Inspection on 03/10/05 for Ashstone House

This inspection was carried out on 3rd October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 21 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 13/07/06

Ashstone House 02/03/06

Ashstone House 09/02/05

Ashstone House 28/07/04

Ashstone House 10/01/04

Similar services:

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Insight - Eastchurch

Southfields

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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 Ashstone House Ashford Road Hamstreet Ashford Kent TN26 2EW Lead Inspector Mrs Sally Gill Unannounced Inspection 3rd October 2005 09:30 Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 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.V254313.R01.S.doc Version 5.0 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.V254313.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashstone House Address 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 Ashford Road Hamstreet Ashford Kent TN26 2EW 01233 733908 Ashstone House Limited Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2005 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 company is part of Allied Care Ltd and the Manager (Nandi Himyuandi), took the up post in August 2005 previously working in a senior position with another Allied Care home has the day-to-day control. The premise is an old detached property with accommodation on two floors. All the bedrooms are single rooms and are located 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 3.5-acre garden, which includes lawn areas, 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 the train station, church, supermarket, hairdressers and newsagents. The Home is also situated on the local bus route to nearby Ashford and the Home has two cars, which can be used to transport Service Users. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on Monday, 2nd October between 9.20am and 6.00pm. Additional time was spent in preparation and report writing. During the inspection the Inspector spoke to four Service Users both in company and/or in private and had brief contact with four others. Also, she spoke to the Manager, the newly appointed deputy and a support worker and briefly met five other staff. Surveys have been sent out after the inspection and will be incorporated into the next report. The Inspector examined various records including a new format care plan, a client’s finances, the fire safety logbook, Medication Administration Record (MAR) charts and accident reports. Two additional visits have been made to Ashstone House since the last inspection and information from those visits will be incorporated into this report. The first was as a result of a complaint and the other was to meet and discuss Ashstone House with the newly appointed Manager. The Manager has only been in post since August 2005. She has recruited a deputy whose first day in post was the day of the inspection. The Manager has supplied the CSCI with an action plan, which nearly covers all outstanding recommendations/requirements. The plan is to implement the Cared4 policies and procedures throughout which have already been adopted by other Allied Care homes. However this is going to be a long process as is changing the culture of Ashstone House both of which are long overdue. Although some positive changes were seen and must be acknowledged the Manager has not been in post long enough to achieve the work required to demonstrate to the CSCI permanent improvements in standards and unfortunately since the last inspection further poor practices have been exposed through complaints and adult protection alerts. The lower NMS scores are therefore not a reflection on the current Manager. Many requirements and recommendations have been brought forward from the previous inspection, as there was not time to inspect all these areas given the findings of this inspection but will be inspected in future inspections. These may have already been addressed by the home; they are not included in the report except on the requirement/recommendation page. There are currently nine Service Users at Ashstone House. There is an informal agreement in place between the CSCI and Ashstone House that no new admissions will be taken until the current adult protection alert is closed. What the service does well: Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Decide clear aims and objectives of Ashstone House including what dependency of Service Users the environment and staffing skills can meet and incorporate this into the Statement of Purpose and Service User Guide so that the Service Users are also clear about this information. Obtain previous assessments and review/reassess with professionals Service Users to ensure they are appropriately placed and the home is able to meet all the needs of current Service Users and they are compatible with others living within the home. Develop care plans that reflect Service Users skills and needs to ensure that their needs can be met, staff take a consistent approach and independence is promoted and developed. Have clear procedures for managing any risks and behaviours. Involve Service Users more in decisions about their own lives and also the dayto-day running of the home. Ensure Service Users have access to education, job and training opportunities. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 7 Daily routines should promote Service Users independence and independent living skills. Staff should interact appropriately and respect Service Users dignity. Where possible Service Users should be enabled and encouraged to manage their own health care. The medication system must be improved to safeguard Service Users. To ensure Service Users are properly protected complaints must be investigated thoroughly and by staff of an appropriate level. When complaints are upheld actions must be taken. The homes systems, records and practices must be improved to protect Service Users from abuse, neglect and self-harm. 