Inspection on 01/11/06 for Ashley House

This inspection was carried out on 1st November 2006.

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 House 28/12/05

Ashley House 14/06/05

Ashley House 18/10/04

Ashley House 21/06/04

Ashley House 01/07/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Ashley House Ashley House 33 Sunnyside Road Clevedon North Somerset BS21 7TL Lead Inspector Nicola Hill Unannounced Inspection 1 & 16th November 2006 09:30 st Ashley House DS0000008081.V317326.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 House DS0000008081.V317326.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 House DS0000008081.V317326.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley House Address Ashley House 33 Sunnyside Road Clevedon North Somerset BS21 7TL 01275 871557 01275 872528 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) Miss Anne Ball Mrs June Lloyd Mr Trevor John Gilpin Care Home 16 Category(ies) of Learning disability (16), Learning disability over registration, with number 65 years of age (16) of places Ashley House DS0000008081.V317326.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Ashley House is registered to accommodate up to 16 residents with learning difficulties. At the time of the inspection, there was one vacancy. The home is a Victorian property set in large attractively maintained gardens and within easy reach of shops and other local facilities. The fees for the home are negotiated on an individual basis and are dependant on the level of support needed. Ashley House DS0000008081.V317326.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection of Ashley House was divided into two visits; the initial visit allowed the inspector to speak with the residents and review records at the home. The second visit allowed the inspector to discuss service developments with the manager. On arrival at the home one resident, who introduced her to the other residents who were at home at that time, showed the inspector around the ground floor. On the second visit the inspector met residents who had not been at home on the first visit. There have been no changes to the resident group since the last inspection when the inspector spent more time discussing the home with them. There are some areas for the manager to develop but overall the home provides an excellent standard of care. What the service does well: What has improved since the last inspection? Ashley House DS0000008081.V317326.R01.S.doc Version 5.2 Page 6 The manager has achieved improvements at the home despite suffering illhealth and absence from work over the last year. There is evidence of constant review of the care and working practices at the home in order to provide the highest standard of care. Improvements have also been made to the surroundings and redecoration of toilets and bathrooms has been undertaken. There is now a formalised system of work in relation to the implementation of health and safety. The manager and his wife have also purchased part of the business, and this will increase so that they become the majority shareholders, and can then affect directly the management and progression of the home. Between the two visits it was noted that the areas for development that were discussed i.e. statutory training, health and safety assessment of the premises, recording weekly summaries to supplement daily records, had all been implemented. 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. The summary of this inspection report can be made available in other formats on request. Ashley House DS0000008081.V317326.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 House DS0000008081.V317326.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The information provided by the management is sufficient to allow potential service users to make an informed choice about the home; the process employed at the home to admit new resident allows for time to be spent with the individual making the transition to life at the home. EVIDENCE: There have been no admissions to the home since the last inspection. However there has been a recent inquiry and a potential resident has visited the home. The process for admitting service users to the home involved the potential resident visiting the home on several occasions, having an overnight stay and then being admitted to the home on a three-month probationary period. Ashley House DS0000008081.V317326.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): 6,7,9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service has a sustained record of delivering a quality service based on the belief that residents should be able to take control of their lives. EVIDENCE: All of the residents have a full assessment of need, and from this the service user plan has been drawn. The inspector reviewed the documentation with the manager, and was able to see that the care file for each individual resident had a personal plan, daily records, health care records, referrals for specialist services i.e. work placement referral, daytime activities. The service plans from the social services department were reviewed on a regular basis. As well as this the home has a service user plan which has identifies any support needed for residents to be as independent as possible. The daily records were informative and used in conjunction with the daily handover sheet, provided a good source of information about the day-to-day running of the home. However some residents had few entries on their record and the inspector Ashley House DS0000008081.V317326.R01.S.doc Version 5.2 Page 10 suggested that the information recorded on the handover sheet be summarised and entered on a weekly basis on the daily record sheet. For some of the residents who may be vulnerable due to their disability, the manager has carried out risk assessments and jointly agreed with residents a safe plan of action. The residents are very active in the day-to-day running of the home, they are involved in the majority of decisions about how the home is developed. All residents have key workers whose role is to form close relationships with residents thereby understanding their personal preferences and goals. The manager was able to illustrate how this works by the arrangements made for residents to go on regular days out which were their choice rather than go on holiday. Key workers accompany the residents on the days out. Ashley House DS0000008081.V317326.