Inspection on 09/04/09 for Ashcroft

This inspection was carried out on 9th April 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashcroft 05/04/07

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ashcroft Milestone Lane Wicklewood Wymondham Norfolk NR18 9QL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marilyn Fellingham     Date: 0 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Ashcroft Milestone Lane Wicklewood Wymondham Norfolk NR18 9QL 01953607340 01953607365 julia.a@break-charity.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BREAK Name of registered manager (if applicable) Miss Penny Newton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia physical disability Additional conditions: A maximum of two (2) mentally disordered people between the ages of 16 and 18 years may be accommodated within the overall total of the mentally disordered category. One (1) person with a physical disability may be accommodated. Ten (10) people with a mental disorder, excluding learning disability or dementia, may be accommodated. Date of last inspection Brief description of the care home Ashcroft is a residential home that is situated in the rural village of Wicklewood and comprises of a two-storey building with ten single bedrooms. Car parking is to the rear of the premises and there is a delightful secluded garden at the back of the house. Care Homes for Adults (18-65 years) Page 4 of 24 care home 10 Over 65 0 0 10 1 Brief description of the care home The home accommodates up to ten women who have suffered severe enduring emotional distress and mental health problems. The home provides a rehabilitation programme that enables women to regain their independence and return to living in the community. It also offers respite care to those who require extra support from time to time that assists them to stay in the community. The home provides detailed information to prospective service users prior to admission. The range of fees charged by the home are £732 - £807 per week, fees for women placed from outside of Norfolk are negotiated for each placement. Care Homes for Adults (18-65 years) Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit that took place over seven and a half hours. The key inspection for this service has been carried out using information from previous inspections, information from some residents, one relative and people who work in the home. The main method of inspection used was case tracking. This involved selecting individual care plans and information about people who live in the home and tracking their experience as a result of the support provided. During our visit a tour of the premises was undertaken and residents records and staff Care Homes for Adults (18-65 years) Page 6 of 24 files were looked at. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The informative needs assessments means that peoples diverse needs can be identified before they move into the home. Evidence: We looked at records for three newly admitted residents to the home, these were very informative and contained all relevant information regarding their needs. All prospective residents visit the home prior to admission, these visits are then extended until it is decided that their needs can be met. This was confirmed with evidence in the records of these residents and also in the daily notes which are kept during these visits which also help the staff to ascertain if the needs can be met. One resident we spoke with told us I came for day visits then I came for an overnight stay before I made my mind up if I wanted to move in. We saw a contract for this resident as all new admissions are given a contract and a statement of terms and conditions. Care Homes for Adults (18-65 years) Page 10 of 24 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information in the care plans is sufficient to ensure that the residents needs are met in a consistent way. Evidence: We looked at three care plans for residents living in the home, two of which belonged to the residents who had most recently been admitted. The care plans for all three residents were very informative and had been formulated using the initial assessment of the residents needs. We could see looking at these care plans that care had been changed when the residents needs had changed, we also noted that the care plans had evidence to confirm that the care plans had been drawn up with the residents full knowledge and co operation. One care plan we looked at had clear guidelines for the resident to follow and the staff in relation to the residents handling of their money; another plan contained information about the resident cooking for themselves and stimulating their independence. All three residents we spoke with were totally aware of their care plans and knew the purpose of them. The staff members we spoke with told Care Homes for Adults (18-65 years) Page 11 of 24 Evidence: us they knew how to use the care plans and one we spoke with had just drawn up a care plan for one resident about budgeting, we saw this and the resident whose care plan it was told us she had discussed the content with the support worker who had put the plan together. We also noted that risk assessments were in place for all three residents whose needs included managing challenging behaviour and risks to themselves. One resident we spoke with told us I never feel afraid to speak, another said this is a warm and caring environment, whilst another told us they were being helped and do feel I can talk to staff a lot. The daily notes for these residents were very informative and as needs arose were added to a plan of care. The staff and residents all have coffee together, the residents choose to do this and they do a crossword from a daily paper; there was a happy atmosphere and lots of social interaction between the staff and the residents: one of the residents had cooked some cakes to have with the coffee. The staff meet with the residents every morning to discuss what the residents wish to do as well as discussion about following their preferred pursuits, one of the residents is doing a computer course, one resident told us we make choices about what we want to do. The staff also meet with the residents once a week where the residents are encouraged to share their views and make choices about how the home is run. Care Homes for Adults (18-65 years) Page 12 of 24 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to take part in meaningful activities and are helped to exercise choice in their daily lives. Evidence: Discussion with some residents and staff, our observations on the day of our visit and records evidenced that the service offers many opportunities for personal development, socialisation and further education. One resident told us they were doing a computer course, another said I buy food and am helped to cook twice a week so that I am preparing to move on towards more independence. Another resident we spoke with said I go out a lot, I do my own washing and keep my room tidy One relative we spoke with said this is the best place my daughter has ever been to. the staff are caring, perceptive and do not take over; they went on to tell us the staff encourage the residents to do as much as Care Homes for Adults (18-65 years) Page 13 of 24 Evidence: possible, communication is good and the staff are always welcoming and I cannot praise the staff enough. The care notes for one resident revealed that they go home on a regular basis to maintain a family relationship; other notes we looked at had records of activities and visits. Whilst we were at the home the residents were planning a trip out with the staff, they were deciding if they wanted to go to Yarmouth, the Sea Lion centre or a day on the beach. The home has a seven seated people carrier so there is no problem taking the residents on trips. The staff we spoke with were aware of the need to promote the residents self esteem and confidence. We noted that the activities that the residents