Inspection on 05/06/07 for Ashington House

This inspection was carried out on 5th June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashington House 17/06/08

Ashington House 17/05/06

Ashington House 16/11/05

Ashington House 03/05/05

Ashington House 22/09/04

Ashington House 29/04/04

Ashington House 06/01/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Ashington House 402 Malden Road Worcester Park Surrey KT4 7NJ Lead Inspector David Halliwell Key Unannounced Inspection 5th June 2007 09:30 Ashington House DS0000013378.V342048.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 Ashington House DS0000013378.V342048.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. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashington House Address 402 Malden Road Worcester Park Surrey KT4 7NJ 020 8330 7476 020 8330 7476 AshingtonHouse@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashington House Limited Post Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The handbasin in one bedroom may be removed, to be reviewed at least annually. 22nd February 2007 Date of last inspection Brief Description of the Service: Ashington House is owned and managed by Allied Care, a private organisation. It is a large semi-detached property on the main road from New Malden to Worcester Park. It is situated close to local amenities and is a short distance from a large local park. The home offers accommodation to adults who have a learning disability, with challenging behaviour. The service aims to provide six permanent placements in time. At the time of the inspection there were two permanent service users residing at the house. Ashington House DS0000013378.V342048.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 inspection. The Inspection covered all the key standards and involved a review of all the homes records and interviews with a new member of the staff team and a new resident to the home. At the time of this inspection there were 3 residents living at the home. They were present over the course of the inspection, there are 3 vacancies with 2 new prospective service users considering their placement at the home. The current fee charges for a placement at the home range from £1300 per week to £2500 for 2:1 staffing levels. Since the last inspection all the requirements and recommendations made then have now been met. The process of continuous improvement mentioned in the last inspection report has continued to gather momentum and there was a positive feel to the unit which reflects a good deal of effort and input made by Dallas, the Home’s Manager and the staff on behalf of the residents. The Inspector found the residents and staff very helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. What the service does well: What has improved since the last inspection? At the last full key standards inspection in May 2006 8 requirements and 5 recommendations were made and at the time of this inspection they have all been met. Improvements have therefore been specifically noted in the following areas and the Manager and the staff are to be commended for the progress that has been made in these areas: Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 6 Requirement No 1 (YA23) – The Manager informed the Inspector that all the staff group have been asked to read the homes policies and procedures and to sign to say that they have read and understood them. Evidence of this was shown to the Inspector that confirmed that all staff had indeed done this as described. This requirement is now met. Requirement No 2 (YA27) – This requirement was made for a resident who is no longer living in the home. Given these circumstances the requirement is no longer relevant to Ashington House. However the Manager informed the Inspector that the bathroom concerned has been refurbished and a new bath installed. The Inspector saw evidence of this when looking over the premises as a part of the inspection carried out. This requirement is now met. Requirement No 3 (YA37) – The Manager informed the Inspector that her application has recently been submitted to the CSCI’s Central Registration Team for her registration as the Manager at Ashington House. Copies of correspondence were shown to the Inspector that supported this claim. This requirement is now met. Requirement No 4 (YA24) – As a part of the tour of the premises the Inspector saw that a fly screen has been fitted to the kitchen door leading to the outside back garden. This was required by a previous environmental health officer’s report and by the CSCI at the last inspection in May 2006. This requirement is now met. Requirement No 5 (YA4) – This required that the Unit follows its own stated procedure for admitting new residents. One new resident has been admitted since the last inspection and procedures have been followed as required. The Manager showed the Inspector all the corresponding paperwork for this resident. On inspection it was evident that the Manager has ensured that the full and proper admission procedures are being followed in this case. It was also evident to the Inspector that the Manager is taking all the processes of placement in the home very seriously in the attempt to ensure that the home can meet the resident’s needs and taking into consideration the needs of the existing 2 residents who are living in the home. This requirement is now being and the Manager will need to ensure that it is for all new prospective placements. Requirement No 6 (YA24) – The Manager showed the Inspector a newly purchased freezer installed in the home’s garage as a replacement for the previously faulty freezer. This means that this requirement has now been met. Requirement No 7 (YA29) – This requirement concerned the need for the home’s manager to ensure that the home can meet the needs of any prospective service users. This included taking into account referring professional’s assessments. Since the last inspection a new resident has been admitted into the home and evidence on the files satisfy that this requirement is now being met. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 7 Requirement No 8 (YA32) – This requirement required the home’s manager to ensure that any new staff recruited to the home have experience of working with people with challenging behaviour. The Manager informed the Inspector since the last inspection 4 new staff have been recruited. Staff records seen by the Inspector indicate an improvement in this area since the last inspection however where staff do lack the experience the Manager must ensure that they are provided with adequate training in order to supplement the experience that have had. This requirement is met but will be reviewed at the next inspection. Recommendation No 1 (YA23) – The Manager informed the Inspector that an inventory of the residents living in the home has been updated and covers their valuable belongings. She also assured the Inspector that taking an inventory is now a part of the admissions procedure and will include the need for at least an annual update. The Inspector saw evidence of this at this inspection so this recommendation has now been met. Recommendation No 2 (YA24) – The Manager informs the Inspector that the agency has now allocated a permanent 2 days a week for the maintenance person to carry out the maintenance work for Ashington House. The Manager assures the Inspector that this is now sufficient to meet their needs and so this recommendation has been met. Recommendation No 3 (YA32) – The Manager informed the Inspector that all staff have now been issued with a copy of the GSCC’s code of conduct. Staff confirmed this. The recommendation has now been met Recommendation No 4 (YA31) – The Manager informed the Inspector that Allied Care have now reviewed and updated all the existing job descriptions for staff in use in all the homes. This recommendation has therefore now been met. Recommendation No 5 (YA36) – The Manager informed the Inspector that she went on staff supervision training in October 2006. She said that it was interesting and helpful to her in her role as Manager and a supervisor of staff. Unfortunately the Manager has not yet received the training certificate, however the recommendation has been met. What they could do better: Ensure the very positive progress made over the last year is maintained, further improved and that the quality assurance process is developed as recommended in this report. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 8 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. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 9 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 Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 10 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): Standard 2. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents may be assured that their needs will be thoroughly assessed and reviewed by their referring agencies, they may also be assured that their needs will continue to be fully assessed at Ashington House and that fully completed documentation will always be held on their files. EVIDENCE: Standard 2 – As a part of this inspection the Inspector reviewed 2 of the 3 residents files. Since the last full key standards inspection 1 new resident has been admitted and his file was one of those reviewed. A full needs assessment from the referring agencies was seen on the files inspected. These needs assessments cover all aspects of the persons life and include their cultural and faith needs. The care staff within Ashington draw up their own needs assessment, together with the resident and their families and this is also based upon the assessment information provided by the referring agency. The care plans seen by the Inspector (and also referred to under Standard 6) are clearly based on the needs assessments referred to above. In both of the Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 11 residents files inspected these care plans were seen to be comprehensive in their detail. The plans include the wishes and preferences of the residents and the process of care planning was sent to be inclusive, in that all the key people are involved in their composition and review. The home also provides service users and their representatives with the information they need to make an informed choice about where to live. The needs assessment and care planning process should assure service users that their needs would be met. There are three service users living in the home at present and the Acting Manager told the Inspector that two prospective service users and their representatives are considering a future move to the unit. With reference to the resident just placed at Ashington it is clear that the home are taking the opportunity to ensure that his needs are being considered along with the needs of the two other service users and the skills and abilities of the staff team. Service users are provided with an individual contract and statement of the terms and conditions within the home. