Inspection on 13/03/07 for Ashcombe Court

This inspection was carried out on 13th March 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashcombe Court 27/10/06

Ashcombe Court 10/02/06

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 Stephen Humphreys Unannounced Inspection 13 March 2007 09:30 th Ashcombe Court DS0000064879.V327073.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 Ashcombe Court DS0000064879.V327073.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. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashcombe Court Address 17 Milton Road Weston Super Mare North Somerset BS23 2SJ 01934 626408 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) ashcombecourt@tracscare.co.uk suehullin@tracscare.co.uk TRACS Tracey Jackson ( Acting) 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.V327073.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered manager to commence the Registered Manager’s Award by December 2005 27th October 2006 Date of last inspection Brief Description of the Service: Ashcombe Court is a care home providing personal care for up to seven persons with a mental health problem or learning difficulty. The care home is a large detached Victorian dwelling situated in a quiet residential area of the town with a garden to the front and an enclosed decked area for outdoor activities at the rear. There are four car parking spaces to the side of the property. The seven bedrooms are all single accommodation and include en-suite shower. The accommodation is over two floors reached by stairs. There is no lift facility, however the home has wheelchair access throughout the ground floor and two ground floor rooms suitable for clients’ who have impaired mobility. There is level access on each floor. The home is compliant with the Disability Discrimination Act. Communal facilities consist of a large sitting room, dining room, smoking room kitchen and laundry. Clients have open access to the kitchen but are supervised when using the laundry. The home is conveniently situated for local facilities such as shops, GP practice etc. Experienced carers who are able to support clients to access community facilities and pursue their social, vocational and leisure interests staff the home. The fees are £1800 to £2000.00 per week with additional charges being made for hairdressing, chiropody, non-therapeutic activities, reading materials, cigarettes and newspapers. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key inspection of Ashcombe Court Care Home using the Inspecting for Better Lives methodology introduced by the Commission for Social Care Inspection in April 2006. The inspection methodology used by the Commission for Social Care Inspection enables the inspector to make a judgement on the quality of the service delivery based on the outcomes for clients. The inspector visited the care home and assessed all of the key younger adult national minimum standards and had detailed discussions with clients, staff and the home manager. Prior to the site visit the inspector sent out survey and comment card to the three current clients and visiting health and social care professionals. No comments were received back from the visiting professional health and social care staff. The three current clients returned completed surveys with positive comments. “I feel very welcome at this home” and “I am happy and settled here” were two comments received. The trigger for this key inspection was to review the progress made in the delivery of care services to persons with a mental health problem following concerns made at the last inspection. During the site visit the inspector was able to spend time talking to staff and clients’. A tour of the home was made to assess and review the quality of the furnishings in the bedrooms. The internal environment at Ashcombe Court is homely, warm and well maintained. Since the last key inspection in October 2006 the registered provider and new manager have introduced changes and improvements to the overall service delivery in this care home. The manager has introduced changes in care practices that have benefited clients. The inspector observed person centred care delivered to clients. The evidence found during the site visit confirmed an improvement in service delivery. Following the site visit the Commission for Social Care Inspection was informed of a vulnerable adult issue in the home. Unfortunately the manager chose not to inform the inspector at the time of the visit. There was no record of any current concerns recorded in the complaints record. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Since the last inspection a new manager has taken up position in the home. The inspector was told that staff moral has improved under the new manager. The inspector found evidence through observation, reviewing care plans and records and talking to staff and clients that the home has moved forward in many areas. The significant improvement is that the manager is now visible and available to clients and staff. The ethos created in the home is one of openness and appears supportive. The home is run for the benefit of the clients. The staff have confidence in the manager and feel listened too. The operational systems and record keeping has improved since the last inspection. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Ashcombe Court DS0000064879.V327073.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 Ashcombe Court DS0000064879.V327073.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): 1,2,3,4,5. Quality in this outcome area is adequate Clients referred to Ashcombe Court will have adequate information about the care home to enable them to make an informed choice. Each client will be assessed and their individual care needs agreed before being accepted into the home. Prospective clients will be given the opportunity to visit and stay at the home for a short time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has updated the statement of purpose and service user guide since the last inspection. The information is specific to Ashcombe Court and identifies clearly the admission criteria for the home. The service user guide should also describe how the service will be delivered and some testaments to the service from clients. Clients confirmed during conversation with the inspector and through survey replies that they felt they had received adequate information about the home. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 10 The manager has now introduced longer trial visits by inviting prospective clients to stay at the home for up to a week, to enable them to make a choice. The assessment process of prospective clients has not changed since the last inspection. Prospective clients have a care needs assessment carried out by a senior officer of the company. Referrals of prospective clients are generally made through the care management approach, to the registered providers head office, with initial assessments being carried out by a multidisciplinary professional team. The registered provider’s assessment procedure includes a care needs assessment, from which the assessor decides which TRACScare home is suitable for the client. The outcome of this assessment is that the prospective client is given the names of suitable Tracscare, care Homes in the areas they wish to live. This practice may lead to inappropriate placements being made as has happened previously in this home. The assessment is then sent to the home manager, who will visit the client, and offer the client a trial stay. The manager at Ashcombe Court has introduced the process of involving the home staff, where they share information, views and opinions before accepting or not, the client. This is an improvement since the last inspection as the home tended to accept clients whose needs could not be met. The manager informed the inspector that before offering a place to the prospective client the home manager agrees the suitability of the client with the divisional manager and identifies any training needs for the staff. As no new clients have entered the home since the manager took up post this could not be evidenced. This may appear to be good supportive practice however the Commission for Social Care Inspection has some reservations with this system. The current procedure carried out by the registered provider places a large responsibility onto the home manager. The Commission for Social Care Inspection has some concern with this practice, as recorded in the last inspection report, due to the home managers lack of specific knowledge and skills in the assessment and identifying of specific and complex care needs in persons with mental health problems. The clients currently residing at Ashcombe Court all have a care management arrangement and the assessments were seen in their individual care plan. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 11 A further concern with the registered provider’s procedure is with the letter sent to prospective clients offering them a place. The letter appears to be sent to the prospective client following the assessment by the company assessor. The letter is offering a placement at the home, subject to availability. The letter does not identify the persons care needs or confirm whether the care home where the placement is offered can meet those care needs. The evidence confirms that the registered provider’s admission procedures are slightly remote from the home and do not involve the home manager at all stages. To promote a robust admissions process the registered provider should review the current system to include recorded documentation of the outcomes of meetings between the company assessors and the home’s management team. The registered provider needs to review the letter offering a placement to prospective clients to include the identified care needs and how the care staff in the home can meet those care needs. The letter should also include any identified support provided to the staff in the home by clinical specialists in mental health. The inspector reviewed the registered provider terms and conditions. A copy of the contract was found in each clients care plan, signed by the client and approved social worker. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Quality in this outcome area is adequate. Clients can be assured that they will have a care plan that identifies their care needs. Clients rights to make decisions is respected and limited through legal restriction processes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector asked permission of each client to review their care plan. The clients granted permission. The inspector reviewed the care plans in detail. Each care plan was a comprehensive record of the client’s history and care. Copies of the care management assessment, needs based assessments and identified care outcomes was recorded. The care plans were considered to be a working record used by the staff daily. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 13 The care plan contained all the necessary details of the client including the client charter and the confidentiality policy. The client had signed to acknowledge they had read and agreed with the care plan. The personal portrait described, likes, dislikes, hobbies, interests and included a life skills assessment. The care plan recorded the assessed care needs and included a monies handling assessment. Each plan included detailed risk assessments based on the clients need to be protected and kept safe. Risk assessments were recorded to support the locked door policy operated by the registered provider. The risk assessments described the need for safety of the client from outside sources. This appears conflictive in context as the registered provider should ensure the home is protected from outside sources through specific approved security measures. Two of the current clients in this home are prevented from venturing outside the home by orders under the Mental Health Act 1983. The locked door policy appears to confirm that currently this care home is a semi-secure unit. Two of the care plans recorded time out sessions in line with the restriction notice requirements. Records of hospital and other professional health care visits were recorded. The daily record was descriptive of the client / staff interactions and included social and care delivery. The care plan did not clearly identify the specialist care requirements or how they would be met. The care plan was presented in a format that was client friendly and could be understood by the client. The care plan was considered to be a working tool and could be used by all staff in the home. Two of the clients said they had read the care plan and understood the confidentiality policy. During the visit the inspector observed staff providing clients with information and support to enable them to make decisions. One client needed information and support to contact and sort out living allowances whilst another client was supported in a visit to the bank to sort out a problem. Staff accompany clients to the supermarket to support them in choosing food for their meals. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 14 As part of the risk management staff record the clothing worn by the client prior to them going out of the home. Clients complete a weekly activities sheet with their key-worker. The benefits to the client are, a structured plan of the day, activities do not conflict with others, clients benefit from personal time and the outcome is the development of self confidence. Clients confirmed to the inspector that they liked the way the home was run and felt involved. The care plans also detailed the agreed short term goals identified by the client. Short term goals recorded identified life style skills and building relationships along with accessing the community and to learning. Clients all said they felt well supported by the staff. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 15 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 adequate. The home manager has introduced a philosophy of care that enables clients to develop life skills. Clients are provided with opportunities to be involved with the local community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of this visit the inspector observed a one to one staff client ratio. This benefited the client as they were provided with time and support to meet their needs. Staff were aware of the client’s needs to develop self confidence and to be able to get back into community life. Staff support the clients’ through their weekly activities plan to promote independence and develop life skills. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 16 One client told the inspector that they like to make their own meals. Staff support them when in the kitchen. Another client is enabled to make snacks and another likes the staff to make the meals. All do the shopping to their choice. The weekly activities plan includes activities in the home and in the community. One client said they like to go out for walks. One client attends woodworking classes at the college. They proudly talked of the table recently made. One client is being supported to enrol onto a hairdressing course at the local college. Another client does occasional voluntary work locally. Evidence was found to suggest that clients are involved in meaningful activities of their own choice. Two clients who like playing their guitars had a jamming session with one of the support workers. The manager told the inspector that future plans included horse riding, bowling and swimming. The manager also wants all clients to have a holiday this year. The issue of holidays was discussed with the manager. The clients contract and the registered provider holiday policy was reviewed. The client service level agreement states: The fee also includes provision of a holiday up to a week’s duration, dependant upon individual client need: The fee is considered an all-inclusive fee to meet the client’s assessed needs and will only be subject to further payments by the client or funding authority with the agreement of all parties and in unusual circumstances e.g. special request holidays outside the norm. The registered provider client holiday policy states: TRACS will commit a budget of £200 to pay for the accommodation aspect of a client holiday. The policy is dated August 2005, and originally the stated TRACS would pay £474 towards the cost of accommodation. The policy also states: The normal holiday is up to three days. The client service level agreement identifies a holiday of up to a week duration however the norm considered by the registered provider is only three days. The registered provider has also reduced the amount they are will to pay for holiday accommodation by half since the policy was written. Given the costs of holidays in toady’s financial climate the registered provider does not appear to be acting reasonably in promoting clients well being by Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 17 encouraging them to take a quality holiday. Generally client holidays are taken in this country at known resorts. Clients are encouraged to help with the housework. Staff help clients clean their personal rooms. Each client has laundry day and is supervised when using the washing machines. All help to clean the communal rooms. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 18 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. Clients can not be assured that staff understand the need for personal support. The home has a robust medicine procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three clients currently residing at Ashcombe Court are self caring with regards to personal hygiene. The current client group do not require a lot of personal or intimate care. The staff on duty at the time of the visit appeared to understand the need for sensitivity and respect when assisting the clients with personal care. Clients said that they feel respected by all staff which is an improvement from the last inspection. Only one member of staff is experienced in counselling. Emotional support is provided in one to one sessions with staff for two clients daily. This gives the clients an opportunity to discuss any concerns or fears they are experiencing. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 19 However as only one member of staff has received appropriate training in counselling the skill level of the support worker in providing emotional and psychological support is limited. Clients are able to receive emotional and psychological support provided by the health care professionals at hospital visits. Staff have information about contacts if urgently required in a crisis situation. Clients informed the inspector that “they do a good job here” in relation to their confidence in the staff. Clients have access to local health services and visit the surgery to see their GP’s if needed. The inspector reviewed the staff training records. There did not appear to be any importance placed on providing opportunities for staff to attend courses in health care or psychological support subjects. There is a detailed medicines policy and procedure. All care staff have received appropriate medicine training. The inspector reviewed all the medicine administration records. No issues were found to give concern. The local pharmacist had recently conducted a medicine inspection in the home. The requirements made were: To update the homely remedies policy. To install a new medicine cupboard suitable to store blister packs. The storage of medicines is not conducive to good practice. Each client has a small locker for their medicines. The “when required” medicines are stored in a filing cabinet at floor level. The situation of this cabinet appears to constitute a health & safety risk to staff, due to their having to bend down very low in a confined space. The registered provider is encouraged to acquire a suitable wall mounted drug cupboard to meet the British standard requirements. The manager carries out weekly drug audits as part of the homes quality assurance procedure. Each client also has an anti-psychotic medicine side effect chart that is completed. Each client has a self-medicating assessment completed and filed in their care plan. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 20 Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 21 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 Clients can be assured that any concerns they had would be investigated thoroughly. Staff have a good knowledge and understanding of the forms of abuse however the correct procedure is not always followed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Clients feel they are always listened to and their needs or wishes understood. During the last twelve months seventeen concerns had been recorded in the homes complaints record. All but two concerns were voiced about a previous client who no longer lives in the home. All the current clients told the inspector they get on with each other and have no complaints. They did know who and how to make any concerns known. The home has a detailed complaints procedure, a copy of which is displayed in all clients’ rooms, the statement of purpose and policy folder. The policy does not provide the Commission for Social Care Inspection address for Somerset. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 22 Staff could identify forms of adult abuse and all said that they would challenge and report any poor practice. The vulnerable adult polices were available to staff and kept in the managers office. Following the site visit the inspector was informed by the local authority vulnerable adults lead that a vulnerable adult strategy meeting was being arranged as a client in the home had made an allegation of abuse. It is concerning that the home manager chose not to inform the inspector of the allegation at the time of the site visit. The procedure on vulnerable adult actions is clear however the manager did not follow the correct procedure and inform the Commission for Social Care Inspection. The inspector contacted the manager post visit to discuss the incident. The manager confirmed that the incident was referred to senior management who decided to carry out an internal investigation. The actions taken by representatives of the organisation are not in line with the vulnerable adults procedure as agreed by the multidisciplinary agencies and registered care homes. The registered provider must follow approved vulnerable procedure at all times. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 23 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): 24,30 Quality in this outcome area is excellent. The internal and external environment is well maintained. The care home is clean, warm and homely with good quality furnishings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered provider and manager ensure that the environment of the home provides for the individuals requirement. Clients are encouraged to personalise their rooms. The manager and staff ensure the communal rooms are furnished with good quality furniture and homely. The registered provider employs a maintenance person who visits the home weekly and carries out routine maintenance. The home is well decorated and gives the feeling of calm and warmth. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 24 The communal rooms are available for clients and staff to gather and socialise in safety and comfort. The outside is decked with areas to sit in good weather. The kitchen and laundry are clean and safe. The laundry is kept locked and one of the fridges. The toilets and showers are kept clean and accessible. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 25 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. The manager is attempting to establish a stable staff group to meet the needs of the clients. Clients cannot be assured that the staff group have the experience or skills to meet all their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken to appeared knowledgeable about the clients care needs and their respective lifestyles however due to the vulnerable adult investigation going on at present it would appear that not all staff employed are skilled or experienced in this client group. Clients comments included “staff are very good and helpful”, “ they are doing a good job” The clients will benefit from a staff group that works together as a team. Staff said “ moral has improved since the new manager took over”. “ The manager is visible and open”. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 26 The staffing rotas were viewed on the day of inspection. The rotas demonstrated that there were adequate staff on duty. Staff training records viewed showed that staff had received all mandatory training but did not show training in physical or health subjects. Staff spoken to during the inspection stated that they felt adequately trained in order to fulfil their role. The recruitment files of the most recent staff members were inspected these demonstrated that the homes recruitment procedures were in line with good practise guidelines and included CRB and POVA checks. . Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 27 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): 37,38,39,42. Quality in this outcome area is good. Clients and staff benefit from a manager who provides clear direction to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager prioritises training in line with the organisations objective. All current care staff have either obtained or are in the process of obtaining an NVQ in health and social care. Unfortunately the registered provider does not appear to include specific training and development courses for staff in caring for persons with a mental health problem other than the studio three training. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 28 Training on subjects such as psychosis and schizophrenia are beneficial however clients would benefit from staff skilled in delivering emotional and psychological support. Comments from most health professionals indicate confidence in the manager and her team although the level of skill in some is concerning other health and social care professionals. The manager and her deputy are very visible in the home carrying out quality audits and spot checks to measure the delivery of service. The inspector observed carers carrying out social care during the visit on a one to one basis. The manager ensures staff follow the procedures and policies and carries out monthly quality audits to measure the outcomes. Staff confirmed they can be open at staff meetings. They felt that the supervision sessions were open and could voice any concerns they had. They felt the manager would provide support and assistance for them. One member of staff said “we would jump over a hoop for her” The manager confirmed that one member of staff was needing monthly supervision sessions. All the statutory records were checked and only found the emergency lighting records incomplete. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 29 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 2 3 2 4 3 5 2 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 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 3 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 2 x 3 X 3 X X 2 x Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 30 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 YA20 Regulation 13(2) Timescale for action The registered person shall make 30/04/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This refers to the need for appropriate storage of medicines in a suitable cupboard. The registered person shall make 30/04/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This refers to the protection of clients from all forms of abuse or potential abuse. 3. YA32 18.1 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users— 30/04/07 Requirement 2. YA23 13(6) Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 31 (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; This refers to the need to review the work force skills and experience and provide a competent and balanced staffing level with skills and experience to meet all needs for the health and welfare of clients. 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. Refer to Standard YA1 YA2 Good Practice Recommendations The service user guide should describe how the service will be delivered and some testaments to the service from clients. To promote a robust admissions process the registered provider should review the current system to include recorded documentation of the outcomes of meetings between the company assessors and the home’s management team. The letter should identify the persons care needs and confirm the care home where the placement is offered can meet those care needs The registered person should ensure the individuals care plan clearly sets out how the specialist requirements would be met. 3. YA5 4. YA6 Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 32 5 YA19 The registered provider should promote staff development skills in emotional and psychological support to clients. Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. Extracts may not be used or reproduced without the express permission of CSCI Ashcombe Court DS0000064879.V327073.R01.S.doc Version 5.2 Page 34 - 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!