Inspection on 27/10/06 for Ashcombe Court

This inspection was carried out on 27th October 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 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 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 Patricia Hellier Unannounced Inspection 27th October 2006 11:45 Ashcombe Court DS0000064879.V318978.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.V318978.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.V318978.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) suehullin@tracscare.co.uk 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.V318978.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 26 July 2006 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 residents’ 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. The provider makes information available through a brochure about the home. CSCI reports are available to read on request. The fees are £1600 upwards per week with additional charges being made for hairdressing, chiropody, non-therapeutic activities, reading materials, cigarettes and newspapers. This information was provided in October 2006. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place over 6 hours with the temporary manager present throughout. Before the inspection the information about the home was received from the pre inspection questionnaire. It was not possible to send comment cards to residents, relatives and Health Care Professionals that visit the home as the information requested was not supplied to CSCI, as requested prior to the inspection. The last 3 inspection reports were reviewed together with all correspondence and complaints since the last inspection. Since the last inspection CSCI has received one complaint regarding poor management of the home. This was upheld and the manager together with her deputy were investigated and either dismissed or resigned. Two other members of staff also resigned at this time. During the course of this investigation an allegation of abuse by care staff was received. This was investigated and not upheld. The accumulated evidence for this report comes from the above and also fieldwork that included the following: discussions with all 5 residents, 2 relatives and 7 staff, observation of practices, tour of the premises, review of documents relating to care, recruitment, health and safety; review of policies; inspection of medication records and storage. The relatives spoken with said that their relative had only been at the home a short time, but they “felt the care was adequate” and the staff were “getting to know their relative slowly”. The relatives said they felt welcomed when they visit and encouraged to feel at home. Comments from residents were “the home is ok”, “staff are not always around to help in the way needed”. What the service does well: The home has a welcoming atmosphere, is bright and airy and well decorated. The staff seek to ensure the well-being and comfort of the residents’ and treat them with kindness. The home is kept clean and tidy with a supply of resources for a variety of indoor activities should residents want these. Craft and art materials are also available. Staff support residents to access facilities in the local community. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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.V318978.R01.S.doc Version 5.2 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.V318978.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Residents’ guide is comprehensive and provides prospective residents with information to make an informed choice. The assessment process by the company is thorough but does not always ensure that the home is able to meet residents’ needs. Prospective residents and relatives are encouraged to visit the home to assess suitability. 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. Prospective residents are assessed by a company representative and matched to the aspirations of the home, which is not necessarily possible for the home at the time, e.g. the potential for a resident to abscond is managed by a locked door policy, which is in breach of the Human Rights Act (1998), thus it would imply that currently the home is not able to meet the needs of residents with such tendencies. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 9 Consideration needs to be given to the experience of the manager and staff team and their ability to meet resident’s needs, also the needs of other residents in the house, prior to acceptance in the home. A comprehensive assessment from the company representative was seen for a recent resident admitted to the home, however the home is struggling to meet the resident’s needs and this is affecting other residents. Prospective residents are encouraged to visit the home and then stay overnight for a few occasions before moving into the home. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 10 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): 6,7,8,9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service users do not benefit from care plans that are clearly written and provide information to meet the residents’ health and social care needs. Residents make decisions about their own lives, sometimes assisted by the staff Personal and environmental risks are managed in a reactive manner and not in a planned, risk assessed way. EVIDENCE: Individual records and care plans were not available for two of the residents during the inspection. These residents had been at the home for more than 2 weeks and had also visited the home on a number of occasions for overnight stays. This lack of care planning and recording of key information for residents is a breach of the Regulations. An Immediate Requirement was issued for these to be put in place within five days. A third resident’s records inspected did not contain all relevant information, was not signed by the resident and had only one general risk assessment Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 11 about behaviour, completed by the company’s Clinical Support Nurse who visits the home occasionally. Other assessment documentation giving a score was present but had no explanation. This indicated that the care plan was not a working document for the provision of care to meet the resident’s needs. Staff interviewed were not aware of all the identified needs in the care plan for this resident, or the risks and how to manage