Inspection on 14/12/05 for Asher

This inspection was carried out on 14th December 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Asher 03/12/07

Asher 03/05/06

Asher 13/07/05

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 Inspection 10:00 14 December 2005 th Asher DS0000062718.V250149.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 Asher DS0000062718.V250149.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. Asher DS0000062718.V250149.R01.S.doc Version 5.0 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 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) Parkview Care Homes Limited Mr Julian Hopkins Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is seventeen (17). Only adults with Mental Health needs who have been assessed as requiring nursing care to be accommodated 11th July 2005 Date of last inspection Brief Description of the Service: Asher is a privately owned nursing home for up to seventeen adults who have a 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 providers also own 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, meeting room and conservatory. 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 DS0000062718.V250149.R01.S.doc Version 5.0 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 10am and 6.30pm. The inspection was undertake with Julian Hopkins (Registered manager) and there were seventeen residents living at the home. The inspection involved a tour of the premises, examination of the homes records, discussion with the provider, consultation with staff, residents and two visiting social workers. Not all residents wanted to participate in the inspection process and this was respected. Since the previous inspection CSCI’s pharmacy inspector has visited the home. This was to monitor the progress made towards addressing shortfalls in medication practices noted at the last inspection. 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? Significant progress has been made to address the requirements made at the last inspection. This has improved resident’s safety through better medication practices and risk management. Standards of care planning has improved significantly enabling a clearer reference guide to the needs of residents. The standard of administration and record keeping continues to improve, which has lead to improved practices around pre admission assessments and increased residents awareness of the terms and conditions of residency. Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 6 Residents have greater involvement in the daily running of the home, from helping to plan their care to undertaking light household chores. What they could do better: Monitoring and training must be undertaken to ensure that staff are operating consistent standards and practices. This is with particular reference to care planning, key working and medication. There is a need to improve further the standard of recording, around care, support and nursing input in order to evidence how residents are being supported and to underpin the positive outcomes being achieved for residents living at the home. Following the draft inspection report the provider responded with an action plan, which detailed how the shortfalls in practices noted in this report were to be addressed. 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 DS0000062718.V250149.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 Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 The home provides both prospective and existing residents with information about what services are provided and what to expect when living at the home. Residents are only accommodated if the home is satisfied that they can meet their needs. The home balances well the needs of those undertaking shortterm care and those who require long term nursing care with outcomes for residents being good. EVIDENCE: There is a range of literature about the home and the services and facilities it provides. This includes a statement of purpose and service user guide, which are provided to interested parties and are displayed within the home. The home provides six long-term and eleven short-term placements funded by a health care trust. Therefore there are a large number of admissions and discharges. Documents for recent admissions showed that copies of the latest Care Plan Assessments were obtained prior to admission. In addition the home now records the needs assessment undertaken by the manager of prospective residents needs. As part of the assessment the home speaks to health care professionals and others who know and understand the residents needs. This ensured that a comprehensive picture had been established in order for the manager to decide whether the home would be able to meet their needs. A recently admitted resident undertook several trial visits to the home prior to them deciding whether they wanted to move into the home. The information Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 9 gathered by the home during these visits ensured that staff were aware of the residents needs upon admission. Most residents consulted said they were happy living at the home. Several short term care residents said they were finding it difficult to cope with some of the long-term residents acute symptoms. Staff reported that this is often an indicator that short-term residents were ready to leave residential care. Resident described their experiences of the home as: “Can’t complain” “feel safe here” “I can do pretty much as I please” “can be a bit boring depends which staff are on” and “you are treated as a person not a nutter here” The outcomes for residents remain good with many short care residents moving onto more independent living and long term residents stating that they are provided with a stable and secure environment. The home is not always able to evidence how this outcome is being achieved, as work is still needed to the care planning process. This is needed to ensure that residents assessed needs are being identified and addressed. Contracts are agreed between the home and the placing agency with contracts generally being specific between the agencies and the home. Along side this the homes contract of terms and conditions of residency has been reviewed as, per previous requirement, and given to residents to sign. One short term care resident did not currently have a contract and it was agreed that this should be initiated and the terms and conditions discussed with them upon each admission. This would ensure that they are fully aware of their rights and responsibilities whilst residing at the home 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. Placement authorities usually visit within the first six weeks to check out with the residents whether their needs are being met. Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Much work has been done to address previous shortfalls in care planning and risk assessments. However improvements had not been consistently applied. Residents are helped to exercise choice and control over their lives. EVIDENCE: The main emphasis of the care planning process is the development of individual goals and targets for each resident. It has been required for some time that the actions to be undertaken to achieve these goals be regularly reviewed and updated. Of the care plans sampled this had still not been completed for all, however several examples were noted whereby this had occurred to a good standard. Not all care plans provided sufficient information on the actions needed to support residents to achieve their goals. Not all care plans were being reviewed regularly to ensure that changes in needs and preferences were identified promptly and this must be undertaken. Discussion occurred on the need to provide further guidance on the social needs of residents in order to support the medical emphasis of the care plans, and ensure that all aspects of residents needs are being addressed. It was not always clear what nursing intervention was being undertaken as this was not always recorded. Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 11 The inconsistency in the standard of care plans was a reflection of the skills/experiences of the staff who completed the care plan. Therefore it is required that staff undergo training in care planning in order to address the ongoing shortfalls in the care planning process. Discussion occurred on the need for greater monitoring of care plans by management. In line with previous requirements residents have been encouraged to become involved in their care plan development and review. However several residents were adamant that they did not wish to be involved in any aspect of their care plan, in these circumstances this had been recorded. The 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 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 was previously recommended that this system be reviewed to enable all staff to record relevant information regarding residents. This had not yet been actioned but plans were in place to start to implement this. One resident spoke of receiving money advice from staff to help make informed choices as to how to manager their money. Another resident said that they had been actively involved in decisions about their future at the home. There is a wide variation between some resident that wish to participate in the running of the home to many residents who expressed little desire to be involved in any aspect. What the preference this is respected by the home. Staff spoke of some residents now helping to set the tables and undertake laundry. Core and specialist risk assessments are undertaken which cover such risks as: aggression, self-harm, domestic safety, fire and bathing. Improvements have been made to the way that the actions to manage or reduce risks are now recorded. However improvements had not been consistently implemented for all risk assessments and it is recommended that staff undergo training in this area. Staff demonstrated an awareness of good practice about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with the people that need to know. Asher DS0000062718.V250149.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 15, 16, and 17 The home continues to facilitate and ensure that suitable arrangements are made for occupation and activities depending upon resident’s individual preferences. Residents maintain contact with family and friends and with the local community as they wish. Residents stated that there is flexibility in daily routines regarding meal times, going to bed, rising and occupation. The standard of catering is very good with resident’s individual preferences being catered for. 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. For some residents the main focus of staff support is to motivate them to undertake basic daily tasks and therefore it can be difficult to extent their interest to leisure activities. Most residents consulted said that they preferred to occupy their own time and all but one resident consulted felt they were Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 13 suitably occupied. Many residents spoke of using local shops, pubs, and cafes either independently, with staff or with other residents. Residents consistently spoke of how their visitors could come at any time during the day. Many residents spoke of visiting relatives over the Christmas period. Staff were knowledgeable of the potential vulnerability for some residents when having contact with their visitors and clear guidelines had been established in order to help safeguard them. Many residents had mobile phones, which enabled them to keep in regular contact with their friends. From observation and discussion with staff and residents it was clear that the daily routines are largely determined by the needs and individual lifestyles of residents. For example, meal times, going to bed, rising and occupation. One resident said that they couldn’t believe that it was a nursing home as they felt free to come and go as they pleased as long as they told staff where they were going. The Kitchen was well-equipped and provided suitable facilities for catering. It was seen to be clean and well organised. Since the previous inspection a new floor covering has been laid which aids effective cleaning. 