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 12 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): Standards 6, 7 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents Lifestyle Plans (Person Centred Plans) are comprehensive and include detailed information on the service users needs. There is evidence that residents are fully involved in completing their own plans so that they can express their wishes and personal goals for the future. Where possible residents are supported in taking risks as part of an independent lifestyle. They can be assured that information about them is handled appropriately and confidentially. EVIDENCE: Standard 6 - Residents have a Lifestyle Plan that follows the Person Centred Plan approach and makes them the central focus of the planning. These plans are very comprehensive and include detailed information on the resident’s needs and personal goals. The plans were seen by the Inspector to be reviewed every at least once every six months. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 13 The home’s manager told the Inspector that resident’s risk assessments have been completed with the support of L. B. Kingston’s Psychologist of Learning Disability at the Rose Lands clinic. The home manager stated that a section of the resident’s Lifestyle plans entitled “My Safety and My Security” is where they discuss risks to themselves. 2 of the 3 residents files were inspected and all the appropriate documents required in Schedule 3 were held on these files. It was also evidenced that appropriate risk assessments had been completed for service users covering all aspects of potential risks to them. Standard 7 - The Inspector found evidence to suggest that residents are enabled wherever possible to make decisions about their own lives. Choices were seen by the Inspector to be offered to the residents to do with many aspects of their daily lives including choice of menu, activities, holidays, what to wear, when to get up and when to see their friends or families. This was also supported by evidence seen in the residents file review and by staff interviewed by the Inspector. Standard 9 - Risk assessments have been completed and were seen by the Inspector to be held on file for the residents. These risk assessments are part of the resident’s plan; they have been agreed with the relevant professionals and the residents where possible. The risk assessments seen by the Inspector detail actions which must be taken in order to minimise potential risks and hazards for residents and yet support them to be as independent as possible. Ashington House DS0000013378.V342048.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): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for the personal development of resident’s are provided through the care planning process in operation within the home. Programmes have been developed to encourage and develop resident’s skills wherever possible. Resident’s are able to take part in appropriate leisure and other activities some of which are part of the local community. They are also encouraged to maintain appropriate relationships with their families and friends. There is strong emphasis in the home on respecting resident’s rights in all aspects of daily living. The menu is varied, offers choice and provides a healthy enjoyable diet. EVIDENCE: Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 15 Standards 12 & 13 – The acting Manager told the Inspector that because of the high level of the residents needs and their dependency on staff for support, residents are not able to take full and independent involvement in community activities. Interviews with residents and staff identified that one resident who is more able, is involved in some local activities such as going to Church, fairs and other local events. The Manager informed the Inspector that residents are registered to vote in elections and are supported by staff to do so if they wish. However staff interviewed by the Inspector also reflected the difficulty in encouraging and motivating some residents to take an active part in this and other activities. Standard 15 – The Manager told the Inspector that families are encouraged wherever possible to engage in the support of their relatives who are resident in the home. This view was supported by relatives who fedback to the Inspector very positively about their relationships with the home’s care staff. There are no restrictions made on visiting hours for relatives or residents. Relationships with the neighbouring community is good and the acting Manager told the Inspector that she works hard on maintaining good communication with them. Standard 16 - Policies seen by the Inspector to be established within the unit ensure that resident’s rights to privacy, respect and dignity are respected. Residents who were interviewed also confirmed that they felt staff respected these rights. This view was again supported by feedback information the inspector received from relatives of the residents. The Manager informed the Inspector that residents do not at present have locks on their bedroom doors. The high dependency needs of the residents precludes this from being a safe option, however a risk assessment had been carried out for each resident in this respect that supported the position taken on door locks. Resident’s mail is unopened, the resident’s preferred form of address is used by staff and staff do knock on their doors before entering. The Inspector observed staff to be interacting with residents in a friendly and respectful manner. Standard 17 - With regards to meals and meal times there is a planned and varied menu which residents told the Inspector they enjoyed. The Inspector saw suitably planned menus for 3 weeks ahead. Specific needs are catered for and a visiting dietician is fully involved given the diabetic needs of one resident and the need for a weight reducing diet for another. A record is kept by staff of Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 16 all the food residents consume and this is seen to be a useful tool that helps staff ensure that residents have an appropriately healthy and varied diet. Ashington House DS0000013378.V342048.