbeing. The records we saw were kept up to date and show that staff monitor residents overall well being on a daily basis. We advised the staff that due to the needs of residents it would be beneficial to include up to date information about each residents Mental Capacity. This helps to protect the legal rights of residents who may not be able to make informed choices in their daily lives. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 13 We saw residents being supported by staff to attend a range of community based social and therapeutic activities during the inspection. We saw risk assessments in place for the resident whose records we checked. The risk assessments set out how to support the resident in a range of activities both in and out of the Home. There was also information written in the resident’s record that showed staff aim to support the residents to maintain their independence in various daily living activities both in and out of the Home. This helps to show how residents are supported to make decisions and maintain their own independence in their daily lives. There were no risk assessments in place to guide staff if visitors come to the Home. Visitors need to be told if there is a risk that residents may inappropriately touch them. As already referred to in the report, an incident took place involving the inspector and a resident. The inspector was not made aware of the risk that this may happen, and there were no staff nearby when this occurred. Ashclyst DS0000003390.V364995.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): 12,13,15,16,17. Quality in this outcome area is good. Residents are supported to make decisions and to take risks in their daily lives. Residents are able be a part of the local community, and take part in a range of leisure activities. Residents are also provided with a varied and well balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Parts of this section of the report have been quoted from the last report, as it is still applicable: Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 15 One aim of the Home as written in the service users guide is to support residents to be able to access community facilities as independently as possible. All residents have been for at least one holiday this year with the support of staff. This is a very good example of residents being well supported by staff to take a holiday. Residents are encouraged and supported by staff to go on regular trips out of the Home, and residents clearly gain satisfaction and enjoyment from these opportunities. One resident went out with staff for a drive during the morning. The staff told us the person concerned goes out every day as they really enjoy this activity. Two residents left the Home to attend community social and therapeutic activities. We read information in the residents records seen that confirmed residents regularly go to local activities and are also provided with day care support. We also saw information recorded in a resident’s file that confirmed the resident regularly attends day care support. We looked at the current menu record to check if residents are offered a varied and well balanced diet. There was a range of dishes recorded as being available for each day. There was evidence seen that demonstrate residents likes and dislikes are included when menus are planned. There was a varied choice of meal options available. Meal options included a range of traditional, nutritional meals. Residents who may not be able to directly make their views known, can now chose their meals from a picture board system. This uses pictures of different meals to help residents to make a choice. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ care plans only partly reflect how needs are met. Residents’ health needs are met. Residents are not consistently treated with respect nor is their right to privacy always upheld. EVIDENCE: There was information in the daily records that staff were monitoring and observing the health of residents and call the doctor, if they were concerned about the resident. There was information that showed that residents receive support and treatment as required from the specialist Psychiatrist. We saw information in the resident’s care records, which confirmed that residents attended appointments at the dentist. This helps to demonstrate that residents’ health care needs are being met. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 17 The staff we met said that they aim to monitor residents’ physical health as well as to provide emotional support. As has been written in standard 6 of the report, there was evidence in the care records that showed that the preferred day-to-day routine of the residents and particular likes and dislikes were recorded. However we refer again to the lack of a care plan in the Home that sets out the reasons why the use of physical restraint is the best option to protect the safety of residents and staff. If physical restraint is to be used, this should only be after a full review multidisciplinary decision has been taken and not before it has happened. We also refer again in this section of the report as it also applies here to the fact that the staff have already used physical restraint twice, while the residents care plan is not in the Home .We were advised that other residents have been in the same room while this is taking place. This fails to protect the dignity of the resident being physically restrained. The procedures and systems in place for administration, storage and disposal of medication were checked to monitor if there are safe systems in place. The medication administration charts of two residents were checked. There was a photograph of the resident maintained with each record. This should ensure medication is administered correctly to the resident named on the chart. The administration charts were up to date, legible and in good order. The staff had signed for medication administrated, or recorded the reasons for any omissions. All senior staff administering medication do regular training to enable them to do this safely. There are also written guidelines in place to advise staff of residents preferred way that they take their medication. This will guide staff and ensure medication is administered in the way residents prefer. The stock of medication held in the Home was satisfactorily organised. Medication no longer required is returned to the pharmacist. This helps ensure residents’ medication supplies are kept in good order and can be easily monitored. The medication administration charts were legible, up to date, and contained the signature of the dispensing member of staff; demonstrating residents’ medication is administered safely. The reasons for any omissions had also been written on the charts. