Inspection on 28/06/07 for Ashgate House

This inspection was carried out on 28th June 2007.

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 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

Ashgate House 06/02/06

Ashgate House 27/10/05

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 Roger Farrell Unannounced Inspection 28 June 2007 12:0no 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.V337743.R01.S.doc Version 5.2 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.V337743.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashgate House Address 13 Junction Road Romford Essex RM1 3QS 01708 756601 01708 749326 alliedcareltd@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) Ashgate House Limited Mr Rionel N Alcid Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service user category to include one named person over 65 years of age. 6th February 2006 Date of last inspection Brief Description of the Service: Ashgate House is a care home that provides accommodation and support for up to ten people who have a learning disability, some of whom also have a physical disability. Opened in July 2001, it is run by Allied Care, a private company who have just over fifty homes in Southern England and the Home Counties, with their headquarters in Woking, Surrey. The company own the building, which is a large double-fronted town house close to Romford town centre. As it is so close to the shopping mall, transport links and leisure services there is restricted parking – however, the house has a front parking bay for up to five vehicles. Roy Alcid has been the manager since August 2005, having achieved quick stepped promotions since he started with the company in December 2002, five months after the home opened. His outstanding managerial and practice abilities mean that this is a very well run home. He in turn is quick to acknowledge the contribution of the deputy, seniors and team as a whole. Residents are sponsored by a range of local authorities – the current range of fees being £880 to £1,357,75 a week. Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection started on 28 June 2007. An inspection had been scheduled for the previous month, but the service users were due to go away on holiday to Bognor Regis. Following the rescheduled visit at the end of June, the inspector was unable to return to complete his checks until 21 August 2007. On the first day the inspector had asked Roy Alcid, the registered manager to do copies of some paperwork he wished to take away. In response, the manager prepared a portfolio of documents, cross referenced with policies and procedures and the main rulebook for care homes, called the ‘National Minimum Standards’. This level of efficiency and attention to detail is typical of Roy Alcid’s thorough and competent approach overall. This home has remarkably well ordered record systems, and as such is a model service in the way it can evidence its delivery of care and prove compliance with the regulations covering care services. On the first day the inspector took time to explain to the manager and the deputy changes in the way the Commission monitors care services. Using a flow chart, he described each change, including – the frequency and types of inspection; the increased importance of the new annual self-assessment form called an ‘Aqaa’; the introduction of ‘star-ratings’, and how these will be made public early next year; and ways of hearing the views of people who use services and their representatives. He also outlined how the Commission is moving towards having regional contact offices, and how to make sure information reaches the right inspector. Six of the service users have little or no verbal communication. Three residents were able to tell the inspector about their life at the home, and events such as holidays and parties. Two other residents responded to the inspector with phrases and gestures. As part of his general observations, the inspector saw how staff are attentive to the signs of those residents who do not use words, including being able to tell the inspector what was meant. The same attention to listening to residents’ forms of expression was apparent during the music sessions taking place on the second day of the inspection. What the service does well: The manager and dedicated staff team continue to provide a very good service to this group of residents who have a wide range of needs. Since April 2002 inspectors have been using the same checklist to see how well staff do their job, to make sure the building is okay, and to find out whether residents get the right sort of help. If inspectors think things need to be done better, they say so in their reports. Since Roy Alcid took over as manager inspectors have said they are happy with what they find at Ashgate House. As with the last main report, the inspector has not picked out any areas needing improvement. All areas achieve at least the ‘good’ pass mark, with the top ‘excellent’ score being given under twelve standards, including acknowledging the strengths of Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 6 the manager and well qualified staff team; the quality of care practice and documentation; and for looking after the house so well, including keeping it fresh and clean. Allied Care are showing through their policies and working documents that they are good at keeping up with what is expected, and helping their managers and staff stay up-to-date on the best way of doing things. Comments from relatives included - “I think it is smashing. I can’t praise it enough.”; and - “I don’t think there is anything I would change…It’s all fine.” One visiting therapist said -“I have been visiting (Ashgate House) for about three years. I must say that this, and Ashking are the best homes I’ve worked in. This home is absolutely excellent, and I love working here.” 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. The summary of this inspection report can be made available in other formats on request. Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 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.V337743.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 5. Quality in this outcome area is ‘excellent’. This judgement has been made using available evidence including a visit to this service. The headings covered in this section are all rated as satisfactory. The last person to join this group was three years ago, and inspection reports described it as a successful move-in. The paperwork covering that transition showed a wellplanned approach to assessment, including good coordination with carers and health workers. This service can show that it used a methodical approach to helping new people become part of this resident group that is in line with the organisation’s guidelines. EVIDENCE: The main standard looked at under these headings is how new service users are assessed to see if the home can meet their needs, and that they will fit in with the household group. The inspector looked at the files of the last person to move in back in March 2004. There was a detailed four-page report by the previous manager; the ten-page Allied Care ‘initial assessment form’ with worthwhile comments; and a good background history report and standard referral report from the referring social services. The sequence of information showed that this was in line with the company’s policies and procedures, including the ‘Admission Enquires For Care Homes’; ‘Admission to the Home’; and ‘Assessment & Planning for Service Users’. The manager has dealt with eight enquires since January 2006, the last on the 26 June 2007/6/2007 and carried out initial assessments. In all instances the referred service users did not meet the criteria for Ashgate House or were not Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 9 compatible with the established group. This shows that the manager has the principal say on who is admitted, and he confirmed that he is not place under any pressure to fill the current vacancy. There is a very well presented ‘Statement of Purpose’ file that was last updated in January 2007, and includes a section on assessment. Each resident has there own equally well-produced ‘Service Users Guide’, updated in December 2006, including using pictures to assist understanding. The excellent standard of information now includes a new brochure, with the photos showing the good standard of accommodation provided. This quality is recognised by awarding the top ‘excellent’ score. A copy of each service user’s contract is held at Ashgate House. Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. Quality in this outcome area is ‘excellent’. This judgement has been made using available evidence including a visit to this service which involved looking at the care plan files of three service users. The headings covered in this section are all rated as satisfactory, with two awarded to top score. The way residents’ files are kept up-to-date show how the team continue to take into account individual needs and choices. Staff are fully aware of the way each person communicates their views, and the extent to which they are willing and able to participate in activities. They show great dedication in making sure every-day living needs are met, in most instances this involves a high level of hands-on care. The manager said that despite some limitations due to physical disabilities, they remain alert to encouraging residents to do what they can for themselves. Comments from relatives included - “I don’t think there is anything I would change…It’s all fine.” And “I cannot find any faults..I’d say the staff are brilliant.” EVIDENCE: The manager gave an overview of each resident’s needs, including level of assistance with everyday living tasks including personal hygiene; any particular medical needs; how they spend their time; and contact with family and others. The inspector looked at a range of service user files, including those of the highest dependency relative, and the most able resident who he met with along with their parent. Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 11 The standard of practice files is excellent. This includes the main ‘Care Plan Files’; the ‘Individual Daily Logs’; the ‘Lifestyle Plan Files’; and the ‘Personal Files’ holding correspondence, finance details and older notes. These are all methodically arranged into sections, and where appropriate have front index sheets and a list of sub-sections. The main ‘Care Plan Files’ have well-designed standard proformas, including the ‘Assessment Care Plan’; ‘Action Plan/Goal Setting’; the main ‘Support Plans’; ‘ Activity Plans’; ‘Risk Assessment and Health & Safety’ section; ‘ Infringement of Rights’ log; and ‘Review’ section. This is a well-designed care planning, monitoring and review system. All sections had been completed in good detail, – with some completed in the first person – and all sections had been reviewed and where appropriate updated within the last couple of months. The precise attention to detail included different type colours to distinguish between general and service user specific information. Another example is inserted sheets that each staff member signs to confirm that they have read the latest updates. All reviews sections are up to date. Eight of the nine residents had reviews with their placing authority within the last year. There are also detailed in-house reviews, with comprehensive details such as a chronological list of all medical contacts and treatments over the past year. The same high quality is also the case for the supplementary files. A visiting manager from another of the company’s home said they look to Roy Alcid for guidance as an example of best practice at using the company’s systems. The inspector is delighted to conclude that the practice records maintained at this home are first class, easily justifying the top ‘excellent’ score awarded under Standards 6, and Standard 8 covering the steps to include residents in