participate in are all documented in their care notes. We looked at examples of menus, they appeared to be nutritious and well balanced; the residents are not restricted by set meal times and if they wish they all eat together in the large dining room with the staff. On the day of our visit we noted that the residents were enjoying a buffet style lunch of their choice and were going to have a hot meal in the evening. The lunch time was a social time for those who wished to eat in the dining room and lots of discussion took place about arrangements for the weekend. One resident told us the food is brilliant, another said I eat three meals a day and one more commented that the food was nice. There are facilities for the residents to make drinks if they wish. Care Homes for Adults (18-65 years) Page 14 of 24 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs are met and the way that medication is managed means that the residents are not placed at risk. Evidence: We discussed with four residents how their days were managed in the home, all four agreed that they were supported by the staff in the way that they preferred. One resident makes regular trips home and is helped to do this by the staff, we saw evidence in this residents notes to confirm this. We spoke with one resident who had been at the home for a short time who told us that they felt the staff were helping them to move forward. It was obvious looking at the residents care plans that they well supported as entries in the care plans complimented what they were telling us. We looked at the medication that the service held in stock and the records to see if they related to the prescribed care and medication that had been administered; we found no discrepancies. The home does now audit all medicines that enter the home, however spot audits of medicines are not carried out; this was discussed with the manager who said that they would ensure that this takes place. We also noted that the care plans did not reflect and give guidance on current prn (as prescribed) medicines. Care Homes for Adults (18-65 years) Page 15 of 24 Evidence: We spoke to one resident who was self medicating and they told us that their medicines were kept in a locked safe in their room and that they signed for them once a week. There were policies and procedures in place that covered all aspects of the handling and administration of medicines. Care Homes for Adults (18-65 years) Page 16 of 24 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are listened to and the staff have knowledge in safeguarding adults. Evidence: The home does have a complaints procedure that is given to all residents. Those residents we spoke with told us that they knew who to go to with their concerns, one resident told us I feel I can talk to the staff and they listen to me, another said I never feel afraid to talk at our meetings. We saw minutes of these meetings and and records of the residents interaction at the meetings. We saw records of complaints that the service had received and how they had been dealt with; these complaints were not significant in their nature and we had not received any complaints. The three staff we spoke to about safeguarding adults were aware of the issues relating to this and we noted in the training records that staff had received training in relation to safeguarding; they were also aware of Whistle Blowing and familiar with the procedure for this. Care Homes for Adults (18-65 years) Page 17 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a homely environment for the residents that is safe and suits their needs. Evidence: We found the home to be in good maintenance order although the paintwork was looking a little tired and needed refurbishing. The general atmosphere was that of a comfortable homey environment with peoples own rooms being individually styled and decorated and the residents told us they liked their rooms. The service provides a number of areas that can be used by the residents, these communal areas were clean and tidy as was the kitchen and the dining room. The garden was looking lovely and colourful, those residents who wish to, do the garden with some members of the staff; there is a maintenance person who cuts the lawns and the hedges. We observed during our visit some residents making use of the garden and the seating arrangements provided for them. Care Homes for Adults (18-65 years) Page 18 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive appropriate training and supervision to enable them to carry out their roles effectively. Evidence: Examination of duty rosters and discussion with staff and the manager confirmed that the home is appropriately staffed to meet the assessed needs of the residents. The number of staff is always adjusted depending on the specific needs of the residents. We looked at the skills of the staff and these complemented the sometimes diverse needs of the residents. We looked at records for newly appointed staff, these contained appropriate checks of staff identity, two references and CRB and POVA checks. The three staff we spoke with felt that they had the necessary skills to do their job; they told us about some of the training sessions that they had attended, these were varied and all related to the people they look after. The staff we spoke with told us that they felt well supported and how they all worked well together. The staff also told us that they received formal supervision on a regular basis and this was confirmed by the records we looked at. Care Homes for Adults (18-65 years) Page 19 of 24 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff benefit from a well managed home and continue to be safeguarded by its policies and procedures. Evidence: Records were in place for yearly appraisals and the staff we spoke with confirmed that these have been taking place. One member of staff told us that the manager is very approachable, another said the manager makes us feel less chaotic whilst another told us she is the best manager we have had and we feel safe with her. We noted that the communication system between staff and management was good and that minutes of staff meetings showed us how new ideas and information is continually passed onto staff. The residents were complimentary about the management of the home and one relative told us that they felt that the home was managed well and communication is good and the manager is always available. We looked at health and safety related information these showed that there are servicing arrangements for all equipment, these included fire training for the staff and the residents, tests for emergency lighting. We looked at the records for incidents and Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: accidents and noted that they are audited by the services haed office. There were very good records in place and all information that we required has been managed well. The service is in the process of developing and extending the process for monitoring the quality of the service it provides. We were advised by the management that the impending closure of the home will now not take place; the disruption initially of the news that the home might have closed has in no way impacted on the care that the residents have received, or on the way the home has been managed and the staff felt that it had overall made them a more cohesive team. Care Homes for Adults (18-65 years) Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Care plans must accurately reflect and give guidance on current prescribed instructions when medicines are to be administered at the discretion of the staff This will ensure justification of continued use. 10/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 Spot auditing of medicines is recommended to enable staff to see if there are any discrepancies in the process of handling medicines. Care Homes for Adults (18-65 years) Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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