Inspection on 23/11/05 for Ashgale House

This inspection was carried out on 23rd 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 no outstanding requirements from the previous inspection report, but made 62 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashgale House 03/11/08

Ashgale House 15/10/07

Ashgale House 21/06/07

Ashgale House 19/12/06

Ashgale House 20/04/06

Ashgale House 22/02/06

Ashgale House 02/11/04

Ashgale House 04/05/04

Ashgale House 26/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Ashgale House 39-41 Hindes Road Harrow Middlesex HA1 1SQ Lead Inspector Ms Sue Barker ` Announced Inspection 23rd November 2005 09:05 Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 1 Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 2 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 Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 3 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. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Name of service Ashgale House Address 39-41 Hindes Road Harrow Middlesex HA1 1SQ 020 8863 8356 020 8863 8491 ashgalehouse@aol.com 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) Mr Aslam Dahya Mr Siyoum Beyene Care Home 14 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (1) of places Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 5 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Within this Fourteen , 4 People may be residents with additional Physical disability. People with Physical Disability will reside on the ground floor of the building. Temporary variation agreed for one named individual (MB) aged 66 years for the duration of her stay. 2nd November 2004 Date of last inspection Brief Description of the Service: Ashgale House is a registered care home providing personal care and accommodation for a maximum of 14 adults aged 18-65 who have learning disabilities. The building is divided into 2 units, with the home registered to provide 8 places on the ground floor (four of these places may be occupied by service users who additionally have physical disabilities) and 6 places on the first floor. Within the 6 registered places in the first floor unit, 2 places are made available to residents (on a local authority contract basis) as respite. The Registered Provider is Allied Care, the Responsible Individual being Mr. Aslam Dahya. The Registered Manager is Mr. Siyoum Beyene. The home is located in a busy residential road on the outskirts of central Harrow, close to shops, leisure and other community amenities. The home was registered in May 2001 and is a two storey building All the home’s bedrooms are single, and none have en-suite facilities. The home has a large garden to the rear that is accessed through the ground floor unit. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection was conducted over 2 days. On 23/11/05 the Inspectors were Mrs Sue Barker and Ms Judith Brindle who remained in the home from 9.05am till 4.55pm. Mrs Sue Barker completed the announced inspection on 24/11/05. The Inspectors were pleased to meet with residents, staff on duty, Mr Beyene and Ms Julie Elliot (the Deputy Manager) and a visitor to the home. In addition the Inspectors briefly met with one of Directors of Allied Care, who visited the home during the announced inspection. The Inspectors were made most welcome and would wish to thank those in Ashgale House for the hospitality and assistance received during the announced inspection. An additional visit was made to Ashgale House by the Inspectors on 10/3/05 in order follow up on compliance with those requirements arising from the previous unannounced inspection. At the time of the announced inspection there were 12 residents living in the care home on a long-term basis with 1 respite user. Mr Beyene indicated that 2 places in the first floor unit are contracted to a local authority on a respite care basis. A number of respite residents have used the service. Mr Beyene stated that he is aiming to develop the service so that residents do their own cooking, washing etc with staff support, as opposed to staff undertaking these tasks, as happens at the moment. What the service does well: Residents are supported by staff to take part in a range of activities of their choosing, both in the care home and within the community. Residents enjoy differing levels of relationship with their families and friends. Residents are supported by staff to make life choices and this was observed during the announced inspection. Complaints recording indicated that residents’ concerns and complaints are listened to in Ashgale House. Residents live in a homely environment within Ashgale House. Resident’s bedrooms show varying degrees of personalisation. Residents are supported by a staff team in Ashgale House, who presented as competent and resident focussed. Those who kindly spoke with the Inspectors verbally expressed extensive knowledge of residents’ needs, choices and aspirations. Residents’ laundry is washed in the care home’s laundries and they live in a clean environment. