Inspection on 29/06/07 for Ashley Close 1 & 2

This inspection was carried out on 29th 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashley Close 1 & 2 07/12/05

Ashley Close 1 & 2 07/07/05

Ashley Close 1 & 2 28/10/04

Ashley Close 1 & 2 28/05/04

Ashley Close 1 & 2 29/01/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Ashley Close 1 & 2 1 & 2 Ashley Close Bennetts End Hemel Hempstead Hertfordshire HP3 8EH Lead Inspector Claire Farrier Unannounced Inspection 29th June 2007 11:30 Ashley Close 1 & 2 DS0000019270.V341077.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 Ashley Close 1 & 2 DS0000019270.V341077.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. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley Close 1 & 2 Address 1 & 2 Ashley Close Bennetts End Hemel Hempstead Hertfordshire HP3 8EH 01442 258226 01442 258226 Ashleyclose2@walsingham.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) Walsingham Ms Pat May Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (12), Physical disability (9), of places Physical disability over 65 years of age (9) Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2005 Brief Description of the Service: Ashley Close was previously registered as two separate homes, both of which opened and first registered in 1996. In 2006 the two homes joined together and they are now managed as one home. Ashley Close provides personal care and accommodation for twelve people with learning disabilities. It is owned and operated by the voluntary organisation Walsingham. The home is part of a modern development in a very quiet cul-de-sac in a residential area in the Bennetts End district of Hemel Hempstead, close to local shops and amenities and two day centres. Each house has six single bedrooms for service users, in domestic style accommodation and suitable equipment to meet any special needs. The houses and gardens are fully accessible for the current residents. Staffing is provided twenty four hours per day. The Statement of Purpose and Service Users Guide provide information about the home for referring professionals and prospective clients. These and the most recent inspection report are available on request. The current charges were not available at the time of this inspection. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection since Ashley Close was registered as one home. The unannounced inspection was carried out over one day. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. We talked to as many of the people who live in the home as we were able to. We also talked to some of the staff. When we were in the home we looked at the home’s records, care plans and staff files, and we made a tour of the premises. We talked to the manager about what we had seen during the inspection. What the service does well: What has improved since the last inspection? What they could do better: There is very little that needs to be done to improve care and support for the people in the home. We made an immediate requirement during the inspection, when we saw a container of motor oil in an unlocked cupboard that could be a risk to the health and safety of the people in the home. It was removed immediately. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 6 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. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 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 Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in the choice of the home and in the assessment process. Staff have the knowledge and experience to meet each person’s care needs. EVIDENCE: One person has been admitted to the home since the last inspection, and the process of assessment and introduction to the home was underway at that time. The assessment involved the input of other professionals, and the person was fully involved in the process. The new resident is the youngest person in the home, with a gap of twenty years between them and the next youngest person. The care plan shows that the age gap is taken into account in the day services and leisure activities that the person takes part in. Since they moved in there has been a need to introduce measures for behaviour management and the Community Learning Disability Team had been involved in assessing how the person’s needs can best be met. The staff said that they have sufficient information and training to enable them to meet the needs of the people who live in the home. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are fully involved in all decisions about their lives in the home. The care plans are person centred and provide the staff with appropriate information to enable them to meet people’s individual needs. EVIDENCE: We looked at a sample of care plans in each house. The care plans are clearly written, with good details of everyone’s needs and procedures and guidelines for meeting those needs. The individual planner has been produced in a ‘person centred planning’ format. Entries are written in the first person and are complemented in some cases by photographs, pictures and symbols that illustrate the person’s personal preferences and how they are supported to make decisions. The staff spoken to said that the care plans provide them with the information that they need to support the people in the home. Appropriate risk assessments are in place, and these are also clearly written, with good Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 10 details of the risks involved and the measures needed to enable the residents to manage the risks safely. Most of the people who live in the home have limited communication, and residents’ meetings are not the most effective way for them to make their views known. Each person has a monthly one to one time with their key worker. The format for these one to one times includes the persons’ views on what they are doing, and what they think about the food and the staff who support them. There is communication with the day service that they attend, and their care plan and finances are monitored to make sure that all the information is up to date. Before the two houses were registered and managed as one home the key workers worked in different ways in each house, and the care plans also had differences in the information that they held. The staff teams in each house have been working towards a common procedure for key workers and for care planning. In one house the files seen were bulky and contained documents that may have been obsolete. It was also hard to locate the most recent updates, although it was evident that regular reviews had taken place. This is being addressed as part of the review of key working. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported to live full and active lifestyles. EVIDENCE: The staff support everyone to take part in their own choice of activities, either individually or in groups. The activities and outings that each person takes part in are recorded in their care plans, and the care plans include each person’s choice of activities. Most of the residents attend a day centre. Daily living activities are written in the care plan as goals. The staff support the people who live in the home to maintain family contacts and enjoy positive relationships with others inside and outside the home. They respect people’s privacy and support the residents to be as independent as possible. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 12 The menus are planned in consultation with the people in the home, and a well balanced, nutritious diet is provided. