Inspection on 15/08/07 for Ashring House

This inspection was carried out on 15th August 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashring House 19/09/06

Ashring House 04/01/06

Ashring House 22/06/05

Ashring House 08/09/04

Ashring House 14/04/04

Ashring House 20/01/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 Ashring House Lewes Road Ringmer East Sussex BN8 5ES Lead Inspector Elaine Green Unannounced Inspection 15th August 2007 14:00p Ashring House DS0000021034.V345898.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 Ashring House DS0000021034.V345898.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. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashring House Address Lewes Road Ringmer East Sussex BN8 5ES 01273 814400 01273 814400 ashring@beaconcaregroup.co.uk 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) Ashring House Limited (Beacon Care Holdings Plc) Miss Margaret Ann Goodwin Care Home 6 Category(ies) of Learning disability (6), Physical disability (4) registration, with number of places Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of residents to be accommodated is six (6). Residents with a learning disability only to be accommodated. The residents must be aged under fifty-five (55) years on admission. There may be a maximum of four (4) people who also have a physical disability. 19th September 2006 Date of last inspection Brief Description of the Service: Ashring House is a detached single storey house located along the main road in the village of Ringmer. It is a short walk to the village where there are shops, local services and the local community college. It is one of a group of homes owned by Beacon Care Holdings for adults with learning disabilities and physical disabilities who are aged between 18 and 55. Ashring House aims to enable its residents to lead a fulfilling life in which they are empowered to make choices and their abilities and rights are promoted. Information about the service, including the Statement of Purpose, Service User’s Guide and CSCI reports is made available to prospective service users or their relatives, on request, as part of the admission process. The current range of fees at Ashring House, as of 20th August 2007, is £958 £1,750 per week. Additional charges are made for hairdressing, chiropody, reflexology, toiletries and holidays. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of the Unannounced Inspection of Ashring House a site visit took place to the home. This took place over 3 hours on the 15th August and a further 2 hours on the 21st August. The Inspector joined three service users in the kitchen for their evening meal, had a tour of the building, and had discussions with the manager and 5 members of staff team whose comments will be reflected within the report. A range of records and documentation relating to the running of the home were also examined and included some of the homes’ policies, procedures & guidelines, daily records, residents’ care plans, medication records and records pertaining to the management of service users finances and health and safety. In addition to the site visit the Commission for Social care Inspection sent the home an annual Quality assurance Assessment to complete. This document provides the CSCI with statistical information related to the management and staffing of the home and gives the home the opportunity to state the things they feel they do well, specify areas they have improved in as well as identifying area they need to improve in and how they are going to achieve them. Some of the information supplied by the Registered Manager in the Annual Quality Assurance Assessment document is referred to within this report. What the service does well: The home is equipped to be able to provide any prospective service user with all the information they would need to know in order for them to make an informed decision about whether or not to move into the home. This would include robust preadmission assessments to ascertain whether or not the home could meet the care and support needs of prospective service users. No service user would be admitted to the home unless they had similar needs to those already accommodated. Service users care plans are robust and contain the information and guidance that staff need in order to support service users safely and appropriately. Staff are well trained and demonstrate a high level of expertise when interacting with residents, particularly with those with communication difficulties. Staff support service users appropriately and treat them with dignity and respect e.g. by knocking on their bedroom doors before entering and by supporting them to make choices in their daily living such as what to wear, what activities to participate in etc. Each year service users have the opportunity to have one weeks supported holiday. One to one support is provided on the holiday and service users have their own accommodation wherever possible. Records confirm that service user lead active lives and participate in a range of activities at evenings and weekends and that staff support activities in the community during the Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 6 summer months. The staffing ratios are high and during the term time every service user gets one to one staff support to attend college or participate in an activity of their choice. All staff complete a skills for care induction and are given the opportunity to obtain a National Vocational Qualification in Care at Level 2 or above. The atmosphere in the home is relaxed and informal. It is clean, hygienic well maintained and homely in most parts. Service users rooms reflect their personal tastes and promote their independence. The equipment provided at the home helps support service users to promote service users independence and is serviced on a regular basis. Comments included on the forms returned by parents and care managers as part of the homes own Quality Assurance include: “The staff are very caring and competent. Ashring suits **** needs very well and he greatly enjoys being there. He always returns happily after a home visit.” Parent “Very good service at Ashring House for my service user.” Care manager “Knowledge of manager is excellent the staff are very good with ** and his lifestyle and daily living skills are always very good- social life, holidays are excellent for ** well done!” Parent. The manager of the home addresses any shortfalls identified by the CSCI or by the homes own Quality Assurance systems without delay. Staff spoke highly of the manager and said they found her approachable. Staff also said they felt they worked well together and made a good team. What has improved since the last inspection? What they could do better: Any actions to be taken to minimise risks to service users should be incorporated into their individual care plans in the form of guidelines for staff to follow. Some of these are currently stored elsewhere in the home. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 7 The home must review its’ practices in relation to providing a varied menu that reflects service users preferences and dietary needs. Particularly for those who require a soft textured diet or softened food. An alternative should be available at each mealtime this should be specified on a menu that is in an accessible format. Service users should be given the choice of when, where and with whom they eat. It is recommended that the manager and staff start working with service users to develop a system that would involve service users making choices in respect of the food and mealtimes The home must reviews its’ recruitment procedures to ensure that all the required identity and security checks are completed prior to deploying staff to work in the home and that all the relevant information is held in staff personnel records. The registered provider must review the practice of paying service users money into any bank account other than one that is in the service users own name. The manager must review the homes’ involvement in the management of service users finances and in particular the practice of withdrawing money from service users bank accounts using cash point cards. In order to protect service users confidentiality, all records relating to service users must be stored securely. The records on the staff work station relating to service users must be either moved to a secure location in the home or housed securely in the hall way using furniture that is in keeping with a domestic setting i.e. not office furniture. It is recommended that they also explore the possibility of moving the medication cabinet and the information on the staff notice board from the communal area of the home to somewhere more suitable. 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. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2&3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with the information they need in order to make an infomerd decision about whether to move into the home. EVIDENCE: The information made available to prospective service users and their relatives, including the Statement of Purpose and Service User Guide, have been amended and are now accurate and up to date. In addition to this to ensure that prospective service users know that the home is able to meet their needs and aspirations, the manager has reviewed the admission and implemented an ‘Admissions File’. This file contains all the information and assessment tools to ensure that a full and comprehensive assessment of care and support needs would be carried out before admission into the home. On the day of the site visit the Inspector examined this file and can confirm that contents included the relevant policies and procedures and the forms that would need to be completed including: an assessment form, transition record, referral form, Authority placement agreement form, admission checklist, admission form, Risk Assessments, contract of residence as well as the service user guide, data protection information etc. The assessment forms examined Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 10 list all areas that information is required and tool for recording information on. The manager stated that the pre admission assessment of a prospective service user would be undertaken by herself in conjunction with the individuals’ care manager, family, previous carers, college staff and relevant health care professionals as required. The information contained in the homes’ ‘Annual Quality Assessment states that in order that race, gender identity, disability, sexual orientation, age religion and belief are promoted and incorporated in what the home does the home follows its’ admission procedure and would only admit new service users into the home who had similar needs to those already accommodated. The Inspector can confirm that 2 service users contracts of residency were examined and found to be satisfactory. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. Service users care plans reflect their assessed needs and goals. Albeit staff support service users to make decisions about their lives, choice in respect of food is not promoted. EVIDENCE: On the day of the site visit the Inspector examined three care plans. All of which were comprehensive, relevant, had been reviewed on a regular basis and were up to date. All care plans contain a pen portrait giving the reader a brief outline of the individual. There is comprehensive information in relation to the health needs of the people who live there, which contains a brief chronology of events over the last 12 months or so and highlights the individual health care needs that need to be monitored and reported. Service users are supported to set their own goals at their annual review and progress Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 12 towards meeting these goals is monitored by staff on a daily basis and reports are written every 3 months to summarise their progress. The communication skills of some individuals in the home are very limited, however in order to provide staff with the guidance they require in order to communicate effectively with these individuals’ detailed information is provided in the communication skills sections of the care plans. The Inspector found these to be very clearly written for example, one care plan states that when happy this person is happy they will sit and rock in their chair tapping their fingers and make happy wow sounds. When sad or distressed they will make loud wailing sounds. Care plans also detail the limitations and restrictions in place for each individual and their wishes on death and dying are specified. The Inspector noted that the manager ensures that all staff had read the care plans by asking them to sign when they had done so. Risk assessments are in place for all activities and where a risk is identified the action detailing how this can be minimised is written. All risk assessments are a reviewed by the manager on a regular basis. Currently they are kept in separate folder from the care plan. It is recommended that for ease of reference and to ensure that all staff are aware, all