CARE HOME ADULTS 18-65 Ashley House 33 Sunnyside Road Clevedon North Somerset BS21 7TL
Lead Inspector Nicola Hill Unannounced 14 June 2005 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. Ashley House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Ashley House Address 33 Sunnyside Road Clevedon North Somerset BS21 7TL 01275 871557 01275 872528 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) Miss Ann Ball Trevor Gilpin Care Home 16 Category(ies) of 1. People with learning disabilities both male registration, with number and female. of places 2. People with learning disabilities over 65, both male and female. Ashley House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 18th October 2004 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. Ashley House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection of Ashley House took place on an afternoon when the older residents of the home were having their hair set by a hairdresser. Some of the younger residents were at the day centres or colleges and at the time of the visit one resident was in hospital following an operation for a hip replacement. The inspector spoke with three staff, Trevor Gilpin, the registered manager, Marion one of the management team, and Chris who worked as the cook at the home. The inspector also spoke briefly with some of the residents at home, many of whom had been there since it opened in 1986. The inspection took place over several hours, and involved looking at documentation, and a tour of the building and grounds. What the service does well:
The home provides a continuity of care for the residents, some of whom are quite elderly and were resettled at Ashley House from long stay hospitals. The quality of care provided at the home could be linked to the longevity of the residents there. Comments made by the residents were that they were happy at Ashley House, and that staff were very kind to them. They enjoyed the atmosphere at Ashley House and had their personal preferences respected by the staff. The home also has very detailed personal support plans in place for all the residents at the home, which clearly identify any action needed to be taken by staff in order to support the residents toward independence. Chris, the cook commented on how pleasant she found working at Ashley House, the staff team and the resident she felt worked together toward the same goals. The kitchen and meal preparation area was very well-equipped, and the budget allowed for meals was sufficient so that a variety of meals could be offered. The residents also made use of the garden area at the rear of the building, which has been turned in part to an area where fruit and vegetables can be grown. The some members of the home enjoy gardening, whilst the other residents enjoy picking fruit and using them to produce puddings etc. The home also maintained good communication with the families of residents, to ensure that relationships are maintained. The communal areas are well furnished and comfortable, and present a very homely environment. The resident freely access all areas of the home. From the point of view of staffing, the level of support offered by the staff was enough to support the residents to be independent. The relationships between the residents and staff are good and create supportive and caring environment, which promotes the security and well being of the residents. Ashley House Version 1.10 Page 6 What has improved since the last inspection? What they could do better:
The manager had not been successful in implementing a regular supervision programme for the staff at the home. This is an area he is aware will need to be developed fully in order to meet the standard. The manager also felt that he had not had the opportunity to liaise with other providers, and develop a network of support for himself and the home within the local area. The residents would be appreciative of more opportunities to go outside the home for social occasions. These excursions from the home are reliant on the number of staff available, and transport being available. Some of the older residents at the home are quite happy to go out on short excursions to obtain shopping etc, whilst the younger ones may enjoy more involvement in activities like tenpin bowling. Some of the residents are registered as partially sighted, and therefore a review of the premises by the Woodspring Association for Blind People would probably highlight any improvement necessary to ensure the continued safety and welfare of residents around home. The inspector also recommended that the manager keep a running balance of the morphine sulphate liquid on the premises so that the home can
Ashley House Version 1.10 Page 7 demonstrate the amount given to the resident, and also be aware of the amount left in stock. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashley House Version 1.10 Page 8 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 Ashley House Version 1.10 Page 9 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 There is clear information available about the service for potential service users. EVIDENCE: The homes statement of since the last inspection. and it is expected that in 16 to 15, and this will be purpose and service user guide has not been revised However, there are double rooms at Ashley House, the future the number of residents will reduced from reflected in the statement of purpose. The manager is actively seeking to fill the vacancy at Ashley House, and is aware of the need to make a thorough preadmission assessment before any new residents are admitted to the home. There have been no admissions to the home; all residents have an individual contract relating to their residence at Ashley house. Ashley House Version 1.10 Page 10 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 There is a clear and consistent care planning system in place to meet individual needs and aspirations. Residents’ views and choices form the basis of the day to day activity of the home. EVIDENCE: All residents have a detailed care plan in place. Four were randomly selected. They were found to be very detailed and comprehensive and gave information relating to residents abilities in relation to personal care, daily living skills, orientation and memory, health needs and personal likes and dislikes. The care plans are linked to the care management reviews, which take place on a regular basis and include the resident. There is evidence of the activities timetable for the residents being directly linked to the staffing rota. Ashley House Version 1.10 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) 11,12,15,17 Residents are able to access varied activities , links with the community are good and support residents access to social and educational opportunities. EVIDENCE: The residents at Ashley House all follow meaningful daytime activity, either provided from a third party, or supported by the staff at the home. Currently one resident has supported employment. Generally the residents follow chosen activities every day, and whilst at home use home entertainment equipment such as televisions and DVD players. In order that residents are as independent as possible the risk assessments are structured to be supportive. The residents participate in all aspects of life in the home including some household tasks. There is a wide age range at the home, and residents are
