Inspection on 02/03/06 for Ashstone House

This inspection was carried out on 2nd March 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashstone House 19/04/07

Ashstone House 13/07/06

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 Mark Hemmings Announced Inspection 2 & 3rd March 2006 09:10 nd Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 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.V283009.R01.S.doc Version 5.1 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.V283009.R01.S.doc Version 5.1 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.V283009.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd October 2005 Brief Description of the Service: The premises are 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. There is the normal range of shared-use rooms, such as lounges and bathrooms. The Home is located in a quiet rural area on the edge of Hamstreet. This is a village which has a number of facilities including a small supermarket. To the rear and to the sides of the property, there is a large garden. The nearest town is Ashford. The service users can access this and other destinations either by a public bus service or by the use of the two cars which are part of the complement of the Home. 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 Acting Manager is Ms N Himyuandi. She has been in post about six months and she is responsible for overseeing the day to day operation of the Home. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was announced and it took about nine and one half hours to complete over the course of two days. During this time, the Inspector spoke with or spent time with eight of the nine service users in residence. Also, he spoke with the Area Manager, with the Acting Manager, with four of the support workers and with one of the team leaders. The Inspector examined a selection of documents and records. Also, he looked at various parts of the accommodation. The Home continues to provide the service users with a domestic environment within which to live. Service users say that they remain satisfied with the provision made for them. There are seven Required Developments at the end of this Report. The Inspector did not examine all of the Standards on this occasion. Consequently, the reader is asked to read this Inspection Report in conjunction with the previous Inspection Report. This should assist the reader to obtain a more detailed account of the Commission’s current evaluation of the adequacy of the facilities and services available in the Home. What the service does well: The assistance each service user receives is provided in consultation with them. Service users say that support workers are considerate in their manner and the Inspector witnessed a number of examples of service users receiving appropriate support and guidance. There was evidence that a suitable balance is being achieved between respecting service users’ rights for independence and recognising their needs for structure and guidance. The support workers have a number of competencies which are relevant to the effective provision of assistance for the service users in residence. The premises provide a generally comfortable and relaxed setting in which service users can make their home. The environment is free from any obvious hazards which might compromise someone’s health and safety. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The Registered Provider needs to give careful thought to what will the future focus of the Home. Within the context of its relatively isolated location, decisions will need to be made about the level of dependency to be accommodated and to the total number of service users to be admitted. The decisions made about these questions need to be reflected in the Statement of Purpose. This is a written account of the essential purpose of the Home which now should be submitted to the Commission. There remain some difficulties in achieving within the staff team the level of coordination which is required if service users are to experience the measure of consistency that they need. Also within the staff team, there remain some differences and disputes about what is to be recognised as good and effective Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 7 residential care practice. Within this context, it is important to note that the Acting Manager has not yet established an organised system of formal professional supervision for all support workers. Once this is in operation, it should constitute an invaluable platform from which issues to do with consistency and appropriateness can be aired and resolved. There is an important omission in one aspect of the arrangements used to safeguard the wellbeing of one of the service users. The resolution of this has been rather delayed. It is important that in future definite action is taken promptly to respond to all such situations. There is some uncertainty about the adequacy of aspects of the calendar of social activities undertaken by some of the service users. The Acting Manager is now going to review each person’s calendar to see if they would like to undertake additional/different activities. Also, the Acting Manager needs to ensure that service users’ attendance at social and vocational commitments does not become disrupted by the fact that none of the support workers on duty can drive the Home’s motor vehicle. The Registered Provider has not introduced into the Home a suitably organised system by means of which to validate the adequacy of the competencies which individual support workers can invest in their professional practice. The Acting Manager is going to address this substantive omission by appraising each person’s command of a series of core competencies. Once completed, this exercise should be able to make a further contribution to the Home’s ability to ensure that service users receive an effective and a reliable response to their needs for assistance. The Registered Provider does not operate a suitable internal quality assurance system. This means that it has not established an organised methodology by means of which service users can suggest and realise improvements to their home. The Registered Provider does not operate a system which is designed to ensure that all members of staff have the competencies they need in order to avoid the occurrence of a fire safety emergency and to respond effectively to one should the need arise. This is important because the level of protection provided by the Home’s fire safety regime depends largely upon the actions taken by members of staff. 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 Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 8 contacting your local CSCI office. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 9 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.V283009.R01.S.doc Version 5.1 Page 10 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 and 2. The Registered Provider has not yet completed its Statement of Purpose in relation to the Home. The Registered Provider takes various steps to ensure that prospective service users are given the information they need to make an informed decision about living in the Home. There are arrangements in place to enable service users’ needs and aspirations to be assessed before they move into the Home EVIDENCE: Since the last inspection visit, the Registered Provider has not admitted any new service users to the Home. This has been a deliberate decision which was taken to enable the Home to settle down after a period in which a number of complaints were received and in which the Commission voiced serious reservations about aspects of the provision made in the Home. The Area Manager said that some of the work which has been undertaken in this interim period, has concerned what should be the future focus for the Home. This has included questions about both the numbers to be accommodated and the level of dependency to be met. The Inspector thinks that these are crucial decisions to be made and that they should be undertaken within the context established elsewhere in this Report. Once these decisions are taken, it will be possible for the Registered Provider to complete a revised version of the written document called the Statement of Purpose. This should contain a full account of the regime to be operated in the Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 11 Home and it should be completed in accordance with the specific headings listed in the relevant Schedule of the Regulations. The Inspector was pleased to see that the Acting Manager has already started work on the revision. The final document should address clearly the issue of numbers and dependency and it should be submitted to the Commission within the timescale established in the relevant Required Development listed at the end of this Report. The Acting Manager has prepared a new Service Users’ Guide. This is a brochure which prospective service users are given and which outlines both in pictures and in text the facilities and services provided in Ashstone House. The Inspector considers this to be a useful development. This is because the Guide has been prepared in a manner which is likely to be accessible to prospective service users. In addition to this, the Acting Manager said that she and the Area Manager will speak with prospective service users and with members of their families. This will be done in order to answer any remaining questions they may have. Naturally, this will be an example of good care practice. The Inspector has not ascribed a score to this Standard at the end of this Report. This is because in the absence of any recent admissions he has not been able to see how these arrangements will work in practice. The Area Manager said that the needs for assistance of each prospective service user will be assessed carefully. This will be done to ensure that these needs can be met reliably in the Home, should the admission proceed. The Inspector notes that she and the Acting Manager are aware of the importance of ensuring that future admissions are characterised by needs for assistance which are in line with those anticipated by the Statement of Purpose. Also, that new admissions are likely to fit in with the existing group of service users living in the Home. Again, the Inspector has not been able to ascribe a score to this function given the absence of any recent admissions. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 12 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 and 9. Service users generally are satisfied that their present and future needs for personal care will be met in a reliable and consistent manner. Service users generally are supported in taking prudent risks. EVIDENCE: There is a service user plan for each service user. These documents recently have been updated and strengthened by the Acting Manager. They describe the assistance the service user in question has agreed to receive. The Inspector sample checked several sections of two of these plans. With the exceptions noted below in this Report, he found them to be detailed suitably. Service users are consulted about the contents of the plans and they are invited to contribute to any reviews which are convened. Service users say or indicate that they consider themselves to receive all the assistance they need. Support workers generally assist service users in a manner consistent with that described in the individual service user plans. Having said this, the Inspector did witness two occasions on which different support workers did not respond to particular situations in accordance with the principles identified in the service users’ respective individual plans of care. In both cases, this resulted the service users becoming anxious and a little Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 13 confused. The Acting Manager said that the incidents in question would be reviewed so that lessons could be learnt to better ensure that all episodes of personal care are delivered in a consistent and appropriate manner. The Inspector thinks that this is an essential development, if the Home is to be able to provide a compensated domestic environment which is not disrupted by what in the past have been all too frequent instances of extreme conduct. Service users generally are assisted to take those reasonable risks which are part of everyday living. The Area Manager and the Acting Manager said that they are aware of the need to keep this matter under continuous review. This is so that service users are assisted to avoid situations in which their own welfare or that of others may become jeopardised. The Inspector reviewed various arrangements which the Acting Manager had taken to respond to a potential risk situation in relation to Service User A. He has asked her to submit to the Commission a written assessment of the risk in question and an account of the Registered Provider’s proposed response. This should be done within the timescale established in the relevant Required Development listed at the end of this Report. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 13, 14 and 17. Service users have opportunities for personal development. These include activities which have both a vocational and a recreational component. Some of the activities involve accessing the local community. Service users are provided with a suitably balanced diet. EVIDENCE: There is a written calendar of social activities which provides a flexible account of what each person may like to undertake each week. The Inspector examined some of the entries and he considers the activities in question to be appropriate for the people concerned. However, some of the entries were noted to be a little vague and could just mean staying at home to watch television and the like. The Acting Manager said that she will now review each of the calendars in order to see what if any additional activities should be specified in relation to each service user. This development will be completed within the timescale established in the relevant Required Development listed at the end of this Report. Also, she is going to double check that a clear record is kept which shows what activities are actually undertaken by each service user on any particular day. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 15 The Acting Manager recognises that there is a problem to be addressed. Given the rural location of the Home, most organised activities rely upon the service users having access to the vehicle supplied by the Registered Provider. The Inspector understands that on a number of occasions recently, a driver has not been available and that this has resulted in missed appointments. Several service users commented to the Inspector about this matter. They said that they do not consider it fair that their expected routine can become disrupted in this manner. The Inspector agrees with them and he is pleased to note that the Acting Manager has taken steps to ensure the increased availability of drivers in the future. The Inspector will review carefully the success of this development when he next calls to the Home. The Inspector had the opportunity to join most of the service users for lunch on both of the days of the inspection visit. The food was noted to be adequate in quality and quantity. Service users said that always they have enough to eat. The Inspector examined the record of the meals served and he concluded that the service users are provided with a normally balanced diet. The dining experience was a little basic. This was partly because the tables were not dressed at all. Also, at some times the dining arrangements became rather chaotic with service users coming and going from the room in something of a disruptive manner. The Acting Manager said that she intends to work with the service users in order to make meal times a more relaxed and pleasant experience. The Inspector thinks that this will be a useful development. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 16 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 and 20. Service users receive personal support which responds generally to their needs for assistance. Service users’ health care needs are met. Suitable arrangements are in place with respect to the administration of service users’ medication. EVIDENCE: The pace of daily life in the Home is unhurried, there being no unnecessary rules or routines to disrupt service users’ experience of a normal domestic setting. Having said this, support workers do bring a definite measure of order to the pattern of each day. The Inspector witnessed a large number of occasions on which support workers responded in an appropriate and kind manner. However and as noted earlier, some of the effect of this good work could be seen to be undermined when there were instances of some of the support workers not coordinating effectively their efforts. On these occasions, disagreements between some of the service users quite quickly escalated and then were more difficult to resolve. Also as noted previously, the Acting Manager has committed herself to improving the level of coordination achieved in the day to day delivery of personal care in the Home. The Acting Manager said that service users will be assisted to administer their own medicines if this is considered to be appropriate. The Inspector noted that none of the people currently in residence has elected to act in this capacity. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 17 This means that the support workers retain and dispense medicines on behalf of all of the service users who need them. The Inspector examined selected aspects of the arrangements used to undertake this task. He noted them to operate so as to ensure that service users take medication in the manner intended by their doctor. Several of the service users have been prescribed for medicines which a doctor has said can be used on a discretionary basis. The Inspector noted that suitable arrangements had been made to assist the team leaders and the support workers to use these medicines in a consistent and appropriate manner. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 18 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 and 23. Service users say that they are confident that any concerns they have will be listened to and acted upon. There are systems in place to respond to situations in which service users might experience abuse or neglect. EVIDENCE: There is a complaints procedure which explains how service users and other stakeholders can make a complaint about any aspect of the facilities and services provided in the Home. Service users told the Inspector that they are confident that any matter they raise will receive serious attention and that if possible it will be addressed. Since the last inspection visit to the Home, the Commission has received two expressions of concern about aspects of the personal care provided for two of the service users. The Inspector reviewed selected aspects of the steps taken by the Acting Manager to investigate and to resolve the matters in question. He concluded that her response had been reasonable. The several support workers with whom the Inspector spoke had a sound understanding of what constitutes good care practice. As part of this, they were aware of the need to be alert to instances which might jeopardise the well-being of a service. However, the Inspector will need to speak with more of the support workers about this matter, before he can validate this aspect of the Registered Provider’s compliance with this part of the Standard. In the recent past, the Registered Provider has been the subject of a number of complaints which have been investigated within an external inter-agency Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 19 adult protection framework. The Inspector notes that these matters now have been resolved and that there are no issues currently being investigated in relation to the Home. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 20 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, 27, 29 and 30. Service users are provided with a generally comfortable setting in which to make their home. There is an adequate number of bathroom and toilet facilities. Suitable provision has been made to assist those few service users who experience a measure of reduced mobility. The accommodation is presented to a normal standard of domestic cleanliness. EVIDENCE: Service users say that their accommodation is homely and that it is comfortable. In recent times, the Registered Provider has refurbished a number of areas of the Home. This has enhanced considerably the general standard of amenity offered by those areas of the accommodation examined by the Inspector. There is more work to do to the interior of the premises and the Inspector notes that the Acting Manager has a clear programme of the items to be addressed. Also, there are quite a few improvements which need to be made to the exterior of the property in order to rectify peeling paintwork and areas of damaged render. By the time if the next inspection visit to the Home, the Inspector will expect the Registered Provider to have a clear timetable which will see these various defects resolved. More generally, there are substantial questions to be asked about the long term viability of the present location of the Home. Contemporary notions of Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 21 good residential practice have now largely discounted services which accommodate more people than would routinely live in a normally sized house. This is because larger numbers inevitably lead to the need to use proportionately more routines if the business of everyday life is to be accomplished. The same notions also incline against the use of premises such as the building accommodating Ashstone House. This is because they are outside of what most people would consider to be easy reach of community- based facilities. In relation to both of these measures, the longer term future of Ashstone House warrants careful review by the Registered Provider. Although there is an adequate number of toilets and bathrooms, more could be done to make these into the welcoming and inclusive spaces envisaged by the Standards. At the moment they are rather bare and functional rooms. The Inspector is pleased to note that the Acting Manager already has identified this to be a problem and that she has prepared plans which should see the situation improved significantly. None of the service users currently in residence experiences a significant measure of reduced mobility. Suitable provision has been made in relation to those few people who do need a small amount of extra help. The Inspector examined selected areas of the kitchen. He noted them to be presented to a suitable standard of hygiene. The Acting Manager said that the kitchen is operated in accordance with what is recognised to constitute good practice in relation to the handling and preparation of food. The Inspector did not notice anything which was not consistent with this account. The Inspector understands that the local Department of Environmental Health has not recommended the completion of any improvements which remain outstanding. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 22 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, 35 and 36. There is an adequate minimum number of staff on duty in the Home. Various arrangements are in place to support effective teamwork. There is some provision which is designed to ensure that support workers have the competencies they need. The arrangements used to supervise support workers need to be strengthened significantly. EVIDENCE: There are normally at least five support workers on duty during the day time and the evening, with each shift being overseen by a team leader. The Inspector considers this to be the minimum number of support workers which should be provided in the Home, given the needs for assistance of the service users currently in residence. At the moment, the Registered Provider does not employ a cook and so the support workers have to complete all of the catering duties. The Acting Manager said that she intends to recruit a cook in the near future. This will be done so that support workers’ time can be dedicated to assisting directly the service users. The Inspector thinks that this will be a useful development. At night time, there are two support workers on waking duty. The Commission’s continued acceptance of the current deployment of staff, depends upon each person working in a focused manner. Within this context, the Inspector does have to note with surprise that on one of the days of the inspection visit, he observed one support worker having little or no interaction Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 23 at all with any of the service users. During the time in question, he sat on one of the sofas reading a newspaper, while his colleagues managed in his absence. Plainly, this is not a sustainable situation. The Acting Manager said that the issue would be addressed promptly with the person concerned. There are various arrangements in place to assist support workers to provide service users with a consistent and reliable response to their needs. These include handover meetings at the beginning and end of each shift. Also, support workers keep diary records of how things are going for each service user and there are periodic staff meetings. The Acting Manager acknowledges that in the recent past there have been some conflicts in the staff team with some people disagreeing with aspects of their colleagues’ professional practice. The Acting Manager recognises that it is essential these disputes be resolved and that mechanisms are established to prevent their recurrence. The Inspector will review specifically this matter when he next calls to the home. The Registered Provider is responsible for ensuring that all of the support workers have the competencies they need in order to respond effectively to the present and likely future needs for assistance of the service users in residence. It is understood that to achieve this new support workers are provided with introductory training which is complemented by ongoing training opportunities. The Acting Manager is now going to complement this arrangement by reviewing and validating the adequacy of the competencies which each support worker can invest in their practice. This will be done using a revision of a model which has been adopted by the Standards and which is recognised to constitute good management practice. The exercise will be completed by 1 November 2006. The Inspector considers this development to be a high priority and so he will check carefully the progress which has been made when he calls next to the Home. Although there are various informal arrangements by means of which support workers’ professional practice is monitored, these are not complemented by the more formal system envisaged by the Standards. This is an important omission, especially given some of the difficulties which the Inspector has outlined earlier in this Report. The Acting Manager said that she will address this oversight within the timescale established in the relevant Required Development listed at the end of this Report. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 24 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, and 42. Service users benefit from the management skills which the Acting Manager brings to her supervisory role. The Registered Provider does not operate a suitably developed internal quality assurance system. There are various recording systems operated in the Home to support its delivery of personal care and other services. Generally suitable provision has been made to safeguard the health and safety of the service users and members of staff. EVIDENCE: The Acting Manager has been in her post for six months or so. During this time, she has introduced a number of welcome improvements which have stabilised and then enhanced the adequacy of the support provided for the service users. As is evident from this Report, more still needs to be done and the Registered Provider needs to ensure that Acting Manager continues to have access to the resources necessary for this to be accomplished. The Inspector notes that the Acting Manager has acquired both of the formal qualifications which the Standards prescribe for her role. These are designed to extend and Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 25 to validate the competencies which she can bring to managing the provision of high quality residential care services. The Acting Manager is about to apply to the Commission to be registered as the manager of the Home. Given the determination yet to be made in relation to this matter, the Inspector is not in a position to formally evaluate this Standard at the end of this Report. However, he can observe on the Acting Manager’s obvious conversancy with aspects of what is recognised to be good residential care practice. The Registered Provider does not operate an organised quality assurance system. This important omission now needs to be addressed. The Acting Manager said that this will be done by introducing a new consultation exercise. This will entail each service user being asked to comment upon the adequacy of the facilities and services provided in the Home. The results of this exercise will be summarised in a written Quality Report. This will explain what the Registered Provider intends to do in order to action any suggested improvements. The material in question will then be shared with the service users, who will be invited to re-enter the consultation process on at least an annual basis. The Acting Manager recognises that a good deal of work will need to be done to ensure that the consultation exercise is meaningful for all of the service users in residence. She has informed the Inspector that the first full cycle of the new quality assurance system will have been completed within the timescale established in the relevant Required Development listed at the end of this Report. The Registered Provider maintains various records in the Home such as those require by the Regulations. The Inspector examined a selection of these. One of these was the record of the occurrence of accidents and other untoward events. He did not notice the presence of any patterns which indicated the need for him to make any further enquiries. Another record concerned the various transactions completed by support workers to administer the disbursement of some of the service users’ personal spending allowances. Suitable arrangements were found to be in place. The Acting Manager said that she has examined the premises and that she has not identified the presence of any significant hazards which could undermine the regime operated in the Home to safeguard peoples’ health and safety. The Inspector did not notice any such hazards. The Inspector understands that all appliances used in the Home remain in good working order and that they have been serviced in accordance with the manufacturers’ instructions. Another part of this general regime, involves ensuring that the continued serviceability of the Home’s fire safety equipment. This is done by the completion of a number of periodic checks. The Inspector examined the record of the checks in question and he found them to be up to date. However, the Registered Provider does not complement this work by the implementation of a Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 26 formal system which is designed to ensure that all members of staff have the competencies they need both to help avoid the occurrence of a fire safety emergency and how to respond effectively to one should the need arise. The Acting Manager said that this matter will be addressed within the timescale established in the relevant Required Development which is listed at the end of this Report. Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 27 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 2 12 X 13 2 14 2 15 X 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X X X 1 X 3 2 X Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 28 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 1 Regulation 4 Requirement The Registered Provider should submit to the Commission a suitably detailed written Statement of Purpose (this Required Development should have been completed by 31 March 2006). Timescale for action 31/03/06 2. 9 13 3. 11 12 4. 5 18 The Registered Provider should 13/03/06 submit to the Commission a written assessment of how it intends to manage a potential risk to an aspect of the health and safety of Service User A. The Registered Provider should 01/07/06 review with each service user their calendar of social and vocational activities and it should implement any agreed revisions. The Registered Provider should 31/12/05 prepare a suitably detailed written account of the terms and conditions in accordance with which it provides accommodation and personal care services in the Home (this Required Development was not reviewed by the Inspector on this occasion. Previously, the Registered Provider was asked to DS0000023307.V283009.R01.S.doc Version 5.1 Page 29 Ashstone House 5. 36 18 6. 39 12 complete it within the timescale listed in the right hand column). The Registered Provider should ensure that all support workers receive regularly a period of formal professional supervision. The Registered Provider should ensure that a suitably specified internal quality assurance system has been introduced into the Home in the manner described in the main text of this Report. The Registered Provider should ensure that all members of staff have been included in a suitably specified programme of fire safety competency appraisal. 01/04/06 01/11/06 7. 42 23 01/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashstone House DS0000023307.V283009.R01.S.doc Version 5.1 Page 30 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. 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