Inspection on 19/07/06 for Ashingham House

This inspection was carried out on 19th July 2006.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashingham House 06/11/07

Ashingham House 15/11/05

Ashingham House 10/05/05

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 Inspection 19th July 2006 09:30 Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 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 Ashingham House DS0000023339.V297309.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. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashingham House Address London Road Temple Ewell Dover Kent CT16 3DJ 01304 826842 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) Ashingham House Limited Mrs Dawn Joyce Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 10 People with learning disabilities between 18 & 65 years of age. Date of last inspection 15th November 2005 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 8 service users in residence, all of which 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 separate toilets within the building. The home has recently had a new kitchen fitted. 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. Ashingham house is owned by the Allied Care Company who has several other homes in the area. The current fees for the service range from £885.96 to £2,202.92p. Information on the Home and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. . Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place over one day. All the key standards were looked at during the visit and the inspector gave special attention to the requirements and recommendation identified in the previous report. This home has improved greatly since the appointment of the manager 2 years ago. The Allied Care Company have been supportive in improving and developing this service by being flexible in their approach and providing the resources needed. The manager has had the support of a deputy manager, which has given her the necessary assistance to develop and improve the home. The manager reported that the management and staff structure at the home has now been stable for some time and this has a positive effect on the service users and care in general. The registered manager and staff should be commended on what they have achieved. The registered manager has demonstrated a clear sense of direction and leadership, which staff and service users understand and are able to relate to. It is now apparent that the needs of the service users come first. The staff the Inspector spoke to are very positive and optimistic about the future of the home. It was observed that the staff have a good relationship with the service users and they were seen to interact in away that was sensitive, caring and respectful. The service users are well kept and dressed appropriately in keeping with their personalities. The staff on duty at the time of the visit were helpful and co-operative. During the inspection the atmosphere in the home was calm and service users appeared content and relaxed. The home have recently experienced a lot of behavioural problems with a service user but they have managed the situation well. This view was supported by fed-back from visiting professionals to Ashingham House. There has been one adult protection investigation since the last inspection. The registered manager handled this in a sensitive and professional manner and all procedures were adhered to throughout. The following methods of inspection and information gathering were used: one-to-one discussion with staff, communicating with service users, observing interactions, care interventions and activities, reading and discussing individual support plans, risk assessments, selected policies, medication charts, training matrix and training programmes and looking at the financial arrangements for the service users. The pre-inspection questionnaire was returned and also comment cards from visiting professionals. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There have been a lot of improvements since the last inspection and the home have met many of the outstanding requirements and recommendations. Through observation and from talking to the staff it was now evident that the staff are now working together as a team to met the needs of the service users. The staff know their roles and responsibilities and are working in the best interests of the service users. Service users and their representatives now have information available to enable them to make an informed choice about whether the home would be able to meet their needs. The home are able to Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 7 provide the information on what services will be covered by n the fees and what will cost extra. The registered manager and staff are now planning the care they give to the residents to ensure that all needs are met. There are systems in place that keep risks to a minimum and keep the service users as safe as possible both inside and outside the home. The service now provides an active and fulfilling life style for the service users. Service users are protected from all forms of abuse and any concerns are acted on immediately. This was demonstrated when a recent adult protection alert was investigated. All safety checks are undertaken at the necessary intervals to ensure that the homes environment is as safe as possible for the service users. There are directions and guidelines in place for the staff when they have to administer medication on a ‘when required’ basis. The bedrooms that were identified as needing refurbishment and redecorating have been done to a good standard and all the bedrooms are individualised and personal. 