actions to minimise risks should be incorporated in care plan in the form of guidelines for staff to follow. This also applies to manual handling and speech and language guidelines, which are currently stored elsewhere. Discussions with staff and observations on the day of the site visit confirm that staff have a good understanding of service users’ needs. Staff explained to the Inspector how service users make choices, e.g. choosing what to wear by the use of eye movements, using happy or sad noises etc. Staff also spoke about how the supported service users to make a choice about where to go on holiday. This is mainly done by the use of brochures although one service users mother also supported them to make a choice. The Inspector joined three service users for their evening meal and it was disappointing to note that no choice was given in relation to the food they were being given to eat. In addition to this the manager and staff stated that service users are not involved in deciding what is included on the menu either. Staff stated that they know what food the service users like through working with them over a number of years and would be able to tell if someone didn’t like the food they were being given. They also said that if someone didn’t like the food they would give them something else instead. It was also stated that the management and staff are hoping to work on a system that would involve service users making choices in respect of food in the future, possibly through the use of pictures. It is recommended that the manager and staff start working with service users to develop this. The homes’ Annual Quality Assurance Assessment stated that the home hopes to improve in the future in respect of supporting service users to make choices Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 13 by accessing the local Community Learning Disability Team for staff training in communication skills and advice on how to support service users in identifying clear choices. They would also like to increase the involvement of advocacy services where required. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 14 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): 12,13,15,16, &17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to maintain relationships and participate in activities of their own choice both in the home and in the community. Albeit that the food provided in the home is nutritious, not all service users are provided with varied and appetising food at mealtimes. EVIDENCE: On the day of the site visit service users were engaged in a range of activities. Music was being played in lounge and two service users were listening to this with staff. One service user was in bed watching their own television and another went out for a walk in village with a member of staff. One service user was sat in the garden enjoying the sun and the remaining service user was going to see their mother in the evening and showed the Inspector the card and flowers he had bought that morning for his mothers’ birthday. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 15 The manager explained that activities are largely planned around college courses and day centre activities during term time with options and alternatives for evenings and weekends. During the summer months’ activities are more spontaneous and are often dependant on the weather. She also explained that recent problems with funding for courses has had a negative affect on the number of courses that are available for service users to attend so the home is looking into alternatives. An examination of records and discussions with staff confirmed that during term time service users are supported on a one to one basis by the staff to attend college courses and activities of their own choice during the day Monday to Friday and that other activities are pursued in the evenings and at weekends. The Inspector examined a range of documentation and records in relation to the activities that service users participate in. It is evident that service users are actively involved in a range of activities that they enjoy and that staff support them appropriately and effectively to do so. All the service users are supported to have a weeks’ holiday annually. Staff stated that although several service users from the home often go on holiday together, wherever possible they ensure that service users all have separate accommodation. They are also are each supported on a one to one basis by the staff member of their choice. This helps to ensure that the service users get a break form each other and that their one to one time is of a good quality. This year five service users are going together to a holiday camp and each of them will have their own two-bedroom accommodation. One service user showed the Inspector a DVD they had about the holiday camp and was obviously excited about the holiday and looking forward to going. He was also able to tell the Inspector who else was going and which member of staff would be supporting him personally. As already stated in the report the Inspector joined service users for their evening meal. The meal served consisted of battered fish, which was cooked in oven, served with mash potatoes and vegetables. This was then softened with gravy for two service users and blended with gravy for another two whose vegetables were also blended. The manager and staff stated that gravy was poured over the food to soften it so that those who had difficulties with chewing and swallowing food could easily eat it. In addition to this it was also pointed out to the Inspector that one of the service users could not eat very rich food such as parsley sauce, which is why gravy was used instead. However, this food did not look appetising and was not well presented. Guidelines for one of the service users in relation to having food that was fork ‘mashable’ was seen on the day and the manager stated that guidelines in relation to a soft textured diet had been written by the speech and language therapist for two of the service users. It is required that rather than just blending ‘hard’ food the home must provide well presented and appetising food suitable for individuals that require a soft textured diet or softened food. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 16 An examination of the menu and records of the food eaten showed there was little variety in the food served for evening meal as meat or fish is served with potatoes and vegetables every day. The manager and staff stated that this was because service users enjoy this food, it is nutritious, service users can eat it easily and that service users often eat out and so are able then to choose what they eat. It was also noted that the records show that the same food is eaten by all service users at each evening meal indicating that one meal is cooked for all rather than preparing separate meals to suit service users different preferences and dietary needs. It is required that the home introduces a more varied diet, that individuals’ preferences in relation to food are taken into consideration and that an alternative should be available at each mealtime which is specified on a menu that is available in an accessible format. In addition to this individuals’ preferences in relation to food should be documented in their care plans. Service users should be also be given the choice of when, where and with whom they eat – none of these choices were presented to service users on the day of the site visit. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Service users personal, physical, emotional and health care needs are met in the way they prefer. The homes’ medication administration policies and procedures are safe and followed at all times. EVIDENCE: The homes’ Annual Quality Assurance Assessment states that the home support service users to all medical appointments and that they involve local Community Learning Disability Team when they require their support. The Inspector examined three service users care plans confirming that they include comprehensive information in relation to service users health care needs. Through an examination of the daily records in the home it is evident that service users are supported appropriately to health care appointments and that referrals are made as required. On the day of the site visit two members of staff stated that one service user was supported into the bathroom in a hoist. The Inspector questioned this practice with the manager who confirmed that the local Occupational Therapist Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 18 (OT) had agreed this. To ensure that this practice was still safe the manager contacted the OT again and she has signed to say that this practice is indeed acceptable in this particular circumstance. The Inspector examined records relating to the administration of medication. All medication that is returned to the pharmacist are recorded and signed by the manager and the pharmacist. A medication handover sheet is completed at each shift and is signed by staff. Medication is only administered by senior staff that have been trained to do so. ‘As and when’ or ‘PRN’ medication guidelines are in place and have been signed by the prescribing General Practitioner. The information relating to all the medication prescribed to service users is kept in a medication file. Photographs of service users along with a list of medication they take, the times and doses are all kept in a medication information file. Medication is always booked in and out of the home when service users are away from the home. All the Medication Administration Sheets examined by the Inspector were found to be complete. The Inspector observed one of the senior members of staff administering medication to a service user confirming that the homes policies and procedures are safe and that they are followed. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Service users views are listened to. The homes policies and procedures in relation to protection ensure that service users are protected from neglect, self-harm and, in the main abuse. However, procedures in relation to the management of service users finances have the potential to be abused. EVIDENCE: The homes’ policies and procedures were examined in relation to adult protection and were found to be complete. The home has a copy of the local guidance and some staff have received training in adult protection issues. The homes complaint policy and procedure in relation to complaints was examined and has been reviewed so that it mentions that if people remain dissatisfied they can contact the Commission for Social Care Inspection. Information received since the Inspection confirms that the correct contact details have been added to this document. On the day of the Inspection the records relating to service users’ money were examined. The manager explained that all service users have their own bank account and their own appointee who is independent from the running of the home. However, it appears that each service users’ income support is being paid into the Providers’ bank account and then the manager, on a weekly basis pays, their personal allowance to them in cash. Each service users’ personal allowance is then stored in the home in a separate tin and records are kept of Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 20 all transactions. An examination of the relevant records confirmed this. Regulation states that the registered person must not pay service users’ money into any bank account unless it is to cover fees. As the personal allowance component of the income support is not to cover the fees this is a breach of regulation and it is required this practice is reviewed so that all service users benefits are paid directly into their individual bank accounts’ as is the case with their Disability Allowance. In addition to this, in order to minimise the risk of financial abuse, the manager must review the practice of the home managing service users finances when they have appointees and the practice of the sharing of Personal Identification Numbers when using cash point cards on behalf of service users. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 21 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): 24,25,29&30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, hygienic, homely and well maintained. Service users own rooms promote their independence and suit their needs and lifestyles. EVIDENCE: The inspector had a tour of the building on the day of the site visit. The home was found to be clean, hygienic, well maintained and in the main homely in appearance. Service users own rooms were seen. Two service users showed the Inspector their rooms themselves and were obviously proud of them. All the rooms seen reflected the service users own tastes and were very different in decoration and style. The homes’ Annual Quality Assurance Assessment sates that ‘decoration is chosen for bedrooms to suit the needs and desires of the residents.’ and that they could make improvements by ‘involving service users more with the decoration of the home.’ Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 22 The staff ‘work station’ is located in the communal hallway. This is where all the service user daily records are kept, also in the hallway is the medication cupboard and a staff information notice board. Although it is accepted that there is limited space in the home for records, medication cupboard and staff information board, it is not very homely to have them in communal areas of the home. In order for the home to look more homely it is recommended that the manager explore the possibility of moving the medication cabinet and the information on the staff notice board from the communal area of the home to somewhere more suitable. The home is equipped with the specialist equipment that the service users currently resident in the home require in order to maintain a level of independence. This equipment is maintained on a regular basis and service contracts ensure that is kept up to standard. An examination of the relevant records confirmed this. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 23 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): 32,33,34,35&36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A competent, qualified, highly affective and skilled staff team support service users to meet their individual and joint needs. Staff are appropriately supervised and supported. The homes’ recruitment practices have the potential to place service users at risk from abuse. EVIDENCE: Observations of staff supporting service users on the day of the site visit indicate that they have a good understanding of the service users needs. Many of the service users at Ashring House have a non-verbal communication. Staff at the home demonstrated that they could understand the non-verbal communication used by many of the service uses and that they are highly skilled at doing so. They did this by translating for the Inspector what service users were trying to communicate and it was apparent by the service users expressions that they were being understood. Some of the communication used by some of the service users is extremely subtle and yet staff were able to understand the slightest eye movement and could interpret its’ meaning. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 24 This confirms that the induction and training that they receive is of a good quality and that the staff are competent. As part of the homes’ customer Satisfaction survey a parent commented that “The staff are very caring and competent. Ashring suits **** needs very well and he greatly enjoys being there. He always returns happily after a home visit.” The homes Annual Quality Assurance Assessment states that they provide the care staff to offer one to one supported day care in order to give service users the freedom to access the community whilst being supported at all times. Discussions with staff and an examination of the staff rota confirmed this. Out of term time the staffing levels are lower as more ‘in house’ and group activities take place although the manager stated that on days where the weather is good extra staff might be brought in to accompany service users in the community. The homes’ Annual Quality Assurance Assessment states that they keep up to date with all relevant and required staff training. They also state that they have a low turnover of staff. Evidence confirming this was seen in the form of certificates in staff training files and in staff recruitment files. The manager keeps a matrix of staff training needs and she stated that this is checked and kept up to date in supervision. The Annual Quality Assurance Assessment also stated that the home could improve by involving residents more with interviewing new staff. The staff told the Inspector that currently prospective staff are introduced to the service users when they come to the home to look round and that staff observe the service users reactions to them. These reactions are taken into consideration as part of the recruitment and selection process. As part of the site visit the staff personnel and recruitment records were examined for the three most recently recruited staff. Several shortfalls were identified. All three individuals had started work in the home prior to the required Protection of Vulnerable Adults check being completed. The manager stated that they were in the home on their induction and had been supervised at all times, however no persons can be deployed in to work in the home until confirmation has been received that this check has been completed satisfactorily. In addition to this none of the staff had completed an application form for the post, one person had only one form of Identity, two people had only one written reference, one of the references was dated September 2006 and yet the person had started work in April 2007. The manager stated that the person had arrived with this reference and there was no evidence to suggest the authenticity of this reference had been checked. All three employees had been recruited through an agency however, employment and identity checks are still required and it is the responsibility of the providers to ensure that this happens. In order to protect service users from potential abuse it is required that the home follows safe recruitment procedures, that all the required identity and security checks are completed prior to deploying staff to work in the home, that two written references are obtained, that the Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 25 authenticity of references are checked and that an application form is completed by applicants prior to employment and that this is kept on file. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 26 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): 37,38,39,40,41&42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent and experienced manager runs this service well. The health and safety of the people who live and work in the home is protected however, not all records are stored securely. EVIDENCE: The experienced manager is clearly competent to run the home. She has worked at Ashring House for the past six years and has been in her current post for four years and completed her National Vocational Qualification (NVQ) Level 4 Registered Managers Award earlier this year. She keeps up to date with changes in regulation and legislation through training and accessing the Internet, particularly the Commission for Social Care professionals’ web site. Staff all spoke highly of the manager and said that they found her Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 27 approachable. As part of the Customer Satisfaction Survey undertaken by the home earlier this year a parent wrote “Knowledge of manager is excellent the staff are very good with ** and his lifestyle and daily living skills are always very good- social life, holidays are excellent for ** well done!.”