Inspection on 21/11/05 for Ashford House

This inspection was carried out on 21st November 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashford House 19/04/06

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 Mr E McLeod Jan Foley Unannounced Inspection 09:15 21st and 24 November 2005 th Ashford House DS0000014372.V255271.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 Ashford House DS0000014372.V255271.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. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 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 Miss Julia Sarah Miles Care Home 10 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (1) of places Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of persons accomodated must not exceed ten. Date of last inspection 28th June 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 is Miss Julia Sarah Miles. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was arranged to follow up recommendations and requirements made at the previous inspection, and to assess concerns about the admission procedures and the protection of residents. The inspection was commenced on the 21st November 2005, and Jan Foley, Regulation Manager CSCI also attended on this visit. The focus of this visit was on care plans, risk assessments, pre-admission assessments and adult protection issues, and a partial tour of the premises was made. The second visit of the inspection was made on the 24th November 2005, and the two visits together lasted seven hours. At this visit, the inspector interviewed two residents, two members of care staff, and the registered manager. The inspector sampled procedures and records including records relating to health and safety, staffing levels, and medication. The inspector would like to thank everyone who contributed to the inspection. What the service does well: What has improved since the last inspection? More further education and work opportunities are being arranged for residents. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 6 The home has changed its’ food purchasing arrangements so that more fresh food is being provided. There has been a reduction in the number of double shifts worked by care staff. Five of the thirteen care staff employed now have the National Vocational Qualification (NVQ) in care or an equivalent qualification at level 2 or above, and five staff are presently undergoing NVQ training. 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 Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 8 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.V255271.R01.S.doc Version 5.0 Page 9 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, 5 The statement of purpose and service user’s guide need to be updated to provide residents and prospective residents with the information required under regulations 4 and 5 of the Care Homes Regulations 2001. The providers need to ensure that pre-admission risk assessment and care planning protects all residents. EVIDENCE: The inspectors read parts of a statement of purpose included on a recently commenced care file. The statement of purpose was dated October 2003. The inspectors noted that the number of difficult behaviours being managed in the home had probably increased since October 2003, and suggested on the evidence of a number of incident reports received from Ashford House that the statement of purpose needs to be reviewed and a clear statement made about the service provided at Ashford House. At present there are service users accommodated who have diverse and complex needs accommodated with service users who are more independent. Registered manager Ms Julia Miles indicated that the statement of purpose is going to be reviewed. The lead inspector discussed with the registered manager the matter that, although the resident group at Ashford House is relatively young, the service is registered to accommodate one service user over the age of 65, and the lead inspector discussed with the registered manager the matter that at present the resident group at Ashford House is relatively young, and it may no longer be Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 10 appropriate to accommodate a resident over the age of 65. The inspector suggests that the provider consider this matter during the review of the Statement of Purpose, and that the provider advise the Commission if a change of registration is contemplated. There has been one new admission since the previous inspection, and records for this were sampled. Pre-admission information and risk assessments had been obtained, and the registered manager had carried out a pre-admission assessment dated 1.11.05. One of the carers from the resident’s previous care home had worked some shifts at Ashford House to assist the settling in period. However, the inspectors suggested to the registered manager that after a difficult few months in which an escalating number of violent incidents had taken place, and evidence from incident reports that other residents in the home were being unsettled by this, that the decision to admit had not sufficiently considered the needs and protection of other residents. It was also noted that the risk assessment and care plan for the new resident did not cover some areas of risk previously identified with the resident, and therefore the service is perhaps not ensuring that the resident and others in the care home are being adequately protected. A terms and conditions of residence was sampled, and found not to have been signed by the registered manager and resident, and not to contain all information specified under standard 5. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 11 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, 9 The care plan for residents likely to be aggressive or cause harm or self-harm should include individualised procedures which ensure the protection of the resident or others. EVIDENCE: Three sets of care plans were sampled by the lead inspector. It was noted that the care plan format encourages resident to give their view of their care needs and how they wish their care needs to be met, and to involve the resident in the drafting of the care plan. Two of the sets of care plans - where the resident had been involved in more than one recent attack on a member of staff or resident - did not refer to these incidents, and did not assess the risk of further such incidents or measures being taken to protect the resident or others. Discussions with staff members provided examples of how residents are being assisted to take responsible risks (with appropriate supervision, for example in the kitchen) in order to assist residents in the development of their independence skills. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 12 Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 13 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): 13, 15, 16, 17 Residents are being supported to access the local community and leisure facilities, and to benefit from further education and work experience opportunities which are available. EVIDENCE: Some residents have recently been on a short holiday in Dublin arranged by the home, and residents interviewed said they had enjoyed this. Residents are accessing leisure and other facilities in the local community, and on the evening of the second visit there was a plan for residents to go bowling. Care records seen indicated that residents were being supported to follow their interests, and to go out to cafes, pubs, work centres and college. Staffing levels at present are supporting such activities taking place. Registered manager Ms Miles said that one of the improvements to the service provided was that a lot more college opportunities were being arranged with residents, with residents choosing the courses they wanted to follow. She said that with residents having different outlets during the day, they have more to talk about with each other in the evening. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 14 Where appropriate, residents are being supported to maintain contact with family and friends, for example by the facilitation of telephone calls and visits. Menus and cooking arrangements were discussed, and Ms Miles said that they were trying to alternate meals provided, and residents are being asked for their suggestions. The inspector was advised that there are always alternatives available at meal times. The home has changed its’ food purchasing arrangements so that more fresh food is available. Residents interviewed said the meals were good. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19. 20 The provider needs to ensure that there is a compatible resident group accommodated, to help create a friendly atmosphere in which residents can develop. EVIDENCE: Routines in the home are reasonably flexible, although enough structure needs to be in place to ensure the aims and objectives of the individual’s care plan are being met. Each resident has at least one key worker who assesses if the care plan goals are being met and if there is a need to update them. Staff interviewed said that every six months the key worker allocation is reviewed, and that the resident can say if they want to keep the same key worker. Positives for residents in the home since the previous inspection have included the availability of college courses and work opportunities, and the holiday in Dublin. It also has been a difficult time, with one resident having died suddenly, and with a number of aggressive and violent incidents being recorded. It has therefore been an unsettled time for many residents, and the inspectors stressed the importance of the resident group accommodated being reasonably compatible. Arrangements for the administration of medication were looked at. Ms Miles said that the recommendations of the previous pharmacy inspection had been Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 16 followed, and that the pharmacist will be providing training for staff in January 2006. At present there are no residents who have responsibility for their medication. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The home’s procedure on the prevention of abuse needs to be updated to help protect residents. EVIDENCE: A copy of Ashford House’s procedure on “Protection and Prevention of Abuse” has been received by the Commission, although the document is not signed or dated as required. The section on “Internal Investigation of Abuse” (section 8) should advise that in all cases it is the local social services department (or the police, if involved) who have responsibility for determining who will investigate allegations of abuse, and CSCI does not undertake the role of lead investigator. This should replace the information on CSCI’s role in sections 8.1 and 8.5 of the document. Ms Miles has been advising the Commission of untoward incidents in the home, and care managers and the local social services team are also being informed of these. An adult protection allegation was being investigated at the time of the inspection, with the involvement of the local social services team. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 30 Bathroom facilities provided do not meet the needs of residents. The provider should ensure that furnishings and fittings are of good quality and fit for purpose. EVIDENCE: A partial tour of the premises was made. Two bedrooms were visited, one of which had water damage to the ceiling which had not been repaired. Some bedroom furnishings and fittings (some wardrobes and sets of drawers, for example) were noted to not be sufficiently sturdy for their purpose or not in good condition. The manager informed the inspectors that new furniture had been ordered and was shortly to be delivered. Communal areas were visited, and it was noted that when the home is accommodating more residents there will not be sufficient space in the present dining area to accommodate all residents. The communal bathroom facilities are one bathroom with a bath, and one bathroom with a shower. The shower was found to be in poor condition, and the bathroom floor was awash with water which appeared to have come from Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 19 the shower as water from the shower curtain was dripping onto the bathroom floor rather than into the shower tray. The inspectors considered that one shower was not enough to meet the needs of ten residents, and that improvement to the bathroom facilities needed to be made. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 33, 35, 36 The manager and provider should continue to review staffing rotas to ensure staff are not becoming over-tired and then not providing a good service to residents. EVIDENCE: Concerns were expressed at the previous inspection that staffing levels were insufficient to meet the assessed needs of residents. Staffing rotas sampled during this inspection indicated that 4 care staff are planned for each care shift, and two night carers. The distribution of staff during shifts was discussed with Ms Miles, and indications were that staffing arrangements were now more appropriate for meeting the needs of residents. At the previous inspection there were also concerns noted of staff becoming overtired through working too many long or double shifts. The staff rota for the week of the inspection indicated that 11 double shifts were planned. Ms Miles said there were some circumstances in which double shifts might be appropriate, but that efforts were now being made to cut down the number of double shifts worked. Staff interviewed said that there were now fewer double shifts than previously, and that, all things being equal, shifts were likely to be less tiring. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 21 It was noted that during the week of the inspection that one member of staff was on the rota to work three double shifts, and their work pattern included a late shift on the Friday and early and late shifts on both Saturday and Sunday. The inspector advised that the manager and provider should continue to review staffing rotas to ensure staff are not becoming over-tired and then not providing a good service to residents. The Commission is advised that five of the thirteen care staff employed have the National Vocational Qualification (NVQ) in care or an equivalent qualification at level 2 or above, and that five staff are presently undergoing NVQ training. A programme of training in core topics and topics relevant to the work undertaken by staff is in place, including regular training in defusing violent behaviour, risk assessment, manual handling, intervention strategies, infection control, food hygiene, autism and mental health issues. Arrangements for staff supervision are in place. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): 39, 41, 42 It would be helpful for residents to know that suggestions made for the improvement of the service have been reviewed and to know what action is to be taken. Required policies and procedures are in place, though some (eg adult protection procedures and the statement of purpose) are in need of reviewing. Environmental risk assessments need to include hazards such as the wet shower room floor. EVIDENCE: A new quality assurance process is being introduced in the home, and a survey of the views of residents, relatives, and appropriate professionals had been carried out earlier in the year. However, no summary of the outcomes of this or resulting action plan have been made available. The registered manager has advised the Commission of fire equipment checks, drills and training which have taken place in recent months. We have also been advised of electrical, central heating, and other health and safety checks which have been carried out. Risk assessments for the home, dated July 2005, were sampled, which included action being taken on such matters as smoking Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 23 in bedrooms. The shower room floor found to be wet due to inadequate shower facilities was assessed by the inspectors to be a health hazard, and a requirement has been made under standard 27. The Commission has been advised of required policies and procedures which are in place in the home. Care plans sampled had been appropriately updated. As previously noted in this report, policies and procedures in need of review include those for adult protection procedures and the statement of purpose. Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 x x 2 Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x 3 x 3 LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x 2 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashford House Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x 2 2 x DS0000014372.V255271.R01.S.doc Version 5.0 Page 25 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 6 Requirement The registered person shall ensure that the statement of purpose and service user’s guide are appropriately and regularly updated The registered person shall not provide accommodation to a service user without suitable assessment and consultation, and shall ensure the assessment is kept under review and revised at any times necessary The registered person shall provide service users with toilets and bathrooms which meet their assessed needs and offer sufficient personal privacy The registered person shall make arrangements to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse The service user plan should establish individualised procedures for service users likely to be aggressive or cause harm or self-harm, focusing on positive behaviour, ability and willingness Timescale for action 20/02/06 2 YA2 14 25/11/06 3 YA27 23 20/02/06 4 YA23 13.6 23/12/05 5 YA23 6.5 14/12/05 Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 26 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 Refer to Standard YA5 Good Practice Recommendations The service user should have a copy of the contract/ statement of terms and conditions of residence which has been signed by the service user and registered manager and includes all recommended information. The results of service user surveys should be published and made available to service users, their representatives, and other interested parties including CSCI The provider should review the present registration categories of the service to ensure they reflect the type of service Ashford House is seeking to provide The provider needs to ensure that there is a compatible resident group accommodated, to help create a friendly atmosphere in which residents can develop. The provider should ensure that furnishings and fittings are of good quality and fit for purpose. 2 3 4 YA39 YA1 YA18 5 YA24 Ashford House DS0000014372.V255271.R01.S.doc Version 5.0 Page 27 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.V255271.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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