Inspection on 06/11/07 for Ashingham House

This inspection was carried out on 6th November 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 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashingham House 19/07/06

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 Key Unannounced Inspection 6th November 2007 10:00 Ashingham House DS0000023339.V353149.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.V353149.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.V353149.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 01304 828982 ashinghamhouse@tiscalli.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) Ashingham House Limited Mrs Dawn Joyce Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Ashingham House DS0000023339.V353149.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 19th July 2006 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, close to 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 7 residents, all of which have their own individual bedrooms. The accommodation is arranged over two floors and the communal facilities are on the ground floor. There are 2 bedrooms on the first floor and the remaining are on the second floor. The staff sleep-in room is located on the 1st floor. There are 2 bathrooms and 2 separate toilets within the building. The large garden is laid to lawn with shrub and planted areas. There is plenty of private space in the garden for the residents to enjoy outside activities in the better weather. The home has its own transport. The Allied Care Company who has several other homes in the area owns Ashingham House. The current fees for the service range from £947.43 to £2,081.99. Information on the home for prospective service users is detailed in the Statement of Purpose and Service User Guide. A copy of the CSCI report is kept at the home and is available on request. . Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over one day. The visit forms part of the key inspection. Since the last inspection the registered manager of the home is working as an area manager for the company and the deputy manager is the acting manager of Ashingham House. This is for a probationary period of 6 months. At the end of November’07 a decision will be made about the future of the management team at the home. This has led to period of change and some uncertainty for residents and staff. Hopefully this will soon be resolved so that people know what its happening and can settle into their roles. The following methods of inspection and information gathering were used: At the time of the site visit there was one-to-one discussion with people who use the service, care staff and management. Staff interactions with residents, care interventions and activities were observed. Individual support plans risk assessments were discussed. Selected policies, medication charts, training matrix and training programmes and financial arrangements were looked at. Since the last inspection we have recorded information received about the service and this is also taken into account when writing the report. What the service does well: The home is well run. The acting manager gives support, direction and guidance to the residents and the staff group. She makes sure that the aims and objectives of the home are met and that the residents receive the care they need. Any prospective resident thinking about coming to live at Ashingham House will have a thorough assessment to ensure that home can offer them the care that they need. There is a stable group of staff who know the residents well. Staff spoken to have a knowledge and understanding of the residents and are able to anticipate and interpret a lot of their needs. They are able to communicate through body language, behaviours and verbal sounds. The care staff on duty talked and interacted with the residents in a respectful and caring way. The residents are encouraged and supported to do as much as possible for themselves. The home does meet the physical and healthcare needs of the people who live there. There is regular input from the local specialist team and G.P Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 6 appointments are frequent. The home continues to be consistent and prompt in reporting untoward incidents. The home has done a lot of work to make sure that residents live a fulfilling life as possible. It must be ensured that this continues to develop. The registered manager needs to ensure that this is not compromised due to not having enough staff available to allow to people to get out and about and do things that they enjoy. Any complaints or concerns are taken seriously and acted on. What has improved since the last inspection? What they could do better: Since the last inspection the home has reduced its staffing numbers. The acting manager said they are just managing to juggle things to make sure this does not affect the residents. It was apparent on the day of the visit that this has an effect on the amount of consistent input and support given to the residents. Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 7 The acting manager does need more support to do her job effectively. At the moment she is trying to undertake all the managerial duties and is also trying to make sure that that everything else is happening, as it should on each shift. She has no deputy to delegate work to help her make sure that everything is done to a good standard. The service needs to streamline and sort out their documentation and how they keep the records. At the moment there is so much paperwork to complete on a daily basis that staff feel overwhelmed. There is also the risk of important information getting lost or not being used because it cannot be easily accessed. Quality assurance systems need further developing to make sure the people living at the home and stakeholders views underpin the review and development of the service. The staff need to make sure that all safety checks are carried out accurately and that procedures are adhered to. The manager needs to make sure that the staff have the competencies and skills to undertake delegated tasks and that there are monitoring systems in place to make sure that tasks are done properly and on time. 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. Ashingham House DS0000023339.V353149.