Inspection on 19/04/07 for Ashstone House

This inspection was carried out on 19th April 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashstone House 13/07/06

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 19th April 2007 09:11a Ashstone House DS0000023307.V336723.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.V336723.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.V336723.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 Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th July 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. Currently there is no manager in post and the area manager has dayto-day responsibility. 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 £800.00 to £1600.00 per week. Additional costs include some activities, hairdressing, toiletries, newspapers and magazines. Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out over a period of time and concluded with an unannounced visit to the home between 9.11am and 5.24pm. The area manager and deputy manager assisted throughout. Service users and staff were spoken to. Observations included interactions between service users and staff. Eight service users were living at the home. Surveys were sent to service users and relatives. Feedback was received from service users and a relative. All service users surveys were completed with the assistance of staff. Two-service users care was tracked to gain evidence. Various records were viewed during the inspection and communal areas and the garden were accessed. What the service does well: What has improved since the last inspection? On the day of the visit service user were benefiting form an atmosphere within the home, which was more relaxed and quieter than on any previous visit. The statement of purpose has been completed setting out information for prospective and current service users and their representatives. All service users have a contract, which is now held on file. Incident and daily reports written by staff are now legible and to the point in information. Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 6 Service users confirmed that they are able to get out and about into the community and do activities. A cook has been appointed and service users are enjoying home cook meals. Support plans and risk assessments have been improved giving a better picture of service user needs. The registered provider visiting the home every month to see what is happening and the details are recorded in a report. The security of the office where medication and records are stored is better. An assessment tool based on service user needs has been used to identify adequate staffing numbers, which matches the staffing rota in place. Health action plans and lifestyle plans are being introduced. Both these should put the service users in more control of their lives. What they could do better: The home must obtain copies of assessments completed by professionals prior to admission. This should help them make the right decision as to whether they can really meet this persons needs. Assessments undertaken by the home should be written and held on file so they can be used to develop a support plan. Service users should have a copy of the service user guide. Contracts should be reviewed against new guidance and agreed with each service user. As soon as it is clear that the home can no longer meet someone’s needs the right action should be taken to protect this person and other service users. Support plans and risk assessments still need further detail. They should be the voice of the service user including their goals and aspirations not just about them. Any limitations agreed with a service user should be recorded. Service user meetings should be recorded in more detail showing what service users are really saying and the responses from management. A range of documentation and communication must be developed to meet the needs of all service users to enable everyone the same participation and choices. In some areas the health and dignity of individual service users could easily be improved. Daily routines should promote independence and service users responsibilities. Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 7 Improvement in some areas of medication records and protocols would protect service users. Service users should be able to easily see and read the complaints procedure. Sufficient detail of each complaint made, investigation and actions taken should be recorded. Staff should be trained, skilled and competent and receive regular supervision. Proper management action should be taken when the staff involved in incidents with a service user has acted inappropriately to protect all service users in the future. Management should ensure that staff handle service users monies as per their procedure. A robust recruitment process should be followed to protect service users. The views of the service users must under pin all-self assessment of the home and its development. Adequate fire safety checks must be in place to protect everyone. 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. Ashstone House DS0000023307.V336723.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.V336723.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, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available to people who use the service and their representatives to use and make a decision as to whether this home is right for them. This would be better supported through a review of contracts to reflect the most up to date details including a breakdown of charges made by the home and then their agreement. The home does not consult professional assessment information prior to admission. Therefore the right judgements are not always made about whether the home will be able to meet a prospective service users needs. The home does not take sufficient action when it is evident that they are not able to meet the needs of service users. EVIDENCE: The home now has a statement of purpose and service user guide in place. This is a standard written format only. There was conflicting information between a service user and the area manager as to whether the service user had been given a service user guide. The home should ensure that all service users receive a copy of the service user guide. Since the last inspection there has been two admissions. One service user had needs for which the home was not registered. It was clear from their previous Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 10 care plan that the home would not be able to meet their needs as staffing numbers were to low to undertake some support and staff lacked