Inspection on 13/07/05 for Asher

This inspection was carried out on 13th July 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Asher 03/12/07

Asher 03/05/06

Asher 14/12/05

Asher 24/02/05

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOME ADULTS 18-65 Asher 33 Wilbury Gardens Hove East Sussex BN3 6HQ Lead Inspector Jane Jewell Unannounced 7 July 2005 1.30pm 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 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 Stationary 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. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Asher Address 33 Wilbury Gardens Hove East Sussex BN3 6HQ 01273 823310 01273 749810 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Parkview Care Homes Limited Mr Julian Hopkins Care Home 17 Category(ies) of Mental Disorder, excluding Learning Disability or registration, with number Dementia (MD), 17 of places Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is seventeen (17). 2. Only adults with Mental Health needs who have been assessed as requiring nursing care to be accommodated. Date of last inspection 24 February 2005 Brief Description of the Service: Asher is a privately owned nursing home for up to seventeen adults who have a past or present mental health illness. The home was registered with the Commission for Social Care inspection in January 2005. Prior to this the home was an independent hospital. The home was originally established as a nursing home when purchased by its current providers in January 1999. The provider also part owns a further three registered care establishments and supported accommodation within the Brighton and Hove area. Asher is a detached corner property situated on the main A270 into Brighton and close to local amenities and bus routes. The home is presented across three floors with a shaft lift providing access to all floors. Resident’s accommodation consists of seventeen single bedrooms with all but one room providing bathing/shower ensuite facilities. Communal space consists of a combined lounge dining room and separate meeting room. There is a small rear patio area connected to a car parking area. The home provides both short and long term placements The homes literatures states that it aims to provide a safe homely environment in which residents have as much control over their lives as possible, enabling them to achieve the maximum degree of independence whilst retaining their dignity. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced routine inspection, which was undertaken between 1.30pm to 8pm. The inspection was undertaken with Mr Julian Hopkins (manager) and in part by Tony Kearns (provider). There were seventeen residents living at the home. The inspection involved a tour of the premises, examination of the homes records, discussion with management, consultation with six staff and eight residents. The focus of the inspection was to look at the experiences of life at the home for people who live there. Not all residents wanted to participate in the inspection process and this was respected. This is the second inspection of the home under the National Minimum Standards and this should be taken into consideration when viewing the number of requirements made. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the inspection. What the service does well: What has improved since the last inspection? Not all of the shortfalls in practices noted during previous inspections have been addressed within the timescales set. The areas that have been fully addressed have improved resident’s safety, monitoring of the home and general administration. Some redecoration has been undertaken which creates a brighter and more modern environment in which to live. A additional laundry has been installed to enable residents to undertake their own laundry. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 6 A conservatory is in the process of being built to provide more communal areas. What they could do better: In light of the number of outstanding requirements action must now be undertaken to address them within the set timescales in order to improve residents safety and administration at the home. Residents need to be involved in the development and review of their care plans in order to ensure that they are active participants in deciding the level and type of support they are to receive. Concerns continue to be noted regarding poor medication practices which do not safeguard residents and this must be addressed as a matter of priority. In response to the draft inspection report, the provided returned to the CSCI an action plan of how they intend to meet the requirements made from this inspection. 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. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4 and 5 Literature about the home has just been finalised and now needs to be provided to all interested parties to ensure that they have information about the home to make judgments about whether the home can meet their needs. Further work is needed to ensure that the assessment process gathers sufficient information in order to make the decision whether needs could be met at the home. Contracts need to be provided and agreed with each resident so they are aware of their rights and responsibilities whilst at the home. EVIDENCE: It was previously required that the homes statement of purpose and service users guide be reviewed to include all relevant information about the home. These documents were finalised during the inspection and now need to be made available to current and perspective residents and interested parties. This is to ensure that residents have the information they need to help make an informed choice that the home could meet their needs and current residents are aware of the services/facilities the home offers. The home provides six long-term placements and eleven placements funded by a health care trust. These are predominantly