Inspection on 13/07/06 for Ashstone House

This inspection was carried out on 13th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashstone House 19/04/07

Ashstone House 02/03/06

Ashstone House 03/10/05

Ashstone House 09/02/05

Ashstone House 28/07/04

Ashstone House 10/01/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Ashstone House Ashford Road Hamstreet Ashford Kent TN26 2EW Lead Inspector Mrs Sally Gill Unannounced Inspection 13th July 2006 08:35 Ashstone House DS0000023307.V300727.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 Ashstone House DS0000023307.V300727.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. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashstone House Address Ashford Road Hamstreet Ashford Kent TN26 2EW 01233 733477 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) Ashstone House Limited Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2006 Brief Description of the Service: Ashstone House is registered to provide accommodation for up to 12 adults with a learning disability and admits people with low right through to high dependencies. The Registered Provider is a private limited company which runs a number of similar residential care homes elsewhere in the south of the country. The manager Nandi Himyuandi has day to day control although not registered with the commission and has been in post approximately twelve months. The premise is an older two storey detached property which has been adapted for its present use. There is provision for all of the service users to have their own bedroom, each of which has a wash hand basin situated on the ground and first floor. The service users have the use of two bathrooms. On the ground floor there is a kitchen, dining room and lounge. The home is surrounded by a 3.5acre garden, which includes lawn areas and established shrubs/gardens, outbuildings and a car parking area. It is set in a rural position on the outskirts of the village of Hamstreet. Within the village there is a train station, church, supermarket, hairdressers, garden centre and newsagents. The home is also situated on the local bus route to nearby Ashford and the home has transport which can be used to transport the service users. The current fees range from £1122.62 to £1747.50 per week. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit took place on Wednesday, 19th July 2006 between 8.35am and 2.20pm, the manager was not present during this visit and the inspector was assisted by the team leader on duty. A return visit was made on Friday, 21st July to conclude the visit and give feedback from both visits. Eight people were living at the home with four vacancies. The inspector spoke or spent time with all eight service users, spoke to four members of staff and observed staff working and interactions throughout the first day. The inspector accessed the communal areas downstairs only and the garden. The inspection process consisted of information collected before and during the visits to the home. Surveys were sent to service users, families, doctors and care managers. Surveys were received from five service users including those that are non-verbal and all were completed with the assistance of staff and feedback was generally positive. Two relatives responded which indicated they are overall satisfied with the care although one commented that the home ‘endeavour to maintain a full staffing ratio’. Care managers indicated again they were satisfied with the overall care and that the manager has improved things after a rather chaotic period. Five surveys were received from doctors which on the whole was positive although one felt there was not always a senior member of staff on duty to confer with and another felt not all staff demonstrated a clear understanding of service users needs. Various records were viewed during the inspection. What the service does well: What has improved since the last inspection? Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 6 The general standard of the environment continues to improve, the bathrooms and the quite room have been redecorated and a new carpet has been fitted in the lounge. For the safety of service users the front driveway has been fenced and a gate fitted, the surface of the driveway has also been improved. A specific risk for a service user highlighted at the previous inspection has been managed and a risk assessment is now in place however discussion highlighted this needs review. Service users calendar of activities and social outings have been reviewed and on two days structured activities are now provided in-house by dedicated people. However a lack of drivers on shift can restrict their opportunities in the community. Support workers are receiving regular formal supervision and feel well supported. Staff have received further medication and core training. The registered provider has introduced an internal quality assurance system however this does not include gaining the views of others involved in the home. What they could do better: There are some things the home was asked to do at previous inspections that they have not done and these continue to be carried forward. This includes write and submit to the commission a detail statement of purpose and provide all service users with detailed terms and conditions. Care plans focus on the negative of service users abilities rather than their skills and do not look forward to any development or achieving any of their aspirations. Risk assessments tend to be generic and need to individualised especially the actions to minimise risks for service users and these should be under constant review. Daily reports cannot always be read and some were lacking an entry. Comments from both service users and staff highlighted that a lack of drivers does restrict opportunities to access the community and activities. Several service users are gaining weight which in one case is affecting mobility and there is a lack of awareness by all staff to adopt a healthier eating culture. The security of the team leaders office should be reviewed both for safety and also confidentially of records. Fire tests must be carried out to timescales to ensure everyone’s safety. Staffing has been reduced since the last inspection and the home must use a formal staffing tool to assess service users needs to check adequate staffing levels. This should go hand in hand with an assessment of staffs competencies to highlight the shortfalls in skills and abilities. Further staff training should be provided. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 7 To ensure the provider is aware what goes on in the home they must undertake monthly unannounced visits to the home and produce a report. 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. Ashstone House DS0000023307.V300727.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 Ashstone House DS0000023307.V300727.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users do not have access to full information in order that they can make an informed choice about whether this home is right for them. Needs assessments do not detail individuals aspirations. Not all service users have an individual agreement in place and those in place lack some key information. EVIDENCE: The manager since taking up post has produced a service users guide although is still to complete the homes statement of purpose which remains a requirement. Previously the home has admitted service users with a complex range of needs which in the inspector opinion and some staff have not always been compatible with each other and this ill matched compatibility remains at present although to a less degree than previously. The future focus of Ashstone House needs careful consideration when assessing new service users for the vacancies and must take into account other service users, the staff skills, the location and the environment. The last admission to the home was in 2005 which was a transfer from another Allied Care unit prior to this the last admission was in 2003. The home has Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 10 four vacancies. Three prospective service users have recently been assessed and the manager stated that copies of the care managers assessments have been obtained. Families and service users will now be invited to look round the home. The home has obtained copies of care managers assessments where possible. All existing service users have been re-assessed using the homes own assessment format. However these are not completed fully and only give details where input is required by staff. They do not include any aspirations or goals where perhaps development of skills could be achieved. The home must ensure when undertaking assessments that it gives a full picture of the service user in order to feed an adequate care plan and this is a requirement. Two service users files were viewed and only one had a contract of terms and conditions in place. However this contract did not contain details of fees payable which they must. It is a requirement that all service users have a contract in place which details their terms and conditions including the amount of the fees. Ashstone House DS0000023307.V300727.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all service users needs; aspirations and goals are reflected in their care plan. Service users generally feel they are able to make decisions about their lives. Service users are supported to take risks but written assessments require improvement. EVIDENCE: Two care plans and risk assessments were viewed. A care plan is in place for all service users however as previously stated these lacked detail. The manager advised there was better detail in those service users that are nonverbal. Care plans were present in different formats and those that had been superseded had not been archived which was confusing. One showed particularly good detail of skills, abilities and supported require by staff but this was only present on one file. It is this level of detail that makes an adequate care plan. There is no goal planning in place to aid development or maintain Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 12 skills and abilities. Information at times was contradicted in other sections of the file. A care plan must be developed that shows service users assessed needs; aspirations and goals and will aid staff in meeting these needs consistently. Service users felt they are able to generally make decisions about their lives. Risk assessments were in place but most appeared to be generic and not individualised. Some were environmental risk assessments which need not be held on service users files. The inspector could not see the need for some risk assessments in place as there was no risk to service users. The risk assessment highlighting the need for coded door entry should be reviewed also. Service users risk assessments should be individual with recorded actions for staff to reduce the risk for the individual service user. Risk assessments should be reviewed at least six monthly. On the whole confidentiality is maintained but the manager should ensure that care plans and daily record files only contain information relating to the individual service user. The security of team leaders office should also be reviewed to ensure safety and confidentiality is maintained. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Leisure activities are appropriate however limited as is the opportunity for involvement in the local community. Service users are supported to maintain and forge relationships. Generally service users rights are respected but their responsibilities are not clear. Service users would benefit from all staff consistently promoting healthy eating. EVIDENCE: Some service users have benefited from a holiday this year. Activity programmes have been reviewed and a variety of structured appropriate activities have been incorporated into programmes including two days of inhouse using dedicated staff. However comments from service users and staff Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 14 confirmed that a lack of drivers has resulted in limiting service users opportunities to access the community and activities outside which was certainly true on the day of the visit. Another contributing factor was observed to be the reduced staffing levels. Outside of the programme structured activities service users did not appear engaged at all and almost left to their own devices rather than engaged with staff. Routines and tasks were planned as staff went along the shift including ringing additional staff to come into to allow health appointments to go ahead. Service users appeared board which lead to situations escalating which were then difficult for staff to defuse and the circle then repeated (service users board another situation occurring). Service users comments highlighted that they feel staff are there to wait on them. Staff enforce this by fetching and carrying for some service users and not always supporting service users to be as independent as possible. This culture needs to change and could be supported by better care planning to obtain a consistent approach by staff. See also staffing standards. Feedback from relatives was generally positive comments included the home endeavour to maintain a full staff rota and complaints have always addressed and to a degree listened to. Several service users have gained weight since the last inspection which is concerning when it is affecting their mobility. Staff stated that a service user has been referred to a dietician however staff need to adopt a consistent approach in promoting a healthy diet and this is practically relevant to drinks whilst waiting for the appointment and consider this for all service users. The manager stated the home has introduced healthy eating menus and staff training is planned for nutrition. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal support for service users could be greatly enhanced by a consistent approach by staff who are able to follow detailed care plans. Service users health care needs are generally met. Service users benefit from a safe medications system. EVIDENCE: Individual good examples of staff trying to correct bad language from service users and also defusing some situations which had escalated were observed. Although at one point it would have been better for an additional member of staff to attend the shouting and screaming rather than one staff member trying to cope. In the inspector opinion the noise in the environment could be contributing to situations escalating. When the inspector arrive at 8.30am and some service users were still in bed music was blaring out of the dining room window which was immediately turned down on sight of the inspector. However the stereo and television competed all day with service users conversations which then lead to shouting. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 16 See previous comments regarding a consistent approach by staff supported by detailed care plans. Service users were dress individually although there were some instances where the dignity of service users could be enhanced and these were discussed with the manager. In one instance highlighted by the inspector action was taken by staff that day. Service users health care needs are met mainly within the community although see previous comment around diets. Several service users have input from the community learning disability team. Medication systems were improved. One signature was missing from the MAR chart otherwise these were in order. Some medication prescribed needs to be changed to PRN in line with practice. Appropriate medication administration was observed. The security of the medication should be reviewed in the light of highlighted risks. Twelve staff plus the manager have recently undertaken medication training. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users views are listened to an acted on. Further improvements are required to fully protect service users from abuse. EVIDENCE: The home has not received any complaints since the last inspection. The complaints log was checked and the manager is reminded that investigations and outcomes must be recorded. Relatives felt their complaints are listened to and acted upon. The home currently has an open adult protection alert involving a service user and allegedly two members of staff. Twelve staff plus the manager are trained in adult protection. In discussion with staff they were aware of where to report abuse both inside and out of the company. However it concerns the inspector that when discussing abuse a member of staff said it would depend on the what another member of staff did as to whether they would report the incident to the manager. The member of staff was advised to report or discuss any concerns. See previous comments around the noisy environment contributing to situations escalating. Twelve staff plus the manager are trained in securicare. Service users finances were checked against balances and both checked did Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 18 not agree. At the time the team leader was undertaking a balance check and the inspector was advised later this was resolved by a thorough check of all finances but this does highlight that staff cannot be following the correct finance handling procedure. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a clean, comfortable and homely environment although some improvements are needed to ensure safety. EVIDENCE: Communal areas were viewed which were clean and tidy. Improvements continue to be made to the environment and the manager advised that a new carpet had been fitted in the lounge and bathrooms and the quiet room have been redecorated. Work on the outside render and paintwork highlighted at the previous inspection remains outstanding. For the safety of service users a fence and gate have been erected at the front entrance and the driveway had been resurfaced. The fire safety logbook was viewed and showed that not all tests are carried out to timescale which they must be. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users do not benefit from a fully effective and competent staff team which also lack specialist training on service users assessed needs. EVIDENCE: The inspector was advised that staffing has been reduced since the last inspection. On the day of the inspection new staffing levels were not adequate and additional staff had to be called in so that service users could attend health appointments although other service users were still not engaged with staff. The registered provider is required to undertake a review of staffing levels which must be determined by service users assessed needs. A copy of the review and staffing levels must be sent to the commission. When taking into account the numbers of sufficient staff required staff competencies must also be taken into account. Although staff are very caring they did not promote independence or really engage with service users unless situations were escalating. When situations were escalating there were at times no support from another team member. The existing staff team lack Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 21 the full skills, abilities and knowledge to fully meet all the needs of the existing service users Staff training has improved in core subjects, medication, Makaton and adult protection. However