Inspection on 09/10/07 for Ashcroft Hostel

This inspection was carried out on 9th October 2007.

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

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

Other inspections for this house

Ashcroft Hostel 03/05/06

Ashcroft Hostel 06/10/05

Ashcroft Hostel 19/07/05

Ashcroft Hostel 28/02/05

Ashcroft Hostel 21/07/04

Ashcroft Hostel 17/02/04

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOME ADULTS 18-65 Ashcroft Hostel 52 Huncote Road Narborough Leicester LE19 3GN Lead Inspector Ms Rajshree Mistry Unannounced Inspection 9 October 2007 10:00 th Ashcroft Hostel DS0000035190.V340703.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 Ashcroft Hostel DS0000035190.V340703.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. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashcroft Hostel Address 52 Huncote Road Narborough Leicester LE19 3GN 0116 286 6024 0116 284 8196 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) www.leicestershire.gov.uk Leicestershire County Council Social Services Mrs Maureen Muggleton Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registrations. Date of last inspection 3rd May 2006 Brief Description of the Service: Ashcroft Hostel is a care home providing care and accommodation for up to twenty-three adults (under 65 years of age) who have needs relating to their mental health. The home provides a residential and rehabilitation placement for up to 2 years, along with respite and crisis intervention care. The home is located in Narborough where service users have access to shops, pubs and other amenities, with local public transport routes. The twenty-three single bedrooms are without en-suite facilities. The home has a large rear garden containing seating for service users with mature trees and shrubs. Accommodation is provided over two floors with access between the floors being a stairwell. Information is located on site detailing the range of services offered, which includes the Statement of Purpose, in addition to this Ashcroft Hostel has copies of the Commission of Social Care Inspections, Inspection Reports, which are located in the main office and are available upon request. The weekly fee is £819.00, this information was provided by the Registered Manager during the site visit. There are additional costs for individual expenditure such as Chiropody, Optician and hairdressing services and social excursions and the fee will depend on services accessed. There are 3 beds for emergency stays for people in a ‘crisis’ and there are 3 beds specifically for women only. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process consisted of pre-planning the inspection, which included viewing the last Inspection Report, reviewing and gathering of evidence from the Annual Quality Assurance Assessment (AQAA) – the Provider’s self assessment, and reviewing the service history of significant events since the last inspection. Surveys were sent from the Commission for Social Care Inspection to service users, their relatives’ health care professionals, and staff who were identified in the AQAA. The unannounced site visit commenced on the 9th October 2007 and lasted 1 day. The focus of the inspection is based upon the outcomes for the service users. The method of inspection was ‘case tracking’ and involved identifying service users with varying levels of needs and looking at how these are being met at Ashcroft Hostel. Four service users were selected; with varying needs and including a new service user. Discussions were held with two service users tracked and other service users at the home. Observations were made of staff engaging with service users. Records of the service users were read, discussions with staff with various responsibilities within the home and reviewing the records, training records and the minutes of team meetings. The CSCI sent out ten surveys to service users and their relatives, of which 60 were returned. The majority of the comments were positive about the care and support they received, access to health care services, and social activities of interests and indicated people were aware of how to complain. CSCI sent twenty-one surveys to social and health care professionals such as Community Psychiatrists Nurse and General Practitioners, of which 38 were returned. The comments received were positive in relation to the skills and knowledge of staff, support provided to the service users, responding promptly to the needs of the service user, and communicated well. Comments received from the General Practitioner who looks after seven service users commented that the staff communicates clearly and works in partnership; senior staff are always available; able to see patients in private; staff demonstrate good understanding of care needs; medication is managed appropriately; take appropriate actions; have had no complaints received and were overall satisfied with the care. Twenty surveys were sent to staff of which 25 were received after the site visit. The comments received were generally positive about the care people receive at the home, the management and included: “ . . from my own observations think that the service users get first rate help, but staff are held back through rules and regulations from doing a more positive and beneficial care plan” Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 6 Comments incorporated within Service Users Comment Cards and direct comments included: “Ashcroft Hostel is a shabby decrepit seventies run-down hostel” “The meals/food is disgusting . . . some staff are extremely lazy” “Ashcroft has been a very big support to me . . . . .it has been my life line” “The food has been first class and staff give a bit of support to me. If I was a bit younger I would like to be a member of the staff, I have got good IQ and have good general knowledge like knitting, embroidery and all kings of crafts” “I am very happy like showers and cleaning” “Sometimes don’t feel understood (as in my illness) and feel staff take anxiety with a pinch of salt/humour, which can be very distressing” Comments incorporated within Professionals Surveys, included: “I have only . . . . contact with the staff. Overall good in review and well informed” “Staff make contact if they have any concerns” “Staff respond quickly to my clients needs, informing me of any concerns they have regarding changes in her