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.V254313.R01.S.doc Version 5.0 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.V254313.R01.S.doc Version 5.0 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, 3 Service Users do not have information and therefore are unclear about the services the home provides. A lack of assessments means the home is unable to ensure they are able to meet the Service Users assessed needs and aspirations. The home is unable to demonstrate its capacity to meet the assessed needs of the current Service Users. EVIDENCE: As a result of the last adult protection alert all Service Users are to be reassessed to ensure that the home is able to meet their needs and it is an appropriate placement. Since the last inspection four Service Users have been moved from Ashstone House. A Care Management review has taken place for two other Service Users and four are planned for October/November. The Manager has also started to implement the Cared4 assessment tool for existing Service Users, which will also be used to feed the new format care plans. The inspector was informed that this has been completed for two Service Users. The Inspector viewed the assessment for one Service User. Assessments should be signed and dated by the person undertaking them. The outstanding recommendation for assessments to cover all areas of standard 2.3 including education/training, provision of disability equipment, treatment/rehabilitation programme and compatibility with others was not checked on this occasion therefore although may have been addressed remains outstanding. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 10 The Manager is still trying to access Care Management assessments/care plans for existing Service Users. The Inspector was very pleased to hear that five Service Users have been or are in the process of being referred to the Community Learning Disability Team (CLDT) and that some progress has been made on recognising the cultural needs of one Service User. The existing Service Users have a very wide range of dependencies from low to high it is hoped that Ashstone House will decide which Service Users needs they are able to meet at Ashstone House given both the environment and the staffing skills which will then be reflected in a Statement of Purpose and Service User Guide. In the Inspectors opinion they are not able to meet the current range of needs and Service Users are not all compatible which each other. As the home does not have a Statement of Purpose or Service User Guide meeting the standards it is impossible to judge whether the staff have the skills and experience to deliver those services but the Inspector does feel that the staff do not have the skills and experience to meet the needs of existing Service Users and this was reflected during the inspection and also in the content of Regulation 37 reports received by the CSCI. The Inspector was informed that at least three Service Users are currently requesting respite from Ashstone House and this is being looked into. The Inspector expressed her concerns regarding this option given all the above information and feels this action gives Service Users mixed messages about their future. Service Users should be reviewed and the long term plan to meet their needs and deliver a quality of life agreed and then actioned. It also unsettles not only them but also others living within the home. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 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, 8 There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet Service Users needs. Service Users could make more decisions about their own lives and be more involved in the day-to-day running of the home. EVIDENCE: As already stated the Manager plans to draw up new care plans for each Service User using the Cared4 format and following an assessment. Currently these have been started for two Service Users. The Inspector discussed with the Manager and deputy including sufficient detail, Service User involvement in care planning, all areas of care and cross-referencing within the care plan to other relevant information. The care plan viewed was a good structured document although the above comments should be taken into account. The list of medication within the care plan should become a history including start dates, stopped dates and reasons for stopped. The Inspector was pleased to hear that it is planned to review behavioural guidelines and risk assessments with input from professionals. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 12 The key worker system is currently under review and the Manager said she is looking at changes to try and marry staff skills and Service User choice. It is hoped that when this is completed Service Users will enabled to be more involved in decisions about their lives. Service Users said that they attend regular house meetings to discuss staff and other house issues such as food. One Service User said that they felt they did not have a say in the day-to-day running of the home and had not been consulted about the colour of lounge, which was being redecorated at the time of the inspection. However the Manager advised that Service Users had been consulted. The Manager is aware of the current lack of involvement of Service Users in the day-to-day running of the home and hopes to address this with time. Historically limitations are in place, which in the Inspectors opinion have not been properly assessed but are the culture of the home. The Inspector was pleased to hear of an example where a change has already been made to allow Service Users a choice. The referrals to the CLDT speech therapist should aid the communication of some Service Users in order to be able to make choices. Support with Service Users finances was discussed with staff together with giving Service Users as much independence as possible. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 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, 16 Service Users are not supported access to educational, job or training opportunities. Improvements are required to ensure Service Users rights are protected and their responsibilities recognised in their daily lives. EVIDENCE: Unfortunately due to recent major changes that have affected the senior staff team Service Users have not been able to gain access to college courses for this term. This is a major disadvantage for Service Users and staff will now have to access valued and fulfilling activities in place. On the day of the inspection Service Users did have the choice to go bowling. One Service User was occupied with their newly built garden shed and one was writing a letter however others did not appear to be engaged in activities. The home has a project centre in the grounds, which can be used for art and crafts but did not appear to be open on the day of the inspection. The Manager advised the Inspector that she is trying to access activities and has managed to source horse riding opportunities. Since the last inspection as a result of a complaint the home had to review Service Users not having access to drinks after 9.30pm and take appropriate Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 14 action that is not detrimental to the Service Users. The Inspector has been informed that this has been achieved and further to that Service Users are now able to have drinks in the lounge. However other accepted practices such as the returning of razors to staff does not promote independence or responsibility. The Manager is aware that the home needs to make significant changes in order that daily routines promote independence, individual choice and freedom of movement. Staff advised the Inspector that new house rules have been developed. The Inspector was concerned to hear inappropriate comments by a staff member during the inspection to a Service User however this was addressed later that day. The Inspector discussed with the Manager inappropriate behaviour by Service Users, which is not addressed by staff such as swearing and bad manners. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 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 There is no clear care planning system in place and Service Users are not supported to maximise their health, independence, dignity and control over their lives. The medication system places the Service Users at risk and harm. EVIDENCE: Recent Regulation 37 reports received by the CSCI evidence a lack of sensitivity and flexibility by staff when assisting Service User with support and personal care. The new care plans should facilitate care being provided in a way that Service Users prefer and require with a consistent approach adopted by staff (see also standard 6). The interaction between Service Users and staff is not always appropriate and the dignity of Service Users is certainly not respected in the use of some staff’s language. Both these shortfalls were discussed with the Manager during the inspection and at a previous visit. As previously stated the key worker system is being reviewed to ensure staff skills and Service User choice are married. Some progress has also been made on recognising the cultural needs of one Service User. The Manager talked of an improvement in privacy when health care professionals are visiting the home. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 16 The Inspector was very pleased to hear that five Service Users have been or are in the process of being referred to the Community Learning Disability Team (CLDT) for speech therapy, anger management, OT and physiotherapy. The Manager has begun to address any healthcare concerns with doctor’s appointments including a medication review, an overall check-up and a referral to a dietician. Currently other health concerns are being assessed and three Service Users liquid intake is being monitored. One Service User has also recently been to the optician and is waiting to collect new glasses. Service Users currently have access to a counsellor and also a psychotherapist. The Inspector viewed the medication system, which is supplied in blister packs by a local chemist. A recent Regulation 37 incident involved a medication error. The Inspector was advised that the staff member involved has undertaken a short refresher training delivered by the prescribing pharmacy. The Inspector was advised that all staff that administer medication have received training. The Inspector discussed the need for checks/audits, which include observations to ensure competency this, does not only relate to medication but other training also. The MAR charts were examined and showed that at times two staff undertakes the administration of medication but not always. The homes medication policy states that one member of staff will administer medication. If this is not the case the policy must be changed to reflect the practice expected of staff, currently they are getting mixed messages which results in risks to Service Users. The storage for external medication is not adequate. It is not lockable and is not only used for medication. The Manager advised the Inspector that a second medication cupboard is being organised. Other concerns included handwritten entries on the MAR charts should be witnessed as well as signed (double signature), tippex must not be used and original instructions must not be obscure even if there is a change. The MAR charts must show all current medication with up to date instructions where this is not the case it must be addressed with the pharmacy. All medication must have a pharmacy label. All creams must be dated when opened. All medication must be stored and used according to the instructions. The issuing of creams etc from the chiropodist must be investigated. There should be written instruction for staff for all PRN medication. PRN medications should be regularly checked to ensure in date and where medication is not used for a long period of time it should be referred back to the doctor to ensure it is still relevant/appropriate. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 17 The Inspector observed a senior member of staff undertaking the administration of medication in an environment, which was busy and with constantly interruptions, this will environment will increase the risks of mistakes. During the administration named pots were used to ‘pot up’ medication as well as medication being handled by staff without gloves. The manager advised later that she had disposed of the named pots. The use of any pot was discussed which are not recommended as good practice. Staff have undertaken training mainly a one day course however audit/checks should be implemented to ensure ongoing competency. These checks should be recorded. Where possible self-administration or part self-administration of medication should be encouraged and supported by a risk assessment. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 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, 23 The handling of complaints has been poor and therefore does not properly protect and safeguard Service Users. Working practices and a lack of staff skills/knowledge mean there are shortfalls in the protection of Service Users from abuse, neglect and self-harm. EVIDENCE: One complaint was received by the CSCI and investigated during a visit to the home in April 2005. The detail of that complaint was that untrained staff administers medication which was upheld. It is a house rule that Service Users are not allowed access to drinks after 9.30pm, which was upheld. The Manager (now ex-manager) keeps the Bookers card in her handbag and uses it for personal use reducing the amount to be spent on Service Users, which was partially upheld. Staffs do not have appropriate work permits/references/disclosures, which was not upheld although the company were advised to seek clarification on whether permits were still legal if the staff member transfers to another Allied Care home. Member of staff abused a Service User, we feel that the investigation into this part of the complaint had not been completed fully by the company therefore we were unable at that time to make a judgement. However the handling of the complaint was highlighted as poor management practice. Staff’s meeting minutes are altered and untrue, we are unable to resolve this element, as we are not present at the staff meetings. The Manager advised the Inspector that a new recording system for complaints will be introduced in future if any complaints are received that will ensure confidentiality. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 19 As previously stated there are two open adult protection alerts at the home. Recommendations from one alert are that staff receive training regarding relationships, consent and appropriate support for Service Users. Service Users are to access education regarding appropriate relationships and consent and the home is to assess the capacity to consent to sexual relationships of Service Users. All Service Users care to be reviewed by their Care Manager. The CSCI receives reports of any appropriate incidents although the content of these has improved they could be improved further which was discussed. Physical and verbal aggression by Service Users is not always understood or dealt with appropriately and the Manager plans to review behavioural guidelines with input from professionals. The culture of behaviour within the home from both staff and Service Users does not always assist a calm atmosphere and further training and observations of practice are required. The Inspector viewed one Service Users finances, which showed a discrepancy, which should be investigated by the home and appropriate action taken with a copy of the outcome to the CSCI. The Manager had already introduced a new recording system for Service Users finances following an audit of Service Users finances, which highlighted two other large discrepancies. The discrepancy found by the Inspector was pre the new recording system. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 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): EVIDENCE: Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 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): 41 The written records within the home do not properly protect and safeguard Service Users. EVIDENCE: The fire safety logbook showed not all tests were carried out to the required frequencies, which they must be. The fire system had been serviced within timescales. The accident report were still in the accident book, which was not kept secure or confidential which they must be. The Manager advised that she has introduced regular health and safety checks with a new recording system although evidence of the checks being carried out was not checked. Also see other standards (1, 2, 6, 20) for shortfalls in records. Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 23 Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 2 1 X X Standard No 22 23 Score 1 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 2 1 X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 1 13 X 14 X 15 X 16 1 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashstone House Score 1 2 1 X Standard No 37 38 39 40 41 42 43 Score X X X X 1 X X DS0000023307.V254313.R01.S.doc Version 5.0 Page 25 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 Standard YA1 Regulation 4 Requirement A Statement of Purpose must be in use that meets the requirements of the Regulation (previous timescale of 31/05/05 not met) A Service User guide must be in place that meets the Regulation (previous timescale of 31/05/05 not met) A copy of the care management assessment must be obtained for each service user (previous timescale 31/07/05 not met) Staff should have the skills to communicate effectively with Service Users (Makaton) (previous timescale of 31/07/05 not met) A written agreement must be in place between the service user and the Home which meets the standard (previous timescale of 31/07/05 not met) Care plans should be expanded to cover all areas of 2.3, should be specific in the level of staff support required and should be up to date (previous timescale of 31/07/05 not met) Goals planning should aid DS0000023307.V254313.R01.S.doc Timescale for action 31/03/06 2 YA1 4 31/03/06 3 YA2 14 30/11/05 4 YA3 18(1) 31/12/05 5 YA5 5 31/03/06 6 YA18YA6 15(1)(2) 30/11/05 7 YA16YA6 12(1)(2) 31/12/05 Page 26 Ashstone House Version 5.0 15(1)(2) 8 YA6 15(1)(2) 9 YA8YA7 12(1)(2) 10 YA9 12(1)(2) 11 YA20 13(2) 12 13 YA22 YA23 22 (3) 12 & 13 development they should be few and realistic (approximately three short term and achievable to keep everyone focused) (previous timescale of 31/07/05 not met) The communication status of each Service User be clearly recorded in care plans this should include individual modes of communication e.g. which Makaton signs the Service Users knows to ensure communication (previous timescale of 31/07/05 not met) All limitations on freedom and choice should be agreed with the Service User which is evidenced and recorded (previous timescale of 31/07/05 not met) Risk assessments should be evidenced as reviewed within recommended timescales, the risk should be clear, actions for staff to minimise the risk should clear and procedures should be in place for staff should the risk actualise (previous timescale of 31/07/05 not met) The home must make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines and address areas highlighted in the text of this report Complaints must be investigated by an appropriately level of staff and fully investigated The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence or DS0000023307.V254313.R01.S.doc 30/11/05 30/11/05 31/12/05 31/10/05 10/10/05 10/10/05 Ashstone House Version 5.0 Page 27 14 YA24 23 15 YA28 16(2) j 16 YA34 17 Schedule 2&4 17 23(4) c 17 18 YA41 YA42 ignorance, in accordance with written policy The floor covering in a toilet on the first floor to be replaced (previous timescale of 31/03/05 extended as not inspected on this occasion) A copy of the EHO’s report to be forwarded to the Commission and work highlighted undertaken (previous timescale of 31/03/05 not met) Staff files to be audited to ensure compliance with the Regulation (previous timescale of 31/03/05 extended as not inspected on this occasion) Maintain records securely as appropriate and in accordance with Data Protection Carry out fire tests to required frequencies 30/11/05 31/10/05 31/12/05 10/10/05 10/10/05 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 2 3 Refer to Standard YA2 YA4 YA16 Good Practice Recommendations The Home’s needs assessment should meet the criteria of standard 2.3 (brought forward from previous inspections) There should be a 12 week trial period for the service users (brought forward from previous inspections) Limitations on facilities such as access to the kitchen and laundry should be reviewed to ensure the behaviours of some Service Users are not unnecessarily restricting the choices of others. The restrictions of access should also be recorded on a risk assessment so they can be reviewed regularly (brought forward from previous inspections) Service Users health care needs are met and where possible they are supported to manage their own health care The medication policy to be reviewed (brought forward DS0000023307.V254313.R01.S.doc Version 5.0 Page 28 4 5 YA19 YA20 Ashstone House 6 7 YA23 YA26 8 YA30 9 10 11 12 13 14 15 16 YA32 YA35 YA35 YA36 YA36 YA39 YA42 YA42 from previous inspections) There should be a policy on the acceptance of gifts & making/benefiting from a will (brought forward from previous inspections and not inspected on this occasion) An audit of bedroom furniture against the standards giving thought to sufficient storage space for possessions (brought forward from previous inspections and not inspected on this occasion) The system for bath mats be reviewed to ensure that bath mats are changed after each bath and not used by more than one Service User (brought forward from previous inspections and not inspected on this occasion) 50 of staff qualified to NVQ level 2 or above (brought forward from previous inspections and not inspected on this occasion) Staff should receive induction and foundation training to Skills Sector Council specification (brought forward from previous inspections and not inspected on this occasion) Staff training should be linked to LDAF Staff training should be linked to LDAF (brought forward from previous inspections and not inspected on this occasion) All staff should receive annual appraisals (brought forward from previous inspections) Staff to receive supervision to recommended timescales (brought forward from previous inspections) There should be an effective QA system in place Further staff are trained in core training (brought forward from previous inspections and not inspected on this occasion) Further staff trained in first aid to ensure that there is a qualified in first aid on duty at all times including night time (brought forward from previous inspections and not inspected on this occasion) Ashstone House DS0000023307.V254313.R01.S.doc Version 5.0 Page 29 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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