Inspection on 13/05/08 for Ashdene House

This inspection was carried out on 13th May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashdene House 21/05/07

Ashdene House 19/07/06

Ashdene House 22/11/05

Ashdene House 01/06/05

Ashdene House 10/08/04

Ashdene House 02/06/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Ashdene House 50 St Mildreds Road Ramsgate Kent CT11 8EF Lead Inspector Mark Hemmings Unannounced Inspection 13th May 2008 09:00 13/05/08 Ashdene House DS0000023721.V363207.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 Ashdene House DS0000023721.V363207.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. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashdene House Address 50 St Mildreds Road Ramsgate Kent CT11 8EF 01843 592045 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) ashdenehouse@aol.com Ashdene House Limited Manager post vacant Care Home 18 Category(ies) of Learning disability (18), Physical disability (18) registration, with number of places Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st May 2007 Brief Description of the Service: Ashdene House (the Service) is registered to provide accommodation and personal care for 18 younger adults who have a learning disability. Some of them may also have a physical disability. Most of the people who live in the Service and people who are likely to move in, have special communication needs. This means that they do not have easy use of spoken and written words. The main premises are a large detached property to which a ground floor extension has been added at the rear. In the main house, the accommodation is provided on the ground and the first floors. There is no passenger lift or stair lift. This means that people who have a physical disability do not have the option of having a room upstairs. On the same site as the main house, there is a self contained smaller house. This can accommodate three people. Again there is no lift to the first floor where all of the bedrooms are located. All of the people have their own bedroom. Each bedroom has a private wash hand basin. The property is located in a quiet residential area that is within walking distance of Ramsgate town centre. There is plenty of off-street car parking. Ramsgate has a mainline railway station. There is a bus service that passes near to the Service. The Registered Provider is a private limited company. It runs a number of similar residential care services in the region. The range of fees charged currently for each person’s residence in Ashdene House runs from £766.00 to £2005.87 per week. The fees paid for some of the people are higher. This is because they receive more direct support. The fees cover the cost of accommodation, personal care, meals at home, laundry, inhouse entertainment and use of the Service’s vehicle. They do not cover extras such as personal toiletries and meals out. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this Service is One (1) Star. This means that the people who use this Service experience adequate quality outcomes. The commission since 1 April 2006, has developed the way it undertakes its inspection of care services. This inspection of the Service was an unannounced “Key Inspection”. The Inspector arrived at the Service at 09.00 and was in the Service for about seven hours. It was a thorough look at how well the Service is doing. We took into account detailed information provided by the Registered Provider in its self-assessment. This is called the Annual Quality Assurance Assessment. Further, we considered any information that the commission has received about the Service since the last inspection. When in the Service, we spoke with some of the people who live there and more generally spent time in their company. This was done to get a first hand feeling of how things run in practice. We spoke with the Service Manager, the Area Manager, the Manager and with members of staff. We looked at some key records and documents. We examined parts of the accommodation and the grounds. There are eight Requirements at the end of this Report. What the service does well: There is a relaxed and homely atmosphere. The people who live in the Service say and indicate by their manner that members of staff are kind and attentive. People receive the support and assistance they need and that this is in line with their expectations. People are served with good quality meals. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Parts of the Service Users’ Guide are not presented in a user-friendly style. This is a brochure that should tell people who might want to move in what is available in the Service. Most of the people who are likely to move into the Service will find it very difficult to know what it is saying. The individual plans of care also are not written in an easy to use way. As a result, most of the people who live in the Service are not able to use them. There are limited shortfalls in the medication arrangements for two people. This is not safe because it might mean that the people concerned do not receive the health care support that has been prescribed by their doctors. Parts of the training arrangements are not well developed. This could limit the ability of support workers to help people in the way they need. There is no registered manager. This is a legal requirement. There are shortfalls in the quality assurance system. This reduces the ability of the Registered Provider to find out what people think about how things are going and about what might need to be improved. The Annual Quality Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 7 Assurance Assessment does not have a plan to sort this out. We highlighted the need for this in our previous inspection report. There are limited shortfalls in the fire safety arrangements. These might reduce the level of protection available in the Service. 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. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 8 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 Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 9 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): Standards 1, 2 and 5. People who use the Service experience adequate outcomes. This judgement has been made using available evidence including a visit to the Service. People are told about the facilities that are available and about the support they will receive. Parts of the Service Users’ Guide are not user-friendly. There are shortfalls in the admissions process. The written statement of the conditions of residence is not user-friendly. EVIDENCE: People who might want to move in are invited to visit the Service so that they can get a first hand feeling of what the place is like. They can also get information from the Service Users’ Guide. This is a brochure that outlines the main things available in the Service. Most of the Guide is user-friendly in that it has various things such as the use of pictures to help people who do not use written words. However some parts are not presented like this. For example, the bits dealing with the fees charged and what they include. There is a Requirement in relation to this matter at the end of this Report. There is also a document called the Statement of Purpose. This gives a more detailed account than does the Guide. This is not user-friendly. The Registered Provider ensures that a copy of our most recent Inspection Report is available. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 10 The Manager says that she will complete an assessment of each prospective person’s needs for assistance. This is done before a decision is made about whether or not the Service can meet the person’s needs. She says that this assessment will be completed in consultation with the person concerned. As appropriate, members of their family will be involved. There have not been any admissions to the Service since the last inspection. However, we were able to look at the assessment completed for someone who was due to move in and then did not do so. There was information about the person’s needs for personal support, about their health and about their special communication requirements. However, the form that is used is not user-friendly. This means that it will be very difficult for most people to taken an active part in preparing the written description of their needs and preferences. There is a Recommendation in relation to this matter at the end of this Report. Each person or their representative, receives a written account of the rights and of the responsibilities they accept when they move in. The document is not user-friendly. Again, this will make using it a problem for most of the people who might want to move in. The Manager says that she will take the time needed to explain to people the main points. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 11 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): Standards 6, 7 and 9. People who use the Service experience adequate outcomes. This judgement has been made using available evidence including a visit to the Service. There are individual written plans of care but these are not user-friendly. People should be more involved in the management of their money. People are helped to not take unnecessary risks. EVIDENCE: The people who live in the Service say and indicate that the support workers offer them all the assistance they need. There is a written individual plan of care for each person. These are important documents. This is because they form one of the means by which people can decide about the support they need. Also, they are a way for them to show their agreement with how this is going to be delivered. The plans are a source of information for staff. This then Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 12 helps them to provide support in the right way. We looked in some detail at five sets of these plans. They contain information about a number of relevant things. For example, there is information about how to help the people say what they want, about how to support them in managing parts of their behaviour and about how to help them with practical things such as getting dressed and using the bathroom. We spoke with three of the support workers about the contents of these plans. They have a good knowledge of the needs and wishes of the people concerned and about particular aspects of the support they need. However, the plans are not written in a user-friendly manner. Also, there is a lot of paperwork and various different forms to go through. This will make it very difficult for the people who live in the Service to make a meaningful contribution to how their needs and wishes are recorded. There is a Requirement in relation to this matter at the end of this Report. Five people have their own bank accounts. However, the others do not. This means that they do not have the opportunity to use a bank in the normal way. There is a Recommendation in relation to this matter at the end of this Report. The Service holds small amounts of cash for each person. This is done to help them to budget. We looked at two sets of the records of the various transactions. The amounts spent were for reasonable things such as seeing the chiropodist and holiday expenses. The paper balances tallied with the cash balances. People are helped not to take unnecessary risks. For example, they are asked to think about whether or not they need help to do particular things such as crossing the road in safety. We looked at three sets of these risk assessments. They show that sensible consideration has been given to the personal safety of the people concerned. However again, they are not written in a user friendly manner. This makes it difficult for people to take an active part in their preparation. In turn, this might result in them not being supported to do new things for fear of having a minor mishap. There is a Requirement in relation to this matter at the end of this Report. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13, 14, 15, 16 and 17. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. People have the opportunity to do occupational and social activities. People can spend their days as they wish. Good quality meals are served, but the menu is not displayed in a user-friendly manner. EVIDENCE: People are free to do things that interest them. Three people undertake occupational activities that involve them being out in the local community. We examined the records of these activities. They show that each of the people concerned had completed one of these commitments in a period of seven days just preceding the inspection. In addition to this, the Registered Provider runs a small day opportunities facility in the grounds of the Service. People can go Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 14 there for several hours in the morning or in the afternoon to undertake craft work. We visited the facility and found six people there. Four were busily engaged in art work and two were having a cup of tea. There is a lively and enjoyable atmosphere. People are expected to help out around the house doing everyday tasks such as vacuuming and generally keeping things in order. The Annual Quality Assurance Assessment says that people will be encouraged to become still more involved in the running of their home. People have the opportunity to take part in social activities. The Service has its own transport. This means that there is the flexibility for people to be out and about. We looked at the records of how often trips out occur in practice. During the seven day period noted above, people variously went swimming, went out for a picnic, went into town shopping and went to the cinema. On the day of the inspection, some people went out for a picnic in the morning and then went out to a local café in the afternoon. People say and indicate that the pace of daily life in the Service is relaxed and unhurried. While they have considerable choice about how to spend their day, there are broad expectations about some of the things they will do. For example, they are expected to adopt reasonable personal practices such as not going to bed too late so that they are then too tired to do things the next day. People are helped to keep in touch with members of their families, if this is necessary and if it is their wish. Family members and friends are welcome to call to the Service at any reasonable time. Also, some people are accompanied on trips to see their parents at home. The Manager in consultation with the person concerned, keeps in touch with family members so that they know how things are going. The records show that during the seven day period one person received two telephone calls from a parent, one person received one telephone call from a parent and another person telephoned their parent. People say and indicate that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant experience. There is a choice of dish available at each meal time. However, the written menu is not in a user-friendly style. Much more could be done to help people choose between dishes. For example, the choices could be illustrated by using photographs of the dishes. There is a Recommendation in relation to this matter at the end of this Report. We looked at the record of the food actually served. This shows that people can indeed choose alternatives and that in general people have a normally varied diet. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 15 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): Standards 18, 19 and 20. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. People are helped to support themselves. This includes using health care services. There are shortfalls in a part of the medication administration arrangements. EVIDENCE: People are assisted in ways that are right for them. For example, some people need more personal space than do others. Or another example is that some people need more support than do others when choosing clothes that are right for the weather at the time. Support workers are courteous in their manner and they respect each person’s individuality. People say and indicate that they can rely upon support workers to be there when they are needed and to be Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 16 approachable. We observed support workers giving people the time they need to express themselves and then responding in a helpful manner to their requests. People are assisted to maintain their health. Support workers are alert to the need to identify occasions when someone is becoming unwell. This is so that medical assistance can be sought promptly. Since the last inspection, people have been supported to consult with family practitioners and other medical personnel such as the diabetes nurse. People are encouraged to promote their good health. For example, there is evidence that some of the people have been supported to manage their weight. Also, people are helped to attend for regular check ups with the dentist. All of the people have their medicine handled by the Service. There is evidence that medicines are checked when they are received into the Service to make sure that they are correct. They are then stored securely and in an organised manner. The support workers who dispense medicines know what they are doing. They have been assessed to ensure that they follow a clear procedure. This is designed to ensure that each person takes the right medicine at the right. We looked at six sets of records relating to the medicines dispensed. There were no errors. In more detail, we looked at two medicines in particular. This was done to check that the record of their use matched the stock that was left in the store. Again, we did not find any errors. There are special arrangements in relation to Person A and to Person B. They need to have a medicine on a discretionary basis for a particular condition that comes and goes. There are shortfalls in the arrangements. This is because what the Service actually does is not what has been agreed with the doctors concerned. There is a Requirement in relation to this matter at the end of this Report. Some people might be able to do more to manage their own medication or to do bits of the process. The Manager says that she is going to look into this so that people can be offered any support they need. There is a Recommendation in relation to this matter at the end of this Report. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 17 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): Standards 22 and 23. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. There is an easy to use complaints procedure. The wellbeing of people is safeguarded. EVIDENCE: There is a written complaints procedure. This has pictures and it is quite straightforward so as help people when using it. The procedure explains how the people who live in the Service and other interested parties can go about raising a concern. Since the last inspection, the Registered Provider has received one complaint from a relative. This concerned the replacement of the people carrier vehicle with a standard car. The complaint pointed out that the people who use wheelchairs are not able to get into a car. We looked at the records of how the complaint was sorted out. They show that the matter received prompt attention and that the people carrier was reinstated. People say and indicate that they feel safe living in Ashdene House. The Registered Provider has a written policy and procedure that tells support workers what to do if they become concerned about someone’s wellbeing. For Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 18 example, if someone is being bullied or having their freedom limited without good cause. We spoke with three support workers about this matter. They are aware of what to look out for and who to contact if they become concerned. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 19 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): Standards 24, 26, 27, 28, 29 and 30. People who use the Service experience adequate outcomes. This judgement has been made using available evidence including a visit to the Service. People live in a generally comfortable setting that promotes their independence. The kitchen is clean and well equipped. There is a separate laundry. EVIDENCE: Most areas of the accommodation are decorated and furnished to a normal homely standard. The outside of the building at the front looks rather run down. This is because of peeling paintwork. At the rear of the main building, there is a large white fence that has become discoloured with age. It looks rather tatty. The people carrier has some accident damage on one side. This has rusted over time and it looks very unsightly. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 20 The premises are fitted with an automated fire detection system. This provides a high level of fire safety protection. The Registered Provider has prepared a fire risk assessment. This has been done to ensure that the fire safety system works as intended. Since the last inspection, a door that leads onto the stairwell has been removed in order to help people move around more freely. This has not been included in the assessment. It needs to be put in because the stairwell is a route that people might need to use if they have to evacuate the building. The Manager says that this alteration will now be done and that the assessment will be sent to the Kent Fire and Rescue Service. This will be done so that its adequacy can be confirmed. There is a Requirement in relation to this matter at the end of this Report. The kitchen is clean and well organised. When the local Department of Environmental Health last called to the Service, it recommended that five minor improvements be made in the kitchen. The Manager says that all of the matters have been addressed. We checked two of the recommendations and found that the things have indeed been put right. Some people need extra help in the bathroom because they have difficulties with their mobility. Support workers know what assistance they have to provide. There is suitable equipment in place to enable them to do this safely and reliably. This includes hoists and there is a special shower that can be used by people who find it hard to stand. Since the last inspection, new locks have been fitted to the doors of all bathrooms and toilets so that they can be locked when in use. The bathrooms are clean. However, they are rather stark. Little has been done to make them into personal and welcoming spaces. New locks have also been fitted to bedroom doors so that people can secure their own private space. We were invited to look in several of the bedrooms. There was plenty of evidence that their occupants have made them their own. For example, one person has installed their own music system and another person has various bits of their artwork on display. Person C does not have a television aerial in their bedroom. This means that they cannot use their new television. There is a Requirement in relation to this matter at the end of this Report. Two people use a wheelchair most of the time to get about. The Service is not purpose built and so there are some awkward doors and turns to be made. We asked one of the people concerned about this matter. S/he did not voice any concerns about the subject and support workers say that they can manage with the present arrangements. The laundry is equipped with a washing machine and dryer. People are encouraged to do their own laundry, but in practice most rely upon support workers to organise this for them. The arrangements used work well. Each person has a sufficient supply of clean and presentable clothes from which to choose. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 21 There are new regulations that have been introduced to ensure that used water does not leak back into the main pipe-work. The Registered Provider is going to check with the local water supply company to make sure that it complies with these provisions. This will be done by 1 August 2008. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 22 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): Standards 32, 33, 34 and 35. People who use the Service experience good outcomes. This judgement has been made using available evidence including a visit to the Service. There are enough staff on duty to make sure that people get the support they need. Security checks are completed on staff. There are some shortfalls in the training provided for support workers. EVIDENCE: There are at six support workers on duty during the day and the evening. At night time, there are two support workers on waking duty and one who sleepsin. On weekdays there is a housekeeper. On six days a week there is a cook, but for the seventh day one of the support workers has to act up in this role. We asked two of the people who live in the Service if there are enough staff on duty. They say that there is and that they get all the support that they need. We asked three support workers about the staff cover. They also think that it is adequate to enable them to give people the support and attention they need. There are three vacancies for support workers. At the moment, these shifts are being filled by people doing overtime. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 23 There is an on-call system. This means that someone senior can be contacted for advice out of office hours. The Registered Provider completes a number of security checks in relation to new support workers. This is done to ensure that they are trustworthy people who are suitable to have unsupervised access to the people in residence. We looked at the recorded checks completed for one support worker appointed since the last inspection. These are in order. They show that his/her identity had been confirmed, that the employment history had been checked, that references have been obtained and that a police check has been received. New support workers receive introductory training before they work without direct supervision. After that, they are provided with ongoing training. The Manager says that there is a number of compulsory subjects that should be completed in the first year. These include things such as first aid, health and safety, food hygiene, administering medication, supporting people who have epilepsy, infection control, the safeguarding of vulnerable adults and fire safety. We looked at the training undertaken by two support workers who have worked in the Service for more than one year. Both of them have completed some training courses, but there are gaps. In relation to Support Worker A, the shortfalls involve health and safety and infection control. In relation to Support Worker B, they are first aid, health and safety, food hygiene, the safeguarding of vulnerable adults, administering medication and supporting people with epilepsy. There is a Requirement in relation to this matter at the end of this Report. We examined the skills and knowledge of three of the Support Workers. They have a good knowledge of the individual needs of people for support. For example, they know how people prefer to express themselves. However, they think that it would be helpful to have more training in the use of communication systems such as makaton. There is a Recommendation in relation to this matter at the end of this Report. They know how to give practical assistance with things such as helping people who have difficulty getting about and who need assistance in the bathroom. They are less clear about how to encourage people to become more independent and about how to enable people to take reasonable everyday risks. There is a Recommendation in relation to this matter at the end of this Report. The Manager says that nearly all of the support workers have obtained a Level 2 National Vocational Qualification (NVQ) in social care. Also, three of them have the more advanced Level 3 and five more are in the process of studying for the qualification. These qualifications are designed to help support workers provide high quality support for people who live in residential care settings. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 24 Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 25 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): Standards 37, 39 and 42. People who use the Service experience adequate outcomes. This judgement has been made using available evidence including a visit to the Service. There is no Registered Manager. The quality assurance system does not collect enough information. There are gaps in some of the health and safety arrangements. EVIDENCE: Although the Manager has been in post for more than a year, the Registered Provider has not yet asked us to register her in this role. This means that we Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 26 have not had the opportunity to consider in detail her suitability. There is a Requirement in relation to this matter at the end of this Report. There are various systems used to promote good team-work. These include handover meetings at the beginning and end of each shift. Also, there are staff meetings. The last one took place in March 2008. We looked at the records of the things discussed. They were relevant subjects such as particular support needs of particular people. Also, there were practical things such as the need to avoid clothes being shrunk when put in the washing machine at the wrong temperature. Several things are done to consult with people about how well the Service is running. These include informal everyday discussions and more organised house-meetings. All of the people who live in the Service are invited to attend these meetings and they can raise any subject they like. We looked at the records of the last meeting that took place in February 2008. They show that a good deal of the meeting was used to discuss what social activities would be welcome. Going swimming and going bowling were two of the suggestions made. In addition to this, the Registered Provider asks the people who live in the Service and their relatives to complete yearly satisfaction questionnaires. There were no completed questionnaires in the Service so we could not see what people had said. Members of staff are not included in this process. Also, there is no system to tell stakeholders what is going to be done to respond to any suggested improvements. There is a Requirement in relation to this matter at the end of this Report. Regular checks are completed to ensure that the Service’s fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells and periodic more detailed checks completed by a contractor. There are unannounced fire drills. The records do not clearly show that each member of staff has been regularly assessed as knowing how to operate reliably the Service’s fire safety procedure. This is very important because the actions taken by staff largely determine the level of fire safety protection available in the Service. There is a Requirement in relation to this matter at the end of this Report. The electrical wiring system and gas-fired appliances have been certified as being in a safe-worthy condition. There have not been any significant accidents or other unwelcome events in the Service since the last inspection, that indicate the need for any further preventive steps to be taken. The Registered Provider checks the premises and the accommodation. This is done to ensure that there are no hazards that might cause someone to have an accident. The Manager says that no such problems have been identified. We did not identify any particular hazards. Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 27 Ashdene House DS0000023721.V363207.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 2 2 2 3 X 4 X 5 2 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 2 25 X 26 2 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 X 2 X X 2 X Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 YA1 Regulation 5, 13 Requirement The registered person shall produce a written guide to the care home which shall include a summary of the Statement of Purpose, the terms and conditions in respect of the provision to service users of accommodation (including the provision of food) (and) personal care, details of the total fee payable … the arrangements in place for charging and paying for any services additional to those mentioned (above), a standard form of contract for the provision of services and facilities by the registered provider to service users, in that the Registered Provider must ensure that there is a summary of the Statement of Purpose, an account of the fees payable and of any extra charges and a standard contract that are accessible to the people who use the Service or which can be made accessible to them if they are provided with support. Unless it is impractical to carry DS0000023721.V363207.R01.S.doc Timescale for action 01/09/08 2. YA6 15 (1) (2) 01/08/08 Page 30 Ashdene House Version 5.2 (a) out such consultation the registered person shall after consultation with the service user or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall make the service user’s plan available to the service user in that, the Registered Provider must ensure that all service user plans (and risk assessments) are accessible to the people who use the Service or can be made accessible to them if they are provided with support. The registered person shall make 01/06/08 arrangements for the recording, handling, safekeeping safe administration and disposal of medicines received into the care home in that, the Registered Provider in relation to Person A and Person B must ensure that suitable arrangements are in place for the use of a particular discretionary medicine. The use of the medicine must be that which has been prescribed by a medical practitioner. Where the Regulatory Reform (Fire Safety)Order 2005 applies to the care home the registered provider must ensure that the requirements of that Order .. are complied with in respect of the care home in that, the Registered Provider must submit to the Kent Fire and Rescue Service a current statement of its fire safety risk assessment. The registered person shall having regard to the size of the DS0000023721.V363207.R01.S.doc 3. YA20 13 (2) 4. YA24 23 (4) (A) (b) 01/07/08 5. YA26 16 (2) (c) 01/08/08 Ashdene House Version 5.2 Page 31 care home and the number and needs of service users provide in rooms occupied by service users adequate … equipment suitable to the needs of service users..,in that, the Registered Provider must provide an television aerial connection in the bedroom occupied by Person C. 6. YA37 8 (1) (b) The Registered Provider shall 01/08/08 appoint an individual to manage the care home where the registered provider is not or does not intend to be in full time day to day charge of the care home in that, the Registered Provider must submit to the Commission a suitable person to become the Registered Manager. 01/10/08 The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home in that, the Registered Provider must introduce a quality assurance system that enables the people who live in the Service and other stakeholders to comment on the Service and to received feedback about what action is to be taken to put into effect any suggested improvements. This Requirement is outstanding from the last Key Inspection. It should have been completed by 01/08/07. 8. YA42 23 (4) (e) The registered person shall after consultation with the fire authority make arrangements to ensure by means of fire drills and practices at suitable intervals that the persons DS0000023721.V363207.R01.S.doc 7. YA39 24 (1) 01/07/08 Ashdene House Version 5.2 Page 32 working at the care home and so far as practicable service users are aware of the procedure to be followed in case of fire including the procedure for saving life in that, the Registered Provider must ensure that all members of staff are competent to operate the Service’s fire safety procedure. 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 YA2 Good Practice Recommendations The Registered Provider should develop a user friendly form of the written assessment that is completed in relation to people who might want to move into the Service. The Registered Provider should enable each person to have their own bank account if this is their wish and should provide them with the support they need to operate them safely. The Registered Provider should ensure that the menu supports people in making choices about the meals they want to have. The Registered Provider should offer people the chance to help to manage their own medicines if necessary with support from staff. The Registered Provider should review the skills and knowledge of support workers in relation to responding to people’s special communication needs and in promoting responsible risk taking. As necessary, support workers should be helped to develop further their competencies in relation to these matters. 2. YA7 3. YA17 4. YA20 5. YA35 Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Ashdene House DS0000023721.V363207.R01.S.doc Version 5.2 Page 34 - 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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