their lifestyle planning. The manager provided an overview of how residents are helped with their personal money. One service user manages his own finances; two are under the Court of Protection; the sister of one service user manages her money; and the company act as appointee for five residents. Personal spend and account sheets are kept on the ‘Personal Files’, along with correspondence about benefit claims. There is a daily cash handover record. Service user meetings are held every two months, and the inspector saw the minutes of the last one held 20 June 2007. There has been discussion in the past with inspectors about meeting the cost of advocacy services. Details of the local advocacy services are available, notably ‘HavCare’ and ‘IMCA’ advisor from ‘HUBB’ Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. Previous reports have praised the way staff helped residents enjoy varied and individually appropriate social and leisure activities. The evidence seen at this most recent visit show that these standards are still being achieved. A measure of this is how the whole household can go away as a group regardless of the differing physical abilities. EVIDENCE: The ‘Life Style Plan’ files provided strong evidence in support of these standards. This has sections on family and social networks; ‘What I like To Celebrate’; and a detailed forty-five page proforma covering lifestyle care plans under a comprehensive series of headings. These are signed as reviewed every six months. The main files also have a ‘Likes and Dislikes’ section. There are clear individual logs of the social and leisure activities each person is involved with, as well an ‘annual resume’ of main events. In addition to the regular parties for birthdays and festivals – which usually involve the other company home five Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 13 doors away – highlights include the recent holiday, trips to the coast; college course award ceremonies; and Christmas pantomimes. The home has an ‘activities organiser’ four days a week between 10am and 4pm. There is a ‘weekly activity table’ for each person, listing the main fixed activities such as the ‘Music Man’ visits; arts and crafts sessions; exercise and foot spas; swimming trips; pub lunches; and visits from the aromatherapy masseur. The home has its own mini-bus. Three service users have regular contact with family; two service users have visits at least once a year; three have even more occasional contact; and one person has no family contact or connections. A service users and relatives satisfaction survey was carried out in January 2007 and the inspector looked at all the returned forms. Service user lifestyle plan is reviewed every 6 months. There is a four-week cycle menu plan with two main choices offered at each meal. This has been agreed in consultation with a specialist nurse. Staff keep a record of what each service user has at each meal. There are individual support plans covering taking meals as well as likes and dislikes lists. All comments made by residents and visitors were satisfactory. Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. This includes maintaining a detailed log of each resident’s contact with medical services over the last year, including medical assessments, medication reviews, and dental and eye care checks. They can show how they link in with health services, and adjust their support to meet residents’ current needs. There are also safe arrangements for helping with medication. Again, the standard of records covering health care are excellent. One relative commented - “I have no worries about the welfare of (my relative). The house is always clean. The staff are very good, very caring. If someone is unwell they call the GP in straight away and keep you informed.” EVIDENCE: This manager is able to demonstrate that responsible steps have been followed to assess and monitor residents’ mental and physical health, and respond when problems occur that need further investigation. The thorough records show how they link in with health services, and how the team adjust their support to meet residents’ changing needs. Of particular note are the medical sections in the ‘Life Style’ files, including specific care plan sheets and the review resumes. The day-to-day files have individual medical contact tracking sheets for each type of practitioner, such as GPs; dentist; opticians; chiropodists; nurses from the community learning disability team; physio and ot; and where appropriate, a psychiatrist. All correspondence regarding health Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 15 care are in appropriate sections of personal files. Over the past twelve months there has been one incident where a service user has been taken to A&E. There are also individual ‘PCT personal health care profiles’ completed by nurses a couple of years ago. Two residents have stayed with their original GPs at the Western Road practice. All others are registered with North Street Health Centre. The manager said – “We have no problems or issues with our GPs. They are very supportive and do listen. I feel we are successful and getting the right referrals when further tests or treatments are needed.” He was equally positive about other health care support, including the general community nurses and the members of the community learning disabilities team, adding – “They are all really helpful, always visiting when we request, such as one service user who is having a six-week course of daily injections for dvt. One person is visited twice a week for help with an enema. Our physio has arranged hydro therapy sessions at Hornchurch, and even joins in on our ‘keep-fit’ sessions.” The individual care plan sheets give clear instructions on help with personal care tasks. As on this occasion, inspectors have noted the good attention to personal and clothes care evident fro the service users’ appearance, and the attention to hygiene and personal preferences that can be seen in