Inspection on 09/08/05 for Ashlee Lodge

This inspection was carried out on 9th August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashlee Lodge 21/11/06

Ashlee Lodge 14/02/06

Ashlee Lodge 03/02/05

Ashlee Lodge 03/08/04

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Insight - Eastchurch

Southfields

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

CARE HOME ADULTS 18-65 Ashlee Lodge 5 Jameson Road Bexhill on Sea East Sussex TN40 1EG Lead Inspector Mike Flint Unannounced 9th and 11th August 2005 10:00 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 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 Stationary 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. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ashlee Lodge Address 5 Jameson Road Bexhill on Sea East Sussex TN40 1EG 01424 220771 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashlee Lodge Limited Lindsey-Anne Baker Care Home 5 Category(ies) of Learning Disability (LD), 5 registration, with number of places Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated may not exceed five (5) 2. That the category of registration may be learning disability with challenging behaviour, not falling within any other category 3. Service users must be aged between eighteen (18) and sixty-five (65) years on admission Date of last inspection 3 February 2005 Brief Description of the Service: Ashlee Lodge is a large detached Victorian house, providing residential and social care for adults with a learning disability and potentially challenging, or self-injurious behaviours. The home was re-registered in June 2004 under the ownership of the parent company, Allied Care Limited, which owns a large number of similar care homes, in the Southeast region. The home is registered for five people. Residents private rooms are on the first and second floors. There are sufficient communal spaces, including a spacious lounge, dining room a sensory room and bathroom facilities on each floor. The home is located in a quiet residential area of Bexhill-on-Sea, within easy walking distance from the shops and seafront. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during two mornings in August, when there were five residents present, each of whom presents with challenging behaviour. Due to an unplanned staff absence on the first day and the nonavailability of relief cover, the inspection was cut short, to avoid disruption to the service. On duty were two support workers and the deputy manager, who were each engaged in supporting residents. On the second visit, the manager was present and satisfactory staffing levels enabled the inspection to be completed. On each occasion the Inspector spoke briefly with one of the residents, who expressed enthusiasm. Positive comments regarding the home’s performance under the present management have been received from members of the Community Learning Disability Team, who are regular visitors to the home. What the service does well: 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. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 7 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 standard(s) 2, 3, 4 People who are referred to the home are fully assessed enabling decisions to be taken in respect of the home’s ability to meet individual resident’s needs. EVIDENCE: The records inspected showed that thorough pre-admission assessments are carried out. The Inspector understands that much care is taken to ensure the compatibility of any new resident, with the existing group. All parties involved are consulted with before any decisions are taken e.g. next-of-kin and caseworkers. Psychological and social care assessments are included as part of the process, prior to admission; this usually being for a trial period, following visits to meet with other residents and staff. The residents’ care planning documents show that individual needs are regularly reviewed and daily report sheets are completed. Where there are specific health care need, residents have received on-going support from medical consultants e.g. in the case of epilepsy. Workers from the Community Learning Disability Team provide therapeutic support and advice to the home. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 8 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 standard(s) 6, 7, 8, 9 The staff have a good understanding of the residents’ support needs enabling pro-active relationships, between staff and residents. EVIDENCE: The restricted abilities of most residents to comprehend/ communicate precludes meaningful discussion with them regarding their care needs and how these are to be met. Wherever possible, encouragement is given to indicate preferences and make choices through the use of pictograms and symbols. The manager said that body language also played an important part in staff understanding the residents’ wishes. One of the service users, only, is able to make decisions about her weekly programme. Nevertheless, the rights of each resident are protected with their being involved in decisions concerning everyday choices e.g. what to wear, meal choices, activities and bedtimes, with staff support as needed. Daily routines are agreed in the context of the detailed risk assessments that are recorded as part of care planning.Within their capabilities, residents are encouraged to participate in the day-to-day running of the home e.g. with simple household tasks, cleaning and laundry. During handovers and at staff meetings, the introduction of any proposed changes is discussed, in response to residents expressed, or perceived needs. The home operates a ‘keeping track’ system. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 9 Staff are trained in care planning and risk assessment. All individual risks are assessed in a continuous process that ensures unacceptable risks are avoided. This comprehensive system of risk management was well documented within each resident’s care planning documentation. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 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 standard(s) 11, 12, 13, 15, Links with the community are good, supporting and enriching the residents’ social lives and their opportunities for recreational activity. EVIDENCE: Residents have opportunities to maintain and develop their social, independent living and communication skills e.g. swimming, bowling and shopping. They are also encouraged to attend the local Gateway and Saturday morning clubs. Staff support residents to become part of, and participate in, the local community in keeping with the individual care planning e.g. shopping, road safety and keep fit classes. Wherever possible, the home identifies and arranges enjoyable, varied and worthwhile activities on an individual basis for the residents e.g. household tasks. The Inspector was shown weekly sheets that demonstrated a range of varied and stimulating activities. A ‘Towards Independence’ course at college plus some paid office work has been arranged for one of the residents, who is being prepared for a move out of residential care, into supported living. Visits to the home by family members, or friends are encouraged. Residents next-of-kin are invited to attend care plan review meetings and when there is a party being held at the home. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 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 standard(s) 18, 19, 20 The health needs of residents are well met with evidence of good multidisciplinary working with the Community Learning Disability Team. EVIDENCE: The care plans inspected show that residents’ individual care needs are well documented. Personal care was observed being offered discreetly to residents, each of who were being treated with dignity and respect by staff and given encouragement to maximise control over their own lives. Care planning reviews are well documented and ensure that resident’s changing needs are responded to. The residents’ health care needs are monitored with appointments being arranged for specialist advice, dental treatment, chiropody and sight tests, which all take place out in the community. The manager confirmed that where a residents’ challenging behaviour created difficulties, health checks were necessarily carried out under sedation. None of the residents have control over their own medicines. The Inspector was told that a recent review and change of medication had greatly improved the behavioural difficulties for one of the residents. Another had been discharged after seven years, under the care of a specialist medical consultant. The homes policies and procedures for the administration, recording, storage and handling of medicines is satisfactory. A representative from the dispensing pharmacist visits regularly and provides training for staff. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 22, 23 The home has a satisfactory complaints system with some evidence that residents feel their views are listened to and acted upon. EVIDENCE: The home has a complaints book for issues raised by residents, or visitors to the home. There is a more formal procedure for dealing with complaints, requiring investigation. Details of a staffing issue that required an internal investigation were reported to the Commission (CSCI) recently. The home also records and deals appropriately with any public concerns, regarding residents’ behaviour, when out in the community. There is a policy and procedure concerning adult protection and the use of restraint. Staff have recently received training in conflict management as part of their mandatory training. Police/CRB and POVA checks are carried out for all new staff employed in the home; the staff files inspected confirmed this. None of the residents is able to manage their own finances. The manager, deputy manager, or senior staff have responsibility for administering individual pocket money; satisfactory records are kept of all transactions. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 24, 25, 28, 30 The overall standard of the environment within this home is satisfactory, providing residents with a safe and homely place to live. EVIDENCE: Ashlee Lodge provides a domestic-style household for up to five residents, which is safely maintained by an employed maintenance man. The home has a congenial atmosphere and is kept clean and hygienic by the support workers with assistance from residents, where this is their choice. The garden is also well maintained, safe and accessible. Fire safety records were satisfactory. Accommodation is arranged with bedrooms on the first and second floors; communal areas, on the ground floor, include a spacious lounge and dining room. It has been recommended previously that improvements be made in the dining room to make it more homely. The manager confirmed that new furnishings for the dining room and lounge were being considered in the context of resident comfort and safety. Some improvements in the kitchen are to be recommended also, were the fitted units, worktops and floor coverings are heavily worn. The on-site laundry facilities are satisfactory. There is a programmed of on-going redecoration, with several areas already completed. The home has a sensory room, which is frequently used for supervised therapy sessions and for calming residents, who become agitated. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 14 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35, 36 Staff morale appeared good resulting in a committed workforce that works positively with residents to improve their quality of life. EVIDENCE: Staff duty rotas show staffing arrangements to be satisfactory and in keeping with the needs of residents. Additional staff hours are employed, on occasions when this has been necessary in maintaining a safe environment. The staff employed bring a range of qualities and experience to the home; records showed that satisfactory recruitment procedures are followed. The deputy manager confirmed that nine of the staff have already gained, or are working towards their National Vocational Qualifications in care, or management. The attitude of staff, observed during the inspection, towards residents was attentive, calm and professional. The manager said that three full-time support workers were to be recruited, where staff vacancies existed; there appeared to be good team spirit amongst those staff spoken with. Staff receive contracts and detailed terms and conditions of their employment. The home has a staff-training plan, which includes the Company’s mandatory skills training and other training to meet the National Training Organisation’s targets. Individual staff supervisions take place and there are regular staff meetings. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 15 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, 42 The home provides sound management and effective organisational support, which ensures the safety and wellbeing of residents. EVIDENCE: The manager is suitably experienced and competent to run the home, and is currently working towards the NVQ at level 4 in Management and the Registered Managers Award. Comments received, prior to the inspection, reflected favourably on the manager’s approach; staff spoken with said they felt well supported. Quality assurance measures for the home are of a high standard; a senior manager carries out detailed monitoring of the home’s performance on a monthly basis; survey questionnaires have been prepared for distribution to residents’ families and other visitors to the home; an annual development plan has been produced. During the inspection it was apparent that the home’s management is continuing to make positive improvements in the home’s performance, in terms of quality of care. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 16 The home’s written policies and procedures are those of the Allied Care organisation. These are comprehensive, well documented and reviewed at least annually. Record keeping in the home is of a high standard, as was evidenced by the records inspected concerning residents and staff, which were well presented and up to date. The Organisation places an emphasis on staff training in safe working practices and there was evidence that the manager ensures staff undertake the training, relevant to their work e.g. recent training has included managing challenging behaviour (SCIP), first aid, food hygiene and manual handling. Risk assessments are completed for safety procedures, including health and safety and fire safety; a recent example, prepared by the manager, was in respect of minimising risks to a pregnant support worker, whilst on duty at the home. Although the growth of the parent organisation is rapid in its acquisition of care homes in the south east of the country, the management and administrative infrastructure appears to be keeping pace with the programme of expansion. Weekly visits to the home are undertaken by one of the company’s Directors. The manager said that these visits were valued and contributed towards good morale in the home. Ashlee Lodge H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 17 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x 2 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashlee Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 4 3 4 3 3 H59-H10 S61465 Ashlee Lodge V237572 090805 Stage 4.doc Version 1.40 Page 18 yes 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 28 Regulation 23(2)(a) Requirement That suitable improvements to the furnishings, fittings and floor coverings are made, where necessary, in the communal areas, used by residents. Timescale for action 01.02.06. 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. 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