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.V353149.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 People who use the service experience good outcomes in this area. Prospective service users have access to adequate information about the home and there are assessments tools in place to assess any prospective new residents. Resident’s places at the home are protected and they know what they are paying for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has reviewed and updated its Statement of Purpose and Service User Guide. These documents have information about the facilities and services the home has to offer. The Service Users Guide is well written and informative. It includes how to make a complaint, terms and conditions, their rights, fees and extras. The guide still has to be transferred into a format that is more understandable for the people who use the service. The deputy manager plans to develop a pictorial guide and audiotape. The guide would also benefit from including the views of the people living at the home. There have been no new admissions to the home since the last inspection. But at the time of the visit an assessment of a prospective new resident was being Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 10 planned. The service has all the necessary tools in place to undertake a good assessment. Only someone with the necessary skills and knowledge will undertake the assessment. For the people who are already living at the home a person centred format and tool is going to be used to assess their needs and aspirations. The acting manager will make sure that this information is transferred into the residents individual care plans to ensure that all needs and aspirations of the present residents have been identified and met. The work is on going. 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.V353149.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience good outcomes in this area. All the people at the home can be sure needs are planned for and their personal goals will be identified and supported. Residents are supported to take reasonable risks This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the people living at the home has a care plan. 3 care plans were looked at in detail. They are of a good standard and reflect the individual and changing needs of the residents. The plans do contain all the necessary information on the action that is required 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. There are also plans on, eating and drinking needs, personal hygiene care, medical and specialist needs, and individual management. The home arranges 6 monthly Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 12 reviews for all the residents but for some residents the care management teams will only attend annually. The home then carries out an in-house review. Some parts of the plans are written in a format, which is more understandable to the residents. There is now a great deal of paper work in place for each resident so much so that it is difficult to find information easily. Some plans are becoming muddled and there are incidents where things have been missed or overlooked. Recording is duplicated in places. Staff reported that they feel overwhelmed by the amount of paper work and are not always using the plans daily because it is difficult to sift through to find the information that they need. Daily records are person centred and contain good and relevant information to show how the residents have made choices and decisions. It was possible to cross reference information to show that care plans and risk assessments are being used to provide the necessary care and input on a daily basis. However the same information was also been duplicated in 2 other places. It needs to be ensured that all records are signed and dated. The files and plans now need to be streamlined. The home has just started to transfer care-planning information into a more person centred format called My Personal Lifestyle Action Plan. When this is completed they need to remove the redundant information from the files. The acting manager is aware of this and has already made a start. Through observation, talking to residents and staff and from looking at the documentation there was evidence to support that people are involved in making decisions on how they live their life’s. Any limitations and restrictions are recorded in the individuals care plan. It was seen that staff listened to what the residents wanted through various means of communication and acted on this. There was evidence available to show how people choose their meals, how they choose what they want to do and where they want to go. One resident was indicating the wish to re-start a smoking habit. Staff were able to produce evidence of this wish and were looking at the residents 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. Risk assessments are recorded in resident’s plans and are reviewed before activities including community access. They are used to promote independence and not restrict people. Staff enable residents to take reasonable risks. 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 there is a consistent approach when dealing with behaviours and incidences of negative behaviour Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 13 have greatly reduced. The staff spoken to were able to explain about risks and how to minimise them. When new risks are identified they are documented in the individuals care plan. Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 14 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): 12,13,14,1516 and 17 People who use the service experience good outcomes in this area. People living at the home are able to maintain and develop an appropriate and fulfilling life-style both in-side and out-side the home. The residents are offered involvement and choice in a varied and healthy diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff at the home said that they are just about managing to make sure that activities do take place as planned. There has been a reduction in staffing levels (this will be discussed later in the report) and this has led to activities having to change or postponed on a few occasions. The home has also had difficulty making sure they have a driver available. It was evidenced that at times activities have to be restricted as there is not enough staff available. This normally happens in the evenings and at Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 15 weekends. The service needs to make sure that they have enough staff on duty to allow residents to go out if they want to. Each of the residents has an individual activities programme in place which is tailored to meet individual needs. 