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): 121,13,15,16, Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The promotion of the individual is central to the homes’ aims and objectives, and ensures that residents have an ordinary but meaningful life in the home and are part of the local community. EVIDENCE: The inspector was introduced to all of the residents at home during the visit. Most of the residents were happy to talk to the inspector about their daily life at the home. The inspector had been shown individual rooms by residents on the last visit. The day-to-day running of the home is dependent on the needs of the residents, also important is that the routines of the home are very flexible and residents can make major choices in their life. The staff team also make sure that the day-to-day life of the resident is supported in such a way so as to maximise their contact with the community, for example, several of the service users attend evening clubs, visit the cinema and also maintain contact with Ashley House DS0000008081.V317326.R01.S.doc Version 5.2 Page 12 their families. The day prior to the inspection one of the service users had a birthday and it was evident that all the residents joined in celebrating of the birthday and had made an effort to purchase cards and celebrate the occasion. The inspector discussed with the manager the way in which activities, education and work opportunities was being sought. The manager was able to show evidence to the inspector that residents can take up work placements, often supported on a one-to-one basis during the placement. There was a very good selection of food, and a variable menu, which was adjusted depending on the weather. The meal times are relaxed, and all the residents eat together in the kitchen of the home, which has two large dining tables. Ashley House DS0000008081.V317326.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): 18,19,20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have flexible personal support which is responsive to change in needs and service users particular preferences. EVIDENCE: The majority of the residents at Ashley House need minimal support with their personal care. For those who do require support, there are male and female staff available should this be an issue. The underpinning ethos at Ashley House is that support is offered to enable residents to meet their optimum personal appearance and promote confidence and self-esteem; for example, the staff may suggest changes in clothing, which may be more coordinated or more appropriate to the prevailing weather conditions. There are sufficient bathrooms around to allow for the privacy of all the residents. The inspector was able to see held on the case files records of any healthcare interventions, also a yearly plan for health care intervention e.g. optician. Some of the residents require more intervention than others, for example one resident recently required input from the occupational therapist. Currently at the home there is a wide range of health care need, and a wide age group Ashley House DS0000008081.V317326.R01.S.doc Version 5.2 Page 14 some of whom have sensory impairments and physical disabilities. The home is to be commended on successfully meeting the wide variety of health care support required by the residents. The manager is pro-active in seeking any support or training needed in order to support the resident more fully, for example, NVQ training. The manager was able to demonstrate the efficiency of the medication procedures in place at the home. There was ample information available for members of staff who have responsibilities to administer medication about the type of medication prescribed, its purpose, and any potential side-effects. The medication records appeared to be up-to-date and accurate, and the inspector was able to see that all medication was stored effectively and safely. The home primarily uses a unit dosage system for those residents on regular medication; regular reviews of medication take place with the GP or the consultant psychiatrist. Ashley House DS0000008081.V317326.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): 22,23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service has a very clear complaints procedure, people associated with the home know that if a complaint is made it will be dealt with in a timely fashion. The adult protection procedures in place at the home ensure that referrals are managed effectively and with sensitivity. EVIDENCE: The complaints procedure at Ashley House is accessible to all residents, and is displayed on the board outside the office. The complaints procedure is also discussed with each individual resident on admission, and is included in the statement of purpose and service user guide. The inspector discussed with the resident what they would do about a situation that was troubling them, and the response was that they would go directly to the manager or staff on duty. The staff at the home confirmed this. No adult protection referrals have been received in respect of the home. The manager and inspector discussed a member of staff who left the home because of their failure to be able to implement safe working practice; this was not identified as intentional and therefore has not been reported as an abuse issue. Ashley House DS0000008081.V317326.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): 24,30 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 physical environment that is appropriate to the specific needs of residents who live there. The home is clean and tidy, and smells fresh. EVIDENCE: The environment at Ashley House, although a converted Victorian property, is very good, and provides a warm and comfortable home to its residents. The residents are encouraged to see it as their own home and are consulted in matters such as redecoration. There are communal areas on the ground floor of the home and a garden for the resident to use. Laundry facilities at the home are not easily accessed by residents. The manager has plans to refurbish areas of the home and was advised by the inspector to include this in the business planning to ensure there is sufficient budget to complete projects in a timely fashion. Ashley House DS0000008081.V317326.R01.S.doc Version 5.2 Page 17 Ashley House DS0000008081.V317326.