CARE HOME ADULTS 18-65
2 Ashley Close Bennetts End Hemel Hempstead Hertfordshire HP3 8EH Lead Inspector
Claire Farrier Unannounced 07 July 2005 06:30 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. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 2 Ashley Close Address 2 Ashley Close Bennetts End Hemel Hempstead HP3 8EH 01442 258226 01442 258226 Ashleyclose2@walsingham.com Walsingham 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) Ms Pat May Care Home 6 Category(ies) of LD Learning Disability 6 registration, with number LD(E) Learning Disability over 65 6 of places PH Physical Disability 6 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: There are no additional conditions of registration Date of last inspection 28 October 2004 Brief Description of the Service: 2 Ashley Close is a care home providing personal care and accommodation for six people with learning disabilities. It is owned by Walsingham, which is a voluntary organisation. The home was opened in1996 and consists of a twostorey, purpose built building. The home is situated on in a residential area on the outskirts of Hemel Hempstead, close to local shops and amenities. It is in a cul-de-sac next another Walsingham home and close to two day centres. All the home’s bedrooms are single, and none of them have en-suite facilities. The house and garden are fully accessible for the current residents. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and took place over one day, starting at 6.30 in the morning in order to meet with the night staff before they finished their shift. The majority of time was spent observing and talking to residents and staff. Some time was also spent looking at care plans, records, complaints and staff training. Five residents and four members of staff were spoken to during the inspection. The staff and residents were very welcoming, despite the early start, and one resident showed the inspector around her home. This was generally a positive inspection, and the majority of the standards were met. A requirement was to regulate the temperature of one fridge. What the service does well: What has improved since the last inspection?
The home is moving towards full implementation of person centred planning (PCP), which places the resident at the centre of all planning and decisions about their lives. Most of the residents’ files are now in a PCP format, although not all are yet fully completed. Staffing levels have been increased so that an extra member of staff is now available during the day from Monday to Friday to provide one to one attention for a resident who doesn’t attend a day centre. The resident now takes part in a wide range of activities outside the home, and is more sociable in the home. The other residents have benefited by having more time for their choice of activities with the remaining staff on their days at home.
2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 6 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. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 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 standard(s) 2 and 5 The home has sufficient information on residents’ needs and access to appropriate services to enable their needs to be met. EVIDENCE: No residents have been admitted to the home since the last inspection. The care plans contain full details of all the residents’ needs, which show that their needs are assessed and understood (See Standard 6). Walsingham has drawn up a new format for the tenancy agreement, which is personalised for each resident with pictures and photographs. This enables them to have some understanding of the contents of the tenancy agreement, and one resident talked about several of the items with photographs in the agreement. There was a note in her file that she will sign the tenancy agreement when her parents have discussed it with her. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 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 standard(s) 6, 7, 8 and 9 The good quality of information in the residents’ files has been maintained. Most files are now in a PCP (person centred planning) format, which focuses on the person being totally at the centre of all planning. Residents are fully involved in decisions about their own lives and activities in the home. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 10 EVIDENCE: The files of two residents were inspected. Each resident has a personal file, an individual planner and a communication file. The personal file contains all the information required to assist the staff to provide appropriate care and support. Full details are included of personal information, health and social care needs, personal and professional contacts and risk assessments. The individual planner has been produced in a PCP (person centred planning) format. The information is written in the first person and incorporates photographs, pictures and symbols on all the person’s likes and dislikes, how they make choices and the help they need. Each person sets their own goals for what they want to achieve in one month, three months and long term. Goals are detailed and include care needs and social activities. The communication file has replaced the former monthly keyworker report, and one example seen had been completed jointly by the resident and her keyworker. It contains photographs, pictures and symbols of activities and comments, for example “She is happy with the menus”, and “She would like to buy a grey cardigan”. Each resident has a daily diary which the staff on each shift complete with relevant information about their activities and any incidents. The residents make decisions about their life in the home as well as activities and holidays, and this involvement is reflected in their individual care plan goals. The staff encourage them to take part in activities in the home, including cleaning their rooms and taking part in shopping and food preparation. Risk assessments are kept in a separate file. Appropriate risk assessments are in place for health and safety in the home. Risk assessments were seen for individual service users, including for the risks of wandering off, attention during the night, and for the management of behaviour, linked to the service user’s behaviour management guidelines. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17 The residents are encouraged to make choices for their activities, and to be involved according to their abilities in developing their skills for independence. This ensures good relationships with their families and with the local community, and that individual rights and responsibilities are recognised and supported. EVIDENCE: One resident was awake when the inspection started at 6.30am, and was having a cup of tea in the kitchen with the duty support worker. The other residents got up from bed during the course of the inspection. Two got up independently and made themselves a cup of tea, using individual teapots, and their own breakfasts of toast and cereal. Three residents then went to the day centre. Two residents had a programmed day off, and they chose their own activities and tidied their rooms. One resident showed the inspector her room, and changed her bedding with minimal assistance. One resident went to the cinema in the afternoon, and another to the library. One resident does not attend a day centre, and extra staffing has been provided so that she can take part in community activities without taking time from the other residents. On the day of the inspection she went to a garden centre to see the rabbits there.