short-term placements, which provide periods of rehabilitative care. Therefore there are a large number of admissions and discharges. Documents were examined for a recent admission and this showed that copies of placement authorities needs assessment had been obtained prior to admission. Although an observation record had been undertaken of a trail visits made by a prospective resident there was no record Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 9 of an assessment having been undertaken by the home prior to their trial visit. It was previously recommended that this should be undertaken in order for the home to have sufficient information to decide whether needs could be met. This has now been made a requirement and the manager subsequently reported that a draft form has been developed and is to be implemented. The homes placement criterion is now laid out in the homes literature. However, in line with previous requirements this needs to include the arrangements for emergency referrals, which make clear the process to be followed and the information needed to be obtained prior to any admission. Most residents consulted said they were happy living at the home and through observations and looking at the homes records there is evidence that the home meets most needs of residents. However, further improvements are needed to care planning documentation in order to fully evidence residents assessed needs are identified. It remains clear that where the home has concerns about meeting the needs of residents, additional support is sought or discussion with the placement authority. Residents described the home as “Home from Home” “wouldn’t find a better home” and “bloody lovely”. One resident said that living at the home had allowed them the time to get their head around things and that this had improved their mental health and could now see the future. A new resident said that they were invited to visit the home prior to admission, the length and type of the visit being largely determined by them. Contracts are agreed between the home and the placing agency with contracts generally being specific between the agencies and the home. Along side this contract a terms and conditions of residency have been developed but has not yet been provided and agreed with residents. The short stay nature of the majority of placements means that there is not a fixed settling in period but is instead determined by the needs of residents. There remains a need to make clear in the terms and conditions the arrangements for trial periods at the home to ensure that residents are aware of their rights during this period. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 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 standard(s) 6 and 9 Much work is needed to ensure that there is an effective care planning process, which actively involves residents and records clearly their assessed needs. The home tries to balance the rights of residents, who may at times present risk to themselves and others but further work is need to ensure that guidelines are provided on how risks should be managed or reduced. EVIDENCE: The main emphasis of the care planning process is the development of individual goals and targets for each resident. It was previous required that the actions to be undertaken to achieve these goals be regularly reviewed and updated. However this had not been completed for all of the care plans sampled. Following previous requirements and discussion with the manager on the need to involve residents more in the development, review and ownership of their care plan. The manager planned to introduce a quality audit on care plans to ensure that residents were active participants in the care planning process and ensure that they were regularly being reviewed. This had not yet been implemented, nor was it clear whether resident involvement had increased. Several residents were adamant that they did not wish to be involved in the Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 11 care planning process, however the majority recalled signing them but wished to have greater consultation as to what was being recorded. The registered nurse on duty is solely responsible for the recording of daily entries about each resident. Support workers feedback information to the nurse for them to record the information. Entries seen were often vague in relation to activities/events that had occurred, as the staff member carrying out the activity did not record them directly. It is recommended that the system for recording daily notes be reviewed to enable all staff to record relevant information regarding residents. Core risk assessments are undertaken which cover areas of risk and include: aggression, self-harm, domestic safety, fire and bathing. As discussed during previous inspection these must include the actions to manage or reduce identified risks. The manager subsequently reported that a form has been developed to address the areas of shortfall but has not yet been implemented. For some current residents smoking is a high-risk activity but an important part of their lifestyles. The home continues to works hard to ensure that these risks are minimised through policies and the risk assessments process. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14 and 17 The home facilitates and ensures that suitable arrangements are made for occupation and activities depending upon the individual preferences of residents. The standard of food is generally good. EVIDENCE: Opportunities for formal education, drop in and day centres is made available but these are accessed by very few residents. Staff continue to support residents to spend their time usefully, but balance this with the understanding that residents have the choice to become involved or not as they wish. Residents contribute their ideas for activities at meetings. Examples were given by staff where activities have been arranged and they have not been well attended. For some residents the main focus of staff support undertake basic daily tasks and therefore it can be interest to leisure activities. Most residents consulted to occupy their own time and all those consulted occupied. is to motivate them to difficult to extent their said that they preferred felt they were suitable Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 13 Some leisure activities are organised by the home, which includes day trips to places of interest, local walks, art therapy sessions and relaxation group. There is some leisure equipment including table tennis and cable television within the home. In addition residents spoke of attending local markets, swimming, playing scrabble with staff and visiting an airport. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 14 Some residents live an independent life and they access a range of leisure facilities independently. The organisation has its own mini buses, which are used to access wider leisure facilities. The Kitchen was well-equipped and provided suitable facilities for catering. It was seen to be clean and well organised, but parts are in need of upgrading. Two chefs are employed to cook all meals. Menus are developed by the head chef and were reported to be based on the likes of residents. Residents said they are asked each day what choice of meals on offer they would prefer. It was previously recommended that the day’s menu be displayed in order to inform residents of the choices available. The head chef reported that this had only partially been tried and agreed to ensure that in future it was displayed. Residents gave the inspector much feedback on the food provided with the majority stating that the food was good. The range of feedback received was passed onto the head chief who was not always aware of resident’s opinions and observations regarding the food. It was recommended to the head chief look at developing a system to obtain regular feedback on the food from residents. Meals times are flexible within reason. During the inspection a resident was celebrating their birthday and a buffet tea had been provided. This was popular with residents and staff who all ate together. In addition to the main meals, snacks and drinks are available at various times throughout the day. Many residents have kettles in their bedrooms and make their own arrangements to obtain snacks. Not all records required to be kept for food safety reasons were maintained and up to date, with particular reference to the record of meals provided. Therefore it could not be accurately assessed the level of choices provided to residents and whether individual preferences were observed. In line with previous requirements the open access to the kitchen has been risk assessed and a barrier created to ensure that the chef controls who enters the kitchen area for health and safety reasons. Staff have also been provided with protective clothing when entering the kitchen area in line with good infection control practices. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Respecting resident’s privacy is central to the ethos of the home. Residents need to be further involved in the care planning process so they are aware and agree to the personal support to be undertaken by staff. Suitable arrangements are in place for meeting resident’s health care needs with evidence of regular input from external health care professionals. Concern is noted regarding the homes failure to improve standards of medication administration in order to safeguard residents. EVIDENCE: Few residents require direct personal care, instead staff prompt and encourage according to the individual’s goals. Residents said that their privacy is always respected and confirmed that staff were following the homes policy of knocking on bedrooms doors and waiting to be invited in. Generally residents were happy with the way staff provided personal support but as in previous inspections could not always understand why staff had to support them for example to maintain their personal appearance. The inspector felt that this relates to not all residents being aware of their care plans and the staff support recorded to assist them to achieving their individual goals. Residents are allocated a named worker to promote consistency and continuity of care. There is some flexibility to this as one resident said that they often Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 16 asks for another member of staff to support them to attend appointments who is not their named worker. The home provides nursing care and where there are concerns regarding the health or welfare of residents further medical advice or intervention is sought promptly. A variety of health care professional continue to support each placements including care co-ordinators, CPN’s and psychiatrists. Residents said that when they have asked to see their GP or psychiatrist this has been sought promptly. One resident spoke of making their own medical arrangements and attend all appointments by themselves. Staff said that when they accompany a resident to an appointment they have to be invited by the resident to attend the consultation. Following concerns noted during previous inspections with regard to the poor standards of medication management the manager had introduced regular audits and spoke with the staff involved. Evidence was seen that standards had improved briefly but this had not been sustained. The areas of outstanding concern which places resident at risk are: • A record was not being maintained each time medication is administered and therefore it could not be ascertained whether residents had received their prescribed medication. • A discrepancy was noted in the number of medication, which was returned to the pharmacy for disposal compared to how many should have been returned according to the homes records. This was of particular concern as it related to medicines where previous