Inspection on 10/01/06 for Ashfield House

This inspection was carried out on 10th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashfield House 15/05/07

Ashfield House 28/11/06

Ashfield House 13/06/06

Ashfield House 21/06/05

Ashfield House 09/12/04

Ashfield House 28/09/04

Ashfield House 29/06/04

Ashfield House 26/05/04

Ashfield House 16/12/03

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Bell House 105 Ashley Road Ashley New Milton Hampshire BH25 5BL Lead Inspector Ms Sue Kinch Unannounced Inspection 16th January 2006 10:30 Bell House DS0000012384.V270191.R01.S.doc Version 5.1 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 Bell House DS0000012384.V270191.R01.S.doc Version 5.1 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. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bell House Address 105 Ashley Road Ashley New Milton Hampshire BH25 5BL 01425 619256 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) Bell House Homes Ltd Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2005 Brief Description of the Service: Bell House is a care home providing personal care and accommodation for service users with a learning disability and present challenging behaviours. It is owned by Bell House Homes Ltd, a subsidiary of Allied Care Ltd, which has a number of other registered properties in the area. The home is located on the outskirts of the town of New Milton, and with relatively easy access to the shops and other public amenities. The home comprises a detached, double fronted property with care parking for 4 vehicles to the front of the building and a well-maintained and accessible garden to the rear. All bedrooms are occupied on a single basis, and seven of these have an en-suite facility. There is a lounge with a television easily accessible to service users, and a separate quiet lounge and dining room. The home also has another room that is freely accessed by service users and is used for recreational activities. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection during the year 2005-6. One inspector completed the inspection in 5.5 hours on 10th and 16th January 2006. The purpose of the inspection was to assess compliance with the key standards not assessed at the last inspection and check that action had been taken following requirements. The report therefore should be read in conjunction with the last to achieve an overview of the standards at the home. Information was gathered by talking with five service users, some supported by staff, four care staff and the manager. Information was also obtained by an inspection of a sample of documentation held in the office. Observations were also made of interactions between service users and staff during lunchtimes. What the service does well: What has improved since the last inspection? What they could do better: Improvements are needed in two areas and these are similar to those needed in the last report. Attention is still needed to medication practices in the home to ensure that procedures are robust and that the system is followed through accurately. Clear guidance for staff is needed to assist in decisions about giving as required medication’. The second area for improvement is the charging policy for service users transport. There needs to be evidence that this is calculated fairly and service Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 6 users should have more control where possible. A requirement has been made in respect of this. 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. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 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 Bell House DS0000012384.V270191.R01.S.doc Version 5.1 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): 2 An effective system is in place to ensure that prospective service user’s needs are assessed before admission to the home. EVIDENCE: Since the last inspection the home has admitted three new residents. The two files viewed contained a copy of the care management assessment and supporting documentation obtained before the admission. They also contained an initial assessment completed by the manager using Allied Care forms. Risk assessments and care plans were being developed. Staff were asked about specific support provided to the new service users. They confirmed that adequate information was available. In conversation two service users were asked about the decision–making process for the admission. They confirmed involvement, that there were pre admission visits and agreement with the decision. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 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): Not Assessed The key standards were assessed at the last inspection on 21/6/05. EVIDENCE: Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 10 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): 15,16,17 Service users lives are enhance by increasing support with relationships and attention to rights and responsibilities. They are enjoying the increased involvement in food preparation and food offered. EVIDENCE: Service users are supported in their relationships with each other, families and friends. Three service users confirmed this by giving examples during conversation. Examples included: support to formal sessions with an external professional for specific needs, help with making arrangements to see friends or family, assistance with use of the telephone, help to buy presents and to see family members. Two staff asked confirmed that they definitely saw it as their role to help with the range of relationships that service users have. One confirmed that staff had time as key workers to discuss relationship issues but that they helped all service users with this. An example of how two people are supported was given showing how individual needs are considered. One staff member commented that knowledge of the service user’s needs had increased since the service stopped sharing staff with other registered homes within Bell House Limited. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 11 There is evidence that service users rights and responsibilities are increasingly promoted in the home. They are encouraged to become involved in more of the domestic activities in the home. One service user had decided to help with preparing the lunch on the first inspection visit and said they were enjoying it. Another said that they do regularly help in the kitchen now. They are able to choose where they wish to be in the home including the garden although there are restrictions in place in respect of the kitchen and laundry. Risk assessments in relation to these were viewed and discussed at the last inspection. Service users were freely accessing their rooms during the inspection and able to choose how to spend their time when at home. Two service users who showed the inspector their rooms, had been provided with keys to them. Rights and choices were discussed with three staff. One gave examples of how they thought these were increasingly met by looking at individual needs. A discussion took place with two other staff about the rights and choices about post and haircuts. This indicated that care practice issues are being evaluated at the home. A member of staff, additional to the shift, cooked the lunch because the cook’s post was vacant. Several service users said they like to help in the kitchen and flexible rota had been devised to enable this. During the inspection other service users also came into the kitchen. A menu is planned and service users can contribute. They were seen to check to see what is for lunch and confirmed that alternatives are possible. The food on the menu was being cooked for lunch with the exception of the pudding. This was because a resident had made a different pudding the night before. This was very positive but the member of staff cooking was advised that service users should also have the option of having the planned choice. Healthy eating is encouraged. Only positive comments were received from the five residents specifically asked about food. Staff were considering individual needs at mealtimes. One service user expressed an increased confidence in receiving food that they liked. Service users were able to eat elsewhere if they did not want to eat in the dining room. Staff had noted that one service user had not eaten much lunch and said that it would be passed on to the next shift. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 12 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): 18,20 Service users individual needs are addressed in the provision of personal care but more robust medication procedures are needed for ‘as required’ medication. EVIDENCE: Three staff said that care plans included details of support required for personal care. Two care plans were viewed and contained this information. Staff also have a daily prompt sheet, which was useful when planning work for a shift. Action is still needed to ensure that the medication policies and procedures are fully implemented. This has been a requirement in the last two reports. Medication is held securely in a locked cupboard. The chemist provides medication in a monitored dosage system and other drugs are held separately for each person. Copies of prescriptions for drugs outside the medication system are held. At lunchtime two staff were observed to administer medication and witness the process. A sample of administration sheets was observed and these were fully completed. However, at the last inspection it was noted that it was not always clear whether medication was at a regular time or ‘as required’. At this inspection it was noted that three service users were prescribed ‘as required’ medication but guidance from the doctor about use was not recorded. This was discussed with the manager who Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 13 could not locate it. Although this is only one area of medication it is vital that doctors’ guidance is followed closely. Although this is only one areas of medication it is vital that doctors’ guidance is followed closely. Another requirement was made at the last inspection about providing evidence of consent issues being addressed regarding disguising medication in a service users food. Following the inspection evidence was sent to the commission. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Increasingly effective systems in the home to provide protection to service users, but more work is needed to ensure that the systems in place offer service users a fairer organisation of personal monies. An easily accessible complaints procedure could make it easier for service users to raise issues. EVIDENCE: Three service users spoken with said that they did not have any complaints and that they knew who to speak to if they had a problem. One said that if you have a problem ‘staff sort it out’. The manager said that issues are raised be service users from day to day. There had been one formal complaint and this had been documented in the complaints file. There was evidence that this had been followed up. The manager said that service users were given a copy of the complaints procedure and it was held in the service users file. It was advised that a copy in accessible formats is posted on the notice board. Two staff spoken to confirmed that they had received training about adult protection in the last year. This included signs of abuse, rights and privacy. Policies and procedures are in the home. The manager was advised to emphasise whistle blowing, local procedures for reporting and being careful not to taint evidence, when training staff. Work takes place within the home to address the challenges presented by service users. These can include physical and verbal aggression. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 15 Since the last inspection staff have received training in working with difficult behaviours including physical intervention. Some of this was tailored to deal with specific needs following risk assessments and incidents at the home. The home does report specific incidences to the commission. At the inspection two were followed up to check the subsequent action taken. The manager confirmed that action had been taken including consultation with other professionals. This was documented with action plans revised or further monitoring taking place. The manager had been slower to report more recent incidents involving a third service user and new elements of difficult behaviours were discussed at the inspection. The manager was seeking external assistance again for dealing with the behaviours. A member of staff confirmed to have recently received a days training on working with this particular service user. They said that individual approaches about how to support people with difficult behaviours are recorded. They demonstrated an awareness of the risk of over reaction and placed more importance to listening to the service users. An allegation of abuse by a member of staff was made and investigated by the home since the last inspection. Local procedures had been followed and the Hampshire Adult Services had been involved. The commission had been informed. However the commission, although verbally informed of the outcome, was still waiting for the report of the investigation at the time of the inspection. The manager had been reminded of this and agreed to supply it. The commission does need to receive such information promptly. Following the last inspection a requirement about resident’s money was repeated because payments based on estimates were being made for transport on some of the residents’ behalf. A clear charging rationale was required. Some information had been provided to the commission but the issues had not been fully resolved. At this inspection the manager confirmed that action was being taken to address this issue and that costings for mileage had been sorted out for new service users and were being followed up for existing service users. She agreed to have this issue resolved by 16/5/06. This does need a prompt resolution. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 16 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): Not Assessed The key standards were assessed at the last inspection of 21/6/05. EVIDENCE: Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 The management need to ensure that staff have developed the skills and knowledge they need to meet the needs of service users. EVIDENCE: Other training issues were assessed at the last inspection but at this inspection consideration was given to National Vocational Qualification assessments training. Of the twelve staff at the home one staff member was reported to have worked to level 3 and another to level 4. The manager reported that most other staff had been registered to start their level 2 assessments in April 2006. Progress will be monitored at future visits. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home is being managed more consistently increasing the provision of continuity in care for service users. EVIDENCE: The manager has completed NVQ level four and has nearly completed the Registered Manager’s Award. The commission has received an application for registration but this process has yet to be completed. Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 x STAFFING Standard No Score 31 x 32 2 33 x 34 x 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 2 x 3 X X X X X x Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 20 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 YA20 Regulation 13(2) Requirement Timescale for action 16/03/06 2 YA23 20(1ab) The registered person must ensure that doctors’ guidance for ’as required’ medication is clearly documented for staff. A rationale for charging service 16/05/06 users for transport must be developed and implemented. This is a repeated requirement from the inspections of 21/6/05 & 9/12/04. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Bell House DS0000012384.V270191.R01.S.doc Version 5.1 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!