Ashley House Version 1.10 Page 12 able to choose appropriate leisure activities, which may be linked to their preferred choices, and in consideration of their age. The meals served at the home are tailored to meet the choices of the residents, and their dietary needs. Ashley House Version 1.10 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) 18,19,20,21 The health care needs of the residents are well met with evidence of access to varied health care providers. EVIDENCE: The personal care support for each individual is identified and known to the staff team. The residents have primary care needs met by the local GP practice, and specialist care needs met by the CLDT. The individual personal files have information on then indicating that the health care needs of individuals is monitored and any action needed is taken. One resident is currently taking morphine sulphate solution on a regular basis, recording as a controlled drug is unnecessary, but it is good practice to maintain a record of the amount given on each dose and to ensure that there is a clear balance available for audit purposes. Currently one resident is terminally ill, is being supported to remain at Ashley House by St Peters Hospice. Due to a recent resident’s bereavement, the manager has arranged for all the staff to attend bereavement training, which has been supplied through St Peters Hospice. Ashley House Version 1.10 Page 14 Some of the residents have visual impairments, and a review of the premises by the Woodspring Association for Blind People is recommended. Ashley House Version 1.10 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 Residents are able to access the complaints procedures EVIDENCE: There have been no complaints made to the home by residents. The complaints procedure is available in an accessible format. Some of the residents stated that they were able to self advocate and raise issues of concern. There were also aware that Ann Ball, the registered person, was available to them. Ashley House Version 1.10 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) 24,30 The standard of the environment within this home is good providing residents with an attractive and homely place to live. EVIDENCE: The inspector toured the building with Marion, and noted that the carpet in bedroom one smelled strongly of urine. This was reported to the manager who requested that the carpet be cleaned, and if this does not alleviate the problem then it will be replaced. Ashley house is a very settled home; all the residents have their own particular seating arrangements in the lounge area. It was noted that all the chairs has incontinent pads on them, despite not all residents being incontinent. This was raised with the manager and he took the decision to remove those that were unnecessary, thereby making the home less institutional. The home, overall, is very comfortable and homely; the gardens in particular are a great asset to the home and could be made more accessible to the older residents however there are areas, which they can freely access. Ashley House Version 1.10 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 There is a stable staff team at the home to provide a continuity of support to the residents. EVIDENCE: Currently there are no staff vacancies at the home. The residents therefore can benefit from a settled and stable staff team who understand their needs and know them well enough to form good relationships with them. The staff rota has been revised to ensure that there are three staff available on the shift, and two sleeping in at night. The staff supervision has not been implemented on a formal and regular basis; this is an area for development by the manager. Additional staff hours are used to cover activities for residents outside the home. Ashley House Version 1.10 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) 37,42 The manager must provide clear leadership throughout the home in order to provide a safe and supportive environment for residents. EVIDENCE: Trevor Gilpin, as the registered manager for the home, has undertaken a role which is not clearly defined. The structure of accountability in the home also seems blurred and needs to be clear enough to allow Mr Gilpin to delegate tasks to which he does not have to retain responsibility for, to other members of staff. This would allow him to focus and prioritise his areas of responsibility, and implement the changes he has identified as necessary. Since the last visit to the home there have been two accidents recorded, one involving a resident and one involving a member of staff. Any incident resulting in any injury or illness to the resident is reported to the commission via the regulation 37 process. At the time of the inspection there were no areas of health and safety
Ashley House Version 1.10 Page 19 implementation that are of concern to the inspector. Ashley House Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x x 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 x x 3 x 3 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x Ashley House Version 1.10 Page 21 Are there any outstanding requirements from the last inspection? NA 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 Regulation Requirement Timescale for action 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 20 Good Practice Recommendations The mThe morphine sulphate solution is not recorded as a controlled drug , but it is good practice to maintain a record of the amount given on each dose and to ensure that there is a clear balance available for audit purposes. Some of the residents have visual impairments, and a review of the premises by the Woodspring Association for Blind People is recommended. 2. 29 Ashley House Version 1.10 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier, Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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