Inspection on 11/08/05 for Ashdale

This inspection was carried out on 11th August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashdale 12/12/08

Ashdale 03/05/06

Ashdale 19/12/05

Ashdale 31/01/05

Ashdale 02/06/04

Ashdale 02/06/03

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Fairways

Treloar College

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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 Ashdale 1 Rakemakers Holybourne Alton GU34 4ED Lead Inspector Rodney Martin Unannounced 11 August 2005 th 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 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 Stationary 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. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ashdale Address 1 Rakemakers Holybourne Alton Hampshire GU34 4ED 01420 549048 01420 5429048 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Iliace Limited Mrs Emily Tutton CRH 4 Category(ies) of LD Learning Disability registration, with number of places Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service Users in the category LD are only to be accomodated between 18 and 55 years Date of last inspection 31.01.05 Brief Description of the Service: Ashdale is one of six homes in the Alton area that is owned by ILIACE. Ashdale is a four bedroom detached property, which is situated in Holybourne, Alton, where there are a range of shopping, leisure and employment facilities available. The home was first registered in March 1999 and all four current service users moved there, from another home, in April 1999. ILIACE has currently another four homes in the Southampton area. Emily Tutton, has worked for nearly ten years for the organisation and has managed Ashdale since March 2002. The service provides for four service users, between the age of eighteen and fifty-five years, who have a learning disability. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were five requirements in the previous inspection report, dated 31 January 2005. It was found, on the day of the visit, that all five actions the home was required to make had been implemented. There were no requirements made following this inspection visit. The unannounced inspection took place between 8.25am and 11.30am and during the visit the inspector, was assisted by the manager, Emily Tutton. On the day of the inspection the home was accommodating four service users whose ages ranged from 38 to 49 years old. Ashdale has two male and two female service users. All four-service users have been in the home since it first opened in April 1999 and have been together as a group, since 1996. The inspector was able to tour the building as well as speak to the two staff members on duty. One service user was on holiday with a parent and two service users left at 9.30am, accompanied by a staff member, to go drumming at the Phoenix theatre. The other service user was taken out for a walk. However, the inspector had received four comment cards, prior to the inspection on 1 July 2005. Although the key worker had helped each service user to complete the questionnaire, they were all positive. Staff are actively encouraged to help residents make decisions in promoting independence. From discussion with the staff and an inspection of residents’ plans the inspector was able to confirm that, as far as is practicable, the home supports the residents to make all the important decisions in their lives. There was evidence available on the day of the inspection to indicate that the core values are being upheld in Ashdale. Care, medication, staff, and fire records were inspected. These were relevant and up to date. All standards, bar two, [5 and 34] were inspected on this occasion. What the service does well: The home provides a safe environment for residents where they are looked after by dedicated and caring staff, who are suitably trained. The home enables residents to participate in appropriate activities, including access to community services and provides flexibility over meal times. There is continuity of care and residents support needs are met within Ashdale. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 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 standard(s) 1, 2, 3, and 4 The home’s admission procedure ensures that prospective residents have opportunities to visit the home. Residents assessed needs and aspirations are met within Ashdale and are supported to maximise their potential. EVIDENCE: There have been no admissions since April 1999 and consequently there has been a long settled period within Ashdale. However, prospective residents would be involved in a comprehensive introduction process, before a final decision is made to admit. The placement would be reviewed on a regular basis. Ashdale does not take emergency admissions. The home has a statement of purpose and service users guide. Each service user has a file with the service users guide, a charter of rights, how to complain, key worker year planner, a copy of their health action plan, important people in their life and a circle of support. The same four service users have been together in Ashdale for a six years and are very much part of a ‘family’ unit. The aims and objectives of the home are “to create an environment which values individuals and promotes continued development through the adherence to care plans and informed choice”. In discussion with the manager, staff, as well as evidence from the service users’ files, the assessed needs of the four service users are being met in Ashdale. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 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 standard(s) 6, 7, 8 9 and 10 There is a clear care planning system in place, with evidence of consultation with service users about decision making, which ensures that their needs are met. EVIDENCE: Each service user has a comprehensive file, which includes important relevant information, their service user plan detailing the service users’ general abilities, with complete details of the care required. The file also included a record of their daily activities from their mood on waking; through to going to bed, as well as the meals they had eaten. Records indicated that these had been completed up to the previous day of the inspection. The files were easy to read and gave a good pen picture of the individual service user. Staff are actively encouraged to help service users make decisions in promoting independence. The manager is appointee for three service users; however, support is given on how they spend their money. Individual choices are documented in the service user’s care plan, residents’ meetings minutes Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 10 and in the service user’s daily diary. Service users are able, with support, to voice their opinion at the regular residents’ meetings. They are also involved in their reviews. A separate activities’ plan for each service user was available, indicating that service users participate in an extensive list of activities. Risk assessments and manual handling assessments are carried out as part of the referral procedure and are updated, as appropriate. Records are kept in the office. The home has a policy on confidentiality. Service users can have access to their records. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 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 standard(s) 11, 12, 13, 14, 15, 16 and 17 Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: Day services/activities and the resident’s social life is part of the care plan. Each resident has a timetable of activities, with a full programme for each one. Service users also attend a cookery course at a local college. Each service user has an individual risk assessment for radiators, outings, swimming, and fire procedures. Residents enjoy a variety of outdoors and community activities during the week. A record is kept each day of the various activities. These were varied, interesting and appropriate for the needs of the individual service user. An example, for the week preceding the inspection, showed that service users had been to Long Down dairy farm, Monkey World, the Forest centre for drama, Queen Elizabeth activities centre in Upper Hamble country park and arts and crafts. Ashdale has a people carrier to transport service users to their various activities and courses. Also available is a minibus, from the organisation. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 12 All service users enjoyed having a holiday in a holiday park in Devon, this year. One service user is going to Euro Disney in September. Although service users are on the electoral roll, it was reported that they do not understand the implications of voting. As previously noted, one service user was away staying with their family. All service users have family visiting them and three go home regularly. A four-week menu was available for inspection, indicating that the meals were balanced and nutritious. Service users have a snack at lunchtime and eat in the evening, apart from Sunday, when they have a roast dinner, midday. On Thursday the service users go to Queen Elizabeth activities centre and because they tend to get back late, have a takeaway meal, which they enjoy. Service users help prepare the evening main meal and all can make their own drinks. Service users sit down with the staff and plan the menus. The inspector was shown samples of a pictorial menu to enable service users to make a more informed choice. Alternatives to the main menu are routinely recorded. The involvement of a nutritionist was discussed, however, the manager stated that the service users went on a healthy eating option, last year, and that the home was aware of providing a well-balanced meal for service users. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 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 standard(s) 18, 19, 20 and 21 The residents’ physical and emotional health needs are being met, with evidence of good support from health care professionals. The home has clear arrangements in place ensuring the medication needs of residents are met. EVIDENCE: Since the last inspection the home has implemented the three actions required regarding medication practices. The home has a record for when paracetamol is given on an as and when required basis [p.r.n.]. However, it was noted that all paracetamol was returned to the pharmacist in July and the home is not holding any stocks of the medication. Medication is now stored separately for each service user and a controlled drugs’ register has been made up. All service users are on some form of medication. The home operates a monitored dosage system. The individual cassettes were found to be correct. Some medication is kept in a separate container, for each service user. The drugs’ cabinet was found to be clean and tidy. The manager has regular meetings with the service users’ GP to review their medication. There was evidence of visits to health professionals, in the residents’ files. There are risk assessments on file for each service user, including for one service user who may require rectal diazepam. Health professionals are Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 14 involved with residents as appropriate. One service user has a fear of hospitals and ‘men in white coats’ and in particular would not allow a dentist to look in their mouth. The home arranged for the dentist, in their ordinary clothes, to do a domiciliary visit. After several visits the manager reported that they now allow the dentist to work on their teeth. The home has a policy on death and dying, including what to do in the event of the death of the resident. However, the service user’s wishes concerning terminal care and death had not been discussed with them or their next of kin. It was agreed, with the manager, that the home would be proactive in obtaining this information. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 15 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 standard(s) 22 and 23 The home has a satisfactory complaints procedure and an adult protection procedure, to safeguard residents from abuse. EVIDENCE: The home maintains a complaints log. There have been no complaints recorded or referred to the Commission. Ashdale has a full complaints procedure and a copy is given to all residents. A summary of the complaints procedure is also contained in pictorial format within the service user guide. Ashdale has an adult protection policy. Staff have received training in preventing and dealing with suspected abuse. There have been no incidents of abuse recorded in the home. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 16 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 standard(s) 24, 25, 26, 27, 28, 29 and 30 A very good standard of accommodation is provided ensuring residents live in a homely, comfortable and safe environment. EVIDENCE: The inspector was able to tour the building. Ashdale is double- glazed throughout and has enclosed rear garden. The home has a lounge, separate dining room and a large kitchen. There is a bathroom with toilet and shower attachment on the ground floor and a separate toilet and another bathroom with a toilet, upstairs. The manager reported that within the capital works list a new bathroom suite for downstairs is planned. The home has various hi-fi, television and video equipment. Since the last inspection the home has written a risk assessment for service users using the garden, in particular the raised decking. Each resident has a single bedroom, which they have personalised with their own possessions and electrical equipment. The home has created a vegetable plot in the garden for residents to grow their own produce. Since the last inspection an air freshening system Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 17 has been installed in the home and a spray cleaning system purchased to kill bacteria, especially for one service user, who is incontinent. The laundry room is situated away from the kitchen and food preparation and is kept under lock and key. Ashdale has a washing machine and tumble dryer. Control of Substances Hazardous to Health assessments [COSHH] policies and procedures are in place, to ensure that staff and residents’ health and safety is promoted. The inspector observed a staff member using protective gloves whilst working in the laundry room, indicating good practice whilst using COSHH materials. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 and 36 Residents are well supported by a sufficient, well-trained and consistent supervised staff team, who offer continuity of care. EVIDENCE: Ashdale employs six-day staff and two night staff members. The home has a full compliment of staff and there have been no new appointments for thirteen months; and so there is continuity of care. All staff have a safe handling of medicines certificate and have attended a course on infection control. All staff have completed the six foundation units for LDAF training [learning disability award framework, which is a qualifications framework aiming to provide a clear pathway for a worker’s training and development from the day they begin to work in the learning disability sector]. The organisation has a training and development manager and has produced a training calendar. Staff receive core training in manual handling, food hygiene, health and safety, fire safety, first aid, communication skills, Makaton [a means of communicating by symbols], adult protection, deep water training – for service users going swimming, autism, people centre planning [PCP] and SCIP [strategies for crisis intervention and prevention]. All staff attended Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 19 epilepsy awareness and the administration of rectal medication workshop, in April 2005. Currently four staff members are on an NVQ level 3 in care course. The last staff meeting was held on 13 May 2005 when five staff members attended. The minutes of this meeting and the previous meeting held on 25 January 2005 were available on the day of the inspection. The manager has completed annual appraisals on three staff members. Staff receive one-to-one supervision, every two months. The inspector discussed various forms of supervision to include one-to-one, work practice issues dealt with in-group supervision or supervision covering all aspects of the staff member’s practice. Each staff member has a personal development plan. Samples of records of staff supervision and staff files were seen, indicating that these were kept up to date. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, 42 and 43 Ashdale is a well run home by a qualified and experienced manager, who provides effective leadership. Service users rights and interests are safeguarded and protected by the home’s policies and procedures and health and safety measures. EVIDENCE: The home has a registered manager, who is suitably qualified, having a degree in learning disability. She has worked for ILIACE for ten years and has been the registered manager since March 2002. She is currently on the registered managers award for NVQ level 4 in both management and care. The manager is starting a one-year distance learning postgraduate course, with Birmingham University, in September 2005. The manager communicates a clear sense of direction and leadership through staff meetings, staff supervision and education and operates an ‘open door’ policy. As noted in the above staffing section, there are regular monthly staff meetings. Staff are in the process of having a yearly appraisal and receive regular supervision. The inspector was Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 21 able to speak to both staff members on duty. They thoroughly enjoyed their job and felt supported to do their work. Relevant records were satisfactorily maintained. The fire logbook was inspected and fire safety equipment had been tested and serviced regularly. Staff receive corporate fire instruction and there was evidence of this in the fire logbook. The home has a current fire risk assessment. The health, safety and welfare of residents is promoted and protected by the manager ensuring that Ashdale is a safe environment to work in, by staff having received current training in first aid, manual handling, infection control, fire safety et cetera. Relevant assessments have been carried out. The accident record was inspected. Appropriate records of incidents are maintained. There are regular monthly-unannounced visits by a representative of the organisation to report on the conduct of the home. The last one was on 7 July 2005 by another registered manager within the Alton group of homes. The manager reported that from September 2005 the head of care at ILIACE will do all six homes for the monthly visit [where the registered provider is an organisation but not in charge of the care home and an unannounced visit needs to be undertaken and a written report prepared on the conduct of the home] to provide a consistency across the group. The home has a current certificate of employers liability insurance. Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 22 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 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 4 4 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashdale Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 23 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 24 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashdale H54 S12380 Ashdale V234405 110805.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!