mental health status. They ensure she attends appointments, has her medication and provide support to her at crisis” “Staff respond quickly to her physical health problems and mental health problems, ensuring she is seen by GP or psychiatrist as required”. “Staff address this with clients having their own rooms their individual care plans and a holistic approach taken with all the clients” “Staff have to manage my clients medication as she tends to not take it. They always follow instructions given by psychiatrist and GP” “Staff have had to dealt with some difficult situations regarding my clients and they have done this in a knowledge and support way” “Staff address this (cultural and diversity needs) in their assessment of clients needs and respect clients wishes” “ . . . staff contact me if they have concerns or noted changes in my clients mental health or behaviours and we discuss ways forward. Staff have adhered to care plans” Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 7 “Staff are very good at assessing clients needs and working with them helping them more to move to independent living. They work well in helping clients develop and improve daily living skills. They also actively encourage clients to maintain skills and they help them socialise” “Staff are approachable and helpful. They provide a caring and safe environment for clients. They are supportive towards clients whilst encouraging them to the more independent”. “Having OT input . . . although the staff appear skilled at helping with development of ADL skills” What the service does well: What has improved since the last inspection? Ashcroft Hostel has developed 3 short stay beds known as ‘Crisis Intervention Beds’ for people who otherwise may be admitted into hospital. There is a clear assessment for admission and staff work closely with the commissioning team and health care professionals to ensure the stay is safe and appropriate. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 8 The 3 beds and living area specifically for vulnerable women has been moved to the first floor, having safe living area and safety. Ashcroft Hostel has appointed two care staff, who have received their induction training and work closely with experienced staff. Information received from the Registered Manager before the site visit highlighted areas of improvement made at Ashcroft Hostel in relation to the environment and training, which supported the findings from the site visit. 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. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 9 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 Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 10 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, 4 and 5. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users have information about the home; involved in the assessment process to make sure the home is able to meet their needs. EVIDENCE: The information about the home is provided to service users before or at the first visit, where the stay has been planned. The information sets out the type of care and support people would receive living at the home, the facilities, the staff skills and management arrangements. There is information as to how complaints, comments and compliments can be made, which is accompanied by information on advice and advocacy services. The information provided by Ashcroft Hostel does not include views or comments of service users who already reside within the home. Service users spoken with confirmed that they were given information about Ashcroft Hostel, at their first visit. The new service user said they viewed the home, met with the staff and looked at the bedroom before agreeing to stay. Staff said introductory visits are flexible and encourage people to visit in the first instance or staff meet with the prospective individual in their current place of residents, which forms part of the assessment process. Staff said whilst Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 11 introductory visits are encouraged this may not be always possible people need of an emergency stay, and using the ‘crisis intervention’ facilities. The care records of four service users care files were viewed. All contained an initial assessment of needs carried out by the Social Worker before they moved into the home. The assessment contained information about other professionals involved. All records were detailed and provided historical and current information, which enables care staff to deliver the appropriate guidance and support. Service user said they were involved in the assessment, and consistent with the survey responses received. Service users with said they signed a contract outlining terms and conditions of occupancy upon admission to Ashcroft Hostel and care files contained copies of the contract. Comments from service user surveys: “Due to my circumstances I was so grateful to get the offer” “I had no choice in the matter (moving to Ashcroft Hostel) as I am both homeless and suffer mental illness” “An interview and shown around the hostel” “Came here from being inpatient in hospital 3 months – told only place available for me, although have home of my own, think was for my own safety” Comments received from health care professionals included: “Staff are very good at assessing clients needs and working with them helping them more to move to independent living. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are supported to continue and develop their lifestyle; making their own decisions and contributes to views in running of the home. EVIDENCE: Staff at Ashcroft Hostel continues to be pro-active in supporting service users, in developing their skills, confidence, decision making in order that they can lead an independent life within the community. Service user said they have been involved in developing their plan of care, respecting their choice of lifestyle, routines and interests whilst promoting their independence. Information from the comprehensive assessments undertaken by a Social Worker is used to form the basic plan of care. The staff at the home carry out a further assessment over 2 weeks, which focuses on daily living skills including house work, community skills, personal care, physical and mental Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 13 health. Information contained within assessments is used to develop