Inspection on 27/02/06 for Ashlea House

This inspection was carried out on 27th February 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashlea House 19/03/09

Ashlea House 04/09/08

Ashlea House 13/06/06

Ashlea House 15/08/05

Ashlea House 20/12/04

Ashlea House 25/05/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

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 Ashlea House Bockhanger Lane Kennington Ashford Kent TN24 9BP Lead Inspector Lois Tozer Announced Inspection 27th February 2006 09:30 Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 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 Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 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. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashlea House Address Bockhanger Lane Kennington Ashford Kent TN24 9BP 01233 643635 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) Nexus Direct Ms Judy Briggs Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Judy Briggs to have completed NVQ 4 in Care and Management by 2005. 15th August 2005 Date of last inspection Brief Description of the Service: Ashlea House is situated in a quiet part of Kennington, Ashford, in a semi-rural setting, but only minutes walk away from local amenities. A public bus service is available a short walk away, but the home has a dedicated car for service user use. Access to town is a short drive away. The home is registered to provide care and accommodation for a maximum of 3 people aged between 18 and 65. It is owned by Nexus Direct and is managed on a day-to-day basis by Judy Briggs. The service is set up to be of benefit to younger adults who wish to move into greater independence, and therefore the aims of the service are to provide a great deal of opportunities for responsibility taking and personal development. The home works closely with other Nexus Direct establishments and acts as a home that people aspire to live in. The property is a large, detached, building set in its own grounds. Bedrooms are situated on the first floor, as is the staff sleep in room, workspace, and the bathroom with shower cubicle and WC facility. The ground floor offers a separate WC, kitchen, dining room, large lounge. Access to the large, secluded, rear garden is via the kitchen door or lounge patio door. The garden features a pond. There is parking for a maximum of 3 vehicles to the front of the house. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 27th February 2006 between 09.30 am and 2.40 pm. The manager, Ms Judy Briggs was available throughout the inspection and offered assistance wherever required. There were 3 people living at the home, all service users gave verbal feedback. Paperwork seen included individual support plans, medication and administration documents, complaints information and the duty rota. Service users were involved with the day-to-day running of the home, and were planning activities for the afternoon. The home had many met standards at the last inspection, therefore the key standards that were not inspected were the point of focus. A lot of time was given to adult protection and restraint issues. What the service does well: Service users are all of similar age (18 – 20), and share similar interests. Decisions regarding the running of the home are largely down to the people living there, with staff support as required. All service users said that they all have their turns in doing practical things, like cooking, cleaning, shopping and making decisions about things that go on, such as group outings. Lots of consultation was evident as taking place, in the individual plan, between the home manager, care manager, relatives, and other people meaningful to the person living at Ashlea House. It is a house ethos that restrictions are minimal and that every person is encouraged to be responsible and think about the outcome of actions. Development of real life skills, practical, coping and negotiating, is very well supported. One people, having progressed with their life plan really well, was getting ready to move into their own flat, within the Independent Living Scheme. Another said that they really liked living at Ashlea House, but didn’t get on all the time with one other resident, but although they argued, understood that they both had responsibility in keeping the peace. Service users said that staff were lovely, other than the incident described below, felt that they could trust them and would seek their support with problems. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were inspected. EVIDENCE: Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 Service users have individual plans that have been written with their input and reflect their own goals and progress in life. Decision making is generally well supported, an area of improvement was identified. Service user consultation is very well supported. EVIDENCE: The individual plans are straight to the point and are written in an informative manner. Individual’s aspirations are clearly identified, and progress is monitored. As a ‘towards independence’ home, the plans really reflect the aims and wishes of the service users, who have guided the process. Decision making and consultation, around the home and in day-to-day aspects of life, is very much focused on encouraging responsible decision-making. Generally, service users are supported to deal with inter-peer conflict and to sort out their problems in a wholly adult and sensible way, however, an incident identified highlighted that particular staff were unable to this and created an avoidable situation, involving restraint. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15, Service users are supported to maintain relationships with friends, family and partners. EVIDENCE: The home and staff are very supportive in enabling service users to be in social situations to make friends and keep in touch. Personal and family relationships are supported. A recommendation that sexual educational, awareness and protection be sought through the care management system has been made. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Personal care is not often required, when it is, it is carried out to the specifications of service users. Healthcare and emotional needs are generally well met. There is little medication in the home, but some improvements for ‘as required’ medication is needed. EVIDENCE: All service users are able to support their own personal care. Staff would only support individuals if requested to specifically by the service user. There is a key worker system in place. Healthcare needs are documented, as are visits to healthcare professionals. Where at all possible, service users see practitioners alone and are encouraged to take responsibility for healthy living. Restraint issues, as described, do not support good mental health support. Very little medication is held in the home, however that which is in place needs better management. An ‘as required’ prescription medication was not labelled with any directions – it could have been anyone’s. There were no protocols in place to guide staff with pro-active strategies to lessen the need for the medication, and what type of behaviour (specifically) would necessitate the use of it. Homely remedies are recorded en-mass in a note pad, so these need to improve allowing each individual their own homely remedies record. Additionally, staff were also using paracetamol from the stock. It’s strongly recommended that the minimum amount of paracetamol is held in the home Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 12 and that a ‘count back’ system is in place to ensure accountability, and staff bring their own paracetamol. A medication journal needs to be in place, so side effects can be looked up, and staff who have medication administration responsibilities need to have suitable training. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Although service users said they felt that they could complain and be heard, staff behaviour has let service users down, and has not ensured that they are protected from abuse and self-harm. EVIDENCE: The complaints process is well known to service users, and they did say they felt they could turn to and trust staff to help them. One service user however had experienced physical restraint, and said it was ‘not nice’ and claimed bruising had occurred. This had occurred 1 month prior to the inspection and had not been reported to CSCI or Adult Protection. The incident report indicated that this could have been easily avoided. The staff member principally involved was the opposite gender to the service user and significantly bigger in stature. Staff who were aware that this had taken place, and were present at the time hold a senior role, yet did nothing to support the service user civil rights. A senior support worker should have qualities and experience that would raise this as a need to whistle blow on bad practice, but this did not happen. This is unacceptable. The incident has now been reported to Adult Protection and will be investigated. The manager must ensure that only suitable staff work with the service users and no time delay occurs in reporting future serious incidents. A full review of adult protection awareness, whistle blowing, policy and reporting procedure must take place. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 The home is comfortable and safe with a homely atmosphere. Bedrooms meet individual needs and lifestyles and promote independence. There are sufficient toilets and bathrooms. Sufficient shared space freely is available. No resident requires specialist adaptations. The home is clean and hygienic. EVIDENCE: The home is well maintained and very attractive, inside and out. Environmental problems are quickly fixed, such as the bathroom having a new floor, and the shower being fixed. The dining room ceiling is due for replastering after a water leak and the majority of the home will have a repaint and minor refurbishment in the spring. The people living at the home do a very good job keeping it clean and tidy. All bedrooms were seen and were personalised and people said that, at this moment in time, they didn’t want to change anything and liked their rooms very much. The communal furniture was of good quality and suited the home and service users. There are two toilets, the people living at the home have designated one as a visitors loo (downstairs), and use the bathroom themselves. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 In general, staff do support the aims and objectives of the home, and understand their roles, but recent events have let this achievement down. Staff have received a range of training but shortfalls exist, which are planned to be dealt with in the coming months. EVIDENCE: Service users were generally very complementary of staff and said they got on very well. Staff however have not been aware of their legal limitations when supporting service users, and have not acted appropriately post event to ensure that service users are protected (through swift reporting to enable investigation and possible recourse). There has been no adherence to whistleblowing. Some staff attitudes were of concern in relation to justification of an incident that had occurred. Some staff have received training in adult protection, but this has not sent a strong enough message, so needs to be reassessed. Medication training is needed, as is some health and safety training. The induction currently used is not LDAF accredited, and, in line with ‘Valuing People’, as well as NMS, should be. A training co-ordinator has recently been appointed to the company, and training provision is currently underway. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 The home has been well run, but recent events have not been processed in the way they are required to ensure the well being of service users. Service user views are incorporated in the running of the home, but greater centrality to individual’s civil and human rights is needed. Drawing out issues that could be easily hidden would better use the registered provider visits. Records are in reasonable order, and day events are documented, but some improvements are recommended. The home is environmentally safe. EVIDENCE: The manager, who as a registered person, takes overall responsibility of the home has been effective in ensuring service users have the opportunities they want and need to develop as people and to move on into the wider community, and eventually, away from care. The service users hold the manager in high regard. However, because the manager is so central to the running of the home, slips in reporting and dealing with serious incidents cannot be overlooked, and the reasons why this occurred must be examined to ensure it does not reoccur. The manager must ensure that all staff who are employed to work in the home are suitable, and have the right attitude. The responsible Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 17 individual for the organisation must also ensure that the right questions are asked to draw out possibly hidden issues. Improvement of the reports sent to CSCI is very much overdue. The service users have a lot of say in the way the home develops, but staff are rotated in and out of the service, and it is not clear how much say that they get in this. The promotion of rights (as well as responsibilities) must be central to quality assurance, and, looking to the future, the home must ensure it has the necessary tools in place to collect evidence for self audit, when the new ‘Inspecting for Better Lives’ is rolled out. Records are reasonably well maintained, however the duty rota could be more accurate by stating staff full name and delegation. Staff who have poor handwriting may benefit from access to a typewriter to make daily and incident report entries. The home is well maintained, and all service certificates are up to date. Fire logs and drills are conducted regularly, however fire fighting equipment stopped having regular checks in December 2005, when the sheet ran out. Shortfalls in mandatory health and safety related training is currently being addressed. Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 18 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 X 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 2 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 N/A 30 3 STAFFING Standard No Score 31 2 32 X 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 3 X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X 2 3 X Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard Regulation Requirement Dignity, complaints and adult protection policy and issues are reviewed, and staff sign up to abide by them. Whistle blowing policy to be reviewed and reinforced. All prescription items to have a pharmacist direction label stating the service user name. Homely remedies are recorded as given on individual sheets, and stock is accounted for. Staff cease using stock paracetamol. Behaviour guidelines are to be in place clearly describing when ‘as required’ medication is given. Obtain a medication journal, and keep it up to date. Staff receive suitable training. All staff to understand and abide by Regulation 37, Notification of Events Through training and other means, staff to understand and respect service users human and civil rights. Staff left in charge of the home to have the qualities that DS0000044974.V276008.R01.S.doc YA7YA22YA23 12 13 16 22 YA20 13 18 Timescale for action 01/04/06 2 13/03/06 3 4 YA22YA23 YA31YA35 18 37 13 17 18 19 24 01/04/06 01/04/06 5 YA31 YA39 13/03/06 Ashlea House Version 5.1 Page 20 6 YA39 26 promote the dignity and rights of the service users. Quality assurance process be reviewed to draw out any significant issues. Visits by the registered provider seek information from service users and staff that assures the provider there are no adult protection issues occurring within the home. 01/04/06 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 Refer to Standard YA6 Good Practice Recommendations In consultation with each service user, a clear indicator of how they like to be spoken to, to be supported when upset etc and a statement to say what they do not wish staff to do is kept in the individual plan. Seek sexual education, awareness and protection support for service users. Review Quality Assurance process to prepare for Inspecting for Better Lives. Duty rota to state staff full name and designation in the home. Staff who have hard to read handwriting have access to a typewriter. 2 3 4 YA15 YA39 YA41 Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashlea House DS0000044974.V276008.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!