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident that they will receive a good quality of personal care and healthcare. EVIDENCE: The care plans that were inspected provide comprehensive details of each person’s personal care and health care needs, and a good relationship was observed between the staff and the people who live in the home. Detailed recording of each person’s health care includes health notes for hospital visits and contact with GPs and other medical professionals and appropriate monitoring of epilepsy. One person had support from a psychologist when their mother died. It is a concern that physiotherapy is no longer available from the Community Learning Disability Team. It is recorded as an unmet need for one person. Sound medication procedures are followed, using the Boots Monitored Dosage System that features pills supplied by the pharmacist in blister packs. Two staff administer medication and carry out a check of the system at each round. Very Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 14 clear instructions to staff on how to administer items to individual residents were held in the MAR (medication administration record) file. The system is effective and minimises the risk of mistakes. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are confident that their concerns are listened to, and that they are safeguarded from the risks of abuse. EVIDENCE: A satisfactory complaint procedure is in place; this contains the required information on how to complain and is available to all residents and their relatives. A simplified version has been produced using pictorial symbols designed to be easier for residents to understand. One complaint has been made on behalf of one of the residents, who was assessed to need a level access shower. The process for funding for the shower has finally been agreed following a lengthy process. One person made a complaint about the behaviour of another person. This was recorded, and the issues were discussed with both of them. The home has up to date policies concerning safeguarding adults (adult protection) that follow the Hertfordshire County Council inter-agency guidelines and a copy of the guidelines is kept in the office. All staff have had training in the prevention of abuse, and the subject is covered in the staff induction programme. Staff spoken with were aware of the general principles involved including the company’s whistle-blowing policy. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and well maintained environment for the residents, and the staff maintain a good standard of cleanliness. EVIDENCE: The home consists of two purpose-built bungalows, situated in a cul-de-sac in a residential area of Hemel Hempstead. Both bungalows are furnished and decorated in domestic styles that produce a homely, comfortable environment that allows the residents to relax and feel very much at home. The residents all have their own rooms, arranged and decorated to reflect their particular interests and tastes. The lounges, dining rooms and kitchens are domestic in style and are comfortably furnished and well equipped. Each bungalow has an enclosed garden with a patio area, lawn and flowerbeds. The home appeared to be clean and generally well maintained, and the staff follow appropriate procedures to maintain hygiene and prevent the risk of Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 17 infection. In the toilets in both houses hard soap is available as well as liquid soap. It was explained that some people are sensitive to liquid soap. However this does not comply with current guidance on infection control. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs. EVIDENCE: The staffing rotas showed that in each house there are two or three support workers throughout the day, and one during the night. At weekends there are usually three support workers in each house, so that they can support people to go out as they wish to. Agency staff are used when necessary, usually individuals who know the residents well and understand the way the home works. Some difficulties have arisen because Walsingham now uses only one agency, and the home no longer has a close relationship with local agencies that know their needs. Walsingham provides comprehensive training for staff that covers all mandatory health and safety training, and training to meet special needs such as epilepsy, and behavioural problems. The staff spoken to said that the Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 19 training and support provided for them is very good. All the staff have either completed or are currently undertaking NVQ2 or NVQ3 qualifications. The staff files of two members of staff were inspected. They contained all the required information to show that they are fit to work in the home. The references, CRB (Criminal Record Bureau) disclosures, evidence of identity and full employment history are stored at Walsingham headquarters, and a record sheet in each person’s file confirms that these are satisfactory. The manager confirmed that the recruitment procedures followed by the company are robust and that she sees all the information on each applicant during the recruitment process. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed for the benefit of the people who live there, and their views are actively sought and acted on. EVIDENCE: The home is well run in accordance with the principles set out in the Statement of Purpose. The manager is experienced in social care and has completed the Registered Manager’s Award course. She was the manager of 2 Ashley Close before the two homes joined together. The manager sets the tone for the home, provides strong leadership to the team and enjoys good relationships with the residents. She is aware of the changes that are needed so that both houses maintain the same standards. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 21 Walsingham has a comprehensive system for quality assurance in its homes, which includes annual surveys of residents and their families. The company carries out regular service audits of the home and monthly Regulation 26 monitoring visits. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. Water temperatures from all outlets are regularly tested and recorded, although the last record of testing in 1 Ashley Close was in March 2007. In both houses the water was below the recommended temperature of 43°C. In 1 Ashley Close the water in the kitchen sink was recorded as between 28°C and 34°C, which may be too low to maintain a good standard of hygiene and control of infection. In the laundry room of 1 Ashley Close a large container of motor oil was seen in an unlocked cupboard, accessible to the residents. It was removed immediately once identified to the staff. Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 22 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 3 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 2 STAFFING Standard No Score 31 X 32 3 33 3 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 3 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 2 X Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 23 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. 1. Standard YA42 Regulation 13(4)(a) Requirement All substances that may be hazardous to health must be stored securely at all times, so that there is no risk to the health and safety of the people who live in the home. An immediate requirement was made at the time of the inspection – and addressed immediately. Timescale for action 29/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA30 Good Practice Recommendations The manager should seek advice to make sure that the soap provided for staff to use complies with the Department of Health Infection Control Guidance for Care Homes, and that there is no risk to the health and hygiene of the people who live or work in the home. The manager should make sure that water temperatures are set at a level which is safe for the people in the home, and suitable for maintaining hygiene and control of infection. This relates to the kitchen water outlets. 2. YA42 Ashley Close 1 & 2 DS0000019270.V341077.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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