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 18 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): 22,23.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents could be better supported to make complaints about the service. There are systems in place to protect residents from abuse. However residents would be better protected if all staff attends training on the subject of `safeguarding vulnerable adults ’. EVIDENCE: We looked at the complaints record book to find out how effectively resident’s complaints are responded to. There had been no complaints made since the last inspection. We talked to Mr Knowles to find out if the staff are supported or trained to advocate on behalf of residents to make complaints . There is currently no formal advocacy service operating in the Home .We advised that residents could benefit if staff were trained and assisted to be able to use the principals of advocating for residents to make complaints on their behalf. We saw procedures and guidance information on the topic of ‘the protection of vulnerable adults from abuse’. This helps to protect vulnerable adults who live at the Home, if staff can access the necessary information to ensure their protection. However as was also applicable at the last inspection the majority of the staff team have not attended recent update training on the subject of the ‘ protection of vulnerable adults ’. We were told that staff are booked to go on ‘ safeguarding ’ training in October 2008. Updating this training is necessary to protect residents from the risk of harm and abuse. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 19 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): 24,25,27,30.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ live in a Home that is domestic in style and provides an adequately comfortable environment to meet their needs. EVIDENCE: We have quoted parts of this section of the report it is still applicable: Ashcylst is a converted private home close to private houses, a short distance from the villages of Winterbourne and Frampton Cottrell and near to bus stops. This helps ensure residents can be a part of the community. The Home has its own garden that looked to be satisfactorily maintained. There are patio seats and a spacious area where residents can sit and walk safely. The building is mostly wheelchair accessible. The Home is a two-storey building, and residents have access to each floor. However there is a steep Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 20 step going from the dining room to the lounge. Residents with reduced mobility would need adaptations to be put in to help them down the step. There are adaptations in place to assist residents and visitors with disabilities in other parts of the Home. There are two bedrooms on the ground floor, and two bedrooms on the first floor, for residents who cannot manage the stairs. The bedrooms were personalised with residents’ personal possessions. There is furniture and fittings provided, including a wardrobe a comfortable chair a bedside cabinet and a chest of drawers in each room. However due to the differing needs of residents, one of the bedrooms does not have a carpet, and the furniture has been secured so that it cannot be damaged. There are photographs, and pictures displayed in rooms that helped to create a more ‘personal’ feel to the rooms. The standard of the decoration and the quality of the fixtures and fittings was satisfactory. We saw two residents looking comfortable in their environment. We saw one resident sitting in the kitchen at the kitchen table spending time with staff, and they looked settled there. Toilets are situated in readily accessible parts of the Home near to communal areas and bedrooms. The bathrooms and toilets were clean, and were well stocked with towels and soap to help minimize risk from cross infection. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by a sufficient number of competent, qualified staff who are supported and supervised in their work. However the practise of physical restraint in the Home may impact on how residents needs are met. We could not fully review the Homes staff recruitment practises and procedures. EVIDENCE: We checked the staff duty record for shifts in June 2008 to see how many staff there are on duty to support residents to meet their needs. Mr Knowles the registered manager currently works for fifteen hours each working week at a Home in Pucklechurch.There is a minimum of two staff is on duty for a day shift, and one staff member at night. An extra staff member will also work a late shift several days in the week to support residents to be able to attend activities away from the Home. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 22 Based on the evidence from the inspection the number of staff on duty at any time is the minimum number necessary to ensure residents ’ needs are met. However, it is also relevant to consider the use of physical restraint that has been written about already as relevant in this part of the report. Specifically if two staff need to restrain one resident, this has a direct impact on the safety of the other two residents. If two staff are both involved in the practise of physically restraining one resident, this will usually mean there are no other staff to support and keep safe other residents. We looked at the training records of three support staff to see if they had attended training relevant to the needs of residents over the last twelve months. The staff consulted spoke positively about the training opportunities they take part in. This should help ensure residents’ needs are being met by the assistance of well-trained and knowledgeable staff. However see comments made in the ‘ complaints and protection’ section of the report about staff training on the subject of the ` protection of vulnerable adults ’. We requested the staff recruitment files of two support staff. However the staff employment files could not be located. We were advised that these records may be at the Trusts head office .We will review the staff files at the next inspection We were told by the staff that the assistant team leader and Mr Knowles provide regular structured supervision sessions to assist them in their work and to help them to understand residents needs. We saw one staff member’s recent supervision records. The records were informative and demonstrated staff supervision sessions take place regularly. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 23 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents who use the service benefit from a generally stable home. However the Home fails to effectively self monitor the service effectively. Residents’ health and safety is adequately protected. However the use of physical restraint for one resident could have an impact on the health and safety of all residents. EVIDENCE: Mr Knowles is a qualified learning disabilities nurse. He has a number of years of experience working with people who have learning disabilities. He is registered with the Commission as the manager of the Home. This demonstrates Mr Knowles is considered suitable and qualified to fulfil the role of registered manager. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 24 Mr Knowles is currently working fifteen hours of each week at a care Home in Pucklechurch. As was also applicable at the last inspection Mr Knowles was working for part of the day at the Home in Pucklechurch. While Mr Knowles was present for part of the inspection, we were told that he would be doing ‘ Supervision ’ with staff at the Home in Pucklechurch. The absence of Mr Knowles impacted on the inspection process. This is because despite the active help from the assistant team leader, there was information we could not locate. We also wished to talk to Mr Knowles directly about the outcome of the inspection. A registered manager who leaves a service during a key inspection for nonurgent reasons (and at the last inspection) could be considered to be committing legal ‘ obstruction ’. This means they have failed to actively assist in the inspection process. Residents’ records are kept securely in the office. The care records and records relating to the running of the Home were satisfactorily written, legible, up to date, and well maintained. The monthly monitoring visits of the Home that must be carried out by a representative of Aspects and Milestones Trust are being undertaken as required by law. The records that we have seen, demonstrate that the designated individual responsible for the visits spends time consulting with people and observing staff carrying out their duties. As was also applicable at the last Inspection we were told that a detailed quality audit of the Home has been undertaken. However a copy of the audit document could not be reviewed because it could not be located. It is a legal requirement that the Home establishes a system for monitoring the quality of the care and service provided. The environment looked safe and satisfactorily maintained in all areas viewed. We saw a record of the monthly checks of the environment. These checks were up to date and showed that a member of staff checks the health and safety of the environment on a regular basis. Staff go on regular training in health and safety matters including first aid, and moving and handling practices. This should help protect residents ’ health and safety if staff are knowledgeable and well trained in health and safety principles and practices. The staff check the temperatures of all high-risk cooked food before it is served to people to make sure it is hot enough and safe to eat. The Home won a five star good practise food hygiene award in February 2008.The award was given by Inspectors from Gloucester Council. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 25 It is it relevant to consider the information about the use of physical restraint that has been written about already in the report, when reviewing the health and safety standard in the Home. It is a potential health and safety risk to the residents if two staff needs to physically restrain one resident, and there is no other staff on duty. This has a direct impact on the safety of the other two residents, This is because if staff are both involved in physically restraining one resident, there are no staff to support and keep safe other residents. The comments that we have made already in the report about the need for visitors to be protected from risks in the Home are also relevant when considering the overall health and safety standards in the Home. The fire logbook record was checked and showed the required weekly and monthly tests of fire alarms and fire fighting equipment were being carried out and were up to date. Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 26 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 N/A 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 1 X 3 2 X Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 27 NO Are there any outstanding requirements from the last inspection? 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 4 Requirement The statement of purpose must set clearly the reasons for the use of physical residents in the Home, and how this will be reviewed, and why this is in the residents’ best interests. There must be a care plan in the Home to set out why physical restraint is the best option for the safety of residents and staff. If physical restraint is to be used on residents the staff must follow the procedure that is in place for the use of restraint. If physical restraint is to be used, this practise must be very regularly reviewed to demonstrate that this is the best option for the resident. There must be evidence of a quality monitoring system in place based on reviewing and improving the overall quality of care in the Home. The staff must attend regular training on the subject of the `protection of vulnerable adults’. This is to help to increase staff understanding, and to thereby protect the residents from the DS0000003390.V364995.R01.S.doc Timescale for action 23/07/08 2. YA6 15,13. (7),(8) 15,13. (6)(7) 15(2), (b),13(7) 07/07/08 3. YA6 23/06/08 4. YA6 23/06/08 5 YA39 24 23/07/08 6 YA23 13. (6) 23/08/08 Ashclyst Version 5.2 Page 28 risk of harm and abuse. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Care Plans should include up to date information about each Residents Mental Capacity. This information is needed to protect and uphold residents’ legal rights, if they cannot give informed consent in their daily lives. Staff should advocate on behalf of residents to make complaints for them. Action must be taken to protect people from unnecessary risks when they are in the Home. This recommendation relates to the incidence when a resident inappropriately touched an inspector. 2 3 YA22 YA42 Ashclyst DS0000003390.V364995.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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