staff have not had access to other specialist training. Staff competencies must be assessed to highlight gaps in knowledge and skills which must then be addressed. In the absence of specialist training it is recommended that the home set up an information manual covering appropriate subjects for staff. Ten staff have undertaken LDAF, two staff are qualified to NVQ level 2 or above and eight are currently undertaking the course. An issue highlighted at the inspection by staff and service users was the availability of drivers on shift. This mainly involves drivers with overseas licences who after twelve months are no longer able to drive company vehicles unless they obtain a British licence. However this is not according to staff implemented consistently across all Allied Care establishments and impacts on opportunities for service users. The company policy should be clear and implemented. However the home must have staff that can fulfil their full duties including enabling service users to access the community and activities particularly given the rural location of the home. A robust recruitment process is in place. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users continue to benefit from improvements made by the manager. Service users could benefit from improvement to the quality assurance system. Improvements in record keeping would protect all. The health, safety and welfare of all are generally met with one shortfall. EVIDENCE: The manager has been in post almost a year and during that time her hard work is to be commended she has made significant improvements to Ashstone House although there is still further work to be undertaken. Staff stated they feel she is supportive, hands on and approachable to service users and staff although not all bad practice has yet been stamped out and communication systems sometimes do not reach everyone. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 23 The manager is appropriately qualified although as yet the commission has not received an application for registration which was agreed would be with the commission by 31st August 2006. The company have implemented a quality assurance process and the home is currently awaiting its report. Although care managers and relatives were surveyed last year only one response was received. The inspector suggested that this would achieve better results if undertaken at the service users reviews. The home has not had a regulation 26 visit from the provider since March 2006 and the manager does not receive formal supervision. It is a requirement that unannounced visits are undertaken monthly with reports. Some service users records written by staff were illegible both to the inspector and to other staff. This must be address for the protection of all either by improved handwriting or alternative methods of recording. There were minor issues of confidentially within records/files. See previous comment regarding the fire safety logbook. However apart from this the health, safety and welfare of all is protected. Twenty one staff are trained in fire, fifteen in first aid and food hygiene, ten in infection control and six in manual handling. These figures are considerable improved since the last inspection. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 24 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 1 2 2 3 X 4 X 5 2 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 2 X 2 2 X Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 25 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 YA1 Regulation 4 Requirement The Registered Provider should submit to the commission a suitably detailed written statement of purpose (previous timescale of 31/05/05 & 31/06/06 not met) The home must ensure when undertaking assessments that it shows a full picture of the service user in order to feed an adequate care plan All service users must have a contract in place which details their terms and conditions their terms and conditions including the amount of the fees A care plan must be developed with service users that fully records their assessed needs; aspirations and goals and will aid staff in meeting these needs consistently Service users risk assessments should be individual with recorded actions for staff to reduce the risk Service users must have improved access to appropriate opportunities for leisure activities Service users must have DS0000023307.V300727.R01.S.doc Timescale for action 31/08/06 2 YA2 14 & 15 24/07/06 3 YA5 4 31/08/06 4 YA6 15 30/11/06 5 YA9 13 (4 ) 30/11/06 6 7 YA12 YA13 16 (2)m 16 (2)m 31/07/06 31/07/06 Page 26 Ashstone House Version 5.2 8 9 10 YA17 YA24 YA32 12 (1)a & 16 (2)i 23(4) 18(1) improved opportunities to access the community Service users health and 31/07/06 wellbeing is promoted by a healthy diet Adequate fire safety testing must 31/07/06 be carried out on fire equipment Staff competencies must be assessed to highlight gaps in skills and knowledge which must then be addressed The home must have staff that can fulfil their full duties including enabling service users to access the community and activities The registered provider is required to undertake a review of staffing levels which must be determined by service users assessed needs using a formal tool. A copy of the review and staffing levels must be sent to the commission. The manager must submit an application for registration to the commission The registered provider must undertaken a regulation 26 visit at least monthly. Records must legible to protect all 31/10/06 11 YA33 18(1) 31/07/06 12 YA33 18(1) 04/08/06 13 14 15 16 YA33 YA37 YA39 YA41 18(1) 8&9 26 17 11/08/06 31/08/06 31/07/06 31/07/06 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 YA16 Good Practice Recommendations Daily routines to promote independence and responsibilities that is supported in the care plan and a consistent approach by staff DS0000023307.V300727.R01.S.doc Version 5.2 Page 27 Ashstone House 2 3 4 5 YA20 YA23 YA24 YA35 Review the security of the office (medication and confidentiality) Staff to follow correct procedure fro handling service users finances Repair/repaint outside damaged render In the absence of specialist training it is recommended that the home set up an information manual covering appropriate subjects for staff. Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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 Ashstone House DS0000023307.V300727.R01.S.doc Version 5.2 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!