Inspection on 10/05/05 for Ashingham House

This inspection was carried out on 10th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashingham House 06/11/07

Ashingham House 19/07/06

Ashingham House 15/11/05

Ashingham House 16/11/04

Ashingham House 15/06/04

Ashingham House 17/02/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Ashingham House London Road Temple Ewell Dover Kent CT16 3DJ Lead Inspector Mary Cochrane Unannounced 10 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashingham House Address London Road, Temple Ewell, Dover, Kent CT16 3DJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01304 826842 Ashingham House Ltd Mrs Dawn Joyce CRH Care Home for Younger Adults 18-65 Category(ies) of LD (10) registration, with number of places Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 10 people with learning disabilities 18 and 65 years of age Date of last inspection 16th November 2004 Brief Description of the Service: Ashingham House is a large detached property standing in its own grounds between the villages of Temple Ewell and Lydden, near the port town of Dover. The home is registered to provide 24-hour care and support for up to 10 people with learning disabilities between the ages of 18 and 65. The home presently has 9 service users in residence, all of whom have their own individual bedroom. The accommodation is arranged over two floors and all the communal facilities are on the ground floor. 2 of the service users bedrooms are on the ground floor and the further 7 are on the 1st floor this is also were the staff sleep-in room is located. There are 2 bathrooms and 2 seperate toilets within the building. The home has recently had a new kitchen fitted which was almost completed at the time of the inspection. The large garden is laid to lawn with shrub and planted areas. Part of the garden is also used as a planting area for the service users. There is plenty of private space in the garden for the service users to enjoy outside activities in the better weather.The home is owned by the Allied Care Company who have several other homes in the area.. Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out in accordance with the Care Standards Act 2000 and under the new guidance of ‘Inspecting for Better Lives’. On arrival at the home care staff answered the door and the appropriate protocols were followed. The home is in the process of having a new kitchen fitted so there was some upheaval and disorganisation at the time of the visit. The inspection took place over the period of a day. The inspector spent the time communicating and talking with service users, care staff and visiting professional, observing interactions, care interventions and activities. The visit involved looking at and examining records. The inspector also toured the home. Concerns were identified at the time of the visit mainly around the competencies, abilities and skills of the care staff, the lack of organised activities and time structuring for the service users and the difficulty in not being able to access information at the home, which should be made available by the providers. These issues will be discussed throughout the report. Ashingham House is still involved with the adult protection service. Planning meetings with the Adult Protection Team, Care Managers the Local Specialist Learning Disability team the CSCI and the Management of the home continue to happen at regular intervals to ensure that the home is making progress in meeting the needs of the service users. The welfare of the Service Users, action plans, progress and activity within the home are reviewed. Throughout the year unannounced visits have been undertaken by the adult protection coordinator and the CSCI. The registered manager has endeavoured to meet requirements and recommendations from the last announced inspection in November ’04, however there is still a way to go before all the requirements and recommendations are met. It has been agreed that new time scales will be put in place to allow this to happen. These will be discussed and identified throughout the report. The homes Registered Manager who has been in for almost a year has worked hard to improve the standards of care within the home. She now requires the support and dedication of the staff team to implement and develop the improvements. What the service does well: The home is very good at reporting incidences that occur in the home. They report to the appropriate departments so that the situation can be monitored by out-side agencies. The registered manager provides support and guidance to the staff members and all staff that were spoken to at the time of the visit reported that there Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 6 had been significant improvements at the home since the appointment of Dawn Joyce as manager. 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. Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,6 The homes Statement of Purpose and Service Users Guide do not provide sufficient information for service users and their family/advocates to make informed decisions about the homes ability to meet their needs. The home does have an admission procedure to ensure the needs of potential service users can be meet. EVIDENCE: The registered manager continues to up-date the homes Statement of Purpose, which requires more information as outlined in Schedule 1 of the regulations. The Service Users Guide is well written and informative. It includes a summary of the Statement of Purpose and details of the complaints procedure. Due to the complex needs and limited communication skills of the service user’s living at Ashingham House the guide needs to be produced in the language and format that can be understood by the Service Users. The registered manager is going to develop a pictorial guide. The guide also needs to be relevant to the individual service users within the home. (See recommendation no.1). The home has no agreed written and costed contracts with any of its service users. This issue was highlighted in the last inspection report and still remains out-standing. In view of this a requirement has been made. This information Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 9 needs to available so the registered manager can do the work that is required. (See requirement no. 1) The service users at the home have all been resident for a number of years so there have been no recent admissions. The home does have admission procedures in place to guide staff on the action to take prior to accepting any one into the home. Any prospective service users would be properly assessed and a planned transition period would take place. Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 There are some short- falls in the planning and implementing of the assessed and changing needs of the all the service users. Not all risks to the service users are identified, recorded and minimised. Service users need to be able to make decisions about their own lives. EVIDENCE: A sample of care plans was looked at during the visit. All care plans have now been transferred onto the new system and there has been a great improvement in the way they are compiled and written. Care files have been reorganised and all information is easy to access. The care plans written by the registered manager are of a high standard and reflect the individual needs of each of the service users and the action that is required of the care staff to attain this. Some of the other plans looked at require further work and development. The registered manager needs to ensure that all plans are written to the same standard and that the standard is maintained throughout. It needs to be evidenced that the care staff actively use the information in the plans to ensure the needs of the service users are met. It was evidenced at the time of the visit that some care staff are not fully aware of the information contained in the care plans and do not use them as a working document. Information that is required to monitor the dietary needs of one service users Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 11 could not be found. This was discussed with the registered manager and she will be reviewing the situation to ensure it improves. (See requirement no.2). The home needs to evidence how each of the service users make decisions and choices as part of their every day live and how they are assisted and supported by staff. The staff need to record instances when decisions are made by others and why. There have been recent instances at the home where it is not clear if the service users right to make a decision has been limited through the assessment and review process involving the service users and the multidisciplinary team. This needs to be clarified. (See requirement no.3) The home has transferred and developed some of the service users risk assessment on the new documentation. Staff are more aware of the risks pertaining to individual service users and the action to take to minimise them. Further work needs to be done to ensure that all individual risks have been identified and that procedures and are in place to minimise them. Staff did report that there has been a recent increase in the intensity of the challenging behaviour of a service users’ and they feel more vulnerable. The registered manager is very aware of this and is in the process of organising a multi agency review to look at whether or not the home can carry on meeting the service users needs, in the meantime it needs to ensured that robust care planning and risks assessments are in place. It needs to be ensured that if a new risk is identified that it is then incorporated into the individuals care plan as soon as possible. Care plans and risk assessments need to be up-dated as often as necessary so as to reflect the changing needs of the service users. All staff need to access and be aware of the information. At the time of the inspection this had not been done for some service users (See Requirement no.4) Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15&17 The home does not provide the service users with opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Family links are encouraged and maintained wherever possible. The dietary needs of the service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: All service users presently living at Ashingham House all have complex learning disabilities. At the time of the visit it was observed that some of the care staff at the home were non-communicative towards the service users and displayed little evidence of meaningful interaction. There was little evidence of activities or engagement with the service users. Service users were observed from a distance and left to wander aimlessly and meaninglessly around the home or left sitting. The registered manager was made aware of this and will be addressing the present culture within the home. Activities programmes were Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 13 erratic and scant in information. Specialist intervention plans have been developed by the learning disability team but it was reported and there was little evidence to suggest that they had been implemented. There was a lack of evidence within the Service Users daily activities sheets or activities diary to demonstrate that activities had actually taken place and whether or not they had been successful or enjoyed by the Service Users. Some staff were seen to be unmotivated, and lacking in skills and ideas in how to interact and undertake activities with the service users. More direction and guidance is required. The registered manager is actively looking into alternative venues and ideas so as to enable the service users to develop and maintain appropriate and fulfilling lifestyles. Standards 11,12,13 & 14 are now requirements and require immediate attention. (See Requirement no.5) It was reported that some of the service users do have family contact and they are encouraged to maintain family links. The service users are also encouraged and supported to visit the other homes within the company so as to develop friendships with others out-side of their own home. One service user has regular weekend at home with his family. Information regarding next of kin is documented in the service users file. The home is presently having a new kitchen installed and this has been a disruptive time for service users and staff, especially the cook. The registered manager has provided the CSCI with the information and risk assessments on how the home is going to manage while the kitchen is out of action. It was evidenced that the home is providing a nutritious, varied and well balanced diet for the service users. Specialist dietary needs are catered for. Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The home needs to provide appropriate personal support for the service users. The home does provide appropriate healthcare support for the service users. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure the service users medication needs are met. EVIDENCE: The Home operates a key worker system to provide individual support to service users. This is in place so as to promote the homes philosophy in personal care, developing life skills and maintaining dignity. Service users are encouraged to do as much as possible for themselves. It was seen that some service users are assisted to choose their own clothes and are supported to shop. However, it was evidenced that at times the care staff do not give the guidance and support to the service users that they may require. At the time of the visit some service users clothes were seen to be stained and creased. Members of staff had to be prompted to change a service users’ stained clothes after lunch. The service user was then dressed in a well worn frayed T-shirt Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 15 that was too small. This was been discussed with the registered manager. (See requirement no.6) The Registered Manager has put a great deal of effort into ensuring that systems have been put in place that assess, recognise and treat the health care needs of the Service Users. Relationships with G.P’s are being developed and the registered manager is assertively attempting to gain their co-operation in meeting the medical needs of the Service Users. Annual health checks still need to be implemented. Specialist intervention is available and the local learning disability team is actively and regularly involved with the home. Some the service users are reviewed at regular intervals by a Consultant Psychiatrist employed privately by Allied Care. None of the Service Users administer their own medication. The home uses the Boots Monitored Dosage System. The requirements made at the last inspection have now been met by the home. The possible side effects of the medication is documented on the reverse side of the MAR sheet. The recording system for the medications was up to date and medication was administered safely. The medication was stored securely in 2 locked cabinets within the staff office. The key to these cupboards was kept on the person in charge of the shift. There is also more medication correctly stored in the downstairs office. The Registered Manager has now ensured that all medications are stored correctly. Blister packs are now stored in a separate cabinet to creams, mouthwashes and eye drops. Topical prescriptions belonging to service users are now all kept in separate individualised containers. There are clear and precise protocols in place for the administration of PRN medication. This standard is no longer a requirement. Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected at this visit but were both met at the previous inspection. The adult protection alert remains open on the home and all those involved meet at regular intervals to ensure that the appropriate actions are being undertaken to protect the service users from any form of abuse. EVIDENCE: Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,26,30 The home needs to continue with its on-going maintenance and refurbishment plans so as to create an environment that is homely, comfortable and safe for those living there. EVIDENCE: The home has on-going maintenance and re-furbishing plans. At the time of the visit the kitchen was being up-graded and re-fitted and was almost near completion, when this is finished it will lead on to the redecorating of the dining area. A new shower/bathroom has recently been installed. The other bathroom in the house is in need of up dating. The downstairs toilet has been refurbished and a new floor has been laid. Externally the property appears to be in a reasonable state of repair and the large garden is well kept. Communal areas within the home are clean and comfortable but did need some brightening up. The chairs in the lounge areas did appear worn and some were without cushions. The registered manager did explain that chairs did become ‘worn-out’ very quickly by service users and were regularly replaced. Decoration has been under-taken in the hallways. The service users bedrooms are all individualised and reflected the Service Users interests and choices. Some of these rooms were also in need of redecoration. Ongoing maintenance and redecoration is required throughout the house. (See Recommendation no.2) Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 18 All the bedrooms are comfortable and reasonably well furnished, some now need redecorating and refurbishing. A wardrobe that was identified in the last 2 inspection, as having no door has still not been repaired. 