Inspection on 27/10/05 for Ashgate House

This inspection was carried out on 27th October 2005.

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

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

Other inspections for this house

Ashgate House 28/06/07

Ashgate House 06/02/06

Ashgate House 17/03/05

Ashgate House 17/01/05

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 Ashgate House 13 Junction Road Romford Essex RM1 3QS Lead Inspector Ms Rhona Crosse Unannounced Inspection 27 October 2005 09:45 Ashgate House DS0000027832.V260328.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 Ashgate House DS0000027832.V260328.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. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashgate House Address 13 Junction Road Romford Essex RM1 3QS 01708 756601 01708 749326 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) Ashgate House Limited Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service user category to include one named person over 65 years of age. 17th March 2005 Date of last inspection Brief Description of the Service: Ashgate House is a care home offering 24 hour care to adults with learning and physical disabilities. All bedrooms are single occupancy. The home is situated close to Romford market town and is in easy walking distance of the centre of the town and close proximity to a local park. There are parking restrictions in the streets surrounding the home. There is parking for 5 cars to the front of the property. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that means that the home did not know the inspector was coming. The inspector spoke with service users, relatives and the acting manager. The records relating to health and safety, care plans daily records, accidents records, activity programmes and staff training being provided were inspected. An inspection of the premises also took place. The manager of the home left due to promotion within the company. A new acting manager is now in post and is carrying out an excellent job. The acting manager must put in an application to register with the Commission. At the time of the inspection the home was appropriately staffed. At the last inspection only 2 requirements were made this evidences that the home is operating to a good standard. Staff training is provided and staffing levels meet the needs of the service users accommodated. What the service does well: There is always a good atmosphere within the home. Staff are always cheerful and provide care to all service users in a professional manner. The home provides a range of different activities in line with service users choices. There is an activities co-ordinator working at the home 7 days a week. Her hours of working are 10 am-4 pm Monday – Friday, 6pm-9pm Tuesday and Thursday (this is to enable service user to go out in the evenings), and 9am-5pm at the weekends. Care plans are well designed and information is thorough and kept up to date. Risk assessments are written for all aspects of daily life where there is a need. Health and safety records are well maintained and easily accessible. In discussions with service users and relatives it was established that choice is provided in all aspects of daily life. Both service users and relatives spoke highly of the staff team and the new manager. The home was clean and free from odours. Fridges and freezers were clean and food was appropriately stored. All areas of the home were tidy. Re decoration of one bedroom was taking place. Winter Pansies had been purchased to brighten up the hanging baskets, these were planted by the activities co-ordinator. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards were inspected as there are no new service users. EVIDENCE: There are no vacancies for service users at the home and there have been no admissions for sometime, therefore the standards in this section were not assessed as they relate to the admissions process. These standards had been met previously. When any new service user is accommodated these standards will be inspected to ensure that the appropriate documentation is provided and the home can met the needs of the service user. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 ,9 and 10 These standards are well managed enabling the home to evidence that they are providing a good standards of care to service users. EVIDENCE: The current care plans are updated as changes occur and risk assessments are written for any service user who has an identified risk in any area of daily life. Behavioural charts are completed and Epilepsy monitoring is being undertaken for one service user after a review and the reduction of some medication. In November 2005 a new care planning system is to be used a (Cared 4 system) information is currently being transferred to the new care plans. Service users spoken with were aware that the home holds documentation about them One service users stated: “they write about what happens in my file, so if I go to the Doctors all the staff know about it and know if I am taking any medicine”. Another service users said: “they write in the daily records what happens, I don’t read it, the writings too small for me”, I know what they put in there” they have to write about us all”. It is not clear how much service users are aware that there confidences are kept, but from discussion service Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 10 users they spoke about trusting the staff and feeling able to tell them things of any nature. Not all of the service users have communication therefore staff have to observe by known body language what choices some service users wish to make, (one service user was said to stare at particular clothing when shown a choice of two items if they wanted to wear that item). The staff have all been at the home for some time and are able to communicate well with the more needy service users. In discussion about choice with service users comments made were: “we can choose when to get up and go to bed, we just ask”. “I go to my room when I want I don’t need any help” they keep an eye on me”, “you can choose what you want to do, what you wear” if you don’t want to do something you are not made to do it, you choose”. Some of the more able service users help with tasks around the home and appear to enjoy the involvement they have. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 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 the following standard(s): 11, 12, 13, 14, 15, 16 and 17 These standards are well managed, therefore the needs and aspirations of service users are being met as far as possible. EVIDENCE: Service users are encouraged to be as independent as their abilities allow and where necessary risks are recognised and a risk assessment is written. Personal development is limited for some service users. Activities are provided for all service users in line with their likes and dislikes. As there is an activities co-ordinator employed at the home 7 days a week the service users all have opportunities to take part in a varied range of activities both inside and outside of the home. The home encourages links with friends and relatives. Services in the in the local community are used. Two service users go to a local Church and staff assist them to do this on a regular basis. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 12 On the day of inspection one service user went to Romford. An Aromatherapist was at the home when the inspector arrived to give a massage to several service users. An occupational therapist came in to carryout exercises with the service users later that morning. Activities such a swimming hydrotherapy, bowling, meals out in café’s and restaurants take place. Pub lunches, arts and crafts both in house and external projects are provided. Shopping trips and holidays to the coast all take place. An ‘Abba’ concert at the Palms (a local hotel) has been booked and also a pantomime in Barking for some service uses who are interested in these activities. Birthdays are celebrated and links with other homes are encouraged. A trip to a home in South End for a Barbeque took place in September. There is an activities plan that is completed on a daily basis for each service user to identify what activity they have been involved in. From the inspection of the meal choices recorded and the menus provided it was established that there is a variety of meals provided and that service users have a choice at all meal times. This was confirmed in discussions with service users and also relatives visiting at the time of the inspection. Service users rights are respected with refusals of activities recorded and also choices recorded. All service users are placed on the electoral role. However due to the range of needs not all service users are able to vote or choose to. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 13 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 and 21. Standard 20 will be inspected at future inspections. The standards are being well managed with information readily available. Service users needs are being well met in these areas evidencing the care being provided. EVIDENCE: The home has just received a new months supply of medication and a staff member was checking the medication that had been received. Medication procedures and practice will be inspected at the next inspection. Health care needs are well recorded and information is readily available. Recording was seen to be informative about health care visits to GP’s , hospitals and any health professional visiting the service users. A medication review had been undertaken for one service user where the medication had been reduced. Appropriate monitoring of this person’s condition was in place. The community nurses from a GP surgery came to give flu injections to service users and also the Pneumonia injection to those who had not received this. The information relating to the wishes of service users at the time of death have been recorded. The home has one service user who has no next of kin. The social services department of the placing authority have been contacted Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 14 and it was agreed that an advocate could be used to support the service user to make a decision about what was wanted. However the home should liaise with their own legal department to find out what is appropriate action to take in this situation. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 15 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 and 23. These standards are well managed. The home has policies and procedures for the protection of vulnerable adults and also for complaints. These standards are well managed. This means that service users are protected from abuse. EVIDENCE: The home has policies and procedure for dealing with any suspected abuse. There are also policies and procedures for dealing with complaints. The majority of staff have attended training for the protection of vulnerable adults. By December 2005 all the staff will have completed this course. In discussion with service users they stated: “the staff are kind to us they look after us well” “everyone is cared for well here, they look after us and are kind”, they are always smiling, specially him you can have a laugh with him” (referring to the acting manager). “If you are not happy with something you tell the manager or the seniors they will sort it out for you”. Relatives stated that: “any concerns raised will be dealt with nothing is left”. “I have peace of mind when I leave that my relative will be well cared for”. “it’s home from home you are always made welcome” “ the staff are nice they deal with any personal care quietly I’ve seen them come up to people and whisper and tell them what they are going to do so everyone does not hear”. The complaints file was inspected. Complaints made are recorded and the action taken is also recorded. There has been one complaint since the last inspection this was made by a neighbour. This did not relate to any aspect of care provided and had been dealt with appropriately by the home. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. The environment is clean and well maintained, these areas are well managed and promotes the wellbeing of service users. EVIDENCE: The home is well maintained. There is a programme of refurbishment being undertaken. All of the bedrooms are to be decorated this year. On the day of the inspection one bedroom was in the process of being decorated to the choice of the service user. Service user bedrooms are all very individual with personal possessions on display. Service users use their bedrooms to relax in when ever they choose. Several service users go to there rooms in the afternoon to rest. Specialist beds and lifting equipment are provided. Both mobile and fixed ceiling track hoist are used. Other aids and adaptations are provided in the bathrooms. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 and 36. Standard 34 will be inspected at further inspections. Staff training is provided and staff are clear about their roles and responsibilities within the home. The needs of service users are being met as staff are well trained and competent. Staff are also well supported by senior staff and management to continue to build on their skills and therefore improve the care they provide to the service users. EVIDENCE: Staff training is provided and a yearly training plan is set up with identified dates for 2005/2006. Training that has taken place or is booked to take place is: Protection of vulnerable adults, medication training, moving and handling, risk assessments, food and hygiene, health and safety, equal opportunities, first aid, sexuality, COSHH (control of substances hazardous to health, fire training. ‘Burn out,’ diversity, bullying and harassment are also training courses being provided for staff. All staff have either qualified or are attending NVQ level 2 training. Several staff already hold the NVQ level 3 qualification. Staff have formal supervision sessions and these are recorded. Staff meeting take place regularly and a staff meeting was due to take place in the afternoon Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 18 on the day of the unannounced inspection. Minutes are kept of all staff meetings. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42. Standard 39 will be inspected at further inspections. The manager has recently been appointed by the home and is putting in an application for registration. The home is well managed with very few requirements made at this inspection. This evidences the home is being run for the benefit of the service users and in line with the regulations. EVIDENCE: The acting manager has recently been appointed and is completing the forms to be registered with the Commission. The manager is currently undertaking the Registered Managers Award. The manager updates his training as necessary and undertook the protection of vulnerable adults course on 19/7/05. All documentation relating to the running of the home was well organised and easily accessible. In discussion with the manager he stated that he had been able, through negotiation, to raise the budget for petty cash for the home for the benefit of service users. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 20 Health and safety is well managed with information readily available. Fire drills are recorded the last drill took place on 21/5/05 (the home is aware that 4 drills a year should be undertaken). The fire alarm and emergency lighting was last serviced on the 26/5/05. The weekly fire alarm tests are being undertaken and record is kept. The fire extinguishers received their annual check on 1/3/05. The 5 year electrical safety certificate was dated December 200 and is due for renewal. The portable electrical appliance test was carried out on 8/10/05. The annual Gas safety certificate was dated 21/9/05. The Legionella test was carried out on the 14/9/05. The hoist were serviced in September 2005. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashgate House Score 3 3 X 3 Standard No 37 38 39 40 41 42 43 Score 2 X X X X 3 X DS0000027832.V260328.R01.S.doc Version 5.0 Page 22 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 YA24 Regulation 23(2)(d) Requirement Replace the poorly applied seal between the wall and the wash hand basin in the identified bedroom. The manager must put forward an application to register with the Commission. Timescale for action 30/11/05 2 YA37 9 01/12/05 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 YA21 Good Practice Recommendations The home should seek legal advice from their solicitors in relation to the social service department of the placing authority stating that the home can use an advocate to identify the needs of a service user at the time of death. The service user is unable to communicate their wishes and has no relatives to act on their behalf. Ashgate House DS0000027832.V260328.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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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