2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 12 She spends most of the time in the house in her room, but her diary entries show that she is becoming more sociable, and on several occasions has spent time in the kitchen talking to staff. The residents choose what they want to eat, and are involved in planning the weekly menus and doing the shopping. One resident is on a special diet to control the effects of PKU (phenylketonuria). She has a supply of special low protein food and milk, and she would make it clear if she was not happy with the choices of food available for her. All the residents take part in a large range of individual activities, which are recorded with pictures in their communication files. These include going to the cinema, shopping, bowling, having meals out and the Gateway club. All the residents are involved in choosing their annual holidays. Their families are encouraged to be involved in the home. Most of the residents visit their families regularly, and are visited by them. Families are also invited to social event such as the home’s summer barbecue. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18. 19 and 20 The staff provide good quality personal care and treat the residents with sensitivity and respect. There is good recording of all the residents’ health care needs. The procedures for administering and recording medication are followed appropriately, and the practice of auditing the medication following each medication round ensures that the risk of error is minimised. EVIDENCE: The care plans that were inspected provide comprehensive details of the residents’ personal care and health care needs (see Standard 6), and a good relationship was observed between the staff and the residents. Appropriate behaviour guidelines were seen for some of the residents, and the staff follow these sensitively, encouraging appropriate behaviour without seeming to impose rules on the residents. Detailed recording of each resident’s health care includes health notes for hospital visits and contact with GPs and other medical professionals, appropriate monitoring of epilepsy and regular weight checks. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 14 The medication round was observed. None of the residents are able to administer their own medication, but one signs the MAR (medicines administration record) chart herself when she has had her medication. The Boots blister pack system is used and PRN (when required) and liquid medications that cannot be dispensed in blister packs are stored separately in the medication cupboard. Two members of staff administer the medication, and good procedures and recording were observed, including an audit of all medication following each medication round. The Boots MDS (monitored dosage system) pharmacist visited the home during the inspection and checked all the procedures. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Residents are encouraged and enabled to make their views and concerns known. Procedures are in place to ensure that people living in the home are protected from abuse. EVIDENCE: The home has a satisfactory complaints procedure in place and service users and their relatives are encouraged to make their concerns and complaints known. There is a simplified complaints policy using pictorial symbols for the residents. The home has appropriate policies and procedures concerning adult protection, which follow the guidelines given in the Hertfordshire County Council adult protection procedures. All the staff have had training in the prevention of abuse, and the staff spoken to were aware of the home’s procedures and of the whistle blowing policy. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The home provides a comfortable and well maintained environment for the residents, and the staff maintain a good standard of cleanliness and hygiene. EVIDENCE: The home is a purpose built chalet bungalow, with three bedrooms and communal rooms on the ground floor and three bedrooms on the first floor. No changes have been made to the fabric of the home since the last inspection. The home appeared to be clean and well maintained. Staff spoken to confirmed that they follow the policies and procedures for maintenance of hygiene and control of infection. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 17 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) 33 and 35 The home is staffed by experienced support workers who are appropriately trained to meet the needs of the residents. The staff spoken to are confident of their knowledge of the needs of the residents and feel well supported in their work. EVIDENCE: The support worker who had worked during the night was on duty at the start of this inspection, and two day staff started their shift with a handover at 7.00am. A third support worker arrived at 9.00am to provide one-to-one support for a particular resident. The support worker on duty during the night was a locum from an agency, but she has worked in the home for a long time and knows the residents needs very well. The staffing rotas showed that a locum is only employed when permanent night staff are on sick leave. All the staff are clear about their roles and responsibilities, and feel positive about their work in the home and their relationship with the residents. Wallsingham provides a comprehensive training programme that covers all mandatory training and training for specific needs, such as epilepsy and challenging behaviour. All the staff spoken to confirmed that there is plenty of training available. All the staff have completed or are currently studying for a NVQ qualification, at either level 2 or level 3, and the manager is completing the Registered Managers Award.
2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 18 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) 42 The residents of the home are safeguarded by the practice of appropriate health and safety procedures. EVIDENCE: 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. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. One issue was noticed which needs to be addressed. Fridge and freezer temperatures are recorded every day by the night staff. The temperatures for one fridge, which is fitted into one of the kitchen units, was recorded as between 8°C and 10°C every day for the past three months, which is above the recommended temperature for good food hygiene. It was observed that the unit doors, and therefore the fridge door, did not close properly, and this may be the cause of the higher temperature in the fridge. It was recorded that this discrepancy was reported, but no action has yet been taken.
2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 19 Water temperatures in the shower and one bath were marginally too high, but an electrician rectified this on the day of the inspection. 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 20 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 x x 3 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 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
2 Ashley Close Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 21 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 42 Regulation 13(4) Requirement The temperature of one fridge was recorded as constantly above the recommended level. Fridge temperatures must be regulated to measure within the recommended limits for maintenance of food hygiene. Timescale for action 07 September 2005 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 Good Practice Recommendations 2 Ashley Close I52 s19270 2 ashley close v228958 230505 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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