Inspection on 03/03/06 for Ashdown

This inspection was carried out on 3rd March 2006.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashdown 08/10/08

Ashdown 17/10/06

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 Annie Foot Unannounced Inspection 6th March 2006 9:00 Ashdown DS0000003643.V252848.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 Ashdown DS0000003643.V252848.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. Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 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.V252848.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Aged 25 Date of last inspection 12th July 2005 Brief Description of the Service: Ashdown provides care for up to 12 adults over the age of 25 years, with a learning disability. The premises are detached, in a residential area of Teginmouth, close to local amenities, bus and train routes. Residents have the use of a mini bus for transport, but may also walk to town or use a taxi. Ashdown is set out over a ground and first floor, linked by stairs. There is a shared dining room, two lounges, and a conservatory. Also a kitchen, office area. All bedrooms are single except for one double. There are 3 bathrooms, 1 shower room and 4 toilets in the home. There is parking to the front of the property, with a sun terrace and garden to the rear. The owners Mr and Mrs Rogers live on site. Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was the second inspection of the year. It was conducted over the morning of 6 March 2006. The purpose of the inspection was to follow up on requirements and recommendations made at the last inspection and review progress made in other areas. The registered manager and proprietor of the home, David Rogers was present throughout the inspection. Mrs Rogers was also on duty, with two care staff, a cleaner and the cook. The inspection included discussions with residents and staff, a tour of the premises, an examination of care and medication records and inspection of staff files. Requirements and recommendations from the previous inspection have been addressed but not all have been met. The home is currently full. One service user is in hospital but expected home very soon. What the service does well: What has improved since the last inspection? Redecoration and refurbishment of various parts of the home have been completed since the last inspection. Bedrooms 3 & 4 have been decorated, also the laundry and staff room. Other redecoration is currently in progress. Mr Rogers aims to undertake redecoration wherever a vacancy presents itself. Service users choose the colours and décor of their rooms. Daily record sheets for residents have been introduced. Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashdown DS0000003643.V252848.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 Ashdown DS0000003643.V252848.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): Standard 2 was inspected at the previous inspection and fully met. It was not reassessed on this occasion. EVIDENCE: The home is full and there have been no new admissions for several years. Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Some care plans, record sheets and risk assessments do not reflect the changing needs of residents and are not legible. EVIDENCE: Since the last inspection, daily record sheets for each resident have been introduced. Brief details of a resident’s daily activity are recorded. A random sample of resident’s files were seen. Although daily record sheets are completed, in some instances, the writing was not legible. None of the records were dated or signed. The managers and senior carer review records, but they also said they could not decipher some entries. The review of care plans is inconsistent. Some had not been reviewed since 2004, although others showed a review in 2005. The manager confirmed that reviews took place with the care manager but finds arranging a mutually convenient time difficult. Risk assessments seen, were variable both in the detail and content. One risk assessment recently undertaken (January 2006) showed that great detail and thought had been given to a particular concern over one of the residents. The Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 10 home has the ability to produce thorough risk assessments but is not consistent in their application. An Inventory of some of the resident’s possessions has started to be recorded. The remainder need to be completed. Up to date resident profiles are in place, which include a photo of the individual. The manager explained that these are used for hospital admissions. Hospital staff have complimented the home on providing this useful information. The manager acknowledges that paperwork is behind and that work is needed to bring records up to date. Seven of the twelve residents are now over 60 years of age. They have lived at the home for many years. The owners wish residents to remain with them for as long as possible. It is important staff receive training and support in working with older people as residents’ levels of dependency and need changes. Ashdown DS0000003643.V252848.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): 12, 17 Residents are encouraged to live active lives at the home and in the community. Meals in the home offer choice and variety. EVIDENCE: A list of activities is displayed on the laundry door. It is difficult for residents to read the list. It is suggested that something similar is displayed, in an alternative format, elsewhere in the home. The programme showed the wide range of activity offered to residents, although none were observed during the inspection, due to staff sickness. The programme is backed up by attendance entries on the tick sheets contained in resident’s files. One resident has been helped to set up an email account so that they can keep in touch with family in Canada. This is a good example of how the home tries to respond to the individually expressed interests and abilities or residents. Two residents have voluntary jobs in the community and another attends the local college. Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 12 The menu is developed by Mrs Rogers taking into account residents likes and dislikes. The menu is changed every six months to reflect the changing seasons. The cook said there was an emphasis on using fresh fruits and vegetables in providing a balanced diet. There are rarely any complaints about the food and residents said they liked the food. Meals are taken around small tables in the dining area. Lunch on the day of the inspection comprised, Scotch broth followed by fish pie and cabbage. Desert was pitted stewed prunes and custard. Ashdown DS0000003643.V252848.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): 20 Systems for administration of medication are safe ensuring that residents needs are met. EVIDENCE: Standards in this section were assessed and fully met at the previous inspection. Apart from medication standards, other areas were not reassessed on this occasion. The Boots MDS system is in place. Medication records were seen to be complete and up to date. The pharmacist last visited the home in August 2005. A medicines max/min thermometer was recommended at that visit. This has not yet been obtained. Medicines are stored appropriately in a locked cupboard. Medicines requiring cold storage are held in sealed containers in the food fridge. Staff who administer medication receive in - house training. The opportunity for staff to attend external training was discussed. This should be arranged to ensure that all staff have received accredited training and are up to date with changes in medicines. Ashdown DS0000003643.V252848.