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): Standards 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care is carried out in a way that service users prefer so that dignity and choice are maintained. Following appropriate risk assessments service users are not able to retain responsibility for their own medication but are protected by the unit’s policies and procedures for medication. The physical, health and emotional needs of residents are being met. The home has sought and recorded the wishes of the service users and their relatives regarding death and dying. EVIDENCE: Standard 18 - The residents at Ashington House are able to express their Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 18 wishes and preferences with regards to the support they receive with their personal care. At this inspection the Inspector saw several ways in which this is achieved. Residents were seen to have a central role in informing their Lifestyle plans. These plans include the wishes and preferences of the residents which are outlined in detail alongside the care plan objectives. Lifestyle plans were seen by the Inspector on each of the residents file’s inspected. The Manager told the Inspector that each resident has their own keyworker and that residents regularly do discuss with their keyworker their needs and wishes for personal support. Residents interviewed by the Inspector were able to confirm this and said that they find the keyworker system helpful. In addition to this residents are able to discuss their needs and wishes with other staff as and when appropriate. Regular “in house” meetings are held and minutes of these were seen by the Inspector. These meetings have been well attended by the residents who have discussed a variety of issues important to them, such as holidays and outings, the menu planning and other in house issues about which they have been able to express their wishes and preferences and make decisions. Residents told the Inspector that they are able to choose when they get up and when they go to bed, what they wear, when they have a bath and what activities they want to do during the day. The Inspector saw this in practice over the day of the inspection where residents were actively engaging in this way with staff. There was also clear evidence of the residents having access to other key professionals who are able to support their needs and with whom they have a participative relationship. Whilst the inspection was in progress an OT was working with a resident to ensure that his aids and adaptations were appropriate for him and the Manager told the Inspector that other professionals such as nurses and care managers also provide regular input to the care of the residents. Evidence of this was seen on the daily notes and care plan reviews held on the resident’s files. Service users families wishes for the service users upon death and dying are now recorded in the service user Lifestyle plan files. Standard 19 - The Manager informed the Inspector that the healthcare needs of residents are assessed and reviewed regularly as a part of the care planning process. This was supported by evidence on resident’s files. All service users do have access to the full range of healthcare professionals thereby ensuring that their needs are being met. Resident’s health checks are usually undertaken by the GP within the home. Standard 20 - The Inspector reviewed the medication records (MAR sheets) together with a senior member of the staff group and no errors were found. 2 Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 19 members of staff have daily responsibility for supervising medication administration for the residents who have been assessed as being unable to administer their own medication. The Manager informed the Inspector that staff have all been involved in discussions about the importance of following the policy on the administration of medication within the home and have received appropriate training on administering medication. A stock take check of the medications held in the home showed that the medication records do accurately reflect the current medication stocks. An appropriate locked metal cupboard is provided for the resident’s medications. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 20 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 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s views are both listened to and where ever possible acted upon at Ashington House. They are protected from abuse, neglect and self-harm by the policies and procedures of the home. EVIDENCE: Standard 22 – During the course of this inspection the Inspector spoke to 2 residents. Both confirmed that they feel their views are listened to and acted upon. A copy of the complaints procedure is made available in the Statement of Purpose and in the Service User Guide so that residents, families and other representatives know the procedure to be followed and would be able to do so if required. Staff interviewed confirmed to the Inspector their awareness of the complaints process and the Manager confirmed that the whole staff group take any issues raised by residents seriously. The Inspector looked at the complaints procedure for the home and can confirm that the procedure is properly constructed and includes all the necessary elements such as timescales and who to contact, including the CSCI with all the appropriate contact details. The complaints record was reviewed by the Inspector and no complaints had been made since the last inspection visit. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 21 Standard 23 - The home has an adult protection policy and the Manager informed the Inspector that the majority of the staff group had received appropriate training recently. New staff that have joined the staff team in the last 2 months are enrolled for this training this year and evidence of this was seen by the Inspector. This was also confirmed by the member of staff interviewed and this means that resident’s should be protected from abuse, neglect and self-harm. The Inspector saw the allegation of abuse record; no allegations had been made since the last inspection. The Manager confirmed this to the Inspector. The Manager informed the Inspector that the home does look after resident’s monies and explained that there is a record of all transactions which is signed by the resident and staff at the time of the transaction. All monies are stored securely. The Manager also explained that she does a monthly audit of these finances. Appropriate records supporting this were seen by the Inspector at this inspection, with no concerns being raised. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and staff are now asked to sign to say that they have read and understood the policies and procedures. This should help to ensure that staff are aware of and are operating within the unit’s policies and procedures. An inventory of residents belongings is taken when they come to live at the home and this is now being maintained and kept up to date by key workers for all residents’ valuable belongings that are kept in their bedrooms. The Inspector checked these records. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 22 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): Standards 24 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents can feel confident that they live in a safe, well-maintained, hygienic and clean home. The bathrooms and toilets provide sufficient privacy to meet the resident’s individual needs. EVIDENCE: Standard 24 – The Manager explained to the Inspector that the home does offer planned respite / short term care for a specified period to the same person every year. He has his own bedroom but otherwise shares the other facilities in the home. Other residents are said to be quite happy with these arrangements. Over this inspection, the Inspector saw all the rooms in the home in order to check that it provides a safe and well maintained environment for its residents. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 23 The standard of décor was seen to be reasonable, it is clean and bright and residents are able to choose the colours and decoration for each of their bedrooms. Residents were seen to have their personal possessions arranged as they wish in their bedrooms. The communal areas such as the dining room and the lounge, bathrooms and toilets are also in a fair state of decoration and the overall impression provided is one of a well maintained and clean home. There are 3 bathrooms / toilets for the unit, 1 of which is ensuite and is wheelchair accessible. The garden is accessible to the residents and is well kept and has a pleasant well-maintained feel. The last report undertaken by the LFEPA was in April 2006 and this identified 3 requirements. The Manager confirmed to the Inspector that these requirements have now been met and the Inspector toured the building with the Manager to check these areas and can confirm they have been satisfactorily met. The Manager explained to the Inspector that they are awaiting a letter from the LFEPA confirming their acknowledgement that these requirements have now been met. The Manager told the Inspector that the Environmental Health Officer last visited on 29th January 2007 and made one recommendation about ensuring the thermometer probe registers the correct readings by inserting the probe in both boiling and frozen water and checking the readings under these conditions. The Manager said that this is now being carried out by staff regularly. At the last full key standards inspection in May 2006 a need was identified for a regular maintenance person who would be able to ensure that general maintenance repairs be addressed regularly. The Manager told the Inspector that 2 days a week have now been allocated for the handyman at Ashington House and that this has made a huge difference in that repairs are now being addressed before work required to be done becomes a hazard. The last check on the unit’s fire equipment found everything to be satisfactory, Fire and Security Ltd undertook this on 28th April 2006. Emergency alarm systems were all checked on 15th March 2007 including the fire alarm, automatic door releases and the nurse call cords and all were found to be satisfactory. A check on water temperatures found both hot and cold water to be within the recommended temperature levels. The unit’s fridge however is faulty and is unable to maintain recommended temperature levels and should be replaced. The Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 24 Manager explained that a new fridge has been ordered and should arrive as a replacement by the end of the week. A satisfactory test was carried out on the unit’s water storage facilities for legionnaires disease in January 2007. Standard 30 – The Inspector was shown by the Manager the home’s policy and procedures on infection control. This contains all the relevant information and legislation on infection control and should provide good guidance for the staff in ensuring high standards are maintained in the home. The Manager also told the Inspector that training is provided to staff on a regular basis and that infection control forms part of the induction training for all new staff. The laundry floor was seen to be impermeable and the walls and floors are readily cleanable. Staff told the Inspector that they are provided with appropriate equipment to do the job. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 25 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): Standards 31, 32, 34, & 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An appropriate recruitment policy and induction process helps protects residents and ensure that they are supported appropriately. Residents are now better supported by the staff team given that they: • have now been issued with new Job descriptions, • have now reviewed all the units policies and procedures and signed to say that they have understood them and are willing to work within them, • have completed the current training programme that they are undergoing. Emphasis must continue to be placed on recruiting staff with experience of working with service users who present with challenging behaviour so ensuring service users benefit from having a consistent approach to their needs. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 26 EVIDENCE: Standard 31 - At this inspection the Manager informed the Inspector that 4 new staff have joined the staff team since the last inspection. The Inspector examined each of the new staff files and also one of the existing staff group files. All the required documents were found on these files. Following a recommendation made at the last inspection it was positive to see that all the Job Descriptions (JDs) had been revised and that staff had received copies of them thereby helping to ensure that staff are clear about their roles and responsibilities. At the last inspection the review of staff files did show that staff had not signed to say they had read the units policies and procedures. A requirement was therefore made for the Manager to ensure that staff are given specific time to read and discuss the policies and procedures and then subsequently to sign to say they have read and understood them and are willing to work within the scope of them. At this inspection the Manager told the Inspector that since the last inspection this requirement has been met. All staff have been asked to read and review the home’s policies and procedures and have signed to say that they have read and understood them. Evidence of this was seen on the files inspected. Also staff were able to confirm to the Inspector that they had done so and had had the chance to discuss the policies and procedures with their supervisors. The Manager said she does also check from time to time on the staffs understanding of these policies and procedures. The Manager told the Inspector that the home does not recruit volunteers. Standard 32 - Staff confirmed in their interviews with the Inspector that they have completed relevant training courses such as in the protection of vulnerable adults, health and safety, medication, secure care and risk assessments. Evidence of training undertaken by staff was also seen on staff files. At the last inspection existing staff were all near to completing their NVQ level 2 training which the Manager thought would be completed at the end of June 2006. The Manager informed the Inspector that this has now been completed and it should mean that staff have all the appropriate skills to undertake their roles and service users should benefit from this. The Manager told the Inspector that the 4 new staff members who have recently joined the staff group would be undertaking their NVQ level 2 training this year. The Inspector explained how during the course of this year all care Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 27 staff are required to hold an NVQ at level 2 as a minimum. Staff interviewed by the Inspector confirmed that they were expecting to receive NVQ training this year. The Manager informed the Inspector she has since the last inspection completed her training as a Registered Manager and has also submitted her application for registration as a manager to the Commission. She is currently awaiting approval. At the last inspection it was recommended that a copy of the General Social Care Council’s Code of Conduct be issued to all staff. The Manager told the Inspector that this has since been done. This was confirmed by staff and evidence of a copy of the code was seen on each staff member file that was examined. Staff were seen by the Inspector to be friendly, supportive and approachable to the service users. Standard 34 - There is in place a recruitment policy and staff files evidenced that suitable application forms are completed, that 2 references are obtained including one from the last employer. All staff files except 1 reviewed by the Inspector evidenced that proper CRB checks have been carried out for staff employed within this unit. Equally that all other documentary evidence required to be gathered for staff was seen to be held on the staff files reviewed. In the case identified a full and enhanced CRB had been obtained by the care group that owns Ashington House when the staff member worked in another of its homes. However in order to properly meet the requirements the Manager should ensure that a new CRB is obtained for this new member of staff at Ashington House. The Manager told the Inspector that this was understood and that a new CRB has indeed been applied for and is expected in due course. For this reason this has not been identified as a requirement that in other circumstances would be the case. The Manager informed the Inspector that where possible residents play a part in the recruitment of new staff. A part of the recruitment process for new candidates is to meet residents and there is a chance for residents to provide feedback to the recruitment panel. Standard 35 - The Manager informed the Inspector that a structured induction