Inspection on 17/10/06 for Ashdown

This inspection was carried out on 17th October 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 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashdown 08/10/08

Ashdown 03/03/06

Ashdown 12/07/05

Ashdown 10/11/04

Ashdown 06/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Ashdown 17 Woodway Road Teignmouth Devon TQ14 8QB Lead Inspector James Rose Unannounced Inspection 17th October 2006 10:00 Ashdown DS0000003643.V308519.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 Ashdown DS0000003643.V308519.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. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashdown Address 17 Woodway Road Teignmouth Devon TQ14 8QB 01626 772995 01626 779629 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) Mr David Rogers Mrs Saw Choo Rogers Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (12) of places Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Aged 25 Date of last inspection 3rd March 2006 Brief Description of the Service: Ashdown provides care for up to 12 adults aged 25 to 65 and over with a learning disability. It is a detached house is a residential area of Teignmouth, close to local amenities including bus and train routes. Residents have the use of a minibus for transport, but also use taxis or walk into town. Ashdown is set out over a ground and first floor linked by stairs. There is a dining room, one small, one large lounge and one sun lounge, a kitchen, two office areas, a bathroom with bath chair and a disabled shower room, toilets and bedrooms; all of which are single except for one shared bedroom. There is parking to the front of the home, and a sun terrace and garden to the rear. The Owners, Mr and Mrs Rogers, live on the premises. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken during October 2006, a pre inspection questionnaire was completed by the registered provider and information was also obtained from two healthcare professionals that provide a service to the home. Samples of the care records were examined during the day of the inspection and residents were asked for their views concerning the care provided. A tour of the whole of the building was completed and two members of the staff team were also interviewed, individually in private. Observations were made of the way care was delivered and Mr David Rogers the registered provider assisted throughout the inspection process. What the service does well: What has improved since the last inspection? Comprehensive care plans are available for each resident receiving a service at the home and these continue to be developed. Risk assessments are in place for residents, these were also discussed with the proprietor and further development is going to be undertaken by the home. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 6 The proprietor has also just completed a course in risk assessment and understands the approach that should be undertaken. The home has introduced a quality assurance system since the time of the last inspection; this is comprehensive and meets the national minimum standard required. A requirement was made in the last report concerning the inappropriate use of door wedges. No door wedges were seen at this inspection, open fire doors were retained by the use of approved devices. What they could do better: The administration of medication undertaken by the home was examined and in general was undertaken appropriately. Advice was given on the secure storage of prescribed medication and a requirement has been raised to ensure that a clear prescription instruction is available for each preparation and that the code system on the medication administration sheets is used correctly. Detailed recording must be provided of the monies that residents have given to carers to look after for them. These monies are held securely and are given to residents on request, currently no record of these processes is available and a requirement has been made to ensure this is undertaken. Advice was given to the proprietor concerning the secure storage of harmful cleaning chemicals and appropriate arrangements are being provided. The requirements raised in this report should be seen in context as a good quality service is given by the staff team and a lifestyle provided that residents were very positive about Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 7 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. Ashdown DS0000003643.V308519.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 Ashdown DS0000003643.V308519.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): Quality in this outcome area is good. Appropriate assessments were in place for residents that covered their needs in health, personal and social areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents assessments were examined in detail, these covered the needs in the areas of health, personal and social. These same residents confirmed that they felt all their needs were met by the service provided at the home. The current residents at Ashdown have been at the home for some time and a new system of assessment has been introduced and will be used for future residents. This is a development of the previous system and will provide even greater detail. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. A detailed comprehensive care plan was available for each resident that contained all their needs. Residents participated in all aspects of life in the home and were sensitively assisted to make decisions. Risk assessments were in place for residents, these would benefit from further development to show how decisions are reached. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care plans of residents were examined in detail as part of the inspection process; these demonstrated what the needs of a person were in the areas of health, personal and social needs. All the residents at Ashdown had been at the home for sometime and their needs were very well known by the management. All the residents consulted advised that all their needs were well met at the home and no needs remained unmet. Included in each of the care plans examined was a risk assessment approach that advised what the hazard was and what the judgement was concerning the Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 11 seriousness of the risk. This process was discussed with the registered provider who advised that the system was about to be developed further and this would demonstrate how decisions are reached. Residents advised that they felt in charge of events that affected them in them in the home, one resident said “I like it here and I know I can get help if I want it”. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. Residents were able to take part in appropriate activities and regularly use the local community facilities. They freely take part in appropriate relationships and their rights are respected. Residents enjoyed the meals at the home, which offered a balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents at Ashdown undertake a range of activities e.g. crafts, exercise, music and karaoke. One resident has a voluntary job and some attend the day opportunities provided by the local authority. When asked all the residents stated that there was enough to do and they did not want any additions. Regular weekly trips out in the home’s own minibus are also available. Residents who wish are able to attend local church services. One resident said “There’s plenty to do, the staff are nice and so are the other people that live here”. Some residents are able to be independent and are able to use the local community facilities after appropriate risk assessment has been undertaken. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 13 The home has an unrestricted visiting policy and friends and family are made welcome when they visit. The home has its own dedicated dinning room where most meals are taken, although there is a flexible approach taken if residents would like their meal elsewhere. Residents were very positive about the quality of the food provided at the home that was healthy and they all said was to their liking. Choice is always available to residents and alternatives are provided if they do not want the meal on the menu. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. Residents were supported in the way that they preferred and their physical and emotional needs were met at the home. In general the administration of medication was correctly undertaken in the home, however, some procedures do require improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents consulted during the inspection process were very positive about life at Ashdown, they advised that they were happy there and had a good relationship with the care team. It was clear from observations made during the inspection that care and support is provided in a sensitive way by the staff and in a way that is preferred by the resident concerned. The residents were relaxed in the home and good-natured banter was overheard between staff and residents several times during the inspection. Appropriate recording is undertaken of residents’ health and other needs and how these are being attended to. Healthcare professionals that were contacted advised that they had no concerns about the service provided at Ashdown. One resident said “If I get ill they take me to the doctor, he’s nice too” Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 15 The recordings of the administration of medication undertaken in the home were examined. In general the record was well maintained with only a very few gaps in the issue record; these are being investigated by the registered provider. The record also demonstrated that the code system shown on the medication administration sheets was not used appropriately and some of the instructions concerning medication were not clearly stated. A requirement has been raised in this report to ensure that all staff follows the homes policies and procedures concerning the correct administration of medication. Advice was also given to the registered provider concerning the correct secure storage of medication in the home. The home has been advised to obtain a copy of The Administration and Control of Medicines in Care Homes and Children’s Services published by the Royal Pharmaceutical Society of Great Britain, Publication date: June 2003. Enquiries can be directed to Lorraine Fearon telephone no. 0207 572 2409. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. Residents in the home advised that their views were listened to and received an appropriate response. The home has an comprehensive adult protection policy and procedure and staff are trained in its use. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an appropriate complaints procedure that is readily available in the home. Residents were confident that if they raised a matter of concern for them with a member of staff this would be taken seriously and resolved for them without delay. No complaints were made during the inspection visit and none have been received since the time of the last inspection. The home has a detailed adult protection policy and procedure in place, which covers all the types of abuse. Care personnel are trained in its used, two staff were interviewed during the inspection, this was undertaken in private, individually and they were clear on the different types of abuse and how matters should be undertaken. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. Residents live in a comfortable, safe and well-maintained building. The home is clean throughout with high standards of hygiene evident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complete tour of the home was undertaken as part of the inspection process. There is a redecoration programme running in the home and the building was well maintained and decorated to a high standard throughout. The home was clean with high standards of hygiene evident. The residents have two lounges to use that are comfortably furnished and each is provided with a television there is also a dedicated dining room available where meals are taken at small tables sitting up to four persons. Specialist equipment is in place where residents need it, e.g. hoist and bath aids etc. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The home has an active training programme running to ensure staff are competent and qualified. Residents felt very positive about the care team and the registered provider. The homes recruitment procedures are appropriate and complete files are in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff files were examined in detail during the inspection process, these contained all the necessary documentation and demonstrated that the required checks had been completed; this ensures that residents are safe. Two of the staff team were interviewed individually, in private as part of the inspection process, they were clear about their roles in the home and understood the polices and procedures of the home. There had been some changes to the staff team since the last inspection and additional carers had been put forward to complete NVQ training. There was also an active training programme in place to ensure that all carers had all the basic information that they required e.g. infection control and abuse etc. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 19 It was clear throughout the inspection that the residents had a very positive view of the care team in the home. Laughter was often heard during the inspection between residents and carers and care was observed to be delivered in a sensitive way. Positive comments were made by all the carers about the staff team, no negative views were expressed. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The registered provider at Ashdown is an experienced person and residents benefit from a well run home. All the residents had good relationships with the manager who clearly had their confidence. Health and safety and welfare issues are given priority by the management. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive quality assurance system in place. This takes account of the views of residents, families, visitors and healthcare professionals. In addition to these processes there are checks made by the management to ensure that the policies and procedures of the home are being implemented appropriately. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 21 Health and safety recording was undertaken appropriately including an up to date fire precautions book. The home reports dangerous occurrences as required to the Health and Safety Executive and the regulations are in place concerning hazardous chemicals. Advice was given to the registered provider concerning the secure storage of hazardous chemicals such as beech and the ability to lock the medication fridge. Currently the home assists residents with their pocket monies and are sometimes asked to look after residents’ monies. No record is maintained of this process and this was discussed with the registered provider who has agreed to implement a system to cover all transactions of this type undertaken. Each resident has their own bank account and these arrangements are satisfactory and convenient. Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME 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 3 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 3 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 2 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 2 X 3 X 3 X X 3 X Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 23 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 YA20 Regulation 13(2) Requirement The registered provider must ensure that all staff adheres to the correct administration of medication in the home. A comprehensive risk assessment process must be carried out with each resident. (Date for completion 21/09/06 not met) Timescale for action 21/11/06 2. YA9 13(4) 06/11/06 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 Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Ashdown DS0000003643.V308519.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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