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 which choice of main meal they 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 been done but caused anxiety amongst some residents and it was decided that this practice was not beneficial. One resident spoke of how the chef had gone out of his way to find something that they liked to eat, as by their own admission they were very fussy. On the day of the inspection the chef was preparing many different meals in addition to the main menu options. Residents confirmed that if they didn’t like the option for that day they could ask for something else. The inspector had lunch with residents and the food provided was of an exceptional good standard. All but one resident spoke positively about the standard of food. Records of meals provided is now maintained which showed that a varied diet is offered. It was suggested that the chef also records when special/additional products have been obtained on the request of residents in order to underpin the level of choices being offered. 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. One resident commented that there was often a shortage of milk to take to their bedroom to make their own snacks. This was discussed with the cook who agreed to address. Asher DS0000062718.V250149.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Respecting resident’s privacy is central to the ethos of the home. The outcomes for resident’s highlights that residents are receiving the necessary nursing input however it was not always clear from records what nursing intervention was being undertaken. Much improvement has been made to medication practices, further work is still needed to ensure residents are being safeguarded by the homes practices. EVIDENCE: Few residents require direct personal care, instead staff prompt and encourage according to the individual’s goals. For example maintaining personal appearance or hygiene. Residents said that their privacy is respected and confirmed that staff followed the homes policy of knocking on bedrooms doors and waiting to be invited in. On several occasions the inspector noted residents asking staff to come back later and this was respected. Each resident is allocated a nurse and a support worker as their keyworker. This practice promotes the consistency and continuity of care/support provided. Not all residents knew who their key workers were and those that did said that they were happy with theirs, but had not been involved in their choice. Staff consulted said that the allocation of key workers is largely gender based but consideration is given to resident’s preferences. Not all staff consulted were aware of what this role involved. It was discussed that the Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 15 system of keyworking was clearly benefiting some residents but this was not consistent for all residents. The home is registered to provide nursing care. All resident’s state that their health care needs are being addressed and the experience for residents is that many move onto independent living or feel that their mental health condition is stable. From this it can be concluded that residents receive the necessary nursing intervention. However, it was not always clear from records what nursing intervention was being undertaken. This was discussed with the provider and is needed to ensure professional accountability. The home works closely with other health care professionals to support each resident, for example local GP’s, psychiatrists and psychiatric nurses. All residents consulted said that whenever they have requested to see any health care professional this has been sought promptly. Some residents make their own medical arrangements and attend all appointments by themselves. It is practice for staff only to accompany residents into medical consultations upon the invitation of the resident. Following concerns raised at the last inspection regarding poor medication practices, CSCI’s pharmacy inspector visited the home to monitor standards and provide additional advice. Much improvement has been made to medication practices, which has helped to safeguard residents. Areas that remain in need of further improvement are: • Examples were noted whereby residents who self medicated some of their prescribed medication (including creams and inhalers) are risk assessed to ensure that they are safe to do so. • Not all stock items of “PRN” and “As directed” medication were being recorded in a manner that enables a clear audit to be possible. This is to provide professional accountability and improve security around these medicines. • There are a few exceptional circumstances upon which the home has had to borrow medication between residents in an emergency. It is recommended that in order to safeguard staff and residents that the homes medication policy makes clear the circumstances upon which medication can be borrowed and how this must be recorded. Asher DS0000062718.V250149.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 There is an accessible complaints system with residents feeling able to air any concerns. 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. There have been no complaints recorded by the home. Residents said that they could approach the manager/provider with any concerns that they had and frequently did regarding minor concerns. The manager was advised to maintain a record of the minor concerns raised with him. This would enable the manager to evidence the actions undertaken to address these concerns. 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 all demonstrated an understanding of their roles and responsibilities under adult protection. Asher DS0000062718.V250149.