them. Resident’s goals had not been recorded and residents spoken with said this had not been discussed. Activities for residents are discussed and planned at the beginning of the week and recorded for each resident on a notice board in the dining room. The inspector observed residents being asked if they wished to pursue this activity or offered an optional choice. One resident said, “I don’t get out much”. Staff interviewed felt that things had gone awry for residents’ recently as life in the home is very unstructured. The interactions of the care staff observed demonstrated respect for individuals and their right to privacy. Staff interviewed spoke of the need to keep residents safe and therefore do not encourage residents to take risks. Residents would benefit from staff that have received training in assessing and managing risks. E.g. one resident was becoming agitated about making a phone call and the reactive management was to give them a phone to make the call rather than following the care plan. This put pressure on the team and gave the resident mixed messages regarding their care. Residents are not encouraged to have an independent lifestyle as systems and practices in place mean they have to ask staff for cigarettes and to enter or leave the home as all doors are locked, and only staff have a key. As mentioned in the previous section this is a breach of the Human Rights Act. One resident said, “it’s ok here, it’s better than hospital anyway”. Residents spoken with said they were not involved in the decisions of the home, saying, “the staff do that and tell us”. It was observed that the more vocal and aggressive residents took up the staffs’ time to the detriment of the care of the quieter residents. One resident said, “staff have left me all morning, no one came to see if I was alright”. Staff commented they “felt one residents mental health was deteriorating because of the above”. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home does not provide opportunities for residents to pursue personal development. Residents are encouraged to be part of the local community, and engage in appropriate leisure activities. Resident’s rights are not always respected in everyday life. Residents are not always offered a healthy diet and do not take part in the preparation. EVIDENCE: There is no evidence that the home encourages and supports residents in pursuing or maintaining personal development in any way. Staff were not observed assisting residents in the home to improve personal skills such as cooking. Preparation of lunch was done for each resident and left on a plate to be given to him or her as they asked for it. One visiting member of staff said “it’s very chaotic with everyone having lunch when they want, but I suppose it Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 13 gives them choice”. One resident attends gardening and woodwork classes for something to do, but it has not been discussed as a possible area for personal development or with a view to being able to be part of a workforce at any time. Care plans for other residents do not identify areas for personal growth or development. One resident told the inspector that she likes to do craft work, however none of it was displayed in the home and she said “she only did it for her amusement”. Leisure activities continue to be agreed by the residents on a weekly basis. These include outings into the community for residents, e.g. swimming, meals out, trips to the pub and shopping. Activities and outings for residents on the day of inspection appeared rushed and of short duration. Residents and staff told the inspector that relatives are welcomed at the home, although none were seen during the inspection. Relatives of one resident were contacted by telephone, they confirmed that they are welcomed at the home and can visit at any time. Residents spoken to said, they felt staff and other residents in the home did not always respect their rights. The meals provided according to the menu are balanced and nutritious. The lunch time meal being provided on the day of inspection, mini pizza’s and bread and butter did not appear balanced and of good nutritional value. The inspector noticed that there was some fruit on the dining room table. The fridge was inspected and did not contain much food and no fresh vegetables were seen. The temporary manager and a member of staff said they were going shopping later in the day. This has been noted on previous inspections and gives concern to the quality and amount of food provided. One relative said that she takes food for her relative, as she likes things that are outside the homes budget, being vegetarian. She did say that the home does provide fresh vegetables quite often. Residents are able to make hot drinks when they want. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 14 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 poor This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer. Rights to choice and control over their lives are respected in some areas. Physical and emotional health needs are recognised but not fully met. The system in place for the management of medicines is poor, and places residents at risk. EVIDENCE: Residents spoken to felt the care they receive is satisfactory. Residents indicated that preferences had been considered but not always able to be carried out due to staffs’ time. Staff interviewed showed an awareness of the emotional needs of residents, but did not feel they always had either the time, skills or support to meet these needs for residents. One resident told the inspector they felt “down and in pain and could do with some one to talk to, but staff have just left me”. The resident was observed sitting in the lounge on her own. Later the inspector heard a conversation between staff and the temporary manager in which the resident was discussed. Staff seemed keen to met the needs but at a loss as to how best to do that at this point in time. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 15 Care records inspected were poor (see section 2) and did not show reviews of residents’ health and well-being. Physical and emotional needs were clearly recorded on the multidisciplinary assessment documentation but this had not been incorporated in to a care plan. In discussion with the temporary manager the inspector was told that he had recently had a meeting with staff regarding this. The home has a “read and sign” file to ensure communication of important issues to staff. In this file there was a record of a conversation with one resident regarding their needs which had not been signed, or included in their care plan, and another entry recorded details regarding an aspect of care for a different resident this had not been dated or signed and did not clearly identify needs or actions for care staff to follow. Staff had signed to say they had read these documents and when interviewed had some knowledge of them. Discussion with staff revealed a lack of knowledge and experience to decide appropriate actions to meet the identified needs of residents. 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. The home uses the Monitored Dose System of medication administration however it was not being used correctly as Medication Administration Record sheet entries, and medication cards did not tally and there was no audit trail possible for medicines entering and leaving the home. This is unsafe practice and an Immediate Requirement was issued for systems to be reviewed and changed within 4 days, for the protection of residents. Hand transcribed prescriptions were seen and these had not been signed by two members of staff when written, thus not providing the recommended safeguards 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.V318978.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents do not feel they are always listened to and their needs or wishes understood. Staff have a good knowledge and understanding of the forms of abuse and are 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. Since the last inspection there has been one complaint about poor and abusive management at the home. This complaint was investigated and upheld. One member of staff was dismissed and another 3 resigned. There has also been an allegation of abuse from staff to a resident. This was fully investigated and not upheld. Residents indicated that they were not happy at times and did not feel the staff always listened if they voiced any complaints or concerns. Residents and staff spoken to, have been unsettled by the recent management and staffing issues and changes; and also by some of the other residents. Staff could identify forms of adult abuse and all said that they would challenge and report any poor practice. Staff said the atmosphere in the home had improved since the last inspection, and residents reported they no longer felt frighten by staff. The home has a clear policy for responding to allegations of abuse. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 17 One resident is potentially at risk due to staff inexperience and lack of support from other professionals involved in the resident’s care. His needs are not being appropriately managed or met. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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.V318978.R01.S.doc Version 5.2 Page 19 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): 31,32,33,35 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staff resident ratio is satisfactory Staff roles and responsibilities are not clear Skill mix and competence does not always provide sufficiently to meet residents needs. The procedures for the recruitment of staff are not always robust to provide safeguards to protect residents Staff access external and internal training as able EVIDENCE: The staff team are currently not at full complement. Recent difficulties and changes in the staff team have lead to a blurring of roles and responsibilities for staff which has affected the care for residents. The home has a temporary manager and staff that are supplied from other care homes in the company to ensure adequate numbers. This dos not provide for continuity for residents, or clarity of roles and responsibilities for permanent staff. The inspector was told a new permanent manager is starting next week. The staff team and temporary manager appeared lacking in experience to deal with the type of residents in the home. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 20 Staff interviewed said they felt “the home should be a good home as most of the staff are good and keen to learn”, but it lacks clear leadership and management. Staff expressed concern that the home is very chaotic at present due to lack of clear leadership and teamwork from management. Recruitment practices for new staff employed are not always satisfactory. One new member of staff worked unsupervised before her completed Criminal Record Bureau check was received, potentially putting residents at risk. Other required recruitment documentation had not been obtained prior to commencement of employment. Staff induction is planned, but in practice is poor, with one new member of staff being left on their own with residents, and no previous experience in care. Staff interviewed spoke of recent training courses they have attended in Manual Handling, First Aid, and Communication Skills. Staff appear well motivated and keen to develop knowledge and competence. Some wish to undertake NVQ training but said this seems “to have been shelved due to the recent management problems” at the home. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 21 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): 37,38,39,40,41,43 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The management of the home is poor, lacking in clear leadership, guidance and support for staff. Residents’ views are not sought and quality monitoring within the home does not take place. The homes policies and procedures are clear for the protection of residents but they are not always followed to safeguard residents, but these are not always followed. EVIDENCE: The temporary manager has been seconded from the company’s fast track management programme. On the day of the inspection the home appeared to lack clear leadership and organisation, with care for residents being provided in a reactive manner. It appear to be crisis management and fire fighting with all Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 22 interventions providing care and support for residents being in a rushed manner which did not adhere to policies and protocols in the home. The registered manager when not with the inspector was not visible in the home but was observed to stay in the locked office at the back of the home. This did not make for open and accessible management, and there was no clear rationale for the door being locked when