2 of the rooms have no carpet but linoleum floors, which is worn in places and is in need of new replacing The registered manager needs to ensure that this is incorporated into the maintenance plan. The rooms are individualised and reflect the personalities of the service users but in some rooms more could be done to enhance this. All bedroom doors have locks. (See recommendation no.2) On the whole the home was clean and hygienic and there was no offensive odours that could be detected. The laundry facilities are sited so that soiled articles are not carried through areas where food is prepared. The home has policies and procedures in place to prevent cross infection, and staff are made aware of these during their induction training. It was evidence that some staff members have not received the appropriate mandatory training in infection control and that some staff required updating. The laundry room in the home does require attention, it is in need of up grading and redecorating. The floor finish needs to impermeable and this and the wall finishes need to be easily cleanable. The staff reported that the soiled laundry is transferred from the bedrooms in the service users laundry baskets and then placed in the washing machine. It needs to be ensured that soiled laundry is kept separate from other clothing. It needs to be placed in a water-soluble bag in the service users’ bedroom and then placed in a red laundry bag. Everything then needs to be transferred to the laundry room and into the machine. Disposable gloves and aprons should be readily accessible in all areas where they may be needed. Liquid soap and paper towels should be available in all areas where personal care is carried out. It was reported by the staff that undertaking laundry tasks during a shift was very time consuming and took one member of the care team away from the service users for quite a period of time. Although it was written on activities sheets that some service users were involved in managing their own laundry there was no evidence of this at the time of the inspection. Policies and Procedures are in place relating to COSHH. (See requirement no.7) Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,35 Some of the staff at the home do not have the required qualities, qualifications, training and support to meet the stated purpose of the home and meet the assessed needs of the people who live there. The home cannot demonstrate that the staff members individually and collectively can meet the complex and challenging needs of the service users, which potentially leaves service users and staff at risk. EVIDENCE: It was evidenced that staff have clearly defined job descriptions in place but on discussion with staff and observation of staff throughout the inspection it was seen and reported that staff are not working to support the main aims and values of the home. The staff need to obtain further skills and knowledge in order to prioritise the needs of the service users and minimise risks at all times. Staff need to be aware at all times the expectations and limitations of their role and the lines of accountability. This was discussed with the registered and area manager who are going to address these issues with the staff. Staff reported that they were aware of the policies and procedures of the home and how to access them. (See requirement no.8) There are 20 care staff employed by the home plus a cook and a domestic. Only 1 member of staff has NVQ level 2 or above. 2 staff members are in the last stages and are awaiting assessment and 4 staff are in various stages of Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 20 training. Training within the home needs to be developed and implemented to evidence that the needs of the service users are met by skilled staff. The home does not reach the required 50 of staff with NVQ level 2 qualifications. The registered manager must be able to evidence that all the staff have the competencies, qualities, skills and abilities to meet the needs of the service users. At the time of the visit some staff were seen to put their needs before that of the service users and although staff have developed good relationships with the service users they seemed unable to anticipate and meet the individual needs of the client group. Some of the staff spoken to said that they felt unsupported by their colleagues at times, especially when the service users were presenting with challenging behaviours. The staff were seen and reported to have a good relationship with the registered manager. (See requirement no 9.) The Registered Manager is trying to make progress in developing an effective staff team with the skills to ensure that the needs of the Service Users are met at all times. On looking at the duty rota it shows that there are sufficient staff numbers to achieve this. However, it was evident that staff require more training, guidance, direction and support to develop a value base, knowledge and skills to assist them in prioritising and acting effectively so as to meet the individual and collective needs of the all the service users. It was observed that some staff have difficulty communicating and understanding the complex and challenging needs of the service user. Some staff were seen to be unmotivated and apathetic and lacking initiative and interest in their job. Other staff were seen to be acting positively and pro-actively. The general impression was one of staff working in isolation and not as a team. Specialist services are accessed on a regular basis and the local learning disability team is regularly involved with the service users. Regular staff meetings are held and records kept. (See requirement no.10) All new staff employed by the home receive a structured induction training within the first 6 weeks of employment. The manager needs to ensure that all mandatory training has been undertaken by staff within the required timescales and that it is up to date and on going. The company has developed a rolling training programme, which should ensure that all staff eventually receive mandatory training and keep up-dated. The training matrix at the home still showed that staff have not received training within the time scales. Specialist training pertaining to the individual needs of the service users needs to be implemented and developed. The Registered manager is taking steps to achieve this. Any gaps in training need to