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 DS0000023339.V297309.R01.S.doc Version 5.2 Page 8 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 Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 9 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): 1,2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose and Service Users Guide provide sufficient information for service users and their family/advocates to make informed decisions about the homes ability to meet their needs. Prospective service users can be sure that the home will undertake a full assessment of needs prior to arriving at the home. Service users places at the home are protected. The service users now know what the yare paying for. EVIDENCE: The home has a Statement of Purpose and Service User Guide. These documents have information about what facilities and services the home has to offer. The Service Users Guide is well written and informative. The registered manager is developing a pictorial guide and plans to do an audiotape for service users who are visually impaired. There have been no recent admission to Ashingham House The home has a procedure and tools in place to undertake robust assessments. The registered Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 10 manager discussed a recent assessment she had undertaken on a prospective service user. The initial assessment indicated that the home would not be able to met the prospective service users needs therefore the procedure went no further. The registered manager and staff are very aware of the impact a new service user would have on the existing client group. All the service users have contracts and terms and conditions of residency on file. There is information about the fees charged what they cover when they must be paid and by whom. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 11 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, and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users individual needs and choices are supported and met by the care staff. Service users are able to make decisions about their daily lives. There needs to be more evidence to show how the home achieves this. Risks to the service users are identified, recorded and minimised. Service users are protected and kept as safe as possible by the homes risk assessments EVIDENCE: There are individual care plans in place for each of the service users, and there is a key worker system operating within the home. The care plans have improved and developed since the last inspection. 4 of the plans were looked at. They are all of a good standard and reflect the individual and changing needs of the service users. The plans contain all the necessary information on the action that is required of the care staff to ensure that needs are met. They also contain information on likes and dislikes, how to manage challenging behaviours and the reasons that infringements are in place. The staff reported that in the past months challenging behaviours in the majority of service users Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 12 has improved. This was evidenced by a reduction and type of incidences reported. There are also plans on, eating and drinking needs, personal hygiene care, medical and specialist needs, and individual management. The home arranges 6 monthly reviews for all the service users but for some service users the care management teams will only attend annually. The home then carries out an in-house review. It needs to be ensured that the plans are used as a daily working document by all the staff and they also need to be signed and dated. Through observation and talking to service users and staff there was evidence to support that service users are involved in making decisions on how they live their lives and any limitations and restrictions are recorded in the individuals care plan. Care staff and service users are able to demonstrate how individual choices are made and the reasons why others sometimes made decisions. For example one service user was indicating the wish to re-start a smoking habit. Staff were able to produce evidence of this wish and were looking at the service user behaviour exploring the ethics and the health risks around making a decision. Input was sought from the local learning disability team, care manager and family. This is a good start in evidencing that service users do have choice and control in their lives. The home does need to be able to produce more evidence how choices and decisions are made on a day-to –day basis. Risk assessments are in place and work has been done to ensure that all individual risks have been identified and that procedures are in place to minimise them. Staff did report that there is now a more consistent approach when dealing with challenging behaviours and they feel more supported by the staff team. There are still reports of incidents of behaviours. The staff are now following the guidelines that are in place. The registered manager remains proactive in organising multi agency reviews to look at whether or not the home can carry on meeting the service users needs. The staff spoken to were able to explain about risks and how to minimise them. New risks are identified and documented into the individuals care plan. The registered manager does need to ensure that care plans and risk assessments are up-dated as soon as needs change. In one plan their had been a delay in up-dating the information but their was other evidence to show that changing needs had been met. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to maintain and develop an appropriate and fulfilling life-style both in-side and out-side the home. The home needs to be able to demonstrate that they have a varied menu and that service users are offered choices. EVIDENCE: The home has continued to improve and develop its activities and leisure pursuits for the service users. Each of the service users have an individual activities programme in place which is tailored to meet individual needs. The inspector looked at 4 of these programmes and cross-referenced them with daily records. On 3 of the programmes it showed that service users had participated in planned activities and comments were made on whether or not it was enjoyed. On the 4th programme planned activities had not happened on several occasions. There was no recorded explanation as to why the activities Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 14 did not occur and what alternative was offered instead. Staff were able to give a verbal account of why activities had not happened. Staff need to ensure that this information is documented and accurate records are kept. Staff rotas are developed around the service users needs to ensure that activities can take place. For example the home ensures that there is always a driver available on shift so service users can go out and about. The service users indicated that they enjoyed what was on offer and looked forward to participating and doing the activities. One service users indicated that she really enjoyed swimming; another indicated that he really looked forward to his shopping trips on a Friday. And another indicated that he was ready to go out for his daily walk to which staff immediately responded. Staff were seen to actively encourage and support service users to participate in activities. Most of the residents go out a daily basis if they wish. Some service users continue to attend sessions at the local specialist centre, some also go to social and disco evenings. The large shed in the garden, has now been converted into an activities room, a snoozelam is going to be developed up-stairs. This has allowed a dedicated space for several different activities to be available to the service users to meet their different needs and different attention spans. Two of the service users had been on an annual holiday this year and there are bookings for the rest to go in August, September and October. The registered manager has made improvements in developing communications with the Service Users families and documentation was in place to evidence this. The Manager has developed a monitoring system to indicate when telephone calls to home are made. Service Users are actively encouraged to maintain contact with their family and friends by writing letters, sending birthday cards. Some of the service users go home for periods of leave. Family and friends are welcome at Ashingham House. The service users have the freedom to access all communal areas of the home The kitchen does have to kept locked when a staff member is not in there. This is because of the particular behaviours of a service user. There is documentation in place to explain this infringement. All other service users go into the kitchen but are always supervised staff. The Service users can choose when to be in the privacy of their own rooms or in the communal areas. None of the service users have a key to there own rooms and this infringement is documented. Previously 2 service users did have keys for different reasons this was not successful. The registered manager said that she would give this a try to see if it works a second time round. Members of staff were observed demonstrating good body language and communication skills when interacting with Service Users. They were seen to Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 15 talk and interact in a positive way and involved and included service users in conversations. The homes permanent cook has recently left and on the day of the inspection the acting cook was sick. This meant that the care staff had to prepare meals. Staff reported they would be very pleased when a permanent cook was found as it took them away from the service users for periods of time throughout the day. Three meals are provided daily. Meal times are flexible and menus are organised over a four weekly period. Drinks and snacks are available throughout the day. The day of the inspection was very hot and staff were observed encouraging service users to drink plenty of fluids. One service user does need to have her dietary intake closely monitored. Evidence was available to show this is done on a daily basis. Service users are given the opportunity to eat alone or with others. The registered manager was unable to evidence that service users were offered a choice of meals, as she was not able to locate the appropriate documentation. On the day of the visit due to the absence of the acting cook, menu plans were not adhered to. Staff said that they just cooked what was available. Service users do need to be more involved with planning and preparation of meals and actively supported and encouraged to do this. The home needs to employ a cook who will ensure that service users are provided with a nutritious and varied diet. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 16 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 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides appropriate personal and healthcare support care for the service users. There is evidence of good multi-disciplinary working taking place. EVIDENCE: The Home operates a key worker system to provide sensitive and individual support to service users. Personal care, life skills and dignity are promoted. Service users are assisted to choose their own clothes and are supported to shop. There is a flexible approach to daily living activities e.g. getting up, bed, bath and mealtimes. Staff were seen to approach Service users in a caring and nurturing manner. It was observed that the service users privacy and dignity is maximised allowing them independence and control of their own lives. At the time of the visit service users were well dressed in clothing appropriate for the weather. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 17 The home ensures that the service users have access to healthcare facilities and routine checks are carried out frequently. Service users health care needs are monitored and they are promptly referred to professionals when necessary. A member of staff accompanies service users when they are attending appointments and visits from healthcare professionals are conducted in private. A medical report sheet is maintained by the home to evidence dental, chiropody, G.P. and other health care appointments. It was reported by the staff that the challenging behaviours of some service users has improved significantly. Comments from visiting professionals state that at times the staff have to manage very challenging behaviour and do this very well. There was a lot evidence to show that staff are very pro-active in seeking specialist support when it is needed and do everything possible to make sure the complex needs of the service users are met. All the service users have seen a G.P in the past 12months and have been reviewed. The registered manager needs to ensure they receive an annual health check from the G.P surgery. The home uses a Monitored Dosage System (MDS) from Boots and all staff who administer medication have received appropriate training. A list of staff competent to administer medication is kept. Sample signatures are also available. The medication is stored in a locked cupboard and the keys to this are kept on the person who is in charge of the shift. MDS were crossreferenced with MAR sheets and at the time of the visit these tallied. There are now PRN protocols in place. The registered manager has ensured that the service users medication has been reviewed and changed. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system. Service users are protected from harm and abuse EVIDENCE: The home has received 1 complaint since the last inspection. This was investigated according to the homes policies and procedures. The complaint was un-substantiated. The registered manager is developing a format to assist service users if they wish to make a complaint this will be incorporated in the service users guide. Staff know what they had to do if they wished to make complaint. There is a copy of the complaints procedure on display, which contains all the relevant information and how to contact the CSCI, and an assurance that the complaint will be responded to within 28 days. A record is kept of all complaints. The home has the appropriate Adult Abuse policies in place and also a Whistle Blowing Policy. The staff are aware of the policy, feel confident to use it if necessary and knew the appropriate action to take if they had to do so. Any incident pertaining to abuse would be followed up immediately and all action taken recorded. The registered manager is very aware of all adult protection policies and procedures and uses them when the need arises. There has been Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 19 1 adult protection investigation since the last visit, which involved the all multi –disciplinary agencies. The registered manager dealt with the situation in a sensitive and professional manner ensuring that the needs of the service users were paramount at all times. All policies and procedures were adhered to. Some staff have received adult protection training and the manager is going to ensure that all staff receive it as soon as possible. The registered manager has now received the information from head office to demonstrate that the service users finances are managed appropriately and safe guarded. Bankbooks are still kept at the company’s main office. The home has received bank details for each of the service users and has also received quarterly bank statements. There are also invoices to the funding authorities. The deputy manager of the home is able to audit trail all service users monies to ensure that their financial interests are safeguarded and protected. The home has developed systems of managing service users personal monies, which protects them from abuse. The home provides a safe place for the storage of monies and valuables. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 20 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, 26 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has continued with its on-going maintenance and refurbishment plans to create an environment that is homely, comfortable and safe for those living there. The service users are provided with a home that is clean and hygienic. EVIDENCE: The homes environment continues to improve and work has been done since the last visit. Improvements and maintenance at the home needs to continue as there are stall areas that require attention. The home does need to have an on-going maintenance plan with timescales to ensure that the necessary work is identified and completed within a reasonable length of time. Some hallways and landings have been made more homely and pleasant. The decorating in 2nd bathroom has been completed. The other bathroom (NO. 24) needs a new shower curtain and a blind at the window. The home still has the specially designed chair which is proving to be robust and worth the extra Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 21 money. The manager hopes to purchase more of these, as one service user has identified the piece of furniture as his favourite chair. The seating in the lounge has taken a battering over the past few months and the manager is purchasing more chairs and a settee at the weekend. The 2 rooms that required new flooring have been done and they have also been redecorated. One of these bedrooms had no curtains at the window. The registered manager was unsure why this was but will address the issue. It was noted that the carpet in the entrance hall was becoming worn and was lifting in places. Also the carpet in the lounge has an iron burn on it. The registered manager needs to ensure that these areas are incorporated into the maintenance plan. The home employs an ancillary member of staff to do the cleaning in the communal areas of the home. The home is kept hygienically clean and there are no unpleasant odours. Service users are encouraged to clean their own rooms with assistance and support from staff. The Inspector looked at the laundry room, which was orderly, and in line with the standard. The home have purchased a new washing machine with sluicing cycles. Service users are encouraged to assist with their own laundry. Any soiled laundry is transported safely and washed in red bags according to the homes procedures. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 22 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): 32,33 34 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff have a good understanding of the service users and positive relationships have been formed. The staff group within the home now stable. The training provision is improving but staff do need more training and also more supervision and support. An effective staff team supports Service users. Recruitment practises are generally sound but one area does need tightening up to ensure the service users are protected. EVIDENCE: The staff reported that they have developed good relationships with the service users and they were able to anticipate and meet the individual needs of the client group. Service users responded positively to staff. The staff also reported a good working relationship with the manager. It was observed that the staff are accessible and approachable to the service users and are able to exhibit good listening and communication skills. It was evidenced that the staff on duty put the needs of the service users first. The registered manager with the Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 23 support of the deputy manager continue to ensure that the staff work towards meeting the main aims and objectives of the home. Staff are more closely monitored and observed. Any concerns are followed up and dealt with. There are regular team meetings in which matters are addressed and the appropriate action taken. Staff reported that they feel confident in the manager that she would listen and act on any issues that are highlighted. Since the last inspection the home has made good progress in meeting the standard, which requires 50 of the care staff to have achieved NVQ level 2 or above. There are 22 care staff employed by the home plus a cook and a domestic. 9 members of the care staff now have NVQ level 2 or above. The deputy manager is being given the opportunity and support to develop her managerial skills and knowledge. She is gaining the experience she will need for commencing her NVQ level 4 in September. The home still needs to reach the 50 of staff with NVQ level 2 or above. The registered manager has maintained the staffing levels at the home to ensure that all the needs of the service users are meet at all times. There are 6 staff members on the a.m shift and 6 on the p.m shift. The night shift is one waking and sleeping staff member. The increase in staff numbers has produced a significant positive effect on the service users. They are now all able to participate in their activity programmes, challenging behaviours have reduced and the service users are living more fulfilling lifestyles. The duty rota is developed depending on the needs of the service users. There is the appropriate skill mix and numbers of staff on duty at any one time to meet all the service users needs. Staff reported that they are aware of the policies and procedures of the home and how to access them. There is a member of staff on every shift who has is a first aid qualification. On the whole the home does have a thorough recruitment practises. And the majority of the staff files contain all the necessary information to ensure that the service users are protected. The registered manager must ensure that a full employment history is obtained from all prospective staff and that any gaps are explored at interview. The staff still need to continue to develop further skills and knowledge in order to prioritise the needs of the service users and minimise risks at all times. This is being addressed through the training programme. More staff need to receive specialist training to give them a better understanding of the service users within the home. Mandatory training is still on-going extra sessions have been introduced into the programme and it is hoped that by the end of the year all staff working at the home will be up-to –date. It then needs to be ensured that training is on going. The CSCI are still getting a number of incident reports from the home but these have reduced since the last inspection and the severity and nature of the incidences has also reduced. From looking at the incidence reports staff are Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 24 now more able to anticipate and diffuse behaviours. The registered manager continues to monitor this very closely and is looking for emerging patterns and ways of dealing with the problems. The staff reported that they now feel more supported by their colleagues when incidences do occur. They also stated that the atmosphere in the home has improved and that everyone ‘gets-on’ better. The Registered Manager is developing an effective staff team with the skills to ensure that the needs of the service users are met at all times. The staff still require more training 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. Specialist services are accessed on a regular basis and the local learning disability team is regularly involved with the service users. The staff are offered the support and guidance to carry out their roles effectively on a day –to day basis. The registered needs to ensure that all staff receive formal supervision on a regular basis. Annual appraisals are taking place. . Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39,42 and 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has registered manager in post who has the necessary qualifications, experience and skills to offer leadership guidance and direction. This ensures the service users receive a consistent quality of care. The health, safety and welfare of the service users is promoted and protected. Service users benefit from competent and accountable management EVIDENCE: The registered manager has now been at the home for 2 years and should be commended on the amount of work she has undertaken and achieved in this time. She continues to put all her time energy and skills into ensuring the home is providing the necessary care for the service users. She has been able to obtain and maintain this improvement as she has had the support of the Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 26 deputy manager who has been able to take on some managerial responsibilities. The result of all this work is reflected throughout the report. The registered manager has achieved her NVQ4/RMA and has the skills, competencies and positive attitude to run the home and meet its stated purpose aims and objectives. The registered manager is able to communicate a clear sense of direction and leadership, which the staff and the service users responded to. The staff and service users reported that they were well supported and responded in a positive, relaxed manner in the presence of the manager. Opportunities for change and development are on going. The company has appointed a dedicated person to undertake effective quality assurance and quality monitoring systems. The aim is to look at managerial effectiveness, improve paper work and highlight any deficits so they can be addressed. The out-come is to ensure all homes within the company are working to the same remit and working to met the minimum standards. Ashingham House was due to have an unannounced audit visit by the end of June ’06 but this had not taken place. The registered manager continues to develop in-house audits to ensure that the home is meeting its aims and objectives and to identify any shortfalls in practises of the service. This has now expanded to include environmental issues, care planning, risk assessments, medication. The registered manager has sent out questionnaires to relatives and received a good response. 7 out 10 replied and comments were positive. Staff questionnaires have also been sent but the response on these is slower. When the manager has received all responses and has gathered all the information she will be measuring outcomes and acting on them. This will assist in improving the service to the residents of the home. More work does need to be done on this before the standard is fully met but he registered manager has made a positive start. Effective quality assurance and monitoring systems will measure the success of the home in achieving its main aims and objectives. The home provides a safe environment for service users to live in and staff to work in. Good working practices ensure the home is free of hazards. The company’ has an induction programme which is in line with TOPSS. All staff need to receive mandatory training, this needs to be on going and up-dated as required. . Policies are in place to strengthen safe practices. All the relevant checks and inspection of equipment and system have been undertaken and were evidenced on the day of the inspection. An accident book is maintained. All fire checks were done and it is now ensured that these are undertaken at the necessary intervals. Water temperatures are taken and comply with regulations. Drug cupboard and fridge temperatures were also evidence and were within the stated ranges. The Manager is aware of RIDDOR and reporting incidences to the Commission under Regulation 37. COSSH products are locked away safely. Environmental risk assessments are in place. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 27 The CSCI have received a copy of the homes financial plan. The home is covered by insurance. Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 X 4 X 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 2 25 X 26 2 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 2 3 Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 YA35 Regulation 18(1)(c) Requirement 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’. (Outstanding requirement from the previous inspections. Timescale of the 31/06/06 not met). The staff need to receive formal supervision with a record kept at least 6 times per year. To continue to develop quality assurance systems to ensure that the service continues to improve and achieve its aims and objective. To ensure that all staff have received the required mandatory training for all the care staff. Timescale for action 30/11/06 2. YA36 16(2) 30/09/06 3 YA39 24 30/11/06 30/11/06 9. YA42 23(4)(a, b, c,) Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 30 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 Refer to Standard YA7 YA12 Good Practice Recommendations The staff need to be able to produce more evidence on how service users make decisions and why sometimes decisions have to be made by others. The registered manager needs to ensure that accurate documentation is kept to show that planned activities have taken place. Staff need to record reasons why activities did not take place and what was offered as an alternative. The home needs to employ a cook who is responsible for providing nutritional, varied meals for the service users. Meals need to be planned involving the service users and choices are need to be on offer. The home needs to have a planned maintenance and renewal programme in place with time scales. All areas of the home need to be made pleasant and homely. One bedroom needs curtains. One of the bathrooms’ needs a new shower curtain and a window blind. 50 of the care staff group need to achieve NVQ level 2 or above. To ensure that full employment histories are obtained and any gaps in employment investigated. 3 YA17 4 5. YA24 YA26 YA27 6 7 YA32 YA34 Ashingham House DS0000023339.V297309.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Kent and Medway Area Office 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. 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