the care plan and steps to achieve and enhance skills for living. Care plans are supported by risk assessments, which detail how risks are to be managed, detailing the factors and behaviours that indicate the individual may need support from other professionals such as the Community Psychiatrist Nurse, where service users have been identified to self-harm. The care plans for four service users were read; all were detailed and signed by both service user and their key worker. Care plans showed the views of the service user, their aspirations and goals and any changes in circumstances were shown from the regular reviews. Care plans read were focused on the individual, detailed the care and the support they needed; arrangement for their medication, the important people in their lives; activities and their goals they want to achieve. Care plans showed that the involvement of service user’s and what support they needed if they were anxious or at risk. Service users were seen approaching staff to talk about matters that are important to them, staff ensured the conversations were conducted in privacy. Staff were made a record of the conversation and the decisions made. Discussions with service users along with records viewed evidenced that service users have control over their finances or are supported. Service users were seen making daily choices in what they did, for example doing their laundry, shopping or going out. The majority of the service users were out for the day, either at college, visiting friends socially or joining in community activities locally. Staff said service users would let them know where they are going, the people they are visiting and places they visit, are written in the care plans. Staff said plans to develop service user’s skills and confidence are built on over a period, such as budgeting and managing money. Although service users have not had recent service users’ meetings, staff encourage service users to speak with staff, formally or informally. Service users were observed speaking with the staff and manager in the office, who ensured privacy, was respected. Comments from service users included: “Found staff helpful and around when required” Comments received from health and social care professionals indicated service users needs are met and staff are support their changing needs. Other comments received included: “Staff have had to dealt with some difficult situations regarding my clients and they have done this in a knowledge and support way”. Information received from the Registered Manager before the site visit stated future plans to ensure service users voice is heard and continue to provide valid choices. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 14 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, 15, 16 and 17. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users enjoy a lifestyle that suits them, supported to be involved in the community and have choice of meals. EVIDENCE: Service users described a range of support, opportunities and access they have in the community. Service user said that after moving in they had the opportunity to develop rehabilitation skills such as budgeting, preparing their own meals with some support from staff. Care files read consistently reflected the information received from the service users and staff. The care files also showed people and professionals that are important to the service users. The provision offered to service users at Ashcroft Hostel also considered their social interests, goals in relation to employment and education. Service users can use the computers if they wished with or without the support from the Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 15 staff. This was demonstrated as staff said some service users have paid employment, participate in voluntary work and community centres and projects. Support is offered through various organisations, specialised in supporting individuals with mental health needs. Although service users meetings have not taken place frequently, service users have opportunity to express their views individually or collectively. As a result of comments received, the ‘T-PEG’ group was formed engaging service users and the community, to share activities that they chose. On the day of the site visit, two service users and a staff member were going to watch a movie at the cinema, with people from the community. There is a newsletter produced by the service users with support from staff for the people at Ashcroft Hostel that contains social events, fundraising and important information for them. Staff said there was one service user using the ‘crisis intervention’ beds, and whilst they were supported and had the facilities close by, they were not restricted in using the main part of the home. The routine within Ashcroft Hostel is flexible, service users have autonomy regarding when they wish to get up and go to bed, service users are asked to advise staff when they leave and return to Ashcroft Hostel in case of fire. Service users were aware where they could smoke and why they could not smoke in their bedrooms. Service user records reflect decisions made by service users, and identify where staff support is appropriate. One service user spoke about their plan to view a flat for themselves and how they maintained their independence and manage housework duties. Whilst another service user returned from viewing another home, and shared their views about the place, including the challenges and dislike of particular meals being served. Everyone is encouraged to take part in housework, for some service users this forms part of their rehabilitation. Lunch is prepared in the main kitchen, although service users, as part of their development of skills are supported to shop, budget and prepare their own meals. Service users said they did have choice of meals ranging from sandwiches, fast food type of meal and traditional meals such as roast, with staff being aware of dislikes and special dietary needs. The care files read reflected service users preferences and dislikes. Comments received from service users in relation to privacy and dignity, and making choices included: • • • “Usually speak with clients in absence of other clients” “Very satisfied with Ashcroft” “Where appropriate they are very encouraging” DS0000035190.V340703.R01.S.doc Version 5.2 Page 16 Ashcroft Hostel Comments from service user surveys: • • “The meals/food is disgusting . . .” “Like walks, washing and ironing, baking and making friends. Don’t worry too much about things. I enjoy music, Robbie Williams, Johnny Mathus and haven’t got much time for the TV”. “Like going to garden centres and craft shops, really am well pleased with my lot, would like to go to a butterfly sanctuary. One of my favourite places is Scotland and I love France” • Comments received from the health and social care professionals included: • • “Staff address this (cultural and diversity needs) in their assessment of clients needs and respect clients wishes” “Staff are approachable and helpful. They provide a caring and safe environment for clients. They are supportive towards clients whilst encouraging them to the more independent”. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 17 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 and 20. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are looked after well, having both their physical and mental health care needs met. EVIDENCE: Service users currently living at Ashcroft Hostel do not require personal support in relation to personal hygiene and care, although staff actively encourage service users to maintain a respectable level of personal hygiene, being independent and taking control of their lives. Service user said they were treated with respect by the staff and felt in charge of their life at the home. Service user said they were aware of the contents of their care file and was consistent with the service users surveys responses. The service users care plans show the needs and support required by the individuals. Health care support provided is on an individual needs basis and care plans show the specialist services involved such as Psychologists, Psychiatrists, Forensic and Approved Social Workers and Community Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 18 Psychiatric Nurses. In additional general health care through Dentists, General Practitioners and District Nurses is provided. A service user tracked said they had an appointment to see the General Practitioner, whilst the new service user kept their General Practitioner in the area they lived in. Service users are encouraged to administer their own medication as part of gaining independence and taking control of their own lives. Service users are risk assessed as to their ability, and regular reviews monitor the process of self-administration. Service users said they take their own medication and have it kept locked in their bedroom. A service user was observed approaching staff for additional prescribed medication, and records signed by two staff when taken. Comments received from health and social professionals include: • • “Staff make contact if they have any concerns” “Staff respond quickly to my clients needs, informing me of any concerns they have regarding changes in her mental health status. They ensure she attends appointments, has her medication and provide support to her at crisis” “Staff respond quickly to her physical health problems and mental health problems, ensuring she is seen by GP or psychiatrist as required”. “Staff have to manage my clients medication as she tends to not take it. They always follow instructions given by psychiatrist and GP” • • Survey response from a General Practitioner, responsible for seven service users felt staff are available; communicates clearly, having a good understanding of needs; works in partnership; manage medication appropriately; take appropriate actions and overall are satisfied with the service provided at Ashcroft Hostel. Information received from the Registered Manager recognised what Ashcroft Hostel could do better such as promoting healthy lifestyle/living, updated information of health check clinics locally and providing information to address sexual relationships and safe sex practices. The improvement plans related to maintaining and continuing the links and partnership working with Health Care Professionals and organisations working with people with mental health illnesses. Ashcroft Hostel has recruited staff and plan to develop a sensitivity to encourage individuals to manage and maintain personal hygiene and accessing healthcare services. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 19 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): 16 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are protected by a robust and accessible complaints procedure and by staff trained in safe guarding adult processes. EVIDENCE: Service users when asked were confident that should they have any concerns, they know who to speak with. Service users were aware of how to make complaints and the written complaints procedure, and how to contact Advocacy Services. Service users stated that they could approach any member of staff in the office at any time. The complaints procedure is displayed at the entrance of the home, on the notice board in the lounge with the kitchen and dining room. Service users spoken with said they felt safe and treated in a manner that suited them. Although service users meetings have not taken place as often as possible, service users were seen speaking with the staff on issues that were important to them. One service user gave an example where staff listened and supported them to express their concerns and anxieties, without making any judgments. Information received from the Registered Manager before the site visit stated that service users are given information; actively encourage service users to express concerns either with their key-worker, staff or the manager. The information received stated Ashcroft Hostel had received 3 complaints. Records Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 20 showed the concerns were investigated, resolved to the satisfaction of the service user that made the complaint. The Commission for Social Care Inspection has not received any expressions of concern about Ashcroft Hostel. Survey responses from the service users indicated that they know how to make a complaint and know who to speak with if they were unhappy. Comments received in the surveys included: “Don’t like being any trouble to anyone and can stand on my own feet” “Have key support worker, but other staff available to speak when necessary” Staff spoken with including the new member of staff demonstrated a good understanding of their