be quickly identified so that appropriate action taken. (See requirement no.11) Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,43 The home requires more effective guidance, leadership and direction to ensure consistent, competent and accountable care for the service users. EVIDENCE: The registered manager is now only a waiting her NVQ level 4 and RMA assessments and the reasons they have not been undertaken are out of her control. It has been evidence since the manager came into post that she has had a difficult and challenging job to perform. In the 11 months she has been in post there have been significant improvements within the home and although these may be hard to identify at the moment the home now has a firm bases on which to develop. The registered manager will have to utilise all her experience and skills to now move the process forward and achieve the required national minimum standards There are no effective quality assurance and quality monitoring in place to seek the views of the service users their relatives and visiting professionals. The Inspector was unable to evidence an annual development plan. (See requirement no.12) Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 22 There was no evidence available at the home at the time of the inspection to show the overall management, effectiveness and accountability of the service. The home is required to produce as evidence an annual business and financial plan for the home and the service, which the CSCI can inspect at times of visits. Systems need to be in place to ensure financial planning and control and budget monitoring. Lines of accountability within the home and with the external management need to be clearly understood by service users and staff. (See requirement no.13) Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 1 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 1 x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 2 x x x 1 Standard No 11 12 13 14 15 16 17 1 1 1 1 3 x 3 Standard No 31 32 33 34 35 36 Score 1 1 1 x 1 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashingham House Score 1 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 1 x x x 1 H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 24 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 5 Regulation 5(b)(c) Requirement Terms and conditions in respect of accommodation to be provided for service users including the amount and method of payments. Also a form of contract for the provisions of services and facilities provided(Out-standing requirement from the previous inspection Timescale of the 31/12/04 not met) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current, changing need,aspirations and achieve goals(Out-standing requirement from the previous inspection Timescale of the 01/04/05 not met). Staff respect service users’ right to make decisions, and that right is limited only through the assessment process, involving the service user, as recorded in the individual Service User Plan. The staff should only allow Timescale for action 31/08/05 2. 6 15 31/08/05 3. 7 12(2) 31/07/05 4. 9 13(4) 31/08/05 Page 25 Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 5. 11,12,13 &14 16(2)(m) (n) 6. 7. 18 30 12(4)(a) 13(3) 8. 31 18,19 9. 32 18(1)(a) Service Users to take identified risks based on decisions formulated in the Individual care plans and risk assessments. These need to be clearly documented, up-dated and reviewed as necessary. Individual risk assessments need to be identified and completed for each Service Users(Outstanding requirement from the previous inspection Timescale of the 01/04/05 not met). The registered person shall provide and make arrangements for the service users to participate in local, social and community activities. Also provide a programme of activities arranged by the care home having regard to meet the needs of the individual service users The staff at the home to respect and ensure the dignity of the service users at all times Suitable arrangements are to be made to prevent infection and the spread of infection within the home by improving laundry facilities,providing the appropiate equipement and ensuring that staff receive training. To evidence that staff understand their own role and responsibilities and others’ roles and responsibilities. To ensure that the staff are aware and understand the values of the home.(Out-standing requirement from the previous inspection Timescale of the 31/12/04 not met). To ensure that the staff have the competencies, qualities,skills and abilities required to meet the service users needs and achieve Sector Skills Council workforce 31/07/05 30/06/05 30/07/05 30/06/05 31/08/05 Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 26 targets 10. 33 18(1)(a) The home has an effective staff team with the complementary skills to support service users’ assessed needs at all times.(Out-standing requirement from the previous inspection Timescale of the 31/12/04 not met). The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users’ The Registered Manager to ensure that an annual development plan specifically for the home is in place and that quality assurance systems are introduced Service Users are to benefit from competent and accountable management of the service and the Inspector requires to see evidence of this when visiting the home 31/08/05 11. 35 18(1)(c) 31/08/05 12. 39 24,26 31/08/05 13. 43 25 31/08/05 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. 2. 3. Refer to Standard 1 24&26 Good Practice Recommendations The Registered Manager to develop the Statement of Purpose and produce a more suitable format of the Service Users Guide. Maintenance and up-grading of the property to be ongoing Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 27 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU 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 Ashingham House H56-H05 S23339 Ashingham House V223830 100505 4.doc Version 1.30 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!