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 7 What has improved since the last inspection? What they could do better: Prospective residents to Ashgale House are not fully assured that staff in Ashgale House assesses their needs and aspirations before they move into the care home. Work must be done to ensure that a thorough documented assessment is undertaken preferably before residents moves in to Ashgale House that establishes whether the care home can meet their needs or not. The care home has done much work to ensure that residents’ changing needs and personal goals are reflected in their care plans in order to provide them with a consistency of care and support. This work, however, was not complete. Work needs to be done on developing staffs’ range of communication techniques in order that they can communicate as effectively as possible with residents. Work needs to be done to ensure that residents are enabled to safely take risks within a risk management culture in Ashgale House. Residents are supported by staff to ensure that their personal care needs are met. Work still needs to be done to ensure that there is clear guidance for staff on how they should work with residents in order to ensure a consistency of care practice. It must be ensured that individual residents’ complex physical and health care needs are understood by care staff employed in the care home, with clear guidance for them on how to respond to any situations that arise. The implementation of the care home’s medication policy largely ensures that residents are protected and assured of a safe service. Work must be done to ensure that the care home’s complaints procedure meets statutory requirements. The use of physical restraint as a strategy to manage residents’ behaviours must be reviewed to ensure the protection of residents’ rights and best interests. Work needs to be done to meet the requirements arising from the announced inspection to ensure that residents live in a reasonably furnished, decorated and safe environment. Residents’ laundry is washed in the care home’s laundries. Residents live in a clean environment. The care home’s infection control arrangements present as Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 8 largely adequate although attention must be paid to the disposal of waste in the laundry areas. Residents are not fully supported and protected by the care home’s recruitment procedure and practices. 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. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 9 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 Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 10 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 Prospective residents to Ashgale House are not fully assured that their needs and aspirations are assessed before they move into the care home EVIDENCE: The updated Statement Of Purpose for Ashgale House was passed to the Inspectors during the announced inspection. The assessment of potential residents referred to Ashgale House was discussed with Mr Beyene and Ms Elliot and the Inspectors viewed examples of written assessments completed by the care home. Mr Beyene primarily carries out the assessment of potential residents. One such assessment viewed covered the potential resident’s behavioural needs, medication review, supported family contact and structured day opportunities/access to the community. The Lead Inspector spoke to Mr Beyene of the areas that must be included in any assessment of potential residents that is carried out by Ashgale House. Inspection did not indicate that this was the case in respect of the examples viewed. In addition not all the examples viewed contained assessments from the referring local authorities. There was no evidence of assessment in respect of a resident who had moved into the care home on an emergency basis. Mr Beyene was advised that the needs of potential residents must be fully assessed before the resident moves in. The assessment must determine whether the home can meet the needs of the prospective resident in terms of their health and welfare. The potential resident must be involved in this process. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 11 Where residents use the care home on a respite basis there is still a need to carry out a full assessment of their needs with a copy of their Care Management (health and social services) assessment/Care Plan obtained from the referring authority. The home has done much work on the residents’ care plans since the last additional visit. This is referred to in standard 6. Up to date care plans were not, however, in place for all residents. One resident’s assessment viewed contained statements regarding identified risks arising from the resident’s behaviours and challenges to the service. There was evidence of written strategies having been developed with the resident for implementation by staff when such challenges occur. These, however, referred to the day placement that the resident attended and were not specific to Ashgale House. The Inspectors advised Mr Beyene that any potential restrictions on the potential residents’ choice, freedom, services and facilities must be assessed prior to their moving in, with strategies for working with the resident in place, that are subject to multidisciplinary agreement. The Inspectors observed a situation where one resident, who lived in the first floor unit, could only go outside to the smoking area when a member of staff was available to take them. The Lead Inspector advised Mr Beyene and Ms Elliot during the verbal feedback that it had been observed that residents living in particularly the first floor of Ashgale House presented as having very different needs and dependencies, with a number recorded as having significant mental health needs. Mr Beyene stated that all the residents living in Ashgale House had learning disabilities. The care home, however, is not registered to accommodate those whose need for residential care is predominantly due to their mental health issues. There was no evidence of staff having undertaken any training in specific or general areas off mental health. It must be ensured that the care home is appropriate to meet the needs of the residents living there in terms of lay out and staff competency. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 12 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 & 9 The care home has done much work to ensure that residents’ changing needs and personal goals are reflected in their care plans in order to provide them with a consistency of care and support. This work, however, was not complete. Residents make decisions about their lives. Work needs to be done on developing staffs’ range of communication techniques in order that the assessed communication needs of residents are met. Further work needs to be done to ensure that residents are enabled to safely take risks within their ordinary living, as part of the care home’s risk management culture. EVIDENCE: The Inspector viewed a sample of 5 residents’ care plans. It was noted that staff had done considerable work on the care plans since the last additional visit with a new format in place. The content of the care plans was variable but Ms Elliot indicated that staff were still working on their completion. One care plan viewed covered a resident’s medical information, ‘daily living and needs assessment form’, lists of resident’s likes and dislikes, personal profile, guidelines for working with the resident, risk assessments, usual daily routine, daily living, social activities and health care plan and lifestyle plan. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 13 Within the documentation there is some indication of what the resident would like to do and have. There was no current care plan for one resident who had moved into the care home earlier in the year. The care plan documentation viewed was from their previous care home. There was no evidence that this had been reviewed since the resident moved to Ashgale House. There remained few agreed goals of care and support for each resident. This is a previous requirement. Some of the individual care plans contained information about 2 residents. Staff separately record in detail their observations of each resident during each shift with the personal care they receive. This includes detail of need that is not apparent from the care plans. Staff must be commended for their depth of their reporting. Inspection of the reports indicated a number of incidents that had occurred in Ashgale House involving residents and staff. For example on 23/8/05 one resident hit another and on 16/11/05 a resident tried to hit a member of staff. On a number of occasions it is recorded that the police had been called to deal with a situation that staff had been unable to with the use of physical intervention. The Lead Inspector informed Mr Beyene that such incidents must be reported to the Commission for Social Care Inspection as is required by Regulation 37. This had not occurred. Individualised procedures must be in place for each resident where they are likely to be aggressive or cause self-harm, focussing on positive behaviour, ability and willingness that are subject to multidisciplinary agreements. The Inspectors viewed individualised procedures for only one resident that had been produced by a commercial company. This procedure had not been subject to multidisciplinary agreement. It indicated that staff should use physical restraint measures to deescalate situations. Staff had recorded a situation where this procedure had been tried without success. This is further evaluated in Standard 23. One resident kindly let the Inspectors know who their key worker was. A number of reviews of care plans had recently been held. The home invites representatives from the funding authorities to attend. There was evidence of the residents being involved. One resident kindly let the Inspectors know that they were having a review. The Inspectors spoke of the need to ensure that care plan documentation is easily available for the staff team in Ashgale House with some rationalisation being suggested to ensure ease of access to the working documents. Those staff, who kindly spoke with the Inspector, were knowledgeable about residents’ personal care and support needs, in addition to their preferences and aspirations. Staff were aware of residents’ care plans. Those relatives and visitors who kindly completed ‘Comment Cards’ for the Commission for Social Care Inspection indicated that they were consulted about important matters relating to their relative/friend. It was further highlighted that occasionally messages are left with staff regarding residents that are not passed on or not acted upon. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 14 During the inspection, some residents kindly spoke to the Inspector about what they were doing that day, as well as some longer term plans. Care plans included some indication of residents’ goals. Some of the residents do not communicate verbally. Staff spoke of their understanding of these residents’ non-verbal prompts. Inspection of one care plan indicated that the resident communicated by using makaton, signs and symbols. Ms Elliot advised the Inspectors that staff are to undertake training in makaton and communication skills. It must be ensured that appropriate training in ‘communicating with residents’ is made available to staff. Ms Elliot indicated that staff are planning to work with one resident to enable them to eventually take responsibility for handling their own money. The Inspectors discussed with Mr Beyene and Ms Elliot the need to begin the process of risk assessment from when prospective residents are being assessed for a placement in the home. Limited numbers of risk assessments were viewed. For one resident (who was assessed as having a range of health and behavioural issues) there was one risk assessment in respect of ‘mobility in the kitchen’. There continues to be outstanding requirements in this area. In addition the Inspectors advised Mr Beyene to extend the range of risk assessments to cover pressure areas for those residents who use wheelchairs to mobilise. Mr Beyene advised the Inspector in the pre-inspection information that there is no procedure in respect of when a resident is missing from the placement. This is required. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 & 16. Residents are supported to take part in a range of activities of their choosing. Residents are supported by staff to access facilities within the community. Residents enjoy differing levels of relationship with families and friends. Residents are supported by staff to make life choices, though this is not reflected in all of their care plans. EVIDENCE: During the announced inspection, the Inspectors noted that residents mostly went out to their day placements and accessed facilities in the community such as shopping, cinema etc. One resident was supported by a member of staff to go into London. One resident kindly advised the Inspector that they were going shopping locally with a member of staff. One resident has budgies that were kindly shown to the Inspectors. One resident kindly let the Inspectors know that they “liked” going shopping. Residents kindly confirmed in their completed ‘Comment cards’ that they were satisfied with the activities available to them in Ashgale House. The Inspectors viewed examples of residents’ pottery work in the care home’s activities Room. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 16 There is a small ‘sensory room’ located in the ground floor unit. The home has its own transport facilities, with a small number of staff being designated drivers. Inspection of the staff rota indicated that there are similar numbers of staff on duty over 7 days of the week. The rota indicated when staff were to support residents to go swimming. Within the sample of long stay residents’ care plans viewed there was indication of their choices in terms of ‘daily living and social activities’. The Lead Inspector did not note that this area was covered in the sample of respite residents’ care plans viewed. Staff on duty kindly spoke to the Inspectors about residents’ routines and what they enjoyed doing. The staff team in Ashgale House present as a multicultural team as do the resident group. The Inspector met with one of the resident’s relatives during the announced inspection. The care home’s ‘Visitors Book’ indicated that there were a range of visitors to Ashgale House. Those relatives and visitors who kindly completed ‘Comment Cards’ for the Commission for Social Care Inspection indicated that they could meet their relative/friend in private and were made welcome when visiting Ashgale House. There was information about residents’ preferred routines in some of their care plans. Staff were observed knocking on resident’s bedroom doors before entering. The Inspectors observed staff talking to residents. Residents were observed moving around both of the units freely. Access to both the units is through keypad systems. Access to the garden is through the ground floor unit. Ms Elliot indicated that the staff focus is to move towards a more person centred approach with staff supporting residents to undertake household tasks. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 17 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. Residents are supported by staff to ensure that their personal care needs are met. Work, however, needs to be done to ensure that there is clear guidance for staff on how they should work with residents in order to ensure a consistency of care practice. It must be ensured that individual residents’ complex physical and health care needs are understood by care staff employed in the care home, with clear guidance for them on how to respond to any situations that arise. The implementation of the care home’s medication policy largely ensures that residents are protected and assured of a safe service. EVIDENCE: Mr Beyene advised the Inspector that all residents living in Ashgale House need help with washing, bathing and toileting. 5 residents require help/supervision/prompts to eat meals. 5 residents have continence issues. 4 residents use wheelchairs to mobilise. ‘Moving & Handling’ assessments were viewed for 2 residents. They included some information for staff on how to safely work with the resident, but require some further details on how many staff are to assist residents with moving and handling operations. For example one such assessment included the statement ‘ensure adequate staffing levels when using the hoist’. Some written guidelines were available for staff to assist residents with their personal care tasks, e.g. toileting, though was not available on all care plans. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 18 This is an area that still needs some development within the care home’s care planning processes. There was written indication of residents’ preferred daily routines within their care plans. One resident kindly advised the Inspector that they like staying up late to watch TV. Staff clearly record in their daily reports the range of personal care tasks residents are assisted with. Moving & Handling training forms one part of the care home’s staff training programme. Some staff kindly advised the Inspectors that they had undertaken this training. Residents have named key workers from within the staff team. Residents living in Ashgale House were noted to suffer from a range of complex medical conditions. Mr Beyene advised the Commission for Social Care Inspection in the pre-inspection questionnaire that all residents have mental health needs and 3 exhibit extreme behaviour. The Inspector advised Mr Beyene and Ms Elliot that staff must have written guidance available to them on individual residents’ medical conditions, e.g. epilepsy. This information was not viewed on individual files and is a previous requirement. Inspection of the some