CARE HOME ADULTS 18-65
Ashdene House 50 St Mildreds Road Ramsgate Kent CT11 8EF Lead Inspector
Clair Brown Announced Inspection 10:00 22 23 November 2005
nd rd Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 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.V252905.R01.S.doc Version 5.0 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.V252905.R01.S.doc Version 5.0 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) Ashdene House Limited Mrs Pauline Forest Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st June 2005 Brief Description of the Service: Ashdene House, registered to provide residential care for up to eighteen adults with learning disabilities and physical disabilities. The Home is situated in a residential area of the seaside town of Ramsgate, within walking distance of most local amenities. The Home has it’s own transport, which is regularly used to access amenities and events, both within the Ramsgate area and further a field. Ashdene is a large property, nestling neatly and discreetly into the other properties on the road, with a two storied building, referred to as ‘the Cottage’, within it’s grounds. This property accommodates three adults who can live more independently, with daily support from the care staff. There is ample on road parking to the front of the Home. The Home is owned by a private Company with the daily management of the Home being the responsibility of the Registered Manager. Staff are rostered to provide supervision and support to the residents on a twenty four hour basis, including wake and sleep-in cover at night. The health care needs of the residents are met by the local primary health care team. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s announced inspection. The inspection was conducted by one inspectors and the duration of the inspection was 13 hours over three days. The Homes representative was the registered manager. Additional time was spent in planning the inspection and report writing. The inspectors spent time talking to 3 service users and 7 staff, Some staff were actively involved in the inspection. Time was also spent observing interaction between staff and service users. Two relatives completed inspection comment cards. A full tour of the premises was conducted, documents and records were examined, service users files were case tracked and medications checked. What the service does well: What has improved since the last inspection? What they could do better:
Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 6 The service users contract needs to produced in formats that the service users are able to understand and relate to. The pre-admission assessments need to show that sufficient information has been gathered in sufficient detail to enable the registered manager to make an informed decision about the homes ability to meet the prospective service users needs. Although there has been an improvement in the quality of the care plans, personal goals and targets need to be followed through, ensuring that the progress is made towards meeting these, is recorded and reflected in the regular reviews of the care plans. Daily reports should record all aspects of care provided and be linked to the needs identified in the care plan. The home has made written commitments to relatives to provide support and transport to enable them to visit their relative, however this has not always been provided. Service users need to have regular nutritional assessments completed combined with detailed records of all meals provided. The recruitment procedures used for employing staff needs to be improved ensuring all of the required safety checks are completed before new staff start work. The cottage accommodation would benefit from refurbishment. Hot surfaces and radiators need to be risk assessed and if needed guarded. 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. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 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 Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 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): 1,2,3,4,5 The statement of purpose and service user guides are not produced in a format that service users can relate to. The contract fails to provide services users with sufficient information about the terms & conditions of residency and is not provided in appropriate formats. Pre-admission assessments for prospective service users do not gather sufficient information to enable the registered manager to make an informed decision. Prospective service users given lots of oppurtunity to visit the home. EVIDENCE: The home is registered for to care for those with learning disabilities yet the statement of purpose, service user guide and the contract is only produced in a typed format, which many of the service users cannot relate to. The statement of purpose and service users guide is produced as one document and not as two. Two different contracts have been seen, one does not specify what services are provided and included for the fees paid, therefore not informing service users of their rights and entitlement. Two recently admitted services users pre-admission assessments were viewed, one was not conducted by the registered manager. This assessment did not have sufficient detailed information about the service users needs to enable an informed decision to be made. The second assessment was written a day after the admission of the service user to the home. For one service user there were records to show that the prospective service user had visited the home on a number of occasions, including staying overnight prior to moving into the home. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 9 Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 10 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): 6,9, The quality of the information within service users care plans has improved and is developing a more person centred approach. Care plans also contain risk assessments. EVIDENCE: Three service users files were case-tracked. One care plan was produced using a more holistic, person centred approach, including areas such as communication and emotional/behavioural needs as well as their physical needs. This was an improvement since the last inspection. Another care plan of a service user who had been living at the home for a longer period of time did not clearly identify the reasons for their particular care needs. The repetitiveness of some of the paperwork was discussed with the registered manager. The files contained individual risk assessments identifying personal risk factors for these three service users. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 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): 11,12,13,14,15,17 Leisure activities are appropriate and individual. Support is offered to maintain family links but not forthcoming when accepted. Daily routines are flexible. The records of meals provided does not show sufficient evidence of a nutritionally balanced diet being offered. EVIDENCE: One service users file revealed that they were looking towards moving into supported living. Although the need to develop independent living skills was identified including the need to enrol the person at college, the records failed to provide evidence that these had been achieved. Progress towards meeting personal goals was not recorded or clearly identifiable from daily reports. One relative has written confirmation that transport will be provided to enable them to visit their son at the home; this was a significant factor in the final decision to place him at the home. However, since admission this has rarely occurred. Service users were seen to go out into the local community to use local facilities with the support of the care staff. Leisure activities included trips out to the local amenities as well as trips to London. The Home has its own day centre, which provides in house activities, this is currently being redecorated
Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 12 and adapted for wheelchair access. The registered manager stated that the company has a caravan which service users go to for their holidays with 1:1 support provided. One service user refuses to go on holiday but enjoys special days out to places such as Chessington world of adventures. Service users routines are individual and flexible, the numbers of staff provided varies to meet these preferences. The menu only records one choice of main meal being provided, however when talking to the cook alternatives are available. The records of meals provided for each service user is vague and insufficient. The service users living in the kitchen are supported to cook some of their own meals. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 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): 18,19,20 Medication is now kept in appropriate storage facilities. The service users Service users are supported with personal care, whilst maintaining dignity. Health care appointments and regular checks up are accessed. EVIDENCE: Only a brief audit of medication practices was conducted, however the outcome of the previously made requirements was fully inspected. New medication cupboards and fridge has been installed. Staff stated they found the new facilities better and easier to use. Observations of between care staff and service users indicated that staff responding appropriately and respectfully to service users. The service users stated that the care staff are very kind and helpful when assisting them with their personal care. The service users looked clean and were dressed in their own clothing. Records are kept detailing doctor and hospital appointments, medical investigations and routine checks up are accessed appropriately. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 14 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 The complaints procedure is now accessible to service users. Service users monies are protected by thorough procedures. EVIDENCE: The complaints procedure has been produced in different formats including makaton. Service users files record the date that staff sat with them to explain the procedure. Service users monies are managed by the registered provider who is appointee for all of those living at the home. The home is sent pocket money for the service users, in the home the procedure used is only a single signature process. Service users cannot easily access details of the account where their money is held, without formally requesting copies of the bank statement. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 15 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): 24,25,26,27,28,29,30 The Home provides suitable accommodation for the service users which has been maintained adequately. There is sufficient call for assistance systems (call bells) to ensure the safety & welfare of both staff and service users. A selection of specialist equipment and adaptations is provided. Infection control procedures have been improved to prevent the possible spread of infections. EVIDENCE: The Home is a large building set in a residential road. It provides a variety of sized bedrooms. The upper levels is not accessible to those who have restricted mobility. The daycentre is being refurbished and adapted to enable wheelchairs access. Some of the bedrooms have recently been redecorated. The separate three bed-roomed cottage provides a living area, which promotes independence, however the cottage is home to three male service users, their communal area is painted pink and the décor is very tired and the furniture and carpets very worn, with holes evident. This year’s maintenance programme has now been produced and implemented. The call bell system has been extended to incorporate some bedrooms and bathrooms. The staff sleep-in room was been improved. There is now provision for calling the sleep-in staff for assistance without one of the waking night staff actually getting them and potentially leaving an emergency situation. There is a selection of equipment and adaptations provided, such as, hoists, wheelchair
Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 16 stair-lifts and assisted baths. The infection control procedures have been improved with changes to practice and the provision of protective equipment provided, such as: alginate bags; aprons; liquid soap and paper towels. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 17 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): 32,33,34,35,36 Sufficient numbers of care staff are provided. The recruitment procedures do not ensure the safety and welfare of the service users. Staff receive sufficient supervision & support for their roles. EVIDENCE: There were sufficient staff on duty at the time of the inspection to meet service users needs. It is acknowledged that additional staff are provided to enable service users to fulfil their wishes such as trips out. Four care staff files were examined, these showed evidence of staff being employed before all of the required safety checks have been completed, such as CRB & POVA & POVA First. A number of the staff have work permits, one was due to expire and the three seen were for Allied care but not for this particular home. Sixteen out of the eighteen care staff have enrolled on the NVQ in care training. The majority of the other training attended is the mandatory courses with some others such as: makaton and mental health awareness. Staff stated they had benefited from the training they had attended. Records show that staff receive formal supervision every 2 months. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 18 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): 37,38,39,41,42 The manager has the experience to manage the home but needs to gain formal qualifications to support this. There is a basic Quality Assurance programme. EVIDENCE: The registered manager has a city and guilds advanced management in care but has not completed the registered managers award. She has 9 years experience as a manager. The findings of the inspection is that she has responded to the majority of previously made requirements and was well prepared for the inspection. The quality assurance programme has implemented this year and the report has been produced. This would benefit from being developed further to incorporate the views of all those in relation to the home, such as service users relatives and other relevant professional parties. The regulation 26 visits have started again recently but the reports are slow in being sent to the CSCI. The hot surfaces and radiators are not risk assessed to try and prevent possible harm. Daily records of care provided does not do this in sufficient detail. Some times of the day & night have no entries at all. The records do not relate to care needs identified in the individual care plans, so there is no evidence of these needs being met. Staff
Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 19 expressed how happy they are working at the home and that they like the good atmosphere and the support they receive from both their colleagues and the manager. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 20 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 2 2 2 3 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 2 15 2 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Ashdene House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 2 2 X 2 2 X DS0000023721.V252905.R01.S.doc Version 5.0 Page 21 Yes 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 YA1 Regulation 4,5 Requirement To produce the statement of purpose and service user guide as tow separate documents and in appropriate formats. Detailed pre-admission assessments must be conducted and fully recorded prior to a service user being admitted. Care managers assessments should be obtained prior to admission. The registered manager must produce the service users terms & conditions in an appropriate format. The contract must state what services are provided for the fees paid. Service users personal development and progress in achieving goals and targets must be recorded in detail. Personal goals and support needed to achieve these must be clearly identified and actively worked towards. Written commitments made with service users and relatives to support and maintain family links should be honoured.
DS0000023721.V252905.R01.S.doc Timescale for action 30/06/06 2 YA2 14,15 28/02/06 3 YA5 5 30/06/06 4 YA11YA12 4 12 14-16 18 23sch1 28/02/06 5 YA15 12,16,23 28/02/06 Ashdene House Version 5.0 Page 22 6 YA17 12-15 17 26 sch4 7 YA20 12-17 23 sch3 8 YA20 12-17 23 sch3 9 YA23 12 17 20 23 sch4 10 YA32 7 9 12 19 sch2 11 YA39 10 12 15 17 24 sch4 12 YA41 15,17 sch 3,4 13,23 13 YA42 Detailed records of meals provided for each service user must be kept. Reheated food should be temperature probed and readings recorded. Nutritional assessments should be conducted for all service users and regularly reviewed. Regular medication audits should be conducted to support good practice. A fridge thermometer needs to be used for the medication fridge and the temperature reading to be between 2 –8’C. The home must access training on medication administration, for those staff designated for administration. This is a previous requirement: 01/07/04 & 31/08/05 A two signature procedure should be used for the recording of service users financial transactions. Copies of bank statements should be accessible to service users and available in the home. A thorough recruitment procedure must be implemented with POVA First checks, CRB & POVA checks and references, interview records, staff photograph prior to commencing employment. Next years quality assurance programme must be developed further to include more peoples views and the results of internal audits. Daily reports of care provided need to legible and be detailed, linking care provided to the care plan. All unguarded radiators and hot surfaces must be risk assessed.
DS0000023721.V252905.R01.S.doc 28/02/06 28/02/06 30/06/06 28/02/06 28/02/06 30/06/06 28/02/06 30/06/06 Ashdene House Version 5.0 Page 23 The registered manager is required to risk assess, taking into consideration the health & safety of staff, the access to the homely remedies cupboard above a door. 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 2 3 4 Refer to Standard YA20 YA24YA28 YA37 YA30 Good Practice Recommendations The registered manager should to find a device for the safe transportation of medication to other areas of the home. The separate cottage communal areas are redecorated and refurbished. The registered manager should complete the registered managers award (qualification). For hygiene and health & safety reason, the hand basin in the kitchen is relocated. Ashdene House DS0000023721.V252905.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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