Inspection on 19/04/06 for Ashford House

This inspection was carried out on 19th April 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashford House 21/11/05

Ashford House 28/06/05

Ashford House 23/11/04

Ashford House 27/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Ashford House 9-11 Winchester Road Worthing West Sussex BN11 4DJ Lead Inspector Mrs A Taggart Key Unannounced Inspection 19th April 2006 08:30 Ashford House DS0000014372.V291052.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 Ashford House DS0000014372.V291052.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. Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashford House Address 9-11 Winchester Road Worthing West Sussex BN11 4DJ 01903 202595 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) Ashford House Limited Post Vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of persons accommodated must not exceed ten. Date of last inspection 21st November 2005 Brief Description of the Service: Ashford House is a care home registered to provide accommodation for up to ten service users aged between 18 and 65 with a learning disability, and one of whom may be over the age of 65 with a learning disability. The accommodation is located in a residential area in the west part of Worthing, where there is access to local bus and train services. The registered provider is Ashford House Limited, for whom the responsible individual is Mr Aslam Dahya. The registered manager’s post is currently vacant. Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was carried out by two inspectors at 9.15am and lasted for seven hours. During the visit the inspectors made a tour of the home, which included all communal areas and some service user’s bedrooms. The inspectors spent time talking to service users and staff and tracked care plans and activity records. Staff files, the complaints book and accident reports were also seen along with health and safety and maintenance records. Service users went out for lunch so the inspectors did not see a meal being prepared or served but menus and food records were seen and discussed. Prior to the visit the inspectors met to plan the visit and a planning tool was completed using information from the last report and any documentation and correspondence received since the last monitoring visit. The registered manager’s post is currently vacant and the acting manager was on a training day. The area manager Eddie Hoult was working in the home and assisted with information during the visit. The inspectors wish to thank everyone who helped during the visit. The current fee range is £900 to £1,550 per week. What the service does well: What has improved since the last inspection? The service user group is now much more compatible and incidents in the home have decreased. Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 6 Some new furniture and fittings have been purchased and there is a programme of redecoration and refurbishment underway in order to improve the environment. Health and safety issues have been addressed and records are in good order. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashford House DS0000014372.V291052.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 Ashford House DS0000014372.V291052.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): 1 2 and 5 There is a suitable process in place designed to inform people of the services provided and to assess the needs and aspirations of potential service users. Outcomes for service users are good. EVIDENCE: The registration certificate has been updated. A statement of purpose dated November 2005 was seen, which describes the service provided. New admission procedures were seen, which have been updated to better protect residents. Comprehensive service user contracts are now in place and service users and the acting manager have signed the documents. To ensure that these contracts fully meet the Standard, the area of the documents regarding fees paid and room to be occupied should be completed. Outcomes for service users are good. The assessment procedure for one person was seen. The document contained comprehensive information and had been agreed and signed by the service user. Ashford House DS0000014372.V291052.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): 6 7 8 9 and 10 Care plans are comprehensive and contain sufficient information to inform the staff team of service user needs. Outcomes for service users are good. EVIDENCE: Care plans for two service users were seen and both contained comprehensive information about the needs and wishes of each individual. The plans contained information regarding risks and choices and detailed how each service user would be supported day to day. There have been no new admissions to the home since the last visit but one service user who has returned to the home and confirmed that they had been consulted and involved in reviewing and updating their plan of care. There was evidence of increased involvement from service users in the running of the home and this involves choosing menus, shopping for food and arranging holidays. There was evidence that service users are aware of documents that relate to them as these were agreed and signed and care plans and other documents are kept securely in a locked cupboard in the office. Ashford House DS0000014372.V291052.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): 11 12 13 14 15 16 and 17 There are opportunities for personal development, access to leisure facilities and support with personal relationships and community integration. Improvements could be made in food recording. Outcomes for service users are good. EVIDENCE: There is evidence that service users attend a variety of social activities and have opportunities for personal development and relationships. During the visit one person was out, another was waiting to leave for college and the remaining people went out for lunch together. Records seen for one person indicated that a range of activities such as social clubs, work experience, sailing and regular outings are organised for them and the person confirmed that they were happy with the their lifestyle. Another person said that they used to have employment in the community, which they now missed and said that the staff team were supporting them to find another job. There is a new activities board situated in the home, which indicates daily activities undertaken by each service user. Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 11 Risk assessment both personal and environmental were in place and for two people these indicated one to one staff support was needed at all times in order for the service users to lead an active life and interact well with other people. Ms. Hoult said that the home had recently undertaken a lot of work with service users regarding menu planning and healthy eating. There were menus available at the home but records of food eaten by service users was sporadic and indicated that a balanced diet was not always being had. Service users said they enjoyed the food provided and often also ate out at cafés or at college. Ashford House DS0000014372.V291052.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 19 20 Service users receive support in a way they prefer, health needs are met and medication is well managed. Outcomes for service users are good. EVIDENCE: At the present time the service user group are compatible and people said they have developed friendships, get on well together and support each other. This has lowered the stress levels in the home and the number of incidents has decreased. Care plans contain information regarding choices around personal care issues and there is evidence of the home being involved with a number of healthcare professionals. Files show that people attend the dentist, optician, chiropodist and local doctors on a regular basis and people also have access to relationship counselling and support. Service users have access to the local community learning disability team and receive support to attend appointments. Medication is kept in a suitable cabinet in a locked room. All medication and MAR sheets were checked and found to be in good order. There is an agreement in place with Boots Pharmacy who also carry out staff training. A homely remedies policy is in place for each service user signed by a doctor. A list of authorised medication handlers in place. Any changes in medication are confirmed by a GP in writing before being actioned.One service user was said to self medicate. When this was tracked the plan for them self medicating was Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 13 found to be out of date. Ms. Hoult said the person was very independent and just went to the GP when they wanted to, so maybe chose not to have the inhalers. It was pointed out that this needs to be risk assessed as the medical condition still remained. Ashford House DS0000014372.V291052.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 Service users are being adequately protected by staff practices and are aware of the complaints procedure. To further protect people, there is still a need for the staff team to access local adult protection training. Outcomes for service users are good. EVIDENCE: The notes from a recent resident’s meeting showed that the home’s complaints procedure had been discussed with service users and they had been advised of the process to use should they wish to make a complaint. There is a copy of the complaint procedure included in the Statement of Purpose and Service User Guide. No recent complaints have been recorded. Adult protection procedures in the home have been reviewed and updated and there are current risk assessments in place within individual care plans. Staff training in adult protection has been provided and staff where aware of their responsibilities should they suspect an abuse had taken place. Ms. Hoult said that training in local adult protection procedures is still being sought and that she had been trying to contact the West Sussex co-ordinator in order to arrange this. Although the service user group living together at present are quite compatible, it is clear from records and from talking to staff and service users that situations can still be volatile. Risk assessments and behaviour management plans were of a good quality but the need for a compatible client group when new service users are admitted is very important especially in view of the vulnerability of some current residents and this was discussed with Ms Hoult. Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 26 27 28 30 Although there is a programme of redecoration and refurbishment underway there are still outstanding areas needing improvement in standards. Outcomes for service users are adequate. EVIDENCE: A tour of the premises was made. The laundry room has an industrial size washing machine with sluice cycle. Each resident now has a laundry day (list seen in staff office) which Ms Hoult said was improving laundry practice. In the kitchen, it was noted that the fire exit needs to be better signed and the environment would benefit from updating and modernisation. The cleaning cupboard was locked. The flooring in the sitting room was deteriorated - Ms Hoult said it had been a mistake to use the wood effect flooring, and they now planned to carpet it. Raised strips on the corridor flooring were not in good condition and also noted to be a trip hazard, areas of this flooring also in poor condition. Trip hazards on stairs due to uneven levels of flooring. Two residents agreed for their bedrooms to be seen. Both rooms had been personalised by the person living there. In one room there were two holes in the wall, a mop and mop bucket left in the en suite bath, and the bath was not in a clean or hygienic condition. In another the room was clean and bright but as in the previous room, taps were scaled and the sink unhygenic. The door to the garden from the games room was in the process of being replaced. Ms Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 16 Hoult advised that as the stairway was being redecorated and the stairs which were bare would then be carpeted when the decoration was complete. The shower room was seen, and this has had a new shower tray and screen installed. There was a tile missing and one strip stopped short of the wall. One bedroom door seen in need of repair. Bathroom had a small pool of water on floor, and part of flooring has deteriorated through water damage. A book for maintenance requests was seen - staff write in jobs to do, and the handyman signs off when the work is completed. There is also a maintenance book, in which the handyman records the work he has carried out. In March 2006 this included removing rubbish, door repair, redecorating downstairs hallway, hedge and tree trimming, shelves in office, installing new shower, water temperature tests and fire tests. A plan of work to be undertaken for January to April 2006 was seen, and most of this work has been completed on schedule. Ashford House DS0000014372.V291052.