care plans indicated that residents attend a variety of preventative health care checks. This was not the case in all the care plans viewed. There must be a clear record of the preventative health care appointments attended by residents with note of any resulting advice for staff in the care home. The district nursing team visits the care home. Staff complete ‘body maps’ in the event of any bruises being noticed on a resident. The Inspectors viewed a number of these completed forms. It was unclear what follow up had occurred subsequently, e.g. consultation with GP, investigation and completion of the accident book. Completed ‘Comment cards’ were received from residents’ GP. The Lead Inspector viewed the medication cupboard in the ground floor unit. The cupboard was locked and its contents were found to be well ordered. There was clear guidance for staff on the circumstances in which PRN medication is to be administered to residents. The cupboard was well laid out with most items being up to date. There were a number of unused items of medication that had been in the medication cupboard for some time and were due to be returned to the pharmacist. There were photos of residents on their medication sheets. The records of medication administered to residents by staff were fully recorded with only one staff signature missing in the sample of sheets viewed. Ms Elliot let the Inspectors know that staff will be working towards some residents self administering their medication, subject to risk assessment. Medication training forms one aspect of the care home’s staff training programme. Senior staff take responsibility for the administration of medication to residents living in Ashgale House. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 19 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 Complaints recording indicated that residents’ concerns and complaints are listened to in Ashgale House. Work must be done to ensure that the care home’s complaints procedure meets statutory requirements. The care home’s policies aim to protect residents from abuse, but the use of physical restraint as a strategy to manage residents’ behaviours must be reviewed to ensure the protection of residents’ rights and best interests. EVIDENCE: Mr Beyene kindly passed the Inspector a copy of the care home’s complaints procedure. It is entitled ‘Compliments, Comments, Suggestions and Complaints’. The policy indicates that complainants will be responded to in within 28 days. The complaints procedure requires amendment to ensure that it contains all the elements required by Regulation 22, including the contact details for the local Commission for Social Care Inspection office. The complaints procedure is produced in a written small print format. Work must be done to ensure that the complaints procedure is appropriate to the needs of the residents. A full record is maintained of any complaints received in Ashgale House. Three complaints have been received since 1/11/04. The reports indicate that the complainants have been responded to in 28 days and indicate the nature of the complaint, action taken and outcomes. Feedback received from residents indicated that they knew who to speak to if they were unhappy. Feedback from residents’ relatives and visitors indicated that they were mostly unaware of the care home’s complaints procedure. The Registered Person must ensure that those acting in behalf of residents have access to the care home’s complaints procedure. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 20 Staff kindly advised the Inspectors that they done training in Protection of Vulnerable Adults from Abuse, as required. Mr Beyene in the pre-inspection questionnaire advised the Inspector that there is a Protection of Vulnerable Adults from Abuse policy for the care home as required. The Lead Inspector discussed the implementation of the ‘Department of Health Protection of Vulnerable Adults Practical Guide for care homes and domiciliary care agencies’ in respect of Ashgale House, with the registers of those who are unfit to work with vulnerable adults. Staff employed in Ashgale House receive training in breakaway techniques and physical restraint from a training agency. Individualised procedures were viewed for one resident only, and generalised guidance was otherwise available. This guidance advocated the use of physical restraint techniques. There were recorded incidents of where these techniques had been unsuccessful and staff suffered injuries. It is required that the use of physical restraint in Ashgale House be reviewed. Physical restraint must only be used as a last resort, by trained staff, in accordance with the Department of Health guidance, whilst protecting the rights and best interests of residents and is the minimum consistent with safety. Mr Dahya, the Registered Responsible Individual, acts an appointee for 5 residents. Ms Elliot kindly advised the Lead Inspector that the care home has obtained information from head office regarding the sums of money held, on behalf of these residents, centrally. Some residents’ monies are held in the care home on their behalf. Staff support residents to do their shopping and records are maintained of this expenditure of their money, with receipts. Two such accounts were inspected and it was found to be correct in respect of the sums held. One resident signed for the money that they receive. There was no indication that senior staff were regularly checking as correct and signing the accounts of monies held on behalf of residents. This must be commenced. One of the resident’s account files viewed contained information about 2 residents. This was discussed with Mr Beyene and Ms Elliot. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 21 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 & 30 Residents live in a homely environment. Work needs to be done to meet the requirements arising from the announced inspection to ensure that residents live in a reasonably furnished, decorated and safe environment. Residents’ laundry is washed in the care home’s laundries. Residents live in a clean environment. A requirement arose concerning the care home’s infection control arrangements. EVIDENCE: Staff kindly showed the Inspectors around the building. One resident kindly invited the Inspectors to view their bedroom. Residents’ bedrooms were personalised to differing degrees. The dimensions of the care home remain unchanged since registration on 18/05/01. A considerable number of requirements were noted concerning the building that are noted later in the report. Ms Elliot advised the Inspectors that some interior works were to be done in the care home during 2006. The Inspectors discussed with Mr Beyene the situation around the four places that are available in the ground floor unit to residents who have a learning disability, in addition to a physical disability. The four largest bedrooms were designated for the use of residents who have additional physical disability. The Inspectors noted that one resident, who uses a wheelchair to mobilise, was Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 22 accommodated in one of the smallest bedrooms on the ground floor. It must be ensured in future that those residents, who have additional physical disability, are accommodated in the four largest bedrooms in the ground floor unit. One resident indicated to the Inspector that they were ‘comfortable’ in their bedroom. The care home is close to community shopping, leisure and transport facilities in central Harrow. The building is in keeping with others in the vicinity. The Environmental Health Officer and Fire Safety Officer visited Ashgale House during 2005. A number of requirements arose that must be complied with. The care home’s 2 laundry facilities are sited in areas that do not require laundry to be carried through areas where food is stored, prepared, cooked and served. The laundry wall and floor surfaces present as impervious. There is a washing machine and dryer in each laundry room. The washing machines have sluice wash facilities. Both laundries contained a number of baskets of clothing on the floor waiting to be washed and dried. This restricted movement around these areas. The Inspectors discussed the provision of shelving as a means of storing clothing through the washing process or alternatively another washing machine. Mr Beyene, in the pre-inspection questionnaire, advised the Inspectors that there are infection control policies for the care home. There are clinical waste bins throughout the building, apart from the laundry area that just contained a broken flip top bin. The Lead Inspector discussed with Ms Elliott the need to ensure that there are appropriate means of disposing of waste in the laundry areas. Staff were observed undertaking cleaning tasks in Ashgale House. Ms Elliot advised the Inspector that she hoped to change the focus of staff care practice with residents being supported by staff to undertake household tasks. Current practice is for staff to undertake household tasks. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 23 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 & 34 Residents are supported by competent staff who demonstrated extensive knowledge of their needs. Residents are not fully supported and protected by the care home’s recruitment procedure and practices. EVIDENCE: The Inspector observed residents in verbal conversation with residents. One resident was observed asking staff who was on duty later in the day. Those staff who kindly spoke with the Inspectors demonstrated extensive knowledge of residents and their particular likes and aspirations. One member of staff spoke of supporting one resident to meet their cultural and religious needs. Mr Beyene indicated that it was hoped that of the 30 care staff employed in Ashgale House, it was planned that 50 will have completed their NVQ level 2 by the end of 2005 as required. Staff spoke of some of the suspected triggers for residents’ behaviours. The Lead Inspector viewed a sample of 4 staff files during the announced inspection. Mr Beyene was advised of the range of pre-employment checks that are required prior to member of staff commencing work as identified in ‘Department of Health Protection of Vulnerable Adults Practical Guide for care homes and domiciliary care agencies’. This concerns references, gaps in employment, written explanations of why the applicant ceased working previously with vulnerable adults and children. The Lead Inspector was Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 24 particularly concerned that there are 3 members of staff employed in Ashgale House for whom satisfactory ‘Enhanced’ CRB checks had not been obtained. A POV A First check had been requested for these members of staff in November 2005. One member of staff’s record indicated that they had spent a 3-week trial period working in the care home as a voluntary support worker. This was also without the care home being in receipt of a satisfactory ‘Enhanced’ CRB check. It must be ensured that the care home is in receipt of satisfactory ‘enhanced’ CRB checks prior to a member of staff commencing employment there. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 25 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): EVIDENCE: None of these standard were assessed on this occasion. One requirement remains unmet in respect of Standard 39. Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 26 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 1 x x x Standard No 22 23 Score 2 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 2 x 1 x Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x 2 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 x 1 x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashgale House Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x x x DS0000017514.V256714.R01.S.doc Version 5.0 Page 27 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 YA2 Regulation 14 Requirement Timescale for action 23/02/06 2 YA2 12 3 YA2 12 4 YA2 12 The needs of potential residents must be fully assessed before the resident moves in. The assessment must determine whether the home can meet the needs of the prospective resident in terms of their health and welfare. Where risks arising from the 23/02/06 resident’s behaviours and challenges to the service are identified during assessment, it must be ensured that written strategies are developed with the resident (and subject to multidisciplinary agreement) for implementation by staff when such challenges occur. It must be ensured that any 23/02/06 potential restrictions on the potential residents’ choice, freedom, services and facilities are assessed prior to their moving in, with strategies for working with the resident in place, that are subject to multidisciplinary agreement. It must be ensured that the care 23/02/06 home is appropriate to meet the needs of the residents living DS0000017514.V256714.R01.S.doc Version 5.0 Ashgale House Page 28 5 YA6 15 6 YA6 15 7 YA6 15 8 YA6 37 9 YA6 13 10 YA7 12 11 YA9 13 there in terms of lay out and staff competency. Care plans must be available for all residents living in Ashgale House. (Previous timescales of 21/01/05 and 10/05/05 not met) Ensure that where goals of care and support are identified within care plans, their achievement is monitored. (Previous timescales of 21/01/05 and 10/07/05 not met) Ensure that where residents have a complex range of needs (as a result of their learning disabilities and physical disabilities) that these areas are addressed within their care plans (e.g. autism, diabetes, continence) (Previous timescale of 10/05/05 not met) It must be ensured that significant incidents/events are reported to the Commission for Social Care Inspection, as is required by Regulation 37. Individualised procedures must be in place for each resident where they are likely to be aggressive or cause self-harm, focussing on positive behaviour, ability and willingness, which are subject to multidisciplinary agreements. (Previous timescales of 04/07/04, 02/01/05 & 10/05/05 not met) It must be ensured that appropriate training in ‘communicating with residents’ is made available to staff. Ensure that risk assessments are completed in respect of individual residents, with clearly DS0000017514.V256714.R01.S.doc 23/02/06 23/03/06 23/03/06 23/02/06 23/02/06 23/03/06 23/02/06 Ashgale House Version 5.0 Page 29 12 YA9 13 13 14 YA9 YA18 17 13 15 YA18 12 16 YA19 12 17 YA19 17 18 YA19 12 identified actions necessary in order to minimise risk. (Previous timescales of 02/01/05 and 10/5/05 not met) Ensure that full risk assessments are undertaken prior to a resident moving into the care home, with clear identification of risk management strategies. (Previous timescales of 02/01/05 and 10/05/05 not met) There must be a procedure in respect of when a resident is missing from the placement. Ensure that Moving & Handling’ assessments include full details on how staff are to assist residents with moving and handling operations. Ensure that written guidelines are available for staff to assist residents with their personal care tasks, e.g. toileting in a consistent manner. Ensure that appropriate working guidance is available for staff regarding those medical conditions residents from e.g. diabetes and epilepsy. (Previous timescale of 10/06/05 not met) There must be a clear record of the preventative health care appointments attended by residents with note of any resulting advice for staff in the care home. Ensure that where ‘body maps’ are completed in the event of any bruises or injuries being noticed on a resident, that there clear recorded indication of what follow up had occurred subsequently, e.g. consultation with GP, investigation, reporting to the Commission for Social DS0000017514.V256714.R01.S.doc 23/02/06 23/02/06 23/02/06 23/02/06 23/02/06 23/02/06 23/02/06 Ashgale House Version 5.0 Page 30 19 YA19 15 20 21 YA20 YA20 13 13 22 YA22 22 23 YA22 22 24 YA22 22 25 YA23 13 26 YA23 17 Care Inspection or completion of the accident book. Care plans and associated guidance for staff must be developed with regard to the prevention of pressure areas and advice for staff on how to work with the resident. (Previous timescales of 26/04/04, 22/01/05 and 10/05/05 not met) Ensure that there is a full record of medication administered to residents by staff. It must be ensured that unused items of medication are returned to the pharmacist within the prescribed timescales. The complaints procedure requires amendment to ensure that it contains all the elements required by Regulation 22, including the contact details for the local Commission for Social Care Inspection office. The complaints procedure is produced in a written small print format. Work must be done to ensure that the complaints procedure is appropriate to the needs of the residents. The Registered Person must ensure that those acting in behalf of residents have access to the care home’s complaints procedure. It is required that the use of physical restraint in Ashgale House be reviewed. Physical restraint must only be used as a last resort, by trained staff, in accordance with the Department of Health guidance, whilst protecting the rights and best interests of residents and is the minimum consistent with safety. Senior staff must