bedrooms. One person who has experience of visiting care homes as part of her work said – “I have been visiting (Ashgate House) for about three years. I must say that this, and Ashking are the best homes I’ve worked in. This home is absolutely excellent, and I love working here.” This visiting therapist went on to add – “The personal care is very good as is the care with clothes, and I would know as I have close physical contact with the service users. I am aware for instance that the women wear different perfumes, and I see how their bedrooms are different according to (individual) taste…..They are very good at passing information over. I do get briefed about issues when I arrive.” Medication is provided by Boots in their monitored dose bubble cassettes, with printed recording sheets. Medication is locked away in purpose-designed cabinets in the top floor office. These are neatly arranged, as are all the related records. Other useful information includes useful guidelines on particular drugs. The supplying pharmacist carries out occasional checks, the last being on 25 April 2007. All sections were rated as satisfactory with the only recommendation to do with the GP prescribing. The company also do spot checks on the medication systems, the last being on the 1 March 2007, which also reported satisfactory findings and also involved an audit of staff medication training, including the emergency administration of Diazipam. There is an aging and palliative care policy, and each person’s file has a section covering their wishes in the event of death. Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service that involved looking at the information available regarding this important section. The manager is aware of the action to take if there is a complaint or a suspicion of abuse, giving an update on an anonymous complaint that was not found to be substantiated. The inspector was satisfied with how this matter was investigated and followed through. Residents and relatives are made aware of how they can raise concerns, and can be confident that these will be followed through. This includes having access to an advocacy service. One service user said - “I have no complaints. This is a nice home.” Asked about any concerns, one relative replied - “I don’t think there is anything I would change…It’s all fine.” EVIDENCE: The company’s ‘Protection and Prevention of Abuse’ policies and procedures were last revised in October 2006, and these include the ‘whistle blowing’ expectation; checking staff application documents and qualifications; and the importance of knowing about local safeguarding procedures. The characteristic attention to detail includes the ‘suspicion of abuse’ guidelines listing the home manager and other manager’s mobile phone numbers. The manager could correctly describe the steps that must be taken if there is a suspicion of abuse or neglect, and has copies of ‘No secrets’ and the local AP guidelines. The only entry in the complaints log was an anonymous complaint made in February 2007, including that night staff were sleeping on duty. The inspector is satisfied with how this matter was investigated, including Roy Alcid and his line manager doing unannounced night spot checks. There was also an insinuation that some staff whose first language is not English cannot always be understood. The inspector asked a visiting professional about this. The reply Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 17 was – “I wouldn’t agree. I have never had a problem being understood, or understanding what information is handed over to me. In fact, I was surprised when I first started visiting how all staff knew my name. I don’t see a problem with service users either…I see staff being very gentle and patient in their interactions.” All staff are listed as having done training in responding to suspicions of abuse. Each staff member has been given a copy of the General Social Care Council’s ‘code of practice’, and have signed to confirm this. Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is ‘good’. This judgement has been made using available evidence including a visit to this service. This is a well-maintained and homely house. The inspector viewed all communal parts of the building and nearly all bedrooms. All bedrooms are well furnished and equipped, each reflecting the tastes and preferences of individual service users. The consistently high standard of cleanliness is being maintained, with good attention to infection control practices. In recognition of these exemplary conditions the household heading is scored at the highest ‘excellent’ level. This building continues to provide all its residents with a comfortable and safe living environment, including being alert to the needs of those residents who use wheelchairs and need transfer equipment such as hoists. One relative said - “I am very glad that (my relative) came to this home. I don’t have to worry. Roy (the manager) is wonderful. He has brought in lots of homely touches, like having photos of the residents, just like you would have in your own family home.” EVIDENCE: This large town house was adapted and refurbished prior to it opening, including fitting an integrated fire alarm system and lift. All residents have their own bedrooms that are above the minimum standard – there four bedrooms on the ground floor and six on the first floor. The main lounge is Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 19 pleasantly decorated, the addition of a conservatory helped achieve adequate shared space. The large ground floor bathroom has a tracking hoist, and the main first floor bathroom has a specialist riser bath with swivel seat. There are separate large toilets on each level. The second floor has additional facilities such as a sensory room and a meeting room that is used for some service user activities. The large well arranged office is also on this third level. There is good wheelchair access including to the large rear garden. This is very pleasantly maintained, and a new pond has just been added. The inspector saw the maintenance schedule covering the planned improvements, which says all bedrooms and communal rooms can be redecorated every two years. Comments made by visitors included how the manager has made the house more homely. There is a part-time handyperson who spends at least one day a week at this home. The benefits of this can be seen in the high standards of household safety as tasks are tackled quickly, and the attractiveness of the garden. Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is ‘excellent’. This judgement has been made using available evidence including a visit to this service that involved checking staff vetting; training and qualifications; and shift cover patterns. These are all satisfactory, with the top rating given for three of these Standards, including recognising that all but one person has an NVQ in care, most being at the higher Level 3. Most of the staff educated abroad are graduates, some in nursing. One quote was - “I am very pleased to say that (my relative) is in a nice home. I look around and can see that (the residents are happy). Staff get on with things when they have to, yet there is a very relaxed atmosphere in the lounge. They do pay as much attention to those who are quiet.” EVIDENCE: The manager provided the inspector with an updated list of all staff, including their relevant qualifications; contracted hours; and how long they have worked at the home. This is a very stable team, with the only move-on over the past year being the result of a promotion within the company. The total number of care hours each week is 524.5, excluding the manager’s time. The normal level of cover is five carers on both the early and late shifts (with a generous 1 ½ hour afternoon handover overlap); and two waking night staff. The inspector looked at a sample range of staff files to check that the right vetting is being carried out. The staff folders have completed application Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 21 forms; two written references; a photo; copies of passports and other paperwork that prove identity; medical forms; permission to work letters; and statements of terms and conditions. The organisation is a registered body with the CRB, and have received enhanced level checks on all staff at this home. The organisation has a good record on training and induction. The inspector saw an up-to-date resume of staff training in all the required core areas – including safeguarding procedures; first aid; food hygiene; risk assessments and manual handling; and infection control. Copies of confirming certificates are kept on each person’s file. The inspector saw the staff supervision schedule and forward planner through to the end of the year showing staff have supervision approximately every eight weeks. He also saw examples of recent staff appraisal forms. He also saw the minutes of the staff meetings, the one having been held on 26 April 2007. This included reference to the company’s helpful assistance with renewing permission to work in the UK, the manager having all up-to-date guidance on this issue. Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42, and 43. Quality in this outcome area is ‘good.’ This judgement has been made using available evidence including a visit to this service. Allied Care have an up-to-date catalogue of policies and procedures, and this manager can demonstrate how well he carries these out in an open and accountable way. There are a number of company audit systems that provide quality monitoring and safeguards for those who use their services. The manager’s competence in operating efficient administrative systems is reflected in the precise arrangements and order of the office. This includes certificates and other documents covering safety arrangements and checks. EVIDENCE: The inspector asked to see a range of documentation and certificates covering health and safety. This included fire safety arrangements; electrical, gas and water safety checks; periodic building safety checks; and insurance cover. The only point raised by inspector was the need to check one aspect of the lift maintenance certificate. The company arrange independent fire risk assessments in line with the revised fire safety regulations, this having been updated in January 2007. The last inspection by and environmental health Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 23 inspector was in September, with satisfactory conditions recorded. The last inspection by a fire safety officer was on 24 May 2007, again resulting in a conclusion of ‘satisfactory’ There are a range of quality assurance systems, including regular ‘monthly visit reports’. These include audits such as checking safety arrangements for handling medication. They also have a section on asking residents about their views. There are also checklists to make sure staff are familiar with all current policies, guidelines, and practice forms. In line with the quality policy statements, the inspector looked at a sample range of guidance including expectations on home managers; responding to discrepancies such as false employment documents; and data protection. He also saw the plan covering major incident s. Other monitoring forms included the ‘Night Check Forms’, ‘Mattress Turning Routines’ and so on. All the information on display in the office was clearly set out and up-to-date. This positive approach to quality monitoring leaves the manager and company very well placed to tackle the ‘AQAA’ assessments being introduced by the Commission this year. Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 4 2 4 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 4 STAFFING Standard No Score 31 4 32 4 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 3 4 4 3 3 3 4 3 Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 Ashgate House DS0000027832.V337743.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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