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): 31 32 33 34 35 36 There is good recruitment practice in the home and the staff team are well supported. There are gaps in the training being undertaken by staff. Outcomes for service users are good. EVIDENCE: Staff rotas show that there are sufficient numbers of staff on duty to provide adequate support for current service users. Two people ate identified as needing one to one support at all times. All staff members have a job description and are aware of their responsibilities. Two sets of staff recruitment records were seen and in one of them a work permit for member of staff from oversees had expired. This was discussed with Ms. Hoult who said that she would ensure that the current permit was placed on file. Other staff records were in good order and contained relevant documentation including Criminal Bureau Checks and references. Training records were seen which showed that a variety of training opportunities are available including mandatory training and courses specific to the service user group being supported in the home. Some records showed that refresher courses were overdue but Ms. Hoult said a new training matrix had been introduced for all staff to address this. Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 18 Many of the senior staff have completed the NVQ award to level 3 and are working towards level 4. Some of the oversees staff said that they would like to access the award but were prevented from starting because of the cost of international student fees. Two staff members spoken to said that they received supervision from the acting manager or Ms. Hoult every eight weeks and records are kept on file. Interactions between staff members and service users were friendly and staff members on duty were seen to be supportive and approachable. Service users said that they were happy and that staff members were kind and caring. One person said, “I am enjoying it here, I like the staff, I go to college and enjoy sailing”. Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 38 39 and 42 In the absence of a registered manager, good interim arrangements have been put in place to ensure the safe running of the home. Health and safety issues need some improvements. Outcomes for service users are good. EVIDENCE: Ms. Hoult advised that interviews for a registered manager were presently underway. Deputy manager Ms. Colbourne and area manager Ms. Hoult have been providing management cover in the interim. Staff members interviewed thought that the home was being well managed and said that they felt supported. There is currently no annual development plan in place in order to identify areas needing improvement within the home. Ms. Hoult said that discussions were in place with Ms. Colbourne to identify issues to be included. The Care 4 You system used within the home has a built in quality assurance system, designed to cover all areas of standards and procedures. Satisfaction surveys have been sent out to service users, families and professionals Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 20 involved with the service and Ms. Hoult said that when these were returned they would be collated and published. Health and safety records were seen and many of the issues identified at the last visit had been acted upon. Some equipment had been replaced and fire, electrical compliance, gas safety and Legionnella tests had been completed. No risk assessments were in place for the trip hazards identified during the visit. Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 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 1 25 3 26 3 27 2 28 2 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 X X X 2 Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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 YA5 Regulation 5 (b) Timescale for action Care plans should be reviewed to 15/05/06 include the amount of support needed by service users to keep their bedrooms hygienic. The home should improve the daily records of food eaten by service users. Risk assessments should be carried out in respect of areas of the home that may constitute a trip hazard. An annual development plan should be devised to highlight areas of the home needing improvement including the environment. The registered provider should take measures to ensure that residents are protected against harm including providing training in local adult protection procedures for staff. 15/05/06 Requirement 2. YA17 Schedule 4 (13) 23 3. YA24 15/05/06 4. YA39 23 31/05/06 YA23 5. 13 (6) 31/05/06 Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 23 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 Refer to Standard YA20 YA39 Good Practice Recommendations Health plans should be updated to include a risk assessment for service users who are self-medicating The results of service user surveys should be published and made available to service users, their representatives, and other interested parties including CSCI . Refresher courses for staff training should be updated and the NVQ award made available for all staff members. A registered manager should be recruited to take day-today responsibility for the home. 3 4 YA35 YA37 Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 24 `````````````````````````````````````````````````````````````` `````````````````````````````````````````````````````````````` `````````````````````````````````````````````````````````````` `````` Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Ashford House DS0000014372.V291052.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!