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): 23 Residents are protected from being at harm from abuse, but not all staff have yet received sufficient training. EVIDENCE: Since the last inspection a senior staff member has attended external training in adult protection. The “No secrets” video is shown to all staff at induction, which is followed up by a written questionnaire and discussion with the manager. Multi-agency training was discussed with the manager and contact information provided. This is recommended for at least senior staff, to ensure that everyone is up to date with local procedures. A copy of the Alerters guide is held at the home. There have been no allegations of abuse or complaints in the last twelve months. Ashdown DS0000003643.V252848.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 Residents live in homely comfortable surroundings, which are regularly maintained. EVIDENCE: The proprietor/manager is currently redecorating several rooms in the home. He explained that he tried to redecorate when someone is away from the home. The Brunel wing has been decorated and completed. The Oak wing is due to decorated within the year. There is a maintenance plan displayed in the office. One of toilets has been under refurbishment to accommodate a wheelchair; it has not yet been completed and new flooring is needed. Several residents’ rooms were seen. They are all comfortable, pleasantly decorated with evidence of personal belongings and possessions. All rooms have locks and residents hold their own keys. Windows on the first floor and not restricted. Risk assessment is needed and restrictors fitted. Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 16 Radiators are not guarded. Some felt very hot to the touch. Risk assessment and guarding is recommended to ensure residents safety. Cleaning was in progress during the inspection. The home was clean and hygienic. Ashdown DS0000003643.V252848.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): 34,36 Staff receive informal support and encouragement from management to meet residents’ needs. Attention is needed to ensure that full documentation is held for all staff to make certain residents interests are safeguarded. EVIDENCE: There is small experienced core staff team who have worked at the home for several years. But there has been a high turnover of staff during the past year, although there are currently no vacancies at the home. The manager explained that recruiting suitable staff has been very difficult, but problems had been overcome through the appointment of two foreign staff. Recommendations were made at the previous inspection for the recruitment and supervision of staff to be reviewed. Five of the seven staff files were examined. There is evidence that a CRB check is made for each new staff member, but not all files contained a record. The manager is clear about CRB procedures and ensures that disclosures are destroyed after three months. While this is good practice there is no evidence on file to verify that a CRB check had ever Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 18 arrived. This was discussed with the manager who agreed that a dated note should be included on staff files. Written references are requested but not all files contained two references. The manager explained that due to the staffing difficulties of the past year attention to revising staff files has slipped. He is aware that all appropriate documentation must be held in respect of each staff member. Both Mr and Mrs Rogers talk to staff every day and provide support but structured one to one supervision has slipped. This must be reintroduced. Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 19 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): 38,39 The continuity of management provides stability to residents and staff. Quality assurance systems in the home are not underpinned by resident’s views. EVIDENCE: The proprietors have been running the home since 1989 and provide direction to the staff team. Mr Rogers achieved the Registered Managers Award in 2003 and both he and Mrs Rogers are NVQ assessors. They live in a house adjoining the premises. Both Mr and Mrs Rogers are present at the home on a daily basis, and also provide night cover. Mr and Mrs Rogers have extensive experience in working with people who have a learning disability. It is clear from their communications with residents that they know everyone very well, considering each person to be a part of their (extended) family. Mr Rogers’ philosophy is to prioritise time toward the care and support of the residents which means that sometimes other systems slip. He is aware of the Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 20 importance of keeping paperwork up to date and is confident that any outstanding areas identified at this inspection will be addressed. Developing an appropriate Quality Assurance system, based on resident and stakeholder views, continues to present a challenge. Mr Rogers is aware that this area of work needs attention. There are a number of policies and procedures implemented within the home. These are currently under review. Fire and accident records were checked. Records were up to date. The manager confirmed that fire instruction took place in October/November 2005. He is aware that staff require training at least twice a year. Mr Rogers raised other issues with the inspector, which will be dealt with under separate cover. Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 21 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 x x x x x Standard No 22 23 Score x 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x x 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashdown Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x 3 2 x x x 2 DS0000003643.V252848.R01.S.doc Version 5.0 Page 22 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 2 Standard YA6 YA9 Regulation 15 13 (4) Requirement More work is needed to develop meaningful care plans A comprehensive risk assessment must be carried out with each resident. (Previous timescale of 21/09/05 not met) To risk assess all first floor windows and fit restrictors, based on the vulnerability and risk to residents. Timescale for action 30/04/06 30/04/06 3 YA42 13 (4) 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6 YA6 YA6 Good Practice Recommendations Care plans need to be written more clearly to ensure that records monitor the progress of residents. Records must be legible. To complete residents inventories of belongings. (Repeated from previous inspection) To develop training for staff to ensure that they are able to understand and meet the changing needs of residents as they grow older. DS0000003643.V252848.R01.S.doc Version 5.0 Page 23 Ashdown 4 5 6 7 8 9 YA12 YA20 YA23 YA24 YA34 YA36 To revise the activity programme in an alternative format (widget/pictures) and display in a place where residents can easily access. To explore opportunities for staff to receive external accredited training in the safe handling of medication. The owners or senior staff should attend the Multi-agency training on the protection of vulnerable adults arranged through Devon County Council Adult Protection team. To undertake risk assessments for all radiators in the home and where risk identified fit radiator covers. To ensure that before employment all required documentation is obtained in respect of each staff member. To reintroduce structured and recorded, supervision for staff at least six times a year. Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashdown DS0000003643.V252848.R01.S.doc Version 5.0 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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