someone was in the office. When staff requested help he did respond and went to assist them, e.g. when one resident needed to be taken to an appointment. Staff were observed congregating in the kitchen and not being around in the main communal areas of the home. Poor practice was observed in the management of monies for residents and petty cash. This was another example where situations had not been planned for and managed, thus the handling and recording of monetary transactions was not in accordance with the homes policies and safe practices. All policies and procedures required by regulation were up-to-date, well maintained and available for inspection. Records required to be kept were of a poor standard and did not provide necessary information for the protection and care of residents. Staff interviewed did not feel well supported by management, and that they were giving minimal care to residents due to pressures on staff and lack of knowledge and skills to meet residents needs. All members of staff said they liked working at the home, but had found the recent months very difficult. Three members of staff said they had at times been asked to work beyond their capabilities. Staff said they were looking forward to having a new permanent manager and hoped things would improve. Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 23 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 1 3 2 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 1 33 2 34 X 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 2 2 X LIFESTYLES Standard No Score 11 2 12 1 13 3 14 3 15 3 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 1 X 1 1 X 2 1 X X Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 24 YES 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 YA2 Regulation 14 (d) Requirement The registered person shall not provide accommodation to a service user at the care home unless: (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. This relates to the assessments being done by someone who does not know the home, its residents and staff capabilities Timescale for action 12/12/06 2 YA6 15 Unless it is impracticable to carry 01/11/06 out such consultation, the registered person shall, after consultation with the service user or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. This relates to the lack of care plans for 2 residents and incomplete care plans for another resident. DS0000064879.V318978.R01.S.doc Version 5.2 Page 25 Ashcombe Court 3 YA7 12.2 Previous timescales of 12/06/06 and 30/09/06 not met Immediate requirement issued The registered person shall so far as is practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. Previous timescale of 30/09/06 not met The registered person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. This relates to the need to assist residents to find or take part in valued and fulfilling activities according to their wishes. Previous timescale of 30/09/06 not met The registered person shall ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. This relates to the locked doors to the home and the need for staff to open any door for residents to get in or out of the building. DS0000064879.V318978.R01.S.doc 12/12/06 4 YA12 12.1 30/12/06 5 YA16 13.7 12/12/06 Ashcombe Court Version 5.2 Page 26 Previous timescale of 15/09/06 not met 6 YA16 12.4(a) The registered person shall make 20/12/06 suitable arrangements to ensure that the care home is conducted: (a) in a manner which respects the privacy and dignity of service users. Previous timescale of 30/09/06 not met Te registered person shall ensure 12/12/06 that the care home is conducted so as: (a) to promote and make proper provision for the health and welfare of service users. This relates to the physical and emotional health needs of residents The registered person shall make 31/10/06 arrangements for the recording, handling, safekeeping, safe administration, and disposal of medicines received into the care home. Immediate requirement issued The registered person shall, 20/12/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users (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. Previous timescale of 30/09/06 not met The registered provider and the registered manager shall, having DS0000064879.V318978.R01.S.doc 7 YA19 12.1 8 YA20 13.2 9 YA32 18.1 10 YA37 10.1 20/12/06 Ashcombe Court Version 5.2 Page 27 regard to the size of the care home, the statement of purpose and the number and needs of service users carry on or manage the care home with sufficient care competence and skill. Previous timescale of 30/09/06 not met 11 YA38 12.5 The registered provider and 20/12/06 registered manager (if any) shall, in relation to the conduct of the care home: (a) maintain good personal and professional relationships with each other and with service users and staff. This relates to the manager being in the locked office for the most part The registered person shall 20/12/06 ensure that all records are (a) kept up to date This relates to the care plans and poor records of cash transactions 12 YA41 17.3 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 4 5 Refer to Standard YA8 YA9 YA11 YA17 YA18 Good Practice Recommendations That residents’ are offered and encouraged to participate in the day-to-day running of the home. Staff are trained to enable residents to take responsible risks. Risk assessments are completed for residents as necessary. Residents’ are enabled to develop personal and independent living skills. To ensure that all meals provide a balanced and nutritious diet. Staff are trained to understand and provide sensitive and flexible personal support. DS0000064879.V318978.R01.S.doc Version 5.2 Page 28 Ashcombe Court 6 YA22 To provide training for staff to ensure residents can feel their concerns and complaint are listened to in a nonjudgemental way. Staff are provided with clear directions as to their roles and responsibilities To ensure a staff team with sufficient skills and experience to met residents’ needs 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 ensure the implementation of the homes policies and practices to safeguard residents best interests and rights. 7 8 9. YA31 YA33 YA35 10 YA40 Ashcombe Court DS0000064879.V318978.R01.S.doc Version 5.2 Page 29 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.V318978.R01.S.doc Version 5.2 Page 30 - 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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