Inspection on 03/05/06 for Ashdale

This inspection was carried out on 3rd May 2006.

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

Ashdale 12/12/08

Ashdale 19/12/05

Ashdale 11/08/05

Ashdale 31/01/05

Ashdale 02/06/04

Ashdale 02/06/03

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Orchard,The

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Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

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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 Hampshire GU34 4ED Lead Inspector Debbie Oliver Unannounced Inspection 3rd May 2006 10:00 Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 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 Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 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. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashdale Address 1 Rakemakers Holybourne Alton Hampshire GU34 4ED 01420 549048 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) ILIACE Limited Mrs Emily Tutton Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2005 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. On the 4th May 2006 the fees for the home on an average basis were £1655 a week. Information about the service provided at the home would be made available to potential service users by providing a copy of the home’s service users guide and statement of purpose. A copy of the last inspection report is available in the office. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was unannounced beginning at 10.00 and finishing at 15.30. During the visit, records and documents were examined, an opportunity was taken to tour the premises and staff working practices were observed. Two staff and the manager were spoken to. All four service users were spoken to and observation also enabled the inspector to gain a better understanding of how the needs of service users were being met. At the time of the visit there were no vacancies with four service users being accommodated, two were female and two were male. There were no service users from ethnic minority groups. Four comment cards from service users were received and two from relatives prior to the inspection. The pre-inspection questionnaire was also received and used as evidence within this report. What the service does well: What has improved since the last inspection? The carpets have been replaced ensuring the home is at a standard expected by the people living there. The water temperature has also been regulated to ensure the safety of service users and staff. The front door has been fixed and this also ensures the safety of the service users living in the home. The house is clean and tidy with everyone responsible for achieving this and the clinical waste is now collected from the home with a relevant policy in place to assist with infection control. Additionally one person’s care plan has also been updated to reflect their personal hygiene needs. The manager is now aware of the fire regulations so she can support the service users and staff in the area of fire safety. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 6 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 DS0000012380.V293517.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home’s systems and procedures for identifying the needs of existing service users are satisfactory. EVIDENCE: The home has had no new admissions and during the last visit it was evident through the assessments sampled that the assessed needs of service users are being met. As there were no new admissions and the current service users have lived in the home for many years the assessments were not viewed on this occasion. On observation throughout the day it was evident staff can meet service users’ needs. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is a clear and consistent care planning system in place, which provides staff with the information they need to satisfactorily meet service users’ needs, but further documentation is needed to ensure the one restriction in place is in the best interests of the service user. Service users are able to make decisions about their lives. Risk assessments are in place and ensure service users are able to take risks as part of an independent lifestyle. EVIDENCE: Three service users were case tracked and the information available is person centred, covering all areas of a persons’ life relating to John O’Brien’s service accomplishments of Community Presence, Community Participation, Competence, Respect and Choice. The plans were being reviewed on a regular basis. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 10 Staff spoken to said ‘ The care plans were invaluable when I first met the service users as it enabled me to get to know people.’ The daily diaries indicate what decisions service users have made throughout the day. During the visit a service user clearly made a decision to have a cup of tea rather than a drink of cordial and this was fully supported by the staff member. Staff spoken to said choices are given to service users through their meetings where they discuss activities and the food menu using pictures and Makaton. There is good use of Makaton in the home and other pictures in the house to show service users where objects are, such as a picture of a knife on the drawer that holds the knives. Throughout the visit staff used open ended questions, so said ‘what drink do you want?’ rather than ‘do you want a cup of tea?’ There was an issue relating to the use of a monitor for one service user. This is used at night as the service user suffers with epilepsy and the night staff can hear if anything happens. This does mean that the service user’s privacy is compromised. Although the manager confirmed the use of the monitor was in the individuals’ best interest, there was no documentation in place to show how the decision was reached with the service user and all other necessary parties. Evidence was seen within the files to support that risk assessments are available and that service users are supported to take risks including swimming and going out on activities. Additionally the two relative comment cards received confirmed they are consulted about their family’s care. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have opportunities to engage in suitable activities and are part of the local community, so promoting independence and choice. Contact with families is well supported, and nutritional needs of service users are well managed. EVIDENCE: The daily diary for each service user shows what activities have been undertaken and whether they enjoyed this. One service user told the inspector how they had recently gone on holiday and visited museums, shops and the seaside. Additionally on the day of the visit service users were attending cookery and drama classes within the community. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 12 The home also has bags with a picture of an activity on them and an object of reference inside relating to the activity, such as for gardening there is a flowerpot in the bag. Throughout the visit service users were out and about and in the afternoon classical music was playing in the home giving a relaxed atmosphere and the service user sitting in the lounge was enjoying the music. One staff member was assisting a service user with their art and craft and another service user was spending time in their bedroom and the lounge. Contact with families is very positive. In one service users’ file it says regular contact with their family is very important and there was evidence to show this happens in the plans. Staff spoken to also confirmed this happened. Other service users spoken to confirmed they also have regular contact with their families. It was evident throughout the visit that service users’ rights are respected such as being addressed by their preferred names as indicated in their plans. Additionally staff were seen knocking on bedrooms doors and waiting for permission to enter. A four-week rotational menu was seen and offered a varied and nutritious diet and staff confirmed this was based on the likes and dislikes of service users. Pictures of meals are used as objects of reference. Staff also confirmed that alternatives are available if needed. Service users are fully involved in the preparation of food. On the day of the visit all service users were attending a cookery session and they were making their lunch for that day. The four comment cards received by the service users stated they liked living in the home, felt well cared for and felt that staff treat them with respect. They also said they liked the food provided in the home. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The personal, physical and health care needs of service users are well met and there are good systems in place that ensures the medication needs of service users are also met. EVIDENCE: Care plans show how service users like to be supported in regard to their personal care. It is now detailed in one service user’s plan how staff support them in their personal hygiene, this information was not available at the last inspection. There are details in the plans showing how service users access health care professionals such as opticians and dentists. One staff member said service users are supported as needed and pictures are used to show service users when they are going to visit the dentist or doctors. Another service user was also supported to visit the doctor’s surgery prior to their appointment so they could familiarise themselves. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 14 The home has a policy on medication and a copy of The Royal Pharmaceutical Society Guidelines. It stated in the pre-inspection questionnaire that the policy remains unchanged and it was therefore not viewed during this visit. There was a medication cabinet and the storage of medication was satisfactory. All the relevant documentation is in place relating to receiving, administering and disposal of medication and the inspector viewed this. All staff receive training through the organisation and all but two staff have completed the twelve week course on the Safe Handling of Medication at the local college. None of the service users in the home self-administer. All staff have also received training in administering rectal diazepam and the records for this was seen. Additionally each service user who has epilepsy has a risk assessment in place showing what support is needed in the event of having a seizure. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 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 the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Arrangements for protecting service users and responding to concerns are satisfactory. EVIDENCE: The manager confirmed there have been no complaints or allegations of abuse. All staff have received training on adult protection and the staff spoken to were clear on the procedure to follow in the event of suspected abuse. The home has all the relevant procedures and policies and the manager demonstrated their knowledge and understanding of the policy. The four comment cards received by the service users stated they all felt safe living in the home. The complaints procedure is available, in a pictorial format for service users. All staff spoken to were clear on what to do if they received a complaint or had a complaint themselves and one staff member said this is easy to do as ‘they have an open culture in the home.’ Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 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 the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A comfortable and safe standard of accommodation is provided for the service users, which meet their needs. EVIDENCE: The inspector toured the premises and since the last inspection the carpets in the hall, on the stairs and landing have been replaced and the home was clean and tidy on the day of the visit. The furniture and fittings seen in the home were satisfactory. Staff spoken to said the cleaning rota is now in place and is working and service users are fully involved in the cleaning of the home. There was adequate living space, the premises were bright with adequate lighting and ventilation. The home has an infection control procedure and protective clothing was readily available and staff were observed using it appropriately. The home has Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 17 now purchased a clinical waste bin and this is emptied every week. The manager has also written a clinical waste policy and the inspector saw this. Staff spoken to said improvements are happening to make the environment more homely such as putting decking down in the garden. This is an improvement for one service user as they are anxious about uneven surfaces and so would not go out in the garden and they now can. All the requirements relating to the last visit have been made and an action plan was sent to the Commission detailing this and was also confirmed on the most recent Regulation 26 visit form. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has procedures and systems in place to ensure staff are properly recruited and that there is always enough staff on duty. Staff training is appropriate and ensures staff have the necessary skills and knowledge to meet the complex needs of service users accommodated in the home. EVIDENCE: From observation and discussion with staff members, they have built good relationships with service users and have a good understanding of their behaviours. Two staff were spoken to and confirmed they have received training including The Learning Disability Awards Framework, an introduction to Autism, Makaton and communication and the records reflected this. The training received also included the core training such as infection control, health and safety and first aid. There is clear documentation to show who has received training and who is soon due an update. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 19 Fifty percent of the staff team have also completed or have started a National Vocational Qualification. Both staff members spoken to felt the training they have received is extremely useful and helps them to do their job. They also stated they can request job coaching if they require further support. They are regularly supervised and felt supported by the management. There was adequate staff on duty at the time of the visit and staff spoken to confirmed this. The inspector sampled two staff files and they contained all the necessary information relating to recruitment. There was one issue relating to a work permit not being available but this was resolved during the visit and head office faxed it to the home. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The management of the home is organised and efficient. Service users are confident their views support the review and development of the home. Staff training and practices in the home ensures the health, safety and welfare of service users are fully promoted. EVIDENCE: The registered manager has been in post since March 2002 and in discussion with her she has attended many courses to update and expand her knowledge. The manager communicates a clear sense of direction and leadership through staff meetings, staff supervision and makes herself available to support service users and staff. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 21 Maintenance issues are recorded in a file clearly indicating the jobs that need to be done and confirmation once they have been completed. The policies seen are in place and the manager confirmed these are all in the process of being updated, this was also confirmed on the pre-inspection form. All staff have been trained in fire safety and in discussion with the manager she has a clearer understanding of the fire regulations and how they affect the home and the people living there. All other fire checks have been completed and were satisfactory. The front door has been fixed so it now locks properly. Staff spoken to were clear on their role in relation to health and safety and had received the necessary training in health and safety, first aid, food hygiene and infection control. The home has environmental risk assessments that indicate the risk around the home and how these can be minimised. On the previous visit it was indicated that systems and equipment in the home were tested and serviced including, portable electrical appliances, boilers and central heating and electrical wiring. This was also confirmed in the pre inspection questionnaire. Systems are in place to review and monitor the service including monthly visits from the service manager, a copy of which is sent to the Commission. Staff meetings are held on a regular basis and showed decisions being made but it was discussed with the manager there needs to be clear documentation showing when decisions have been actioned or not met for any reason. The manager confirmed comment cards have been sent to the staff and the outcome of these will be used and made into a report that will be available for discussion. There are also comment cards for service users and it was agreed that someone from out side of the house may be able to assist them in filling them in such as a family member or a friend of the people living in the home. The accident book was seen but there have been no accidents for many months and recent regulation 37 notifications have not given cause for concern. Although the service user comment cards received stated they wanted to be more involved in decision making, there was enough evidence during this visit to say they do. It was discussed with the manager this needs to be constantly reviewed with the service users and their keyworkers to ensure they are satisfied. Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 22 Two comment cards were received from relatives and both were satisfied with the support their family members were receiving and one said ‘Very happy the way things are, no complaints.’ Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X 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 X 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 X 3 X X 3 X Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 24 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 YA6 Regulation 13(4)(c) Requirement The registered person must ensure the relevant documentation is in place to support the decision to use a monitoring device throughout the night. Timescale for action 03/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashdale DS0000012380.V293517.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hampshire Office 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 DS0000012380.V293517.R01.S.doc Version 5.1 Page 26 - 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. 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