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 and 30 The home provides a good standard of accommodation with Resident’s bedrooms individualised according to their tastes and preferences. Communal areas were clean with a good standard of hygiene being in place. EVIDENCE: The home is located near to local amenities and bus routes into Brighton and Hove which many residents make use of. Much effort continues to be made to create a domestic feel to the décor and furnishings throughout the home. Standards of maintenance were generally satisfactory. The home is decorated to an acceptable standard with parts in need of minor redecoration. The organisations maintenance staff is gradually addressing these areas. In line with previous recommendations as part of the daily fire checks on resident’s bedrooms, health, safety and maintenance issues are now also checked to ensure that they are promptly addressed. Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 18 Due to the levels of smoking amongst residents there are inevitable signs of wear and tear on both fabric and furnishings around the home. A conservatory has been built which is now the designated smoking area. This has improved significantly the standard of air quality in the communal lounge. 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 are provided with one, along with anyone else who requests one. There are sufficient number of toilets and bathrooms located around the building, this includes all but one bedroom having their own ensuite facilities. The lifestyles of some residents and the level of privacy afforded means that some bedrooms could not always be cleaned and kept odour free. Standards of cleanliness in other areas have improved with regular domestic staff now employed. One resident said that they were not happy with the standard of cleanliness in their bedroom and this was feedback to the cleaning staff. 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. There is a shaft lift, which provides level access to all floors. A call bell facility is fitted to all bedrooms and toilets. Those checked were in working order. The majority of residents said that they never use it. One residents said that they have only ever used it at night and staff attended promptly. In line with previous requirement risk assessments have been undertaken on the ligature risk that the call system pull cords could present. Some shorter cords had been obtained if a risk had been identified. Some good infection control practices were noted throughout the home, which included easily accessible protective clothing and in the handling of soiled laundry. Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 19 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): 31, 33, 34, 35 and 36 There are sufficient staff on duty to meet the needs of residents who demonstrated an understanding of residents needs and who were committed to supporting residents to achieve their individual goals. EVIDENCE: Staff consulted spoke respectfully and professionally regarding residents and demonstrated much commitment towards supporting residents to achieve their individual aims. Visiting health care professionals commented that staff were very knowledgeable about the needs of residents and were always very helpful. Residents described staff as: “very kind” “very helpful” “great” “one or two are a bit above themselves” “all are really great” and “alright”. Clear boundaries were evident between nursing staff and support workers with much feedback received that support workers skills were not being utilised to undertake some of the administration tasks currently undertaken by nursing staff. Staff meetings are undertaken including separate support staff meetings. Feedback was that these meetings could sometimes have limited value as nursing staff do not attend. This was discussed with the provider. These issues were clearly affecting the effectiveness and moral of the team. For example in the standards of care planning. The manager and provider were aware of these issues and had started to review job descriptions with a view to improving staff efficiency. Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 20 Staff said that it is usual practice to have four or five staff on duty during the day. This is in addition to the manager, cook and domestic staff. Staff felt confident that if additional staffing were needed then this would be supplied. Residents felt that there was always sufficient staff on duty to get the support they needed. The manager reported that no staff have been recruited since the previous inspection. The provider and manager continue to demonstrate a clear understanding of good recruitment practices and at the last inspection the homes practices were noted to safeguard residents. In accordance with previous requirements a training and development plan has been developed which identifies the training available for the proceeding months. This includes many specialists’ courses in mental health related issues. These are in the main undertaken by the providers. As previously noted training in care planning and risk assessment is needed to ensure that staff have the necessary skills to complete these to an acceptable standard. Staff consulted felt supported by the manager to carry out their roles, however not all support staff felt that they received the necessary support from nursing staff. Support staff are supervised by nursing staff with some inconsistency in the frequently and the quality of supervision. Not all nursing staff, including the manager were receiving regular clinical supervision. It has been required that all staff receive regular supervision in order to ensure consistent standards and to monitor job performance. Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42 The home was found to be managed in an open and friendly manner. Further work is needed to ensure that there is an effective system for self-monitoring the quality of the services provided. The health, safety and welfare of residents and staff is generally promoted and protected. EVIDENCE: The manager is a Registered Mental Nurse 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, visitors and residents all spoke positively about the manager with particular reference to their approachability, easygoing manner and fairness. It was previously required that additional senior management support be made available to the manager. This was to enable him the time away from the dayto-day management of the home to focus on addressing the shortfalls in practices noted. The inspector was informed that a deputy manager is to be appointed. In the interim some management responsibilities have been delegated amongst the senior team eg: health and safety and medication to Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 22 help elevate some of the pressure off the manager. Significant progress has been made to address all of the previous requirements. Some further work is however needed by the manager in order to ensure consistent practices. Residents felt at ease to approach the inspector with feedback on the home and the atmosphere at inspection was relaxed. Visiting health care professionals said that they were particularly impressed at the openness of the home for example residents being encouraged to speak to them without staff being present. Further progress has been made in the development of tools to self-monitor standards at the home. The manager reported that this has included audit checks of specific areas such as medication and care planning. The providers undertake the required monthly-recorded visit to the home to monitor services and provide an overview of the performance of the home. The standard of auditing in these reports is very high. It was reported that residents feedback questionnaires have recently been completed, however it could not be established how this information was being managed. It was discussed that systems for obtaining feedback from other stakeholders such as health care professionals, Doctors and relatives remains outstanding in order to fully meet previously made requirements. All records requested by the inspector were made available. As previously noted much progress has been made to improve the standard of care planning and medication records, which has improved resident’s safety and practices at the home. Records about residents were securely stored. A senior staff member has been delegated the lead on health and safety issues. Generally there was a good standard of record keeping. It was discussed with them the need to undertake further training in health in safety in order to update themselves on changes to legislation. Practices that were noted that promote the health and safety of resident’s, staff and visitors include: • A record of accidents is kept and was seen to be up to date with no specific patterns identified. • There is regular servicing and testing of fire safety equipment, fire safety training and drills are undertaken. The fire risk assessment is now being reviewed regularly. Residents also attended fire safety training. A mattress was being stored in the boiler room and it was immediately required that combustible material is not stored in the boiler room. Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 23 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 3 3 2 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 2 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 2 X 3 X 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Asher Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 2 x 2 2 x DS0000062718.V250149.R01.S.doc Version 5.0 Page 24 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 YA6 Regulation 15(2)(b) Requirement That care plans are updated regularly, at least once a month to reflect changes in needs and preferences of service users. Timescale for action 13/12/05 2 YA6 3 YA6& YA30 YA20 That the actions recorded for service users to achieve their individual goals are regularly reviewed and updated. (Made at inspection of the 24/2/05 with timescales of 30-4-05 and 30/10/05 not met). 18(1)(c)(i) That staff involved in the care planning process undergo training on their completion. 13(2) 15(2)(b) 28/02/06 28/03/06 4 5 YA20 13(2) 6 YA36 18(2) That detailed risk assessments 13/12/05 for any self administration. (Made during monitoring visit of 31/8/05 with timescales of immediate not met). That an audit to be possible for 13/12/05 medicines used on a “When required basis”. (Previously a recommendation made during monitoring visit of 31/8/05). That staff receive appropriate 13/12/05 supervision at all times. Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 25 7 YA39 24(1) 8 YA42 23(4)(a) That a system be established and maintained for monitoring the quality of the care provided, which includes a system for obtaining feedback from service users their representatives and other stakeholders on the services provided and the performance of the home. (Made at inspection of the 24/2/05 with timescales of 30-6-05 and 30-10-05 not met) . That combustible materials are not stored in the boiler room. 13/03/06 13/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA6 YA6 YA9 YA20 Good Practice Recommendations That care plans include greater guidance on the social care needs of service users. That the system for recording daily notes be reviewed to enable all staff to record relevant information regarding residents. That staff undergo training in risk assessments. That the homes medication policy makes clear the circumstances upon which medication can be borrowed from another residents and how this must be recorded. Asher DS0000062718.V250149.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection East Sussex Area Office 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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