Inspection on 04/05/05 for Ashclyst

This inspection was carried out on 4th May 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashclyst 15/12/08

Ashclyst 23/06/08

Ashclyst 25/06/07

Ashclyst 03/05/06

Ashclyst 16/11/05

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 08/07/2008.

CARE HOME ADULTS 18-65 Ashclyst 23 Park Lane Winterbourne South Glos BS36 1AT Lead Inspector Wilfried Maxfield Announced 4 May 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashclyst Version 1.10 Page 3 SERVICE INFORMATION Name of service Ashclyst Address 23 Park Lane Winterbourne South Glos BS36 1AT 01454 250946 0117 970 9301 Aspects & Milestones Trust Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Ian John Knowles Care Homes for Younger Adults 4 Category(ies) of LD Learning disability for 4 registration, with number of places Ashclyst Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 4 residents aged 19 - 64 years Date of last inspection 25-Oct-2004 Unannounced Brief Description of the Service: Ashclyst is based in a modern 4 bedroom detached bungalow. Accommodation is on 2 floors. Bedrooms are en suite. Communal areas consist of a lounge and dining area/kitchen. Bathroom and toilet facilities are situated on both floors. The home is located in a somewhat remote, almost rural position on the outskirts of Winterbourne. Residents rely on the local bus service to be able to reach local amenities. The homes own minibus as well as taxis is used to get to local, as well as destinations further a field. Ashclyst is registered to provide accommodation, personal care and support for up to four people with learning disabilities. It may accommodate up to 4 residents aged 19 - 64. This range is reflected in the ages of residents currently supported at the home (30 - 40). Their needs include communication, behavioural and mental health requirements. Ashclyst is operated by the Aspects and Milestones Trust. Ashclyst Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over one day. The registered manager was present for most of the morning and an assistant manager helped with the inspection process for the remainder of the day. The registered manager helped to focus the inspection on policies and procedures, service user planning and organisational management and systems such as staffing, training and supervision. Requirements and recommendations from the last inspection were also discussed with a particular focus on staffing issues. This was vital because an ‘Immediate Requirement’ had been made during the last inspection visit to improve on staffing levels. Subsequently, a major part of the inspection concentrated on staffing including a thorough analysis of the current rota and bank staff arrangements. Details of staffing rotas were sent to the Commission for closer inspection after this visit. During the second part of the day and with the help of the assistant manager, attention turned to the service users, their assessments and day-to-day needs and the environment. This included an extensive tour of the premises and review of equipment. In addition care planning documentation including service user files were inspected. A sample of care plans was discussed. Two further members of staff were formally interviewed. Interaction of staff with two of the residents who were present for some of the day was also observed. All residents had returned from their respective day placements by the time this inspection had finished and the opportunity was taken for informal contact and introductions. The Commission received a number of ‘Comment Cards’ from relatives prior to this announced visit. Views from these were incorporated into this report. Some comments made on cards were also followed up by telephone. Equally, Regulation 26 visit reports identified issues since the last inspection report dated 25th October 2004 that were appropriate and relevant, were also incorporated in this report. What the service does well: The current group of residents has lived at Ashclyst for some years and is very settled and at home. Their primary, health and general care needs are well taken care of. The staff group is commended for its skilful, positive and dedicated work with a very complex and challenging group of residents. An experienced core group of staff has worked together for a long period of time and is well qualified and dedicated to the residents and the aims of the Ashclyst Version 1.10 Page 6 Trust alike. All staff interviewed commented on the positive atmosphere within the team and the clear and supportive attitude of the registered manager. Comments from relatives were very complimentary of the home. In the words of one of the relatives: …”we have every confidence in the staff at Park Lane who seem to be very caring and confident”. The inspector shares this impression. What has improved since the last inspection? What they could do better: The quality of life and residents general well being could be greatly enhanced if improvements were made to the physical environment. This includes furnishings as well as full re-decoration of the entire home. The character and homeliness of Ashclyst would benefit if odour and ventilation measures were more effective. The general health of residents and staff and the prevention of the spread of disease could be improved if infection control and continence management measures and procedures were more robust. Continence management would be greatly improved if adequate laundry and sluicing facilities were available at the home. Hygiene would be greatly improved if the home stopped the current practice of carrying soiled articles through the dining room. The welfare of one resident would be greatly supported and the odour management in the environment helped if the home could find more suitable bedding materials. The heath and welfare of residents would benefit if the home would regularly review the menu using appropriate nutritional guidance from a dietician. Ashclyst Version 1.10 Page 7 The staff team would feel better supported and residents would benefit from this if a suitable staffing strategy were put in place. The implementation of an effective quality assurance and quality monitoring system would help the home to better assess whether it is currently achieving it’s aims and objectives to provide the best possible service for residents. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashclyst Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Ashclyst Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 5 The home has updated its Statement of Purpose and Service User Guide to a high standard. Equally, Service User Plans including initial and ongoing assessments, reflect the high level of expertise the home has in these areas. EVIDENCE: Updated versions of the Statement of Purpose and Service User Guide have been sent to the Commission after recent inspections and placed on file. Both were scrutinised as part of this visit and found to be of a high standard. The Service User Guide is available in a pictorial format and the registered manager related the very positive responses from staff, relatives and service users alike when testing the guide to communicate with residents. Standard 2 expects the home to assess the needs of residents prior to admission and, although all of the residents have been at the home since opening in 2001, the inspector was able to find some very good examples of initial assessment work. Equally, ongoing assessment efforts were well reflected in individual Service User Plans. Discussing some of this work with the registered manager and the assistant manager good and relevant examples were given to demonstrate how the home delivers assessed needs on a day-to-day basis. Ashclyst Version 1.10 Page 10 In the last inspection report a requirement was made to update licence agreements to include all the specifications listed in this standard. This work has been completed and all specifications outlined in NMS 5 have been included. Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 The home showed convincing evidence that its emphasis on the person centred planning approach leads to positive outcomes for its residents. This includes supporting user participation and enhancing residents preferred lifestyles. EVIDENCE: Three residents’ files were studied as part of this inspection and some good written details of residents assessed personal, social and healthcare needs were found. These were discussed with the managers present and actions taken by the home to meet needs were debated. The home has good expertise in the person centred planning approach and some good examples were given to illustrate how this method leads to more individualised needs assessments, user participation and supports residents in their preferred lifestyles. All of these areas had been well documented on individual residents’ files and residents’ choices and preferences had been written into their care plans. Ashclyst Version 1.10 Page 11 During the last unannounced inspection the inspector had raised concerns with regard to the management of one residents’ behaviour. No evidence of a review by an appropriate clinical consultant was available at the time of inspection. A copy of a recent review assessment has since been sent to the Commission. Behaviour management procedures concerning the individual resident were discussed and found to be robust and clear. Methods of communication are an important issue at Ashclyst since individual residents needs and abilities vary and are particularly complex. This was well assessed and examples of support to provide individual residents with the information, assistance and communication needed to make decisions about their own lives were well documented. Equally, good and consistent communication support is given to residents about policies and procedures and a whole range of available services, including activities. This was well evidenced by providing the inspector with documents, which are accessible to residents specific communication needs and are available individualised and in suitable formats. The homes risk taking policy was scrutinised as part of this inspection and found to cover relevant guidelines. Risk assessments were seen to be part of individual residents plans and had been systematically reviewed. Ashclyst Version 1.10 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 17 The home enables residents to maintain appropriate and fulfilling lifestyles in and outside the home. EVIDENCE: There was good and well-documented evidence that residents were encouraged to participate in a range of activities held in the home. These were seen to be domestic activities including cookery, gardening and cleaning. The home also offered arts and craft activities as part of the residents’ weekly schedule. All of these programmes were set up to enable residents to develop practical skills. A member of staff interviewed was able to give good examples on how residents were formally integrated in domestic tasks to facilitate the development of these skills. All of the residents attend Resource and Activity Centres during the day. Activity schedules were seen for every resident and evidence for their involvement in occupational or educational activities was well documented in Ashclyst Version 1.10 Page 13 the respective timetables. Links with the local community were generally maintained through attendance at Resource and Activity Centres. Each Service User had been on holiday during the year. The home keeps folders with photographs taken during holidays for each of the residents. Families were able to visit whenever they wished. There was good anecdotal evidence and sufficient recording to deduct that families and friends are welcomed and their involvement in daily routines and activities is encouraged. A balanced and nutritious diet was offered although this was not reflected in the records maintained. This was also the view of the inspector who conducted the last unannounced inspection and the announced inspection on the 22nd of April 2005. A recommendation was made in both reports for the home to review the menu using appropriate nutritional guidance or assessment by a dietician to ensure a continuous/consistent supply of nutritious balanced meals. This recommendation is made again in this report. Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 The residents receive sensitive and flexible support and care. Arrangements to meet individual residents healthcare needs are excellent. However, continence management across the unit needs urgent revision. EVIDENCE: Ashclyst Version 1.10 Page 14 Each individual had a keyworker, who related closely to him and offered support in maintaining as much independence as possible. Individual working records set out preferred routines and likes and dislikes of residents. There was good evidence that the home works closely with advocates, family, friends and relevant professionals and that this is in the best interest of individual residents and with their consent. The inspector conducting the last announced inspection commended the home for ‘good practice’ in meeting the healthcare needs of service users. This view is echoed here. Recording of medical and health input including medical and general health review sheets was seen to be of a very good standard. Medication procedures were scrutinised and discussed with the assistant manager. No Service User was able to manage the administration of his own medications. Medications were stored appropriately and no Controlled Drugs were held at that time. The Medication Administration Records confirmed that the correct procedures were followed in the home. Continence Management if a major issue within the home and its ‘environmental impact’ is described in the relevant section of this report. NMS 19.2 recommends the home to help residents to gain access to up to date information to take control of and manage general health issues. In the opinion of the inspector this standard applies to the home as a whole in as much as there is a need for additional guidance relating to the adequate management of this issue. A point in case was found in the way bedding was arranged for one resident. Inadequate cover (no Kylie sheet, broken plastic sheet cover) had left the mattress to soak through and a more than unpleasant smell extended into the environment. The inspector felt this to be a wholly unsatisfactory situation. Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Ashclyst Version 1.10 Page 15 The home’s complaints and POVA (Protection of Vulnerable Adults) procedures are robust and sound and staff are aware of the different stages, time scales and other relevant processes involved. EVIDENCE: During the previous unannounced inspection no copy of the home’s complaints procedure was found. The policy was available for this inspection. In addition, the contact details for the Commission and an updated complaints procedure have now been included in the Service User’s guide. Details of how to contact the Commission and a procedure, which is in a user-friendly format, has also been made available to Service Users and their representatives. The action plan of the last inspection includes a statement promising a separate complaints procedure to be send to the Commission as required by the then inspector: A complaints procedure, which includes contact details for the Commission and is in a user-friendly format, must be available to Service Users and their representatives. This document is still to be sent. A Protection for Vulnerable policy was found in the home’s office. Good evidence was found that the Trust systematically trains its entire staff group on this topic. Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 30 Ashclyst Version 1.10 Page 16 The home manages to reasonably maintain the current premises. However, the home currently fails on a number of environmental issues including hygiene and control of infection. The home is in need of a thorough refurbishment. EVIDENCE: Regulation 24.6 requires the home (amongst other criteria which the home meets) to be airy, bright, cheerful, and free from offensive odours. In the opinion of the inspector and after an extensive tour of the premises the home does currently fall short of the above criteria and urgently needs to be completely refurbished and redecorated. In addition there was a strong odour in two of the bedrooms in spite of windows having been left open for some of the morning. This smell extended into some parts of the upstairs and downstairs hallways including communal areas. Infection control measures need an urgent re-assessment. Continence management protocols and handling procedures need revising. Domestic style appliances are hardly suitable to cope with the current demands made on them with most of the residents being affected. Temperature used by staff to wash contaminated clothing was generally far lower than recommended. The home is advised that the minimum recommended temperature for foul laundry is 65 degrees Celsius. In addition, the home has no sluicing facility although in the opinion of staff this would improve infection control measures considerably. Staff have to carry large amounts of contaminated laundry through the dining room to reach the utility room. The laundry facilities are positioned very close to the kitchen. Issues around the design of the home have been discussed with a previous inspector but procedural outcomes have not been recorded leaving staff without clear written guidance on how to transport contaminated laundry safely. Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. Ashclyst 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. Version 1.10 Page 17 35. 36. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35,36 Although the home was adequately staffed at he time of the inspection and rota arrangements were robust, concerns remain about the way the home manages high levels of staff sickness including an over dependency on bank and agency staff. EVIDENCE: Requirements and recommendations from the last inspection were discussed with a particular focus on staffing issues. An ‘Immediate Requirement’ had been made during the last inspection visit to improve on staffing levels. Subsequently, a major part of the inspection concentrated on staffing including a thorough analysis of the current rota and bank staff arrangements. Details of staffing rotas were sent to the Commission for closer inspection after this visit. The last unannounced inspection produced grave concerns about the homes staffing arrangements. The duty rota demonstrated that only one support worker had been on duty for several hours on the day of inspection and the preceding two days. An immediate requirement notice was served requiring that two staff were on duty during the day. The Commission has received a document dated 15th of December 2004 (on file) detailing the criteria for staff support relating to the amount of residents present at the home. The proposals outlined in this letter were deemed appropriate by the inspector who conducted the unannounced visit depending on risk assessments being updated on a regular basis. Overall, the inspector found a dedicated and experienced staff team. The nucleus of this team has been working together since the home was opened in 2001. Rota arrangements were inspected over a number of preceding weeks and found to be meeting residents needs. However, staffing margins are currently ‘cut fine’ (6 members of staff - 4 residents) leaving the home vulnerable when core staff are off because of sickness or holiday. This leads to an inappropriately high use of bank and agency staff. This view was confirmed during staff interviews as well as Relatives Comment cards. Staff were also Ashclyst Version 1.10 Page 18 less than complementary about the Trusts new bank staff arrangements and procedures. The efficiency of these new procedures will need to be the subject of future inspections. The decisions, to make the registered manager an acting ‘Area Manager’ and take him outside the home’s remit, as a manager of other services for some considerable part of his working week must be seen as ‘risky’ considering recent criticisms of the home. This remains the firm opinion of the inspector in spite of the reassurances of management. All permanent members of staff currently hold a NVQ (national Vocational Qualification) level 2 or above. Training records showed that the support workers all had achieved NVQ level 3 in Promoting Independence. One support worker was also an NVQ assessor. Previous inspectors commended the home for the 100 target rate of staff training achieved. This is to be congratulated. All the support workers have an annual appraisal and supervision sessions with the manager every month. Records for these were inspected and seen to be of a very high quality. All staff employment records were available at the home for inspection. This meets a previously made requirement. Ashclyst Version 1.10 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 42 The registered manager and his assistant demonstrate good leadership and management skills however; this needs to be evidenced by better internal quality assurance processes so that residents can benefit from an improving service. EVIDENCE: The registered manager holds an RHMH (Registered Nurse Learning Disabilities). He has completed the NVQ 4 Registered Managers award and holds additional qualifications as a ‘Positive Response’ trainer. The manager is very experienced and has worked in this field for many years. Staff interviewed were very complimentary about the high levels of support they were receiving and about the clear sense of direction and leadership he was providing for the team. Members of the staff group also confirmed that they felt enabled to voice concerns and that the management of the home was open and transparent. Ashclyst Version 1.10 Page 20 Standard 39 requires the home to develop self-monitoring and quality assurance systems using a formal, consistently obtained and verifiable method. Although the home does not have such a formal system the inspector acknowledges good internal processes for seeking residents views and choices. These include: • Regular reviews of individual life plans. • Staff meetings. • Staff personal development planning. • Essential life planning with residents. • Regular review of the home’s standards through an appointed visitor. The home has up to date policies and procedures relating to the promotion of the health, safety and welfare of its residents. However, in line with comments made throughout this report, infection control measures need to be assessed by a Health and Safety (Continence management) expert. 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 Ashclyst Score 3 3 3 x Standard No 22 23 ENVIRONMENT Version 1.10 Score 3 3 Page 21 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x 2 2 x x 1 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 2 Standard No 31 32 33 34 35 36 Score 3 4 2 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x 1 x Ashclyst Version 1.10 Page 22 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. 2. 3. 4. Standard 18, 19 24. 6 24. 6, 10, 12 18, 19, 30 42 Regulation 16. (c) 23 23 13, 23 Requirement The home needs to provide one specific service user with adequate bedding. The home needs to be kept free of odours. The home is in need of refurbishment and complete redecoration. The home needs to ensure that Health and Safety procedures are in line with ‘best practice’ for continence management. Expert advice needs to be sought and assessment sent to the Commission. Continence management needs better facilities including laundry and sluicing appliances. The practice of carrying soiled laundry through the dining room must be stopped. The registered person needs to ensure that the home has a sufficient number of staff. That a user-friendly quality assurance system is put in place. That risk assessments are reviewed regularly and that staffing levels in general are assessed on a regular basis to ensure that staffing levels in the Version 1.10 Timescale for action Immediate Immediate 1/01/06 1/10/05 5. 6. 7. 8. 9. 30 30 33 39 33 23 13, 23 18 35 18 1/10/05 Immediate Immediate 1/10/05 Ongoing Ashclyst Page 23 home meet the assessed needs of service users. 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 17 Good Practice Recommendations Review the menu using appropriate nutritional guidance or assessment by a dietician to ensure a continuous/consistent supply of nutritious balanced meals. Ashclyst Version 1.10 Page 24 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashclyst Version 1.10 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!