discrepancies had been noted by the inspector. The manager was required to undertake an immediate investigation to establish why this had occurred and locate missing medicines. • Alterations made to the prescribed instructions had not been signed, dated, authenticated and a written explanation provided by staff to evidence that any alterations had been authorised by persons qualified to do so. • Hand written Medication Administration Records had not all been checked and countersigned by another member to check that the information had been accurately transferred to the homes records. The manager reported that it is only trained nurses who undertake the administration of medication. It was previously required that staff involved in the administration of medication are aware of the medication policies and procedures however, it was clear that staff are still not following these procedures. The failure to safeguard residents by not improving standards of medication practices has been discussed with the provider who is required to address these areas as a matter of priority. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. There are procedures and practices in place that supports the protection of vulnerable adults. EVIDENCE: There is an accessible complaints procedure for residents, their representatives and staff to follow should they be unhappy with any aspect of the service. Residents said they felt confident to express any concerns or complaints to the manager, provider or staff and when they have done this it has been acted upon promptly. There are written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff have undergone in house training in adult protection and they showed a good understanding of their roles and responsibilities under adult protection. Staff undergo police checks prior to employment commencing. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 18 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 standard(s) 24,26,27,28,29 and 30 Much effort is made to create a domestic feel to the home with some further redecoration work needed to ensure consistent standards throughout the home. Resident’s bedrooms are all individualised according to individual tastes and preferences. Standards of cleanliness remain variable. EVIDENCE: The home is located near to local amenities and bus routes into Brighton and Hove which the vast majority of residents make use of. Much effort is made to create a domestic feel to the décor and furnishings throughout the home. Standards of maintenance were generally satisfactory. However, minor maintenance issues were noted by the inspector, which the home were unaware of. The inspector feels that this was not through intent on the homes behalf but due largely to the level of privacy afforded to resident’s through limited access to bedrooms. It is recommended that as part of the agreed fire checks on resident’s bedrooms health and safety issues are also checked in order to pick up any issues promptly. Parts of the home are in need of minor redecoration, which is being addressed gradually by the organisations maintenance staff. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 19 Since the last inspection some bedrooms and hallways have been redecorated and new carpeting to some stairways. During the last inspection one bedroom’s ensuite was in the process of being redecorated. This had still not been completed five months later. Concern was expressed over the time taken to completion this works which left the bathroom in an unsatisfactory condition. Due to the high level of smoking amongst residents there are inevitable signs of wear and tear on both fabric and furnishings around the home. Bedrooms were seen to be individualised, reflecting the tastes and preferences of residents. Residents are able to bring their own furniture/ personal processions to the home and where the home provides furniture then this is to the required standard. The manager stated that lockable safes have been obtained and residents assessed to self medicate will be provided with one, along with anyone else who requests one. Communal facilities include a combined lounge dining room and separate small meeting room. Communal space is limited and the provider is addressing this through installing a conservatory. This was in the process of being built, with residents looking forward to this room then becoming the designated smoking area. There is a small rear patio area and car park which residents and staff were observed using during the inspection. The home is not designated to offer services to people with physical disabilities and the access arrangements within the home would make it unsuitable for residents with a permanent restricted mobility. A shaft lift is fitted which accesses all floors. A call system is fitted to all bedrooms and toilets, which is turned off at the point of call. Those checked were in working order and promptly answered by staff. It was previously required that risk assessments be undertaken on the provision of call cords as the home has been advised in the past that these could pose a potential ligature risk and the pull cords were therefore tight up in some bedrooms to prevent their use. The manager reported that the provider has been leading on this issue and some shorter cords have been provided. They were not aware whether any risk assessments have been undertaken to identify how all residents would assess a calls system in their rooms. The lifestyles of some residents and the level of respect and privacy afforded means that some bedrooms could not always be cleaned and kept odour free. Standards of cleanliness in other areas were variable with a need to ensure that consistent standards are applied throughout. A new laundry room has been provided on the top floor for residents to undertake their own laundry if desired. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,34,35 and 36 Staff had a clear understanding of their responsibilities and were supervised and competent to undertake their roles. Staffing levels are currently sufficient to meet the assessed needs of residents. A system for the regular review of staffing levels is recommended to ensure that flexible staffing levels are underpinned and evidenced by the needs of residents. The procedures for the recruitment of staff are robust and provide the necessary safeguards to protect residents. EVIDENCE: Staff showed a good understanding of the boundaries of their role and felt able to seek advice and support from the manager or provider if they were unsure how to manage a situation or residents needs. All staff consulted spoke respectfully and professionally regarding residents and demonstrated much commitment towards the home and supporting residents to move on to more independent lifestyles. The inspector observed friendly often humorous interactions between staff and residents with residents appearing relaxed around staff. Residents described staff as “very friendly” “OK” “Can be a bit bossy” “brilliant” and “you can have a real laugh with them”. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 21 At inspection there were three care staff and a student nurse on duty with the manager being the nurse in charge. This was in addition to domestic staff, chef and provider. A more flexible approach to staffing has recently been implemented to allow for fluctuations in the needs of residents. Staff felt confident that if additional staffing was needed then this would be supplied. Due to the stability of current residents needs staffing levels were operating at the minimum and the inspector received two comments that this level did not enable staff to accompany residents on as many one to one outings as it did in the past. There was no other evidence to suggest that at the current time staffing levels were insufficient to meet the assessed needs of residents. These comments were fed back to the provider and it was recommended that they undertake regular reviews of staffing levels through consultation with staff and residents. This is to ensure that flexible staffing levels are underpinned and evidenced by the needs of residents. The inspector reviewed a sampled batch of recruitment and selection documentation. These revealed that standards of recruitment remain good with all the necessary documentation in place to protect residents and ensure that appropriate staff are employed. In line with previous requirements training documentation has been more systematically organised to enable the manager to more easily identify the training undertaken and needed for each member of staff. Although this system had not yet been fully implemented the training profile seen showed that all core-training topics had been undertaken as well as some specialised training in mental health. It was previously required that a training and development plan be developed to identify the specialist training to be made available in mental heath. The provider who largely undertakes this training complete a yearly programme, however this has not been completed and therefore specialist training has not been regularly undertaken. It remains essential that this be undertaken in order to keep staff updated on changes in good practices and legislation and to provide new staff with the specialist knowledge they need to undertake their roles. Staff confirmed that they received an induction to the home when they first started however, not all induction documentation had been completed to evidence that the induction had covered all key areas and the manager agreed to ensure that this was completed in the future. Staff consulted felt well supported by the manager to carry out their roles. An annual appraisal system has recently been developed and the manager reported that they plan to implement this shortly. This is in addition to the current supervision arrangements and regular staff support meetings. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 22 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,41 and 42 The manager is well respected and liked by staff and residents, additional senior management support is needed at the moment to enabled them to have more time to devote to fulfilling their legal responsibilities. Systems to selfmonitor the quality of the services at the home now needs to be implemented. Generally the health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The manager is a RMN and has many years experience in mental health services. He has been the manager of the home since 2001 and is currently undertaking additional training to NVQ level 4 standard. Staff and residents continue to speak positively about the manager with particular reference to their approachability and easygoing manner. The manager was open and helpful in their discussions with the Inspector. The manager models good practices around openness and transparency and demonstrates good leadership skills in their support of staff. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 23 However, their failure to address fully the shortfalls in practices noted from previous inspections is not due to lack of competence but evidence suggests that additional senior staff support is needed to enable the manager the time to concentrate on fully meeting their legal requirements. This was discussed, with the provider subsequent to the inspection and they agreed to look into temporarily employing a deputy manager. It was previously required that a system be developed to monitor the quality of services provided at the home. Formal quality audits have been developed but these have not yet been implemented. In addition feedback is received from residents via regular residents meetings. All records requested by the inspector were made available. As previously noted not all records required by regulation to protect residents and for the effective and efficient running of the home were maintained to the required standard. Including Care plans, risk assessments and medication. Records about residents were securely stored. Practices that were noted that promote the health and safety of resident’s, staff and visitors include: • A clear account of accidents is maintained. The manager now undertakes an audit of all accidents. • Systems to support fire safety were in place including servicing of fire safety equipment, staff training, fire drills, testing of equipment and daily fire checks. It was previously required that the fire risk assessment be reviewed frequently and records significant findings and the actions taken to ensure adequate fire safety precaution in the home. This was unable to be located at the time of inspection and the manager subsequently reported that it had been located and will be examined during future inspections. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 24 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 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 2 3 3 2 2 Standard No 11 12 13 14 15 16 17 x 3 x 3 x 2 x Standard No 31 32 33 34 35 36 Score 3 x 3 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Asher Score 2 3 1 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x 2 2 x H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 25 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 2 Regulation 14(1)(c) Requirement That a written format for the assessment of prospective service users is developed in line with the homes admission criteria and the National Minimum Standards. (Previously a recommendation made on 24/2/05) That Terms and Conditions of residency is developed and agreed with each service users and a copy maintained at the home and which make clear the arrangements for trail occupancy. (First made during inspection of the 24/2/05 with timescales of 30-6-05 not met) That the actions recorded for service users to achieve their individual goals are regularly reviewed and updated. (First made during inspection of the 24/2/05 with timescales of 30-405 not met) That, unless it is impracticable to do so, service users are consulted on the development and review of their care plan. (First made during inspection of the 24/2/05 with timescales of 30-4-05 not met) Timescale for action 30-08-05 2. 5 5(1)(b) 30-08-05 3. 6 15(2)(b) 30-10-05 4. 6 15(1) 30-10-05 Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 26 5. 6 15(1) 6. 9 13(4)(c) 7. 8. 17 20 17(2) Sch 4 (13) 13(2) That care plans detail the actions 30-10-05 that need to be taken by staff to ensure that all aspects of the health, medical and personal and social care needs of service users are met. (First made during complaints investigation of Jan 05 with timescales of 30-4-05 not met) That comprehensive personal 30-08-05 risk assessments are completed, which are reviewed regularly and records significant findings and the actions taken to manage identified risk. (First made during complaints investigation of Jan 05 with timescales of 304-05 not met) That a record of food provided 30-08-05 for service users be maintained. That the records relating to medicines movement, namely receipts, administration and disposal are maintained and accurate. (First made during inspection of the 24/2/05) That hand written Medication Administration Records are checked and countersigned by another member of staff for accuracy. (First made during inspection of the 24/2/05) That alterations made to medication record sheets are signed, dated, authenticated and a written explanation provided. (First made during inspection of the 24/2/05) That all staff involved in the administration of medication are aware of the medication policies and procedures at the home. (First made during inspection of the 24/2/05 with timescales of 30-4-05 not met) Immediate 9. 20 13(2) Immediate 10. 20 13(2) Immediate 11. 20 13(2) 30-08-05 Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 27 12. 26 23(2)(d) 13. 29 13(3)(C) 14. 35 18(1)(c) (i) 15. 37 10(1) 16. 39 24(1) 17. 42 13(4)(c) That the redecoration of the ensuite in bedroom two is completed to a satisfactory standard. That individual risk assessments are undertaken for each service user on the use of call cords, which record significant findings and are reviewed frequently. (First made during inspection of the 24/2/05 with timescales of 30-4-05 not met) That a training and development plan be developed which is linked to the homes statement of purpose, service aims and service users needs and individual plans. (First made during inspection of the 24/2/05 with timescales of 30-6-05 not met) That additional senior management support is provided in order to assist the manager to fulfil their legal responsibilities as registered manager. That a system is established and maintained for monitoring the quality of the care provided. (First made during inspection of the 24/2/05 with timescales of 30-6-05 not met) That the fire risk assessment is reviewed frequently and records significant findings and the actions taken to ensure adequate fire safety precaution in the home. (First made during inspection of the 24/2/05) 30-08-05 30-08-05 30-08-05 30-10-05 30-10-05 Immediate Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 28 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. 5. Refer to Standard 6 17 17 24 33 Good Practice Recommendations That the system for recording daily notes be reviewed to enable all staff to record relevant information regarding residents. That the day’s menu be displayed. That systems are established for the chefs to receive direct feedback from residents on the food provided. That regular health, safety and maintenance checks are undertaken on resident’s bedrooms. That a system be introduced to monitor staffing levels, which includes regular consultation with staff and residents. Asher H-59-H10-S62718 Asher V230624 070705 Stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. 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