Inspection on 03/11/05 for Ashcott House

This inspection was carried out on 3rd November 2005.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashcott House 01/06/06

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

CARE HOME ADULTS 18-65 Ashcott House 12 Tokio Road Ipswich Suffolk IP4 5BE Lead Inspector Anna Rogers Announced Inspection 3rd November 2005 11:00 Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 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 Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 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. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashcott House Address 12 Tokio Road Ipswich Suffolk IP4 5BE 01473 710607 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) Alliance Home Care Limited Mrs Claire Elizabeth Collins Care Home 15 Category(ies) of Learning disability (15), Physical disability (2) registration, with number of places Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th May 2005 Brief Description of the Service: Ashcott House is a service for adults with learning disabilities situated in a residential area to the east of Ipswich town centre. The home was first registered in 1986, and comprises two separate buildings (formerly known as Cotswold and Hillside) but recently renamed Side A and Side B Ashcott House. Side A is a seven bedroomed bungalow, plus staff office. Side B is a twostorey house with six single bedrooms and one shared bedroom. The main office facilities are based in Side A, although both houses have sleeping-in facilities for staff. Both properties have their own bathrooms, toilets, and communal living areas including a lounge, kitchen / diner, conservatory, and laundry. The more physically dependent service users live in the bungalow, Side A. The garden is shared by all fifteen service users, and can be accessed directly from either property. The front of the property is mainly a car parking area, which provides off-road car parking for staff and visitors, and parking for the minibus. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which took place over 6.5 hours on a weekday. The inspection process involved discussions with five residents, the manager and three support workers. The communal areas of the home were seen as well as bedrooms. A selection of records were seen including residents care plans and risk assessments. Records relating to the safety of residents were also seen and these included, staff recruitment, staff training and medication. The reader may wish to read this report in conjunction with the report of the unannounced inspection, which took place in May 2005. What the service does well: What has improved since the last inspection? The two requirements from the last inspection have been actioned. Four of the service users bedrooms have been redecorated with evidence that service users had been included in deciding colours. It was noted at the last inspection that some of the bedroom furniture while in reasonable condition was dated and bulky. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 6 There was evidence at this inspection that the organisations commitment to gradually replacing bedroom furniture has begun in the rooms decorated. 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. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 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 Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 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, 5. Residents can expect the homes Statement of Purpose and Residents Guide will set out how the home will care for them. Service users can expect that their needs will be assessed. EVIDENCE: The Statement of Purpose contains the information as required by regulation and has since the last inspection been updated to reflect changes in the organisation. There is currently one service user vacancy. No new service users have been admitted since the last inspection but all the existing residents have had their needs re assessed by the placing authority as requested by the organisation. As noted at the last inspection the organisation has developed a new resident contract detailing the terms and conditions of the home. The Regulation 26 visit report for September identified the need for these contracts to be completed for the existing service users. The manager confirmed that now the reassessments have been completed the terms and conditions would be updated. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 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): 6,7,8,9 Service users can expect that the home will meet their assessed needs. Service users can expect that they will be supported to make choices and where necessary these decisions will be supported with risk assessments to ensure their safety. The administration of medicines is not carried out in a manner that assures the safety and welfare of service users. EVIDENCE: A sample of three care plans were inspected. The format is presented in two sections i.e. care plan and lifestyle plan. The care plan identifies the needs and the lifestyle plan identifies how the needs are addressed and taking into account the wishes of the service user. There was evidence that each of the care plans had been audited prior to the reassessment of needs in July 2005. From the sample of plans seen there was evidence that the needs had been identified but these had not been actioned in all cases for example one service user likes to play a guitar but cannot now hold the guitar and requires a support aid to enable them to continue playing. Other plans did confirm the support given to the service user to enable them to maintain contact within the community. There is also a need to show that a review of the plan (minimally six months) has been undertaken. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 10 The care plans confirm that the choice of service users is taken into account. There was evidence that although service users have day service programme they are able to choose on a daily basis whether they wish to attend or not. There was also evidence that service users have a choice about whether they want to attend day services five days a week. As noted there is evidence that service users are given opportunities to participate in decision-making and this is positively reflected in deciding where they want to go on holiday. From the choices made it is clear that staff encourage new experiences as well as familiar and enjoyed activities. There is however a need to develop further opportunities for service users to be consulted and make decisions through residents meetings. There was evidence that a requirement from the last inspection has been actioned. There was a need to develop risk assessments to support service users preferred choice or activity. Risk assessments are clearly identified in the residents file and the section also has an index for easy reference. However it would be useful to cross reference the risk assessments to the relevant section of the care plan. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 11 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): 15, 17 Service users can expect to be encouraged to maintain contact with family and friends. Service users can expect to be provided with a varied diet but further development is required to ensure they are consulted. EVIDENCE: Service users are encouraged to maintain links with people who are important to them. Care plans confirmed that service users are involved in a wide range of activities within the community and are encouraged to attend weekly clubs for example Gateway and Christies. There was evidence that service users are supported to maintain appropriate sexual relationships. One service user is currently involved in 1 to 1counselling sessions with a Community Practice Nurse (CPN). There is currently a six-week winter menu in place. Discussion with the manager confirmed that they do consult with the service users but this tends to be on an individual basis. The meals provided are in the main traditional meals but the inspector was informed that recently service users had a “Take Away Chinese Meal”. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 12 Specialist diets are catered for either by the service user being offered an adapted meal from the menu or a different meal depending on the nature of their dietary needs. On the day of this inspection Side A were for the evening meal having Spaghetti Bolognese and Side B had Chicken Kiev. Service users who had eaten Spaghetti Bolognese said it had tasted good. Lunch on Side A consisted of Hot Dogs. The table had been set with tablecloth, sauces, and drinks were available. The mealtime shared with staff and service users was relaxed, with quiet conversations between staff and service users. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 13 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): 19,20 Services users can expect that they will be given good access to healthcare services. However, the administration of medicines is not carried out in a manner that assures the safety and welfare of residents. EVIDENCE: The key worker is responsible for ensuring all the relevant health care appointments are made. There was evidence that appointments have been made with GP’s, Dentists, and other health care professionals are arranged. The home has also established links with more specialist services for example the Community Psychiatric Nursing and Diabetes services. The home has recently reported through Regulation 37 reports a medication error, which resulted in the member of staff being suspended while the error was investigated. The administration charts for residents on Side B were inspected and while the majority indicated that medication had been given at the prescribed times one chart had been signed for a lunchtime medication but the medication was still in the blister pack. There were also two blister packs that had had a tablet taken from it for another day but there was no written explanation why this had occurred. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 14 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 Service users can expect that staff will listen to their concerns and take appropriate action to protect them. However there is a need to update the guidance relating to the Protection of Vulnerable Adults (POVA). EVIDENCE: The home does have a clear complaints procedure. The home’s statement of purpose and service user guide also includes details of the complaints procedure. Service users felt they were listened to if they had a concern and two spoken with said they would speak to staff if they were worried about something. Four of the six comment cards received from relatives indicated that they were not aware of the complaints procedure although none had needed to make a complaint. One comment was received from a relative who said they would not know who to speak to. This information was given to the manager. The home also had a protection of vulnerable adults policy, detailing the procedures to follow to safeguard residents from abuse, a whistle blowing policy and “No Secrets Here” leaflet. The home did not have an up to date (June 2004) copy of the Suffolk Protection of Vulnerable Adults inter agency policy, procedures and guidelines for staff. Discussion with staff indicated their understanding of what they should do in the event of receiving or suspecting abuse and they were clear that the protection of the service user would be paramount. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 15 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, 25,27 Service users can to live in a safe and welcoming environment but there is a need to make sure that resident’s bedrooms fitted with locks can be accessed in an emergency. EVIDENCE: As noted at the last inspection a service user has a ground floor bedroom with en-suite facilities (Side B). The kitchen door between this service users bedroom is fitted with a Yale lock and is kept locked at night to prevent service users accessing the kitchen unsupervised. Once the kitchen door is locked this isolates this bedroom. The service user has a buzzer in their bedroom, which is linked to the staff sleeping in bedroom. The inspector discussed this arrangement with the service user who was clear what they would do in an emergency. Following the last inspection a risk assessment has been developed based on the service users’ health and understanding of the isolation of their bedroom. One service user who was living on the first floor (Side A) and was beginning to find using the stairs difficult has moved to a vacant bedroom on the ground floor. This has been decorated in the colours chosen by the resident. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 16 The manager confirmed that the organisation is committed to gradually replacing the dated furniture, as bedrooms are re-decorated. It was noted that this bedroom has a Yale lock fitted which the service user could double lock from the inside and preventing staff to access the room in an emergency. All bedrooms seen had been personalised and looked well cared for. Four bedrooms in total have been decorated and furniture upgraded since the last inspection. Service users spoken with confirmed that they had been able to identify colours they wanted bedrooms decorated in. There is one double bedroom and the service users who share get along very well together. Service users have a choice between bathing and showering and these facilities were located near to bedrooms. All areas seen were clean and fresh. Hot water temperatures are tested on a weekly basis although this had lapsed but is now being undertaken regularly. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 17 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): 32,33,34,36 Service users can expect to be cared for by a staff team who are committed to keeping their knowledge up to date. The procedures for the recruitment of staff are robust and provide the safeguards for the protection of service users. EVIDENCE: All new staff have an induction, which is currently undertaken by the manager over a four-week period and includes opportunities to become familiar with the policies and procedures. New members of staff are also expected to undertake core training, which includes, Health and Safety, Manual Handling, First Aid, Fire Safety and Food Hygiene. Four members of staff hold an NVQ level II or III qualification and two other members of staff are in the process of completing their NVQ level II There have been a number of staff changes since the last inspection. Seven member of the staff team have been recruited by the organisation from overseas including the Philippines. Staff spoken with said that having a number of new staff has put pressure on the established members of the team to support a number of new staff at once some of who do not have a full understanding of the English Language. Staff spoken with said this lack of understanding had caused some frustration from the service users. Staff morale was described as low. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 18 Staff meetings have not been held as regularly as usual (once a month) although one had taken place in October and one in August had concentrated on service users. Five staff files of new workers were inspected. The organisation uses a recruitment agency for staff from overseas. None of the staff have been in the UK for more than three months but all had provided a police check from their country of origin. There was also evidence of references being available. The manager confirmed that once the members of staff have lived in this country for three months a Criminal Records Bureau (CRB) check would be undertaken. Discussion with staff indicated that supervision has not been arranged and was felt to have contributed to the low morale as communication had suffered. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): 37,42 The service users can expect the home to be well managed. The home provides a safe environment to residents in relation to health and safety matters. EVIDENCE: The manager is currently working towards the Registered Manager’s Award. The manager is currently without a Deputy as they are on maternity leave. There is also a vacancy for a senior support worker. This has placed additional work pressures on them in the induction of new staff and management of the home. It was evident from discussion with the manager that they realise the need to delegate some of the tasks to the senior members of the team. There was evidence that the staff team are provided with core training, which includes first aid, moving and handling, food hygiene, health and safety and fire safety. Discussion with staff confirmed that some of the above courses are in need of updates which they were confident would be arranged. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 20 A recent Regulation 26 visit report (September 2005) highlighted a number of checks that are not being undertaken regularly for example testing of the hot water, COSHH risk assessments, and environment assessments. Checks have been undertaken on fridge/freezer temperatures and fire equipment checks and tests although from the information provided in the Pre Inspection Questionnaire there is a need for a fire drill. The manager confirmed that staff have been reminded of the need to ensure regular checks are maintained. Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X 3 Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 X 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 X 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashcott House Score X 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 X X X X 2 X DS0000064918.V263400.R01.S.doc Version 5.0 Page 22 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) Requirement The registered person must ensure that safe procedures for medicine handling and administration are followed at all times. All staff responsible for the administration and recording of medication must receive appropriate training to undertake the task The type of lock fitted to bedroom doors must be reviewed to ensure the safety of residents. Records relating to the health and welfare of service users as set down in this Regulation must be maintained. Timescale for action 30/11/05 2 YA20 13 (2) 30/11/05 3 YA24 13 (4) a 30/11/05 4 YA42 13 (2) 30/11/05 Ashcott House DS0000064918.V263400.R01.S.doc Version 5.0 Page 23 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 6 Refer to Standard YA6 YA6 YA8 YA22 YA23 YA36 Good Practice Recommendations Service users needs identified in care plans should be actioned. Service user care plans should be reviewed minimally every six months. Residents meetings should be developed to encourage resident’s involvement and consultation in decisionmaking. Relatives should be provided with a copy of the complaints procedure. The home should have access to the current copy of the Suffolk Protection of Vulnerable Adults inter agency policy, procedures and guidelines for staff. Supervision for staff should take place at least six times a year as set down in Standard 36 (36.4). 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