Inspection on 04/09/08 for Ashlea House

This inspection was carried out on 4th September 2008.

CSCI found this care home to be providing an Adequate service.

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 2 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 13/06/06

Ashlea House 27/02/06

Ashlea House 15/08/05

Ashlea House 20/12/04

Ashlea House 25/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 04/12/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ashlea House Bockhanger Lane Kennington Ashford Kent TN24 9BP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Geoffrey Senior     Date: 0 4 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Ashlea House Bockhanger Lane Kennington Ashford Kent TN24 9BP 01233643635 01233643635 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Alan Edward Rogers,Ms Joanne Clare Rogers,Mrs Sharon Ann Colton,Mrs Sylvia Margaret Rogers,Mr Mic Name of registered manager (if applicable) Mrs Margaret Vanstone Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Ashlea House is registered to provide accommodation for up to 3 adults with a learning disability and admits people with low to medium dependencies. Nexus Direct (a partnership) operates the home.There is currently no registered manager.An acting manager is in day to day control. The service is set up to support younger adults to move into greater independence. It aims to provide opportunities for risk and Care Homes for Adults (18-65 years) Page 4 of 27 3 Over 65 0 Brief description of the care home 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 home is not suitable for people who have mobility problems. The property is a detached house 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 resident use. Access to town is a short drive away. All bedrooms are single occupancy. There is one bathroom / WC and a separate toilet. Information on the current scale of charges, previous reports and the action plan for improvements can be obtained from the home. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit undertaken on 4th September 2008 as part of the key inspection of the service. The visit lasted for about five hours. We spoke with the Manager, a staff member and two of the service users during the visit. We looked at a range of documentation and records. We also considered information forwarded to the Commission in the Annual Quality Assurance Assessment completed by the Manager. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Adults (18-65 years) Page 7 of 27 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their representatives may visit the home before admission and are provided with information to help them make a decision about moving in. Assessments are undertaken to ensure the home can support the service users needs. Evidence: There have been recent changes to the service user group at the home. Departures and admissions have been to or from other homes within the Organisation. These were initiated by service user request and by consideration of where is best suited to meet the needs of the individual. There are no changes to the existing admissions procedure. People who are interested in living at the home are invited to visit with their family and their representatives prior to admission. They may use the opportunity to meet and spend time with the existing service users and staff, view the accommodation and find out about the routine and lifestyle they could expect to experience at Ashlea House. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: Assessments are undertaken prior to, and subsequent to admission. The recently appointed Manager acknowledges the comments of previous reports. The assessments need to be included as part of the care planning process and she is currently working on changing the structure of the client files to ensure they are more relevant, specific and reflect the service user input. Service users spoken with indicated an awareness of their roles and responsibilities in relation to group living and personal development. They spoke of involvement in the decision making processes affecting their short term, immediate and longer term goals. The most recent admission already knew the house and staff and is pleased with the amount of personal space and levels of independence the regime affords him. Both service users have agreed targets for social and educational development and employment aspirations. It was understood that there have been no changes to the format and presentation of the service user agreements, guides or statement of purpose. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system is being developed to provide staff with clear and consistent information and guidance when supporting residents. Introduction of more person centred approach has led to aspirations being identified and realised. Risk assessments are undertaken in order that service users can participate in activities with the appropriate level of support and supervision. Evidence: The Manager is currently working on and updating documentation in order to have in place, better structured and more informative client files. The content is designed to help new and existing staff to better understand and effectively support the needs of service users. The emphasis in the care plan documentation is moving towards a person centred approach and guidelines will relate less to physical care of the individuals and more on supporting social, educational and therapeutic goals and aspirations. Currently much of the staff practise is directed by verbal communication on shift or from staff meetings and handover periods. One of the two people who live Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: at the home said he had a clear idea what was in his plans and that the staff knew what his long-term goals and dreams were. The other was less certain but felt that the staff listened to him and supported him in things he both wants and needs to do each day. Risks are viewed positively by the home and assessments are undertaken in order that service users can participate in activities with the appropriate level of support and supervision. Risk assessments have been updated and service users are asked to contribute with their perception of the risks involved in any particular activity. Daily records note the completion or otherwise of support tasks identified in care plans and cross-reference with the activity-planning chart. They may benefit from service user input about what the person did with their day and what they got out of it. Service users are helped to make day-to-day decisions affecting their lives with regard to activities, outings, routines and food choices amongst other things. Service users were observed expressing preferences and making choices. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to participate in a variety of in house and community based activities chosen by them. The meals in the home offer service users choice, variety and consider any special needs. Service users are supported and helped to maintain contact with families and friends. Evidence: Staff in the home have worked positively with the service users to establish interests, likes, dislikes and abilities. Each service user has devised, with support, a weekly planner that they follow. This provides continuity for their routines and incorporated are tasks and activities that will encourage and boost their self confidence and independence. Service users are able to request activities that they would like to do daily, if adequate staff and monies are available then this will be arranged and implemented. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: Service users choose 2 meals a week that they then cook for the rest of the house with appropriate support from staff, they also have an independent cooking day where they choose what they would like to eat, estimate the cost, purchase from the shop and then cook the meal for themselves. Staff record and monitor their progress and level of support. Service users are supported to take part in many community activities. These include cinema, pub trips, day outings, theme parks, libraries and local leisure centres. Individuals are encouraged to participate in specific areas of interest. One is part of a local football club and plays in matches as well as training. Individuals where possible are encouraged to use public transport , buses and trains, timetables are available in house. Support to obtain further education, paid employment and activities away from the home is good. One person hopes that a placement whilst at college will lead to paid employment. All get to go out into the community, meet up with old friends and go on holiday. People go to see their families (or have them visit at the home), which staff support. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are treated with respect and their privacy is respected. Healthcare needs are appropriately addressed. Medication systems address the storage, administration and recording requirements. Evidence: Service users are encouraged to express preferences they may have about their personal care and support, lifestyle and daily routines. Records seen indicated that service users health care needs are monitored and addressed. Various health professionals are involved with the service users and are contacted for advice and consultation as necessary. Key workers ensure that regular doctors, opticians and dentist appointments are arranged and attended. A chiropodist visits every 6 weeks. Outside facilitators support the service users. A Behavioural Psychotherapist visits every 2 weeks and a Psychologist visits every month. The medication records and storage facilities are adequate for the immediate needs of the home. It was recommended that the store cupboard is more securely affixed to the wall. Service user self management of medication is currently limited to individuals Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: being encouraged to ask for it when it is time, and reminded if they forget. They are asked to double sign the medication when it has been administered. Records were clear and up to date. The Manager reported that all staff that are involved with medication have received training. It was recommended that staff competency assessments are undertaken and recorded for all those involved in dealing with medication. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to protect the service users from the risk of harm. Significant incidents and actions should be fully documented to safeguard service users and staff. Evidence: Staff have received protection of adults training and written information is available to them. Staff spoken to were clear about their responsibilities with regard to protecting people in their care. Service user comments include feeling safe in the house and being able to talk to staff if they are worried or unhappy about anything. They were aware of who to talk to and their right to be heard and responded to. The Manager confirmed that, as a new manager into Ashlea House she checked service users knowledge of the complaints system and who they would speak to. They spoke about the procedure and were aware of the location of CSCI address and telephone number. She reminded service users that they contact CSCI at any time they feel necessary, but essentially concerns and complaints may be bought to her attention in the first instance. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are offered a comfortable, homely and safe environment in which to live Evidence: The premises are comfortably furnished and well decorated. It is bright and homely and there is an adequate amount of communal space with a large lounge and dining area. Service users rooms are decorated and furnished according to choice and have personal items on display. Service users may have their own key to their room if they wish. The garden is accessible and well maintained. Information received prior to the visit indicated that maintenance and service checks are satisfactory and up to date. Care Homes for Adults (18-65 years) Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a positive and friendly atmosphere in the home. Staff ands service users interact in a non patronising and positive manner. Most staff have attained NVQ to at least level 2 but would benefit from further input to be able to meet the support needs of specific conditions. Evidence: The staff on duty clearly knew the service users well and how to respond appropriately to them. There was a good deal of friendly, non-patronising banter observed. The currently small group of service users and staff means that there is often opportunity for one to one support for general activities and for identified personal development goals such as travel training and orientation in the community. With lower numbers of service users in the house at the moment there are usually two staff working each shift and staff on the premises overnight. The Organisation offers a staff development programme. Staff are supported through the induction process which should then be followed by mandatory training. There are six staff members,4 have attained NVQ level 2 or 3. Given that there are no dedicated catering staff and service users are supported to prepare meals, the number of food hygiene trained staff is very low. There was indication of some training input relating to the diverse needs of the service users but this was again limited in range and Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: attendees. Staff recruitment procedure includes obtaining satisfactory references and Criminal Record Bureau checks. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is commited to improving the home and has a positive attitude to the development of the service. Checks are undertaken to promote the safety and well being of all at the home. The Registered Provider needs to visit and report in order to fulfil the requirement of Regulation 26. Evidence: The manager presents as a well-motivated and informed individual who has worked hard to develop an open and inclusive atmosphere in the home. She is seeking to commence RMA NVQ 4 in Care and is also keen to promote appropriate and relevant training for her staff. A statement is requested from the manager relating to seeking registration as Manager. Registration is the process, through which the Commission for Social Care Inspection (CSCI) assesses whether those who wish to operate services for adults are suitable to do so. The manager organises her work so that she can spend a reasonable amount of time Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: with the staff and service users as well as the completion of administrative and supervisory tasks. The home should be visited on a regular basis by the provider. There were no records of visits for the three months preceding the Inspection visit. The provider is reminded of the requirement to visit, unannounced, at least once a month and prepare a written report of the visit in accordance with Regulation 26. Reg. 26 visits and documentation are a requirement for quality assurance, and is an offence not to comply. As this continues to remain outstanding, enforcement action may be taken. The AQAA made mention of Quality Assurance in the form of service user questionairres but there was no information available as to the responses and outcomes. Service users and staff stated however that they are regularly consulted and have ample opportunity to contribute to the decision making process. The staff feel that the home is run in the best interests of the people who live there. The health, safety and welfare of all is promoted and protected. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 39 26 (1-5) Visits by the registered 12/09/2007 provider must take place monthly and be documented with a copy kept at the home at all times. Care Homes for Adults (18-65 years) Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 32 18 so service users have better development opportunities, staff trainingto reflect the assessed needs, i.e. autism, communication difficulties. No significant input since last report 30/01/2009 2 39 26 visits by registered provider to take place monthly and be documented with a copy kept at the home and available for inspection. no significant improvement from last report 28/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The Manager agreed to ensure that assessment information is included and informs the care and support planning process. The manager agreed to ensure that the client files are up to date, relevant and accessible. Risk assessments to reflect current activities at Ashlea and to replace those referring to Page 25 of 27 2 6 Care Homes for Adults (18-65 years) previous placements. 3 20 Manager to check adequacy of staff medication training and to undertake competency assessments. Service user self medication management to be assessed. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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