regularly check as correct and sign the accounts DS0000017514.V256714.R01.S.doc 23/02/06 23/02/06 23/02/06 23/03/06 23/03/06 23/03/06 23/02/06 23/02/06 Page 31 Ashgale House Version 5.0 27 YA24 23 28 YA24 23 29 YA24 23 30 31 YA24 YA24 16 23 32 YA24 13 33 34 35 36 YA24 YA24 YA24 YA24 23 23 16 23 of monies held on behalf of residents. This must be commenced. The laminated floor surfaces throughout the building are showing signs of wear and are no longer impervious surfaces. These require replacement. Carpet in the first floor communal areas and lounges are quite stained and must be deep cleaned or (if unsuccessful) replaced. Communal areas of the building require redecoration (both walls and woodwork) in the lounges, corridors and dining areas. Provide seating and tables for residents to use in the garden The paving to the front and side of the building require replacement where the surfaces are cracking and potentially creating trip hazards. Where rugs are in use within residents’ bedrooms they must be securely affixed in order to avoid a trip hazard. The radiator cover requires replacement in Room 5. Room 6 requires redecoration The carpet at the doorway to the laundry room requires fixing down to avoid a trip hazard. The use of wedges to prop open bedroom doors in Ashgale House must be reviewed, with consideration being given to the use of approved door opening devices, in consultation with the Fire Safety Officer. Reseal the shower and baths within Ashgale House (in addition to the flooring in these areas) in order to provide impermeable surfaces throughout. DS0000017514.V256714.R01.S.doc 23/03/06 23/02/06 23/03/06 23/04/06 23/03/06 23/02/06 23/02/06 23/03/06 23/02/06 23/03/06 37 YA24 23 23/02/06 Ashgale House Version 5.0 Page 32 38 YA24 23 39 40 YA24 YA24 23 23 41 YA24 16 42 YA24 23 43 44 YA24 YA24 23 23 45 46 47 YA24 YA24 YA24 16 16 16 48 49 YA24 YA24 23 23 The Ground floor bathroom was very warm with no opening window and an internal extractor fan. Ventilation of this area must be reviewed and improved in order to provide a comfortable environment for residents. Redecorate the ground floor bathroom ceiling where stained. The ramping to the front door requires attention where there is a steep drop that requires levelling to offer ease of access to those using wheelchairs to mobilise. The sofas in the first floor unit lounge require deep cleaning or (if unsuccessful) replacement as are stained and worn. The sofas in the ground floor lounge are also showing signs of wear. There is extensive cracking of the walls in one area of the first floor lounge. The cause of this must be eradicated if possible and the area redecorated. The hole in the wall in room 13 must be repaired and redecorated. The toilet seat in the second floor toilet facility requires secure fitting as was wobbly. (Previous timescales of 02/01/05 and 10/05/05 not met) The aroma in Room 14 must be eradicated. The bed in Room 14 must be replaced as is stained. Many curtains in the care home have shrunk and must be replaced in order to ensure resident privacy in all areas. The carpet in Room 14 requires deep cleaning as is extensively stained. All fire doors in the building must close positively. DS0000017514.V256714.R01.S.doc 23/03/06 23/02/06 23/03/06 23/02/06 23/03/06 23/03/06 23/02/06 23/02/06 23/02/06 23/02/06 23/02/06 23/02/06 Page 33 Ashgale House Version 5.0 50 YA24 23 51 52 53 YA24 YA24 YA24 23 23 23 54 YA24 23 55 56 YA24 YA24 23 16 57 YA24 23 58 59 YA30 YA30 13 16 60 YA34 19 Ventilation in the fist floor laundry must be reviewed, as this small area is excessively hot, with the temperature roughly measured at in excess of 75°F. The first floor unit kitchen surfaces require replacement in the areas that are damaged. The kitchen unit handles in the first floor unit require replacement where missing. The first floor unit kitchen flooring requires replacement, as has a hole in it, therefore making the surface pervious. The hard to clean areas between kitchen cupboards and appliances must be included in the cleaning schedules for the care home. The hand rail in the ground floor bathroom requires securing as is loose It must be ensured in future that those residents, who have additional physical disability, are accommodated in the four largest bedrooms in the ground floor unit. Ensure that the requirements arising from the Environmental Health Officer and Fire Safety Officer visits to are complied with within the stated timescales. Ensure that there are appropriate means of disposing of waste in the laundry areas. Arrange for additional shelving to be supplied in the laundries as a means of storing clothing through the washing process. It must be ensured that the full range of required preemployment checks are carried out prior to member of staff commencing work as identified DS0000017514.V256714.R01.S.doc 23/03/06 23/02/06 23/03/06 23/03/06 23/02/06 23/02/06 23/02/06 23/03/06 23/02/06 23/03/06 23/02/06 Ashgale House Version 5.0 Page 34 61 YA34 19 62 YA39 24 in ‘Department of Health Protection of Vulnerable Adults Practical Guide for care homes and domiciliary care agencies’. It must be ensured that the care home is in receipt of satisfactory ‘enhanced’ CRB checks prior to a member of staff commencing employment there. Forward a copy of the report of the annual review of the quality of care that is conducted with regard to Ashgale House. (Previous timescales of 04/08/04 and 02/01/05) 23/02/06 23/03/06 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 Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 35 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Ashgale House DS0000017514.V256714.R01.S.doc Version 5.0 Page 36 - 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. 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