training in this specialist area. The service user then had to be moved to a more appropriate home, which took several months. For both admissions to the home since the last inspection the home had not obtained a copy of the care management assessment prior to admission and for one to date. Although the manager apparently undertook an assessment there is no written evidence of this on file. All service users must have their needs assessed prior to admission and the home must obtain a copy of professional assessments prior to admission. It is acknowledged by the home they are not able to meet the needs of an existing service user due to continue incidents of aggression putting other service users and staff at risk. Although notice has not been served care management are now looking for another placement. The home should not offer a place to any service user where they cannot meet all their needs. A service user said they had visited the home prior to admission with their support worker although had not stayed over night. Contracts are in place on file for service users. However these have not been agreed or signed by service users. They do contain fees but these are not broken down as per the latest guidance. The area manager was not aware of the Office of Fair Trading guidelines for fair contracts in care homes. Contracts should be reviewed against guidance from the Office of Fair Trading and then agreed with individual service users. Ashstone House DS0000023307.V336723.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, 8 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals are generally involved in decisions about their lives. However those with communication needs may not always be given this opportunity. Better support planning and risk assessments are in place. However there is little evidence of involving service users to say how they wish to be supported and what goals they may have. EVIDENCE: Working folders have been introduced which contain support plans and risk assessments. All service users have had their needs reassessed since the last inspection, which has then lead to the development of new support plans. The support plans although better still lack detail in some areas to enable a consistent approach by staff. The area manager agrees that there is still further work to do on these and the format used is not always helpful. The support plans are not person centred but talk about the service user. Some service users were aware of their support plans and others were not. None of the plans evidenced service user involvement. No goal planning is in place at Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 12 present. The home is beginning to introduce lifestyle plans, which again are repetitive in some areas of the support plan. These however are more person centred. Not all limitations in place are recorded on the service users file although service users were aware of these and are not unhappy about them. Behavioural guidelines are in place for some service users/behaviours and others are still to be completed. Where these are in place they give staff a consistent way of working and a proactive approach, which in the past has always been reactive. Risk assessments have also been rewritten and again are better. However these also need to be looked at carefully and some details added specific to individual service user and/or the risk. Key workers have recently been reallocated based on skills. Discussion highlighted some good work being undertaken with a key worker regarding faith and dietary needs. All service users spoken to were aware of their key worker. Service users are able to attend monthly meetings to express their views and discuss choices about day trips etc. The minutes of these meetings need to be more detailed to reflect the service users views. The manager should also respond to any actions/requests. Service users feel they are generally able to make decisions about their dayto-day lives and choose to do what they like. It is concerning that surveys completed with assistance of staff commented that it was ‘not applicable’ for some service users to make decisions about what to do each day. This was discussed with the area manager to address with staff. A range of documentation/communication needs to be developed to meet the needs of service users and enable participation for all. Ashstone House DS0000023307.V336723.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 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. People who use the service feel they have opportunities for accessing the community, appropriate activities and maintaining family contact. Support to develop skills and abilities and help service users recognise their responsibilities however is lacking. EVIDENCE: Some service users are attending college and staff hope that more service users can enrol next year. One service user discussed having a job previously and wanting to look for another. Service users feel they are able to get out and about in the community and do what they want. Recent trips have been to the cinema, the village, garden centre, Ashford outlet and supermarket, discos and Leeds Castle. On the day of the visit several service users went to the zoo. Two service users are supported to attend places of worship. One service user was supported to go on holiday abroad this year. Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 14 Service users talked about contact with their families through visiting and telephone which when necessary is support by staff. Feedback from a relative confirmed that generally they are satisfied with the service. The daily routines and historic behaviours continue to use staff to do for rather than promote independence through responsibility of household tasks. Service users are not generally involved in shopping and meal preparation or cleaning communal areas. However it is pleasing to see service users accessing the kitchen at most times and being able to help themselves to snacks and drinks. One service user confirmed that they had a key to their bedroom. The atmosphere within the home was quieter and more relaxed than on previous visits. It was evident during the visit that service user are able to choose to be alone if they wish. Service users have recently acquired two pets a hamster and two goldfish. A day care coordinator has been appointed. However there was limited evidence of activities within the day centre. See previous comments regarding development of communication aids to ensure participation of choice for all. A new cook has been appointed. All service users spoken to confirmed the food is OK or good. The cook is currently planning a new summer menu. Some progress has been made to introduce a healthy diet for service users. Some service users are vegetarian and this diet is catered for. The lunchtime meal was relaxed. Staff assisted sensitively and used aids during the meal where appropriate. To maximise dignity thought should be given to in the type of protective wear wore at meal times and hygiene afterwards. Ashstone House DS0000023307.V336723.