Inspection on 28/06/05 for Ashford House

This inspection was carried out on 28th June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashford House 19/04/06

Ashford House 21/11/05

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 Unannounced Tuesday, 28 June 2005 V223910 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashford House Address 9-11 Winchester Road, Worthing, West Sussex, BN11 4DJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01903 202595 Ashford House Limited Miss Julia Sarah Miles Care Home 10 Category(ies) of Learning disability - 9 Both, Learning disability registration, with number over 65 years of age - 1 Both of places Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Total number of persons accomodated must not exceed ten. Date of last inspection 23.11.04 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 H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 28th and 29th June 2005 and lasted six and a half hours. The inspection was arranged to follow up on recommendations made at the previous inspection, and issues highlighted in a recent adult protection strategy meeting. The inspector spoke with two of the seven residents, and talked to three members of staff and the registered manager. Policies and procedures and care records were sampled. The inspector also discussed the home’s registration details as displayed on the certificate, and the registered manager will consider with the registered person if this needs to be amended to better reflect the service provided. What the service does well: What has improved since the last inspection? Residents are happy with the new pool table. Some improvements to the premises have been made. A new care planning system is being implemented. Policies and procedures are now signed by the registered manager. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 6 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 H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4, 5 Service users and prospective service users are not being protected by arrangements in place for pre-admission visits, assessments, and care planning. There was a lack of individual information provided in the statement/terms and conditions of residence seen, and it is therefore possible that the resident concerned was unaware of the basis for their placement. EVIDENCE: Pre admission records, assessments and care plans were sampled for one resident who was recently admitted for a four week trial stay and one person referred for accommodation who had a recent weekend stay. Both were said to have visited the home prior to their admission or stay, although there were no written records to fully confirm this. Both residents were noted to have complex needs, to be coming from outside the local area, and to present a risk to themselves and others. No strategy meeting with the purchasing authority had taken place previous to admission for either person, and although it is likely both will need support from the local learning disability team no referral or contact had yet been made with that team. In neither case had arrangements for day care or specialist support been made. In neither case had a formal agreement as to staffing level needs been agreed with the purchasing authority prior to admission, and no plan of care was in place. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 9 An activities plan was in place for the resident on a trial stay. A note on the file indicated that extra staff would be “needed on the floor with him” but staffing rotas indicate no increase in staffing levels has taken place since the resident’s placement. Care records and incident reports indicate that in the period since admission some serious incidents had taken place. At the time of the inspection, these incidents had not been advised in writing to the funding authority or CSCI. The inspector advised the registered manager that any incidents of an adult protection nature should be advised to the adult duty team in Worthing and CSCI. Some risk assessments had been carried out with the resident on trial stay, but some areas of risk indicated by the pre-admission information had not been assessed or acted upon. With the prospective resident who had come for a weekend stay there was no written record of the progress of a pre-admission visit or the weekend stay. There was also no record of assessment or risk assessment by Ashford House. No care plan or activities plan was provided for the stay. The funding authority advised Ashford House that the prospective resident “would require 24 hour support and waking night staff” but again staffing rotas indicate no extra staff were being provided for the period of his stay. The inspector understands that incidents that took place during the weekend stay have not been advised to the placing authority or CSCI. A contract/ terms of conditions of residence was seen for the resident on trial stay, but this did not include information on the fees and had not been signed by the resident or manager. It could not be confirmed therefore that the resident was aware that he was being accommodated for a four week trial stay. The contract/terms and conditions seen referred to a review of the placement after the first two weeks, but at the time of the inspection this had not been planned. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 Care planning is at times not adequate, which leads to residents’ needs not being properly addressed. EVIDENCE: A new care planning system is being put in place, and some examples of this were seen. It was noted that there was no care plan in place for the resident most recently admitted. The inspector sampled the care plan and intervention strategy for a resident recently subject to an adult protection strategy meeting, and found the care plan had not been updated to reflect arrangements in place to ensure the protection of the resident. There was no indication that this resident’s safety had been risk assessed in relation to recent admissions to the home. Residents gave examples to the inspector of how staff support them to follow their interests, maintain contact with family and friends, and encourage their independence and choices. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 Residents are benefiting from activities plans (where these are being followed) and facilities provided by the home. EVIDENCE: An activities plan for one resident was seen, but the resident was observed during the first day of the inspection to be restless and not taking part in any particular activity. Some activities, such as a visit to a café with a resident, did take place on the day of the inspection. One resident interviewed said he had been on a recent holiday to Disneyland in Paris with other residents which had been arranged and accompanied by staff. Both residents interviewed said they enjoyed playing pool on the recently purchased pool table, and that they had made friends in the home since coming to live there. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 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 standard(s) 20 Improvements to the arrangements for medicines in the home are needed. EVIDENCE: A recent pharmacist’s inspection report seen by the inspector has highlighted some areas in the administration of medicines such as storage and recording which need to be improved upon. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 There are shortfalls in how the home is protecting residents from possible harm or abuse. EVIDENCE: A complaints procedure is in place, and the complaints record was seen. Proper risk assessments and care planning that would assist staff to ensure the safety of individual residents were not in place for a recently admitted resident, a prospective resident who had had a weekend stay, and for a resident whose vulnerability had been highlighted by a recent adult protection referral. The manager was advised by the inspector of the need for adult protection incidents to be referred to the local social services duty desks for adults, CSCI and the funding authority. Untoward incidents (for example, attacks on staff and fights between residents) must to be advised to CSCI and the funding authority. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Not assessed during this visit, although it was noted that some improvements have been made to the premises and maintenance work is regularly carried out. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 The high level of needs of residents is not being reflected in staffing levels provided, which creates risks for residents. The high incidence of long shifts being worked by staff increases the risk that staff will become overtired and their judgement in providing care and dealing with incidents will be reduced. EVIDENCE: Discussion with staff and records seen indicate that appropriate training and supervision are being provided for staff. Staffing rotas seen for the weeks commencing 13th June 2005 and 20th June 2005 indicate there were 26 occasions when members of care staff worked shifts commencing at 7.30 am and ending at 10 pm. On the first day of the inspection, two of the three members of care staff interviewed were working a fourteen and a half hour shift. Both staff members said it would not be their choice to work such long shifts – one said such shifts were “exhausting”, and the other said that such shifts gave staff no time to recover from a difficult incident that had taken place before the next difficult incident was arising. Staffing rotas for those two weeks indicate that there was no increase in staffing levels provided when a new resident was accommodated for whom it was identified that “extra staff (are) needed on the floor with him”. Similarly, when a resident who was assessed as requiring “24 hour support and waking Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 16 night staff” came for a weekend stay for the first time no commensurate increase in staffing was provided. Discussions with registered manager Ms Miles indicated that one of the assessments received indicated a particular resident being referred would need a “2 to 1” staff to resident ratio, but that on the telephone the funding authority care manager said the need was for a “1 to 1” staff to resident ratio. The inspector notes that no formal agreement of what staffing levels would be provided for the resident was put in place before or since the resident’s admission. Ms Miles said that two of the other residents accommodated require a 1 to 1 level of escort when on outings in the community. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 41 Residents have not been informed of how the views they have expressed in questionnaires they have filled out are being taken on board. The care planning for residents and assessment of their needs in some cases is not being supported by appropriate recording and updating of information. EVIDENCE: Since the previous inspection, a new manager for the home has received CSCI registration. Policies and procedures seen are now being signed and dated by the registered manager. An annual development plan for the home for 2005 was seen. In the three sets of care records sampled by the inspector, a number of care records and care plans had not been appropriately updated, and for two of them care plans had not been provided. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 18 Ms Miles said that a survey of the views of residents, visitors and relatives, and appropriate professionals on the service provided had been carried out, but that these views had not yet been summarised and published. Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x 3 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 3 x x x x x Standard No 31 32 33 34 35 36 Score x x 2 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashford House Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x 3 x x H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 20 no 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 23 Regulation 13.6 Timescale for action The registered person shall make 30th August arrangements to prevent service 2005 users being harmed or suffering abuse or being placed at risk of harm or abuse The registered person shall not 30th July provide accomodation to a 2005 service user without suitable assessment and consultation, and shall ensure the assessment is kept under review and revised at any times necessary All records on service users 30th included in Schedule 3 of the September Care Homes Regulations 2001 2005 must be held in the home The registered person shall 30th July ensure that at all times suitably 2005 qualified, competent and experienced person are working at the care home in such numbers as are appropriate for the health and welfare of service users Requirement 2. 2 14 3. 41 17.1 a 4. 33 18 Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 21 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 5 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 recommendations made in the recent pharmacists inspection report should be implemented. The results of service user surveys should be published and made available to service users, their representatives, and other interested parties including CSCI 2. 3. 20 39.4 Ashford House H60-H11 S14372 Ashford House V223910 280605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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. 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