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, 34, 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The recruitment process is well developed and recruitment of quality staff is seen as integral to the delivery of an excellent service. EVIDENCE: The home has recruited two new members of staff since the last inspection. The inspector was able to review the recruitment process both new members of staff. The recruit processes were followed in obtaining an application form, references; a CRB check (where necessary) had been followed. The induction process was discussed with the manager and should be further developed to be more specific around measuring competence. The manager and inspector also discussed LADF qualifications for the two members of staff who are inexperienced in this field. The staffing levels reflect the needs of the residents and rotas are flexible to fit around the lifestyles of individuals, for example there is an additional allocation of workers where there is an activity outside the home e.g. swimming. Staff meetings are held regularly at the home this was confirmed by the staff that spoke with the inspector. The manager has daily contact with the Ashley House DS0000008081.V317326.R01.S.doc Version 5.2 Page 19 majority of the team. The manager also stated that due to be very close contact he has with the team, formal recorded supervision sessions were not happening on a regular basis. The inspector was able to see that recorded supervision had happened for all staff, however this may only have been one session this year. The manager and inspector discussed the delegation of supervision to senior care staff to allow him time to supervise and develop the skills of the senior team at the home. The manager also has an appraisal system that he intends to implement at home which will identify the training needs of the individuals working there. Generally there is a low turnover of staff at home, and staff enjoy working with the residents much as residents stated to the inspector that they enjoyed working with members of staff. Training for the staff group had been arranged for statutory training updates, and fire training; the manager is in the process of accessing adult protection awareness of training for staff through North Somerset Council. The staff working at Ashley House mostly work part-time, the majority have an NVQ in care, or equivalent qualification. The inspector discussed with the staff team the training they receive specific to service user needs, they were able to confirm that for new equipment e.g. a hoist, training was always given. The staff also suggested that additional training in autism and dementia care would enhance the service. There is minimal use of any agency staff. Ashley House DS0000008081.V317326.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): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager works to improve the services and quality of life for the residents at the home. There is a strong ethos of being open and transparent in all areas of the running of the home. EVIDENCE: The manager has qualifications and experience to run the home, and the home appears to them smoothly providing a good service to its residents. Management training is to be sourced in order to complete the NVQ 4 or equivalent qualification. The manager is very person centered in his approach and support staff to have a resident focused attitude. The policies at the home undergo review on a regular basis and the manager is very insistent that policies and procedures are changed to meet current legislation or good practice guidance. Ashley House DS0000008081.V317326.R01.S.doc Version 5.2 Page 21 The home does not currently have a quality assurance system that monitors the outcomes of the processes and procedures at the home. The inspector suggested using a quality audit, which would be an audit of the system of the home over a year. The manager will was receptive to the suggestion and would be able to implement and link it into the AQQA assessment system currently being piloted by the Commission. The area of concern for the inspector is the failure by the majority shareholding partner to carry out regulation 26 visits. The partner is now resident outside of the UK and the manager has no influence on the completion of these visits. The current plan is that the manager purchase the majority shareholding in the business within the next three months, so that regulation 26 visits will not be required. In order to support the manager the inspector has not taken enforcement action in relation to the regulation 26 visits on this occasion however should the purchase not go through then the lack of oversight of the business by the majority shareholder may be raised as a cause for concern and question their fitness as a provider. The implementation of health and safety at the home is good with regular monitoring of systems to ensure that they are not a hazard to either staff or residents. The inspector was able to see evidence of a health and safety review of the home by Peninsula. No serious defects or areas for immediate action were identified. The fire safety risk assessment was available to the inspector as were the records indicating the checks on the fire safety system. The number of accidents at the home was minimal, and all serious incidents are reported to the Commission. Ashley House DS0000008081.V317326.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 X 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 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 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 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Ashley House DS0000008081.V317326.R01.S.doc Version 5.2 Page 23 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 YA43 Regulation 26 Requirement Where the registered provider is an individual, but not in day to day charge of the home he shall visit the care home in accordance with this regulation. Visits shall take place at least once a month and shall be unannounced. The person carrying out the visit shall prepare a written report on the conduct of the care home. The registered provider shall supply a copy of the report to the Commission. Ann Ball as the majority partner for the home must complete regulation 26 visit reports and these must be forwarded to the commission. Timescale for action 16/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA36 Good Practice Recommendations Regular supervision is implemented at the home. DS0000008081.V317326.R01.S.doc Version 5.2 Page 24 Ashley House Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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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