programme is offered to new staff and documentary evidence of this was seen by the Inspector and supported in the interview of a new staff member. The Inspector at this inspection interviewed a new member of staff who was able to confirm that she had received the induction training and that it had been a Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 28 useful source of information about safe working practices; her own role as a support worker and in effectively meeting the needs of the residents. The Manager told the Inspector that staff are offered regular training opportunities in the following areas: • Fire safety • Moving and handling • First aid • Food hygene • Health and safety • Specific training on LD • Managing challenging behaviours • Adult Protection • Safe handling of medication. Staff spoken to by the Inspector confirmed this so residents needs should be met appropriately by appropriately trained staff. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 29 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): Standards 37, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that they will benefit from a well run home. The home’s quality assurance process has not yet been fully developed and so residents cannot be fully assured that their views underpin all self-monitoring review and development by the home. The health, safety and welfare of the residents are being promoted and protected appropriately. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 30 EVIDENCE: Standard 37 - A requirement was set at the last 2 inspections that the organisation must appoint a manager to run the home and the Manager must be registered with Commission for Social Care Inspection. The Manager informed the Inspector that this application has since been submitted and she is waiting confirmation of her registration from the Commission. The Manager told the Inspector that over the last year she has updated her training in the following areas: 1. Manual handling 2. Autism 3. Mental Capacity Act awareness 4. Challenging behaviours 5. Valuing people 6. Providing activities for people living in a care setting. The Manager showed the Inspector her job description, which does support her in her duties. Standard 39 - During this inspection the Inspector asked the Manager about the quality assurance process being used within the home and how this had been progressed over the year since the last inspection. This is important at it will help assure service users and their representatives that their views underpin all service improvements and developments made by the home. The Manager informed the Inspector that a feedback questionnaire was provided to the residents and their relatives in January this year however the Manager told the Inspector that other sources of potential feedback have not been sought out e.g. from visiting professionals to the house, such as GPs and nurses. It is strongly recommended now that this should now be used to seek their views about the services offered by Ashington House. Once received this information together with the other feedback information could then be analysed by the management team to build on and improve these services. It would be useful if this information were included in the business and annual development plan for the home. Standard 42 - Policies were seen by the Inspector for Health and Safety; fire; moving and handling and risk assessment relevant to the unit. The Manager informed the Inspector that all staff have been asked to read these policies and procedures and sign to say that they have read, understood and are prepared to work within them. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 31 Most of the staff have received training in moving and handling; fire safety; first aid; food hygiene and infection control. The Manager should ensure that all staff have undertaken recent training in these areas. Food temperatures are taken and recorded for every meal. Appropriate records were seen by the Inspector Fridge and freezer temperatures are tested daily and records kept were seen by the Inspector. Hot water temperatures are being regularly tested (last tested 2.6.07) and records seen by the Inspector can confirm that temperatures have all been within the accepted ranges. Up to date certificates were seen for the appropriate checks and requirements within Standard 42 of “safe working practices” • Boiler – 16.6.06 • Electrical systems check is now due • Fire alarms and all fire prevention systems and equipment – 15.3.07 • Emergency lighting tested – 16.3.07 • Portable electric appliances – 4.07 • Legionella water test – 4.1.07 • Nurse call system is checked weekly and last overhauled on 2nd June 2007 • A general buildings health and safety check is undertaken by the Manager regularly and a record of these checks was seen for April 2007. Weekly fire alarm tests are being carried out and these checks are recorded on paper appropriately. The home has self-monitoring systems in place such as internal audits and regulation 26 visits. There are regular residents meetings and it was very evident from the minutes that they are given an opportunity to express their wishes and concerns at these meetings. The Manager told the Inspector that all incidents and accidents are recorded in a record book. The Inspector saw evidence of this. Incident and accident forms are used, the last was recorded in May 2007 and was satisfactorily resolved. Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 32 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Ashington House DS0000013378.V342048.R01.S.doc Version 5.2 Page 35 - 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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