Inspection on 10/02/06 for Ashcombe Court

This inspection was carried out on 10th February 2006.

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

The inspector found 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

Ashcombe Court 13/03/07

Ashcombe Court 27/10/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Ashcombe Court 17 Milton Road Weston Super Mare North Somerset BS23 2SJ Lead Inspector Patricia Hellier Unannounced Inspection 10th February 2006 09:00 Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 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 Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 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. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashcombe Court Address 17 Milton Road Weston Super Mare North Somerset BS23 2SJ 01792 459 571 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) TRACS Ms Melanie De Nobrega Care Home 7 Category(ies) of Learning disability (7), Mental disorder, registration, with number excluding learning disability or dementia (7) of places Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered manager to commence the Registered Manager’s Award by December 2005 New service Date of last inspection Brief Description of the Service: Ashcombe Court is an adapted Victorian building providing residential care for men and women with mental health problems and / or learning difficulties. The home is situated in a quiet residential area of the town with a garden to the front and an enclosed decked area for outdoor activities to the rear of the home. The accommodation is on two floors. There is no lift facility, however the home has wheelchair access throughout the ground floor and two ground floor rooms for service users who have impaired mobility. There is level access on each floor. The home is compliant with the Disability Discrimination Act. The home can accommodate 7 residents and all have single rooms with ensuite facilities. Communal facilities consist of a large sitting room, dining room, smoking room and access to the kitchen under supervision. The home is conveniently situated for local facilities such as shops, GP practice etc. Staff support residents to access community facilities and pursue their social, vocational and leisure interests. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours on 10 February 2006. The Registered Manager, Melanie de Nobrega, was not present for the inspection. All residents and members of staff on duty also took part in the inspection. The inspection focussed on the residents’ experience of the home; the care given and the way in which it is provided, to make sure residents are comfortable and care is being given to meet their needs in the best possible way. The inspector checked the medication and fire records, inspected 2 resident care files and 3 recruitment files. She read through the home’s policy and procedure files. Both residents, and four members of staff were spoken with during the inspection. What the service does well: What has improved since the last inspection? What they could do better: The assessment of resident’s needs and matching to the provision of the home, needs to be more robust, to prevent unnecessary disruption to individual residents and others in the home. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 6 The management structures when the manager is off duty need review to ensure robust and experienced management for the benefit of residents. Staff selection needs to take into account the needs of residents and the experience of the staff in this area. Staff training and induction requires development to ensure adequate provision proportionate to the employees experience and the job required. Residents experience of the home is that they feel unsafe at times with some staff thus staff training and supervision is needed. There is no homely remedies policy and this should be developed in conjunction with the local GP’s. Hand written medicines, on the medication administration sheet, do not have two signatures Some fire doors were ill fitting and potentially putting residents at risk. These need attention to make safe. No evidence was seen of regular testing of fire alarms and practices and staff have not received fire training. This is necessary to ensure the safety of the residents. 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. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 7 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 Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 8 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 the following standard(s): 1,2,3 The Residents’ guide is comprehensive and provides prospective residents with information to make an informed choice. The home’s assessment process is thorough but does not always ensure that it is able to meet residents’ needs. EVIDENCE: Residents are provided with a comprehensive Service User’s guide containing the Statement of Purpose and all the information required to ensure they or their relatives have access to the relevant information at all times. Care records inspected contained assessments from various members of the multidisciplinary team, but no specific assessment documentation showing how the home can meet the identified needs. Consideration needs to be given to the experience of the staff team and their ability to meet resident’s needs. Both residents said, “the staff do not understand me”. “The manager is good”. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 6,7,9 Service users benefit from care plans that are clearly written and provide information to meet some of the residents’ health and social care needs. Residents make decisions about their own lives sometimes assisted by the staff Personal and environmental risks were observed to be well managed but with inconsistent documentary evidence to support practice. EVIDENCE: Individual records are kept for each of the residents and inspection of the records for both residents contained some personal and environmental risk assessments to ensure the safety of the resident while promoting independence as able. The inspector was informed of one resident whose personal risks are not well managed and reflect unsafe practice. The care plans identified health and social care needs and actions to meet these needs. However key information and developments in care needs had not been clearly documented to ensure staff awareness and continuity of care for residents. The interactions of the care staff observed demonstrated respect for individuals and their right to privacy. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 12,13,15,16,17 Staff enable residents, as required, to access leisure activities. There was no evidence of management of personal development or goals. Residents right to choice and control over their lives are well respected and encouraged to the point of being unsafe. EVIDENCE: Residents do not have any daily routines. Activities are chosen on and ad hoc basis and staff assist as required. Some trips out are planned. Residents and are assisted to make use of community facilities such as pubs, bowling, cinema and local events. Where able they are encouraged to help with some basic household chores. Friends and relatives are welcomed in the home. Menus showed a varied, balanced and nutritious diet, however more healthy eating options would be beneficial in helping meet residents identified needs. Evidence of personal preferences was seen in care records in that one resident is refusing to eat at the home. There was no action plan to deal with this issue. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 18,19,20 Residents right to choice and control over their lives is well respected, and encouraged. Physical and emotional health needs are recognised but not fully met. The system in place for the management of medicines is unclear and does not provide for the safe storage and administration of medicines. EVIDENCE: During the inspection the relationship between residents and staff appeared to be one based on mutual respect. However one resident was seen sitting in the sitting room doing nothing for most of the inspection. Comments from the residents stated they “are frightened at times”, “nice house and good manager but don’t like the staff”. Care records inspected showed that residents healthcare and well-being is reviewed monthly. Physical and emotional health needs were well recorded however actions to meet these needs were not well described or appropriate actions documented. Discussion with staff revealed a lack of knowledge and experience to decide appropriate actions to meet the identified needs. The other members of the Multidisciplinary team were reported as being unhelpful in supporting the home to plan actions to meet physical and emotional needs while maintaining the residents safety. The home’s duty of care to residents needs to be more fully understood and clear boundaries identified with residents in their care plan, for the maintenance of their safety. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 12 The home uses the Monitored Dose System of medication administration however it was not being used correctly as MAR sheet entries and medication cards did not tally. This is unsafe practice and an immediate requirement was issued. Hand transcribed prescriptions were seen and these had not been signed by two members of staff when written, thus not providing the recommended safeguard for residents. Homely remedies are stocked and administered but there are no policy guidelines developed with the local GP’s to ensure the safety of residents. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 22,23 Residents do not feel they are listened to and their needs or wishes understood. Staff have a good knowledge and understanding of the forms of abuse but are not fully aware of the local policy for handling abuse issues. EVIDENCE: The home has a detailed complaints procedure, a copy of which is displayed in all residents’ rooms. There have been no complaints. Residents indicated that they were not happy and did not feel the staff always listened if they voiced any complaints or concerns. Residents and staff spoken to, say the manager is very approachable, listens and seeks to address issues. Staff could identify forms of adult abuse and all said that they would challenge and report any poor practice. Staff said they had not seen any signs of abuse in the home. The home has a policy for responding to allegations of abuse however it does not include reference to the local ‘No Secrets’ policy and procedures. One resident is potentially at risk due to staff inexperience and lack of support from other professionals involved in the resident’s care. Her needs are not being appropriately managed or met. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 24,30 Residents are provided with safe, comfortable surroundings. Outdoor space is attractive and accessible for residents to enjoy. Control of infection practices and facilities in the home to prevent cross infection are sufficient and suitable. EVIDENCE: The property is well maintained, with homely and comfortable communal spaces. The living accommodation is well decorated and homely. Residents’ rooms are personalised and comfortable with some having been decorated to resident’s choice. Communal lounges are well equipped with TV and video, and a variety of board games. The home was clean and free from offensive odours throughout. The laundry facilities were well organised. Staff interviewed and observed demonstrated good understanding of Infection control procedures and practices and maintained a clean and hygienic environment. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 There is a high staff resident ratio. Skill mix and competence does not always provide sufficiently to meet residents needs. Staff access external and internal training to ensure training is matched to the residents needs. EVIDENCE: This is a new home and staff team. Staff to resident ratio is high at present to provide support and enable staff training. Staff appear well motivated and keen to develop knowledge and competence. The staff team appears young and lacking in experience to deal with the type of residents in the home. The manager is encouraging staff to access training and achieve the qualifications to meet residents’ needs. Staff spoken with confirmed there are regular opportunities for training. Notices about forthcoming training days were seen. Topics for these days were ‘Autism and Asperger’s syndrome’, ‘Mental Health Issues’, ‘Seeing it from the Client’s perspective’. There was no training and development plan for the staff team as a whole or individuals. Staffing rota’s inspected showed adequate numbers on duty to meet resident’s needs but poor skill mix of experienced and new staff. Recruitment procedures are robust. Files inspected contained all the required information and necessary safety checks had been completed. All staff interviewed stated they had contracts of employment and job descriptions. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 16 Newly appointed staff confirmed there is an induction programme but little evidence of completion was seen. Staff interviewed told the inspector that they had not yet covered some of the key induction points. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,42 The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment when on duty. When the manager is not in the home there is little leadership and management giving rise to a potentially unsafe environment. EVIDENCE: Residents and staff spoke highly of the manager’s leadership qualities and abilities. Residents said, “the manager is good, she listens”. On the day of the inspection the manager was not on duty in the home and the staff team while very welcoming did not give the impression of being in control of the home. Records indicating whether regular safety and fire checks are carried out were not available. Some staff spoken to said they had not received fire training and drills had not taken place. Some wedged open fire doors were seen and these had not been risk assessed. Two other fire doors were seen to be illfitting and requiring attention. Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 1 X 3 3 X X X 2 X Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 19 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 YA6 Regulation 15 Requirement To provide a written and appropriate plan of care as to how all identified care needs are to be met To make proper provision for the care, treatment, education and supervision of residents To make arrangements for the safe receipt, handling, administration storage and disposal of medicines in the care home. An Immediate Requirement was issued To safeguard residents in the home by addressing current residents anxieties and ensure the home is a place where all residents feel safe To seek the advice of the fire safety officer in regard to best management of propped open and ill fitting fire doors. To ensure all staff receive fire training on induction and at regular intervals. Timescale for action 30/03/06 2 3 YA19 YA20 12 13.2 30/03/06 11/02/06 4 YA23 13.6 30/03/06 5 YA42 23.4 20/03/06 6 YA42 23.4 20/03/06 Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 20 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 2 3 Refer to Standard YA2 YA7 YA18 Good Practice Recommendations To provide clear evidence of assessment of needs and hoe the home can meet these needs. To keep records of individual choices showing how residents are supported by staff and the use of limitations to prevent self harm or self neglect. To ensure personal support is given in the preferred way through planned routines and boundaries, (as stated in care plans) and the inclusion of members of the Multidisciplinary team. To provide training for staff to ensure residents can feel their concerns and complaint are listened to in a nonjudgemental way. To review the work force skills and experience and provide a competent and balanced staffing level for residents. The provision of a staff training programme to ensure staff have the knowledge and skills to meet the changing residents needs and the aims of the home To appoint a responsible person for the health and safety issues in the home. To provide first aid training for staff to ensure someone with this knowledge is on duty at all times. 4 5 6 7 8 YA22 YA32 YA35 YA42 YA42 Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Ashcombe Court DS0000064879.V280907.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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