responsibility and procedures to follow in relation to safeguarding adults and were confident to whistle-blow poor or bad care practices. Staff files read contained evidence to show that staff have received training in safe guarding adults, part of the Local Authority’s induction training and attaining a National Vocational Qualification (NVQ) in Care. Staff surveys received indicated staff were aware what to do if a service user had concerns, in that, they would refer them to the manager or the officer in charge. Survey responses from health and social care professionals indicated that they had no concerns or complaints about the service provided to the service users. Comments received included: “ . . . staff contact me if they have concerns or noted changes in my clients mental health or behaviours and we discuss ways forward. Staff have adhered to care plans” “Staff have had to dealt with some difficult situations regarding my clients and they have done this in a knowledge and support way” Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 21 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, 28 and 30. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users live in a clean home and would benefit from improvements to the décor and furnishing to create a more homely place for people. EVIDENCE: There are a number of lounges in the home, including designated smoking lounges one on the ground floor and the first floor and a lounge with exercise equipment. Service users were seen watching television in the lounge/dining room on the ground floor. Service user said they can use any lounge to relax in and can chose to watch a film from the video collection in the larger lounge. The main lounge is large and multi-functional with dining table, pool table and computers, which are used by the service users and staff. Although some effort has been made to create a homely and welcoming atmosphere, the communal areas and bedrooms are practical and functional. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 22 The area designated for women only has been relocated to the first floor after setting up of the ‘crisis intervention’ beds for 3 people. The living area has individual bedrooms, lounge, kitchenette and bathroom. The management team have considered the risk and support needed by the service users. Service users have single bedrooms, which are close to bathrooms and toilet facilities. The Inspector was invited to view the bedroom of a new service user, who said they viewed the home and the bedroom before agreeing to move in. Service users said they have keys to their own bedrooms and felt the living areas were comfortable for them. Service users said they are encouraged to keep their bedrooms and the living areas tidy. Staff said some service users may need reminding but generally, service users manage. The laundry room is located away from areas where food is stored and prepared. All staff have received training in health and safety and infection control. Staff were seen cleaning the kitchen and bathroom using cleaning materials and wearing protective clothing. Information received from the Registered Manager before the site visits highlighted the desire to re-design the garden area; the need to re-furbish the laundry area and improve the home environment. Comments from service user surveys and directly, included: “I sort everything out for myself but staff are around to help me if I need it” “The home smells very fresh and lovely. I like cleaning and cooking” “Ashcroft Hostel is a shabby decrepit seventies run-down hostel” “Some residents make mess, which are left till the next day for the cleaners and cook” Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 23 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, 34, 35 and 36. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are protected by good recruitment processes and staff trained and supervised to care and support the people using the service. EVIDENCE: Staff were aware of their roles and responsibilities, where to find the home’s procedures and who to report any concerns to. Staff said they had completed induction training and special training to working with people with a learning disability and promoting independence. Staff observed used skills that encouraged the service user to make decisions, tactfully distracted them from being more agitated. The recruitment and selection procedure in place is robust and is supported by the Human Resource Team accordance with the Local Authorities’ equal opportunity policy and guidance. A new member of staff described the recruitment process, requirements of the job such as experience of working with people with mental health and started work after satisfactory references, POVA first and CRB disclosure was received. This was consistent with the Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 24 information received before the site visit and the Registered Manager demonstrated the system of confirming receipt of satisfactory pre-employment checks. Staff were aware of their roles and responsibilities, where to find the home’s procedures and who to report concerns to. Staff said they had completed induction training and additional training to enhance their skills to work with people with a mental illness, which was consistent with training records and information received from the Registered Manager before the site visit. Staff were observed sharing key information about the service user’ wellbeing and any concerns. Staff said staff meetings take place on a regular basis and minutes read confirmed this. Staff confirmed supervision meetings take place on a regular basis, which was consistent with the information received from the Registered Manager before the site visit. The new staff said they work under supervision with experience staff during their induction training and probationary period. Staff said key-working and being involved in care planning helped them understand the service user, used the steps to develop daily living skills, whilst being aware of triggers that would create risks. Staff observed encouraged service users to make decisions and gave re-assurance to support their decisions made. Service users said they felt that the staff understood their needs. Service users said staff were supportive and available if they needed, which suited them. The information received from the Registered