3 of these programmes were looked at and cross-referenced with the daily records. On 2 of the programmes it showed that the residents had participated in planned activities and comments were made in the daily records whether or not it was enjoyed. On the 3rd programme planned activities had not happened on several occasions. There was no recorded explanation as to why the activities 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. On the day of the visit the house was busy. During the morning residents who wanted to be were engaged in various activities. Some residents were in the activities room. There was an outing to town and another went out for a long walk. One resident was listening to music in her room. Residents indicated that enjoyed what they had been doing. In the afternoon some residents were not engaged in planned activities. One person’s activity was stopped as the staff member was called away to do something else. 4 residents were left for a long period of time in the lounge, as there was no staff available. The residents have the freedom to access all communal areas of the home. The kitchen is kept locked when a staff member is not in there. There is documentation in place to explain this infringement. Residents do go into the kitchen but are always supervised staff. The residents can choose when to be in the privacy of their own rooms or in the communal areas. No one has a key to his or her own rooms and the reasons for this are documented. The residents have regular contact and with their families and are actively encouraged to write letters, send cards and make phone calls home. There is evidence in place, which supports this. Family and friends are welcome at Ashingham House. Members of staff were observed demonstrating good body language and communication skills when interacting with residents. They talk and interact in a positive way and involve and include residents in conversations. The home provides a healthy, nutritious and varied diet. Since the last visit the home has employed a new cook. He works Monday to Friday. At weekends an extra member of the care staff team is brought in to do the cooking. The acting manager has done a lot of work developing ways in which residents can choose the types of food that they like. There is a daily pictorial menu Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 16 board as well as a written one, both are on display in the dining room. Residents are encoraged and supported to choose the food they like and this is recorded. 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. Residents are given the opportunity to eat alone or with others. Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. People who use the service experience good outcomes in this area. The home provides appropriate personal and healthcare support care for the people who live there. There is evidence of good multi-disciplinary working taking place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care needs and how they are to be met are detailed in individual residents plans. Staff said that residents are encouraged and supported to as much as possible for themselves. The home operates a key worker system to provide sensitive and individual support to residents. Personal care, life skills and dignity are promoted. Personal care is delivered in a way that is flexible reliable and person centred. The staff were seen to respect the privacy and dignity of the residents allowing them control over their own life. The residents are encouraged to choose their own clothes and are supported to shop. There is a flexible approach to daily living activities e.g. getting up, bed, Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 18 bath and mealtimes. Staff were seen to approach the residents in a caring and nurturing manner. The service makes sure that the residents have access to all the healthcare facilities and routine checks and monitoring are carried out at the necessary intervals. Resident’s health care needs are closely monitored and they are promptly referred to professionals when necessary. All the residents have recently been referred to the local specialist team. A member of staff accompanies residents 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 residents has improved significantly. There was a lot evidence to show that staff are pro-active in seeking specialist support when it is needed and do everything possible to make sure the complex needs of the residents are met. All the residents have seen a G.P in the past 12months and have been reviewed. 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 drug dispensing sheets and at the time of the visit these tallied. There are robust protocols in place for medication that is given when required. Medication is reviewed regularly. Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good outcomes in this area. The home has a satisfactory complaints system and residents are protected from harm and abuse This judgement has been made using available evidence including a visit to this service. EVIDENCE: All complaints made to the home are taken seriously and acted on. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Timescales are adhered to. The home understands the procedures for safe guarding adults and has been pro-active in the past in highlighting adult protection concerns. The home has reported one adult protection issue at the beginning of the year. The registered manager immediately took the appropriate steps to deal with the situation. The home has an adult protection and whistle blowing policy. Some staff have received safe guarding vulnerable adults training but there are a few who still need up dating. The acting manager is in the process of arranging the training. Staff competency also needs to be regularly tested in this area. The service has the information from head office to demonstrate that the resident’s finances are managed appropriately and safe guarded. The acting manager has been actively trying with local banks and building societies to Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 20 open personal individual accounts for each resident but has come across obstacles while doing this. The registered manager is aware of this issue and is going to assist. At the present time the residents do not have their own bankbooks. Information is still kept at the company’s main office. The home has received bank details for each of the residents 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 monies. The home has developed systems of managing resident’s personal monies, which protects them from abuse. The home provides a safe place for the storage of monies and valuables. Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good outcomes in this area. The home provides an environment that is appropriate to the needs of the people who live there. On the whole Ashingham House is homely, comfortable, safe and clean. This judgement has been made using available evidence including a visit to this service. 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 still areas that require attention. The home now has an on-going maintenance plan with timescales to ensure that the necessary work is identified and completed within a reasonable length of time. The house does feel more homely and inviting. There are pictures on the walls the hallways and landings have been made more pleasant. The furniture has been replaced in the lounge and the downstairs hallway and lounge has been Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 22 re-carpeted. There is now a shower curtain in the bathroom and new curtains have been bought. The gate at the front of the house is not in keeping with the rest of the property and is rusty and old. There is a padlock on the gate, which was originally put in place there to delay a resident from leaving the property. This resident is no longer at the home but the padlock remains in place to prevent any other resident from leaving the grounds and risk injury on road. The lock also prevents easy access for visitors. The registered manager is going address this issue. The home employs continues to employ a housekeeper. She has a very good relationship with all the residents who is very much part of the team. The home is kept hygienically clean and there are no unpleasant odours. Residents are encouraged to clean their own rooms with assistance and support from staff. The laundry room was orderly, and in line with the standard. Residents are encouraged to assist with their own laundry. Any soiled laundry is transported safely and washed in red bags according to the homes procedures. Any clinical waste is disposed of appropriately. Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 People who use the service experience adequate outcomes in this area. The staff have a good understanding of the residents and positive relationships have been formed. The staff group within the home is stable. More specialist training and increased numbers of staff at times will improve the care and support given to the residents. Staff competencies need to be checked to make sure they know and understand how to meet the residents needs. Recruitment practises protect the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff reported they have developed good relationships with the residents and are able to anticipate and meet the individual needs of the client group. The residents responded positively to staff and they reported that they like the staff. Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 24 It was observed the staff are accessible and approachable to the residents and exhibited good listening and communication skills. The registered manager needs to ensure that the staff work towards meeting the main aims and objectives of the home and don’t lose site of why they are there. At the time of the visit the staff on duty put the needs of the residents first. Staff reported that they feel confident in the deputy manager. They said that she would listen and act on any issues that are highlighted. The home employs 16 staff of varying skill. To date 5 members of staff have completed their NVQ level 2 or above and 5 are working towards the qualification. The home still needs to reach the 50 of staff with NVQ level 2 or above. The company provides an on-going training programme. Training opportunities for staff have improved greatly and the training programme is being further developed and expanded to include subjects like equality and diversity managing risk. New staff receive an induction programme. All staff have now completed mandatory training and this is updated at the necessary intervals. Some staff have received specialist training and this is on going. The management of the home now needs to make sure that staff competencies are checked at regular intervals. At the time of the visit areas of concern were identified. A resident had lost weight in a 2-week period but the staff member doing the weight had not taken any action on their findings and had not reported it. Water temperatures were taken incorrectly and this had been happening for a considerable period of time. Fire checks had been missed on a couple of occasions. Since the last inspection the number of care staff employed by the home has reduced from 22 to 16. There is no longer a deputy manager in post and the hours of allocated staff time has reduced by 52.5 per week. The service told us if a particular activity is happening or someone is going out then extra staff are brought in and this is planned for in advance. From looking at the duty rota there are a lot of occasions when the home runs on 4 staff per shift. On the day of the visit there was 4 staff on duty in the afternoon. It was planned that one resident went out this needed 2 staff. To allow this to happen one of the staff members had to stop the activity he was doing with another resident. Another resident then needed one to one attention for quite a long period of time. This left one member of staff with 5 people. When another resident needed one to one input it left 4 residents alone in the lounge for a considerable period of time. This left them at risk. Also during the afternoon period no planned activities happened. Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 25 Staff reported that outings in the evening are not so frequent as there are not enough staff available. This was discussed with the registered manager and acting manager. They will be addressing the issue. The home does have a thorough recruitment practises. The sample of files looked at contain all the necessary information to ensure that the residents are protected. The acting manager now ensures that a full employment history is obtained from all prospective staff and that any gaps are explored at interview. The service told us that regular staff meetings are held, evidence of this was seen during the inspection. However due to an open door policy, issues are usually discussed as they occur. All staff have regular supervisions and appraisals booked in advance. Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 26 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): 37,39 and 42 People who use the service experience good outcomes in this area The home is well run and in the best interest of the people who live there. The health, safety and welfare of the service users is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the moment the registered manager of the home is undertaking a probationary 6month period in the post of area manager for the company. Therefore her time working within the home is minimal. The deputy manager is undertaking a 6month probationary period as acting manager of Ashingham House. She has recently completed her level NVQ4 and has started the Registered Managers Award, which she will complete in June ’08. She has several years experience in working with people with a learning disability. Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 27 The acting manager has a clear understanding of the key principles and focus of the service. She is aware of the shortfalls within the home and has the vision and plans on how these will be addressed. She is working continuously to improve the service and provide an increase quality of life for the residents. She understands the importance of person centred care and actively promotes and leads the staff team. The acting manager has regular contact with the registered manager to keep her up to date on all developments or issues that arise. The deputy manager does need more support from the organisation so she can undertake her role more effectively. She now needs the support of a deputy manager. To bridge this gap in the short term the registered manager plans to spend a day a week at the home. The service needs to ensure that they inform the commission about managerial plans at the end of the probationary period. The company has 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. Due to unforeseen circumstances the quality assurance visits have not happened recently. The acting manager continues to develop and use in-house audits to ensure that the home is meeting its aims and objectives and to identify any shortfalls in practises of the service. Questionnaires have been sent to relatives and staff and other stakeholders. The information needs to be collated and the strengths and weaknesses of the home identified. From this information the home needs to improve the service it provides for the residents. This will ensure that the aims and objective and statement of purpose of the home are being met. On the whole the home provides a safe environment for residents 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 Skills for Care and all have received mandatory training, Policies are in place to strengthen safe practices. All the relevant checks and inspection of equipment and systems have been undertaken and were evidenced on the day of the inspection. An accident book is maintained. Fire checks are being done although on a couple of occasions they had been missed. Water temperatures are undertaken on a weekly basis. At the time of the visit it was identified that these were inaccurate, as they were not been recorded correctly. The temperature of the water from the resident’s sinks was very high. The risk of injury was reduced by the fact the taps turn themselves off after short while. The management of the home took immediate action to Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 28 address this issue and the registered manager is arranging for thermostats to be fitted to the sinks. 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.V353149.R01.S.doc Version 5.2 Page 29 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 2 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 3 X Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 30 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 YA33 Regulation 18(1)(a) Requirement The service needs to make sure that staff have the competency to undertake the task they have been asked to do. The service needs to make sure that there are sufficient numbers of staff on duty at all times to meet the needs of the residents. To continue to develop quality assurance systems to ensure that the service continues to improve and achieve its aims and objective. Timescale for action 31/12/07 2 YA33 18(1)(a) 30/11/07 3. YA39 24 30/11/07 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 YA1 Good Practice Recommendations The Service Users guide needs to be in a format, which is more accessible and understandable to the people who use the service. The files and care plans need to be streamlined so they can be used as an effective and efficient working tool for DS0000023339.V353149.R01.S.doc Version 5.2 Page 31 YA6 Ashingham House residents and staff. 3 YA12 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. All residents need to have their own individual bankbooks and all staff need to have up-to date training in safeguarding adults. 50 of the care staff group need to achieve NVQ level 2 or above. The manager needs to make sure that all checks are done properly and accurately and at the required intervals. 4 5. 6. YA23 YA32 YA42 Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Ashingham House DS0000023339.V353149.R01.S.doc Version 5.2 Page 33 - 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. 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