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. 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. Not all the health and personal support needs of the people who live in the home are currently met. In a minority of areas the principles of respect, dignity and privacy put into practice need reviewing. EVIDENCE: See previous comments regarding support plans and lifestyle plans. Service users confirmed that times for getting up were flexible and this was evident during the visit. One service user felt the time for going to bed was 10pm rather than flexible. Most service users were dressed appropriate for the weather. Where service users lack the skills to choose and maintain appropriate clothing though the day staff should take a more proactive approach. Service users spoken to say the staff were OK to good. One commented two were lazy but three helped when you asked. The home has recently introduced health action plans. See previous comment regarding a service users dignity at meal times. Service users have access to health care services both within the home and community. A district nurse was visiting the home on the day of the visit. The Community Learning Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 16 Disability Team (CLDT) are involved with four service users and another has recently been referred. The CLDT have agreed that the home cannot meet the needs of one service user and are looking for a more appropriate home. An incontinence problem for one service user has not been referred because staff felt it was not that much of a problem. This was discussed with the area manager as not acceptable. The medication system was viewed. Medication Administration Records (MAR) showed use of appropriate signatures and codes. Some handwritten entries were not dated, signed and witnessed. Medication storage was in order. Medication was checked in and a returns book was in use for any returns. No service users are self-medicating or part self-medicating. The majority of medication prescribed as and when required still need written protocols for staff. One care plan lacked medication details. Ashstone House DS0000023307.V336723.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. 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. People who use the service feel able to express their concerns. However the format for the complaints procedures cannot be easily seen and records of complaints lack detail. Aggressive outbursts and the management of poor practice leave people at risk from abuse and harm. EVIDENCE: A pictorial format complaints procedure is displayed within the home. Although in this is very small print and difficult to see. One complaint had been logged in the complaint log since the last inspection. However details of this complaint could not be found. Service users indicated they felt able to voice their concerns saying they would approach staff and felt they would address any issues. Others said they would speak to their family if there were a problem. This was also the case if service users felt another service user was being abuse they would report to staff or their family. The high number of aggressive behaviours displayed does have an impact on other service users and put them at risk. Often areas have to be cleared or service users have to go to their rooms for safety. All incidents are reported appropriately and content and legibility of reports has improved. Outside professionals are involved at present. Staff are trained in securicare. One adult protection alert has been closed and another opened since the last inspection. An action from the closed alert for the service users care manager to hold a review remains outstanding although is now planned. Proper management action is not always taken when staff who are involved in Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 18 incidents with service users have acted inappropriately. The balances and monies of two service users were checked and evidenced that staff continue not to follow the full procedure for handling service users monies. Service users confirmed that they could access their monies as they wish or have agreed. Ashstone House DS0000023307.V336723.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. 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 live in a clean, comfortable and homely environment with very large grounds. Maintenance is reactive rather than planned. Some improvements are needed to ensure safety. EVIDENCE: Some parts of the home were accessed (dining room, kitchen, lounge, and team leaders and managers office. The quiet room has become the manager’s office. The area manager advised that this was because the quiet room didn’t really get used and means the manager is now inside and able to see more what is happening in the home. The old managers officer will in time be renovated into a quiet room/snozelan, which is quieter and more remote as outside. Service users confirmed that the home is always comfortable, clean and tidy. Service users confirmed that they were happy with their rooms and that things were mostly in good order. One service user said they had changed their room and this one was better because it didn’t get so hot. Work on the outside render and paintwork highlighted at the previous inspections Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 20 remains outstanding. However the area manager has recently been asked to contacted builders to come and give quotes. The large garden was looking nice with plenty of area for games of football etc. A service user was working hard in the garden. The one ensuite toilet and the staff toilet have been highlighted as needing refurbishment although staff had not been given the go ahead/resources from higher management as yet. Maintenance for both the home and garden is prioritised daily depending generally on any recent incidents and the weather. The fire safety logbook was viewed and again showed that not all tests are carried out to timescales. Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 21 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): 31, 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. Staff in the home are not sufficiently trained, skilled and supervised to support the people who use the service and the smooth running of the service. Sloppy recruitment practices could put service users at risk. EVIDENCE: Service users are generally satisfied with the staff at the home. Although there was a comment that particular staff are ‘lazy’. The area manager advised that the staff competency checks highlighted as needed at the last inspection had not yet taken place. She felt that staff have been enthusiastic to recent changes within the home. A staff meeting had been held but had been poorly attended. The home has used a formal tool to calculate staffing hours and have staffing in place to meet these. The staff team is male and female. Since the last inspection a part time cook and day centre person have been appointed as well as a deputy manager. Two staff files were examined. There was one shortfall in employment history and another in appropriate references. Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 22 The training matrix sent to the commission prior to the visit did not make sense and the area manager agreed to resubmit the training stats. Induction to Skills for Care has not yet been implemented. Only two members of staff has acquired an NVQ level 2 or above. However eight staff are currently undertaking the qualification and this will met the 50 target. In the absence of specialist training an information manual has not been set up. There is a training plan in place for the home for 2007/8. Courses include equal opportunities, epilepsy, medication, supervision, autism and learning disability, bereavement and loss, moving and handling and first aid. Two staff said they were responsible as team leaders for supervising others. One team leader said they had received supervision once. Management should understand the importance of staff supervision and how this a tool to help address shortfalls within the home and staff practices. Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 23 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): 27, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home is not effective in implementing procedures and systems that will protect the people living and working there. Quality assurance systems need to receive feedback on what its like to live there. EVIDENCE: It is apparent that there is improvement within the home since the last inspection. The support plans; risk assessments and report writing although still requiring further work has improved. The atmosphere within the home is more relaxed and not so noisy. Service users confirmed that they are able to get out and about into the community to do things. Staff also felt the manager had made considerable progress within the home. It is disappointing that the home is to have another manager change and is without a manager at present. The area manager who also oversees two other homes is currently managing Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 24 the home assisted by the deputy manager. Comments on the day of the visit indicated that the home feels at present like it is biding it time. The home is not in a stable enough position to bide its time. It must appoint a new manager who is right for the home without delay. As management have not yet addressed the work on staff competency, supervision and poor practice this should be a priority for the new manager. Although processes are in place within the organisation for quality assurance these are not apparent with Ashstone House. Regulation 26 visits do take place but the involvement of service users is poor with only one service user spoken to twice since November 2006. The views of the service users must under pin the all-self assessment of the home and its development. Not all fire safety testing was up to date. Other health and safety checks are in place. The cook needs to undertake food hygiene training and this is planned. Accidents are recorded. Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 25 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 2 2 1 3 1 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 2 32 2 33 2 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 X 2 X X 2 X Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 2 Standard YA1 YA2 Regulation 5(2) 14 Requirement Service users and prospective service users should receive a copy of the service user guide The home must not admit a service user unless they have obtain a copy of the professionals assessment and can demonstrate they are able to fully meet their needs The home must only accommodate service users whose needs they can fully meet Documentation/communication must be developed so all service users can participate and have choices Review practices to ensure service users dignity is respected (clothing, mealtimes) Adequate fire safety testing must be carried out on fire equipment Timescale for action 30/04/07 30/04/07 3 4 YA3 YA8 14 12(2) 31/05/07 31/05/07 5 6 YA19 YA24 12(4) 23(4) 04/05/07 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 27 No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Refer to Standard YA2 YA5 YA5 YA6 YA6 YA7 YA11 YA20 YA22 YA23 YA35 YA36 YA35 YA39 Good Practice Recommendations Assessments undertaken by the home should be recorded, used to develop the support plan and held on file In line with the Office of Fair Trading guidance for Fair Contract in Care homes the provider review service user contracts Contracts should be agreed with individual service users Support plans should contain sufficient detail and reflect the way they wish to be supported, their needs and aspirations Any limitations should be agreed with the service user and recorded Minutes of the service user meetings should reflect their views and record management responses Daily routines should promote independence and responsibilities Medication prescribed on an as required basis should have written protocols in place The complaints procedure should be produced in a format that can be seen and read by service users Staff to follow correct procedure for handling service users finances The home should ensure that staff are sufficiently trained, skilled and competent Staff should receive supervision at least 6 times per year In the absence of specialist training it is recommended that the home set up an information manual covering appropriate subjects for staff The views of the service users should under pin all self assessment of the home and its development Ashstone House DS0000023307.V336723.R01.S.doc Version 5.2 Page 28 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. 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