Manager before the site visit, detailed the training provided and planned for staff, which included medication training, food hygiene, first aid and health and safety. The information received stated over 75 of the staff had attained National Vocational Qualification (NVQ) level 2 in Care. Staff said they had completed their NVQ level 2 and 3 in care, respectively, whilst the new staff were considering NVQ training upon completion of their probationary period. From discussion with staff, mandatory and refresher training is available to staff and where necessary alternative training is identified to address specific training requests. Comments received from staff surveys included: “ . . from my own observations think that the service users get first rate help, but staff are held back through rules and regulations from doing a more positive and beneficial care plan” Comments received from health and social care professionals indicated staff were supportive towards the service users and included the following comments: Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 25 “Having OT input . . . although the staff appear skilled at helping with development of ADL skills” “Staff are very good at assessing clients needs and working with them helping them more to move to independent living. They work well in helping clients develop and improve daily living skills. They also actively encourage clients to maintain skills and they help them socialise” “Staff are approachable and helpful. They are supportive towards clients whilst encouraging them to the more independent”. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 26 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, 42 and 43. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well managed home, offering leadership, involvement in the running of the home that influences their care and rehabilitation. EVIDENCE: The Registered Manager has a number of years’ experience working with people with mental health and managing a residential care home. The Registered Manager has attained the National Vocational Qualification level 4 and the Registered Manager’s Award. The Registered Manager said there are clear roles and responsibilities and senior staff are undertaking specific managerial tasks as part of their further development. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 27 Service users were aware of their rights, whilst living at Ashcroft Hostel. Service user and staff said there is an ‘open door’ policy and people can approach the Registered Manager and staff at any time. The information received from the Registered Manager before the site visit stated that policies and procedures are updated at County Hall and cascaded to the home’s manager to share with the staff team. Staff knew where to find the policies and procedures. The Registered Manager spoke about working closely with colleagues in the Primary Care Trust, whilst maintain a focus on providing social care to service users. The Registered Manager said service users meetings have taken place in the past and minutes of those meetings were available, this has not happened in recent months. These meetings are to re-start which the new member of staff taking responsibility to arrange the meeting. From the information received from Registered Manager before the site visit and discussion on the day, it was confirmed that there are no monthly visits carried out by the Responsible Individual or a representative the from the management team, who is external Ashcroft Hostel. The Registered Manager said whilst the monthly visits are not carried out, Senior Management are available. Steps should be taken to ensure monthly visits are carried out and a report of the findings produced addressing shortfalls, and that demonstrates internal checks are carried out. The Registered Manager said service user questionnaires’ were recently completed that gave service users an opportunity to express their views and services offered at Ashcroft Hostel. A number of the completed questionnaires were read, showed service users made constructive comments from their experience of living at Ashcroft Hostel. Although the Registered Manager was able to demonstrate how steps have been taken to address comments and introduce new ideas, this process needs to be formalised to establish a Quality Assurance system. The report needs to be distributed to those that took part in the process and demonstrate that the Ashcroft Hostel monitors the quality of the service in relation to the aims and objectives set. Service users said they manage their own money and have lockable storage in their bedrooms. Staff said part of the care planning process looks at handling money and specific support is offered from handling money to shopping and budgeting. Ashcroft Hostel has a handyperson responsible for repairing minor faults within the home. The information received from the Registered Manager before the site visit indicated equipment such as fire detection and emergency equipment are maintained and regular fire drills and tests take place. Risk assessments are in place for the home, service users and staff. Ashcroft Hostel has a planned programme of maintenance and records of checks carried out are kept up to date. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 28 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 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 3 3 3 1 Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 YA43 Regulation 26(2) (a) Requirement The Responsible Individual or their representative must visit the home at least once a month, under this regulation; inspect the premises, the records, any complaints and produce a report on the conduct of the home. Timescale for action 09/11/07 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 Refer to Standard YA39 Good Practice Recommendations The existing Quality Assurance process should be formalised, seeking the views of service users, their relatives/main carers and professionals, as to the care provided by Ashcroft Hostel, producing a report as to the outcome for people that participated, which details any actions the home intends to introduce as a result of the audit. Ashcroft Hostel DS0000035190.V340703.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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. 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