. As part of the site visit the Inspector examined a range of documents and certificates in relation health and safety. Confirmation that the following had been tested or serviced by a person qualified to do so was seen fire alarm testing, emergency lighting, Gas boiler, central heating and all Potable Electrical Appliances. The home has a Quality Assurance system and in January and February 2007 questionnaires were sent to service users families, representatives and Care Comments on included on the returned forms include:“The staff are very caring and competent. Ashring suits **** needs very well and he greatly enjoys being there. He always returns happily after a home visit.” Parent “Very good service at Ashring House for my service user.” Care manager “Knowledge of manager is excellent the staff are very good with ** and his lifestyle and daily living skills are always very good- social life, holidays are excellent for ** well done!.” Parent. “Not sure how much *** is involved in the running of the home.” Parent. Overall the response was good and indicated that these people are happy with the service that is provided at Ashring House. The manager stated that the results of the quality assurance were yet to be fed back to service users and their representatives formally but that any shortfalls that are identified from the surveys are addressed straight away and the action taken fed back individually to those concerned. A monthly-unannounced visit is made to the home to as part of the homes’ quality assurance. The Inspector examined documents confirming that monthly visits are taking place. Requisitions for works to be completed/serviced were attached to the most recent form examined. Most of the areas highlighted as needing attention had already been addressed by the manager and the system used by the organisation is open and transparent. Some of the daily records kept in the staffs’ ‘work station’, which is in the communal hallway, contain sensitive information and should be stored where they can be locked away and are not accessible to anyone other than those authorised to do so. It is required that all records containing information pertaining to service users must be stored securely, the home must either relocate the staff ‘work station’ or provide secure housing for it which is in keeping with a domestic home i.e. not office furniture. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 28 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 3 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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 4 34 2 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 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 2 3 x Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 29 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 YA17 Regulation 16 (2) (i)(h) Schedule 3(3)(m) Schedule 4 (13) Timescale for action In order to promote service 30/09/07 users’ dignity, choice, independence and well being the home must provide all service users with wellpresented and appetising food. Particularly those who require a soft textured diet or softened food. They must also ensure that the diet provided is varied and takes into consideration individuals’ dietary needs and preferences. An alternative should be available at each mealtime this should be specified on a menu that is in an accessible format. Individuals’ preferences in relation to food should be documented in their care plans and service users should be given the choice of when, where and with whom they eat. In order to protect service 30/10/07 users from potential financial abuse the registered provider must review the practice of paying service users money into any bank account other than that in the service users DS0000021034.V345898.R01.S.doc Version 5.2 Page 30 Requirement 2. YA23 20(1)(a)(b)(2) (3) Ashring House 3. YA34 4. YA41 own name. The manager must review the homes’ involvement in the management of service users finances and in particular the practice of sharing Personal Identification Numbers and withdrawing money from service users bank accounts using cash point cards. 19(1)(a)(b)(c)( In order to protect service 30/08/07 2)(3)(4)(a)(b)( users from potential abuse it is i)(c)(5)(a)(b)(c required that the home follows )(d)(i)(ii)(iii)(6 safe recruitment procedures, that all the required identity ) Schedule 2 and security checks are (1)(2)(3)(4)(5) completed prior to deploying (6)(7)(a)(b) staff to work in the home, that two written references are Schedule 4 obtained, that the authenticity of references are checked and 6(a)(d) that an application form is completed by staff prior to employment and that this is kept on file. 17(1)(a)(b) In order to protect service 30/09/07 users confidentiality, all records relating to service users must be stored securely. The records on the staff work station relating to service users must be either moved to a secure location in the home or housed securely in the hall way using furniture that is in keeping with a domestic setting i.e. not office furniture. 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 YA9 Good Practice Recommendations In order to promote service users health, safety and DS0000021034.V345898.R01.S.doc Version 5.2 Page 31 Ashring House 2. YA7 3. YA24 independence any ‘actions to be taken’ resulting from risk assessments should be incorporated in care plans in the form of guidelines for staff to follow. This also applies to manual handling and speech and language guidelines, which are currently stored elsewhere in the home. In order to promote dignity, choice and independence it is recommended that the manager and staff start working with service users to develop a system that would involve service users making choices in respect of the food that is included on the menu, the food they are offered at mealtimes and where when and with whom they wish to eat. In order for the home to look more ‘homely’ it is recommended that the manager explore the possibility of moving the medication cabinet and the information on the staff notice board from the communal area of the home to somewhere more suitable. Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Ashring House DS0000021034.V345898.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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