CARE HOME ADULTS 18-65
Ashtons Cross 2 Tithebarn Road Ashton-in-makerfield Wigan Greater Manchester WN4 0YD Lead Inspector
Mr Mike Perry Unannounced Inspection 22nd September 2005 09:30 Ashtons Cross DS0000022412.V253273.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 Ashtons Cross DS0000022412.V253273.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. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ashtons Cross Address 2 Tithebarn Road Ashton-in-makerfield Wigan Greater Manchester WN4 0YD 01942 767 060 01942 767062 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) www.trurehab.com TRU Limited Mrs Karen Connor Care Home 15 Category(ies) of Physical disability (15) registration, with number of places Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 15 PD Date of last inspection 24th March 2005 Brief Description of the Service: Ashton Cross opened in June 1992 and is a home, consisting of two separate houses (Woodlands and Beeches), registered to provide personal care and support to 15 service users with physical disabilities. Ages can range between 18 and 65 years. The home specialise in rehabilitation for service users who have acquired brain injuries and aim to assist them back to independent living. The two units offer different levels of support. The home is owned by TRU (Transitional Rehabilitation Unit) and is managed by Mrs Karen Conner. The Responsible Person is Mr Bill Kenyon. Residents of the Home are encouraged to undertake paid work linked to achieving agreed aims and objectives on individual care plans. The home is part of a comprehensive rehabilitation service involving another care home and community services as well as a variety of work based units. The home is located in the rural area of Ashton-in-Makerfield and is set in its own grounds with gardens. The home receives referrals nationwide due to the specialist area of care given. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted over a period of 6 hours on one day. All day and recreation areas were seen and some of the residents bedrooms. Care records and other records kept in the home were also viewed. In total the inspector spent some time with residents and spoke with 4 in more depth. There were no visiting relatives on the day. Comment cards were left with the manager so that visitors can complete them if they wish. The manager and 4 care staff were spoken with as well as a member of the psychology team. Administration staff [at Mgt House] where also interviewed. 9 of the 20 Core standards were covered on the inspection The feedback from the residents was generally positive with regard to the care in the home, which is very specialised. There were some issues raised around the views of a minority of the residents regarding what they perceive as communication difficulties with some staff who speak English as a second language. The management team has addressed this and the inspection did not reveal any consequence for the care of the residents. There are very good individual care programmes aimed at the rehabilitation of the residents. The assessment process and the ongoing reviews by the multi disciplinary team at TRU ensure a comprehensive service. What the service does well:
The Home is part of a larger organisational structure that aims to cover all aspects of brain injury rehabilitation. Ashton’s Cross is generally recognised as the second stage in this process and is the pre community unit. It links in well with the other care home in the group and community support team. Throughout the organisation there is an internal economy in operation linked to specific goals on care programmes. The assessment process for residents referred is very comprehensive and includes psychologist input as well as home visits by the assessment team who agree initial goals and objectives for coming into the home. Once actually admitted there are further assessments and these include further input by the care team including physiotherapy and Neuropsychiatrist. Individual care plans are drawn up wit the resident’s involvement at all stages. The resident agrees set goals to achieve and progress is reinforced by the token economy system in place throughout the organisation so that residents can ‘earn’ money as they achieve objectives. The coaching staff supports care plans and there are regular reviews held attended by all the clinical team and the resident.
Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 6 There is a range of opportunities for social interaction and leisure pursuits. TRU run a series of training groups to assist with social skills and personal development. A good programme of leisure pursuits and outings helps quality of life on the unit. Residents spoken to identified regular outings and social events held at Ashton’s Cross and the associated homes. Local community facilities are also used for swimming, cinema etc. Occupational training is offered on the various sites and these include woodwork, gardening and other opportunities to help maintain and develop skills in a safe environment. Residents interviewed recognised the specialist nature of the service and the support that they were getting. Being a pre community unit there are considerations around the residents need to self-monitor medication administration. This is managed within careful assessment of the risk involved. There is a well-formulated complaints process and this is used by residents to raise issues of concern. There are currently some ‘live ‘ issues being considered by the management and these are managed openly. Ashton’s Cross is part of the Transitional Rehabilitation Unit [TRU] organisation that includes another care home, administration, work units, and community support. It fits in along side these other units and is therefore able to offer a more comprehensive service. The general environment of the home is maintained well and offers comfortable accommodation. What has improved since the last inspection? What they could do better:
Staff recruitment files were reviewed on the inspection. The necessary checks that must be completed to ensure that staff are fit to work with vulnerable people had not been completed on some staff currently working in the organisation. This has the capacity to put residents at risk and must be dealt with as a matter of some urgency. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 7 There was discussion around the medication policy in the home and how this may benefit from the input of the supplying pharmacist who can carry out routine auditing and also have some input into the training programme. The structured nature of the daily routine at the home means that some residents see this as restrictive. For example set times when residents have o be in their rooms at night. This issue should be addressed in the information that prospective residents are offered prior to admission so that they can make a more informed choice. 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. Ashtons Cross DS0000022412.V253273.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 Ashtons Cross DS0000022412.V253273.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): 2 The assessments carried out by the home are very comprehensive and help ensure that the home can meet the needs of residents admitted. EVIDENCE: The initial assessment process for residents to be admitted to the unit is very comprehensive and involves all levels of staff at TRU. The Clinical Neuropsychologist carries out the initial assessment. There is then a referral to the appropriate management team consisting of the manager and Programme Coordinator who visit the prospective resident in their own home and make an initial assessment and contact in terms of rehabilitation needs. The team also contact and discuss residents with referring professionals from both health and social care. Care files seen evidenced this and residents interviewed described some aspects of this process. The unit takes referrals nationwide. From the interviews conducted it is clear that service users are included in all aspects of the assessment process. Further assessments carried out in house are linked to rehabilitation programmes on offer such as social skills training, problem solving, anger management, stress management, ADL [activities of daily living] and other specialised groups. Ashton’s cross generally forms the base for pre admission back into a community setting and so links closely and takes referrals from Lyme House which is the other home in the group which covers the first stages of rehabilitation.
Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 10 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, 9 Individual care plans are drawn up with the resident’s involvement and reflect changing needs and personal goals, which helps ensure participation and develops a meaningful plan of care. Risk is managed appropriately so that residents are encouraged to involve themselves in daily living in a safe manner. EVIDENCE: The inspector evidenced this standard through viewing a selection of Service Users plans and discussing some of the issues with an onsite psychologist. All plans viewed were comprehensive and well organised. Assessment documentation was included and it is clear that a holistic approach is used. Many professionals (e.g. speech therapist, occupational therapist, physiotherapist, counsellor etc) had had input into formulating a rehabilitation programs which was specific to the residents needs. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 11 A weekly meeting is arranged for residents and their key staff. Plans and progress are discussed as part of this session. The larger multi disciplinary team then reviews the plans and progress on a monthly basis. One resident discussed his plan of care. There was a clear timetable showing how the resident would be spending his time. The plan was very structured and the resident was ale to explain that clear goals were important so that progress could be measured. Goals are given specific monetary reward through the TRU internal economy. Residents are also encouraged to formulate their own personal goals and objectives. Residents have copies of all key documentation to refer to. The concept of risk is clearly understood by the care team who were able to explain how some residents are supported to extend their goal setting in a structured manner. One resident had expressed a wish to go on a home visit and the risks attached to this were documented, assessed and a framework of support was put in place so that this could be achieved. Untoward incidences of aggression are later assessed by the clinical team and there is always a plan formulated in terms of future management. One resident discussed the need for staff to continually monitor his whereabouts. He explained that whilst he found this intrusive to some degree it was ‘ for my own safety’. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 12 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): 11,13,14,17 There is a planned approach to the organisation of social activities and programmes in the home, which encourages personal development for residents. Residents are encouraged to make use of local facilities, which assists in community integration. Meals are well managed and provide opportunities for residents to develop social and domestic skills. EVIDENCE: Residents explained that Ashton’s cross is part of a rehabilitation service that is geared towards creating a structured environment that provides opportunities for learning coping mechanisms and encouraging self help skills aimed at promoting a more independent life style. One resident had a personal goal ensuring regular visits home to see his family and this was being achieved through a programme whereby he was better able to control his behaviour. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 13 Another long stay resident was engaged in some cooking [There is a kitchen facility available for cooking and all service users are expected to use this with varying amounts of support] and was also being encouraged to attend for some Gym sessions during the afternoon as well as swimming in order to improve motivation. Residents are encouraged to make use of local facilities and shops. The service has access to professional psychology support on a daily basis in terms of counselling and development of behavioural approaches to care as needed. One care staff member explained the programme for on resident who had learnt a set of ‘triggers’ in order to help control impulsive behaviour. The staff also commented that psychology support was also available for staff in order to help meet the rigours of such, at times, intense work. The service as a whole has created [and continues to create] a lot of opportunities for work-based activity either at Ashton’s Cross, Lyme House or Mgt House. There are workshops for woodwork, gardening projects and mechanics [in some instances]. The unit has good day space including grounds and this is well used by residents. Social events are organised regularly and held throughout the TRU sites. Staff accompanies residents on holidays [one highly dependant resident went to Disney land last year] and trips out. There is a mini bus available and there is traditionally an outing each weekend. TRU produce there own in house magazine ‘Insight’ with a lot of input from residents. The latest edition includes ideas for a Christmas concert, regular football matches at Lyme House, and other contributions by both residents and staff at TRU. Residents are encouraged to undertake their own cooking and devise menus as part of the programmes at TRU. Each has a specific budget to buy food and plan meals. Residents where observed to be involved in this with varying amounts of staff support. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 14 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): 20 Medicines are well managed so that residents are protected by safe practice. EVIDENCE: There is one resident currently who has started a programme of selfmedication. This has undergone necessary risk assessment and has started with the resident being able to identify medicines and times that they should be taken. The requirement form the last inspection regarding the storage of medicines has been addressed. Medication Administration Records [MAR] sheets were seen and the recording was satisfactory. There was an audit trail for when residents go on leave so that medicines can be tracked. The medicine storage and administration is subject to some internal auditing. The possibility of the supplying pharmacist becoming involved in both routine auditing and staff training was discussed. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 15 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 The home has a complaints procedure and this is used by residents to raise issues of concern which are acted on. EVIDENCE: There is a complaints procedure in the home and residents were aware of how to raise issues of concern. Complaints are recorded. A small minority of residents did raise current tissues of concern around their perceived communication difficulties with over seas staff that the management were aware of and where dealing with. There were issues raised around the times residents have to be in their rooms at night which some found restrictive and undermining of choice. This was discussed with the manager who explained how the structure of the day had to be geared around rehab programmes and that the ‘curfew’ had been agreed at a residents meeting so that resident sleep patterns could be regulated and that daily activity could settler down at a reasonable time. This was open to review by the same process. There was some discussion around the restrictive nature of some of the daily routines and that this is not always to some residents liking. The information on the home [service user guide] should include reference to any restrictions so that residents referred have prior knowledge and can make informed judgements regarding placement. The inspector made the manager aware of a complaint from a resident during the inspection that she did not know about previously.
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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 The environment at Ashton’s Cross is being developed along appropriate guidelines and principals which helps ensure therapeutic, comfortable and safe living conditions for residents. EVIDENCE: The service is divided into two physically separate units, Beeches and Woodlands. Beeches has a large lounge area, a separate quiet lounge, which is equipped with a computer and a separate dining, area. Woodlands has a combined L shape lounge and dining area. All areas viewed were accessible to the service users although this excludes kitchens, which are opened at specific times as a house rule stipulates that staff have to be present [risk dictates]. Each unit was decorated to a good standard. The service has a separate facility, which is used for group meetings and is equipped with a pool table and further computers. Ashton Cross has very well maintained and accessible grounds. Some work has been completed since the last inspection and there is now a landscaped garden area. Service users bedrooms seen [not all] were comfortable and well personalised. Residents can maintain the rooms as they wish. Rehab programmes encourage residents to maintain standards of cleanliness in rooms.
Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 17 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): 34 The recruitment processes in the home are not robust and do not provide sufficient protection for residents. EVIDENCE: Staff personal files are maintained at Mgt House, which is the main administration building for the organisation. Staff files seen were complete in details of identity and references. Protection of Vulnerable Adult [POVA] and Criminal Record Checks [CRB] where inspected separately and for some staff these where incomplete. Of the files seen 2 staff had not received any CRB check and had been working at TRU for 6 months. There was some discussion with the administration department and the inspector left a copy of the requirements under Schedule 2 of the Care Home Regulations. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 18 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): Not inspected. EVIDENCE: These standards were not inspected. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 19 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 X 4 X X X Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 X X 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 4 12 X 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 2 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Ashtons Cross Score X X 3 x Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000022412.V253273.R01.S.doc Version 5.0 Page 20 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 YA34 Regulation 19 Requirement All staff employed by TRU must undergo routine POVA and CRB checks to ensure fitness to work with vulnerable people. All existing files must be updated with the necessary checks and information listed in schedule 2 of the Care Home Regulations. Timescale for action 30/10/05 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 Refer to Standard YA1 Good Practice Recommendations The Homes Statement of Purpose and Service User Guide should contain reference to the tight structure of the daily routine in the home and house rules such as set times for retiring to bedrooms should be included. [This arose from assessing standard 22 on complaints] The supplying pharmacist should be included in routine auditing of the medicine storage, policy and procedures as well as being included in staff training for those administering medicines. The complaint raised on the inspection and discussed with the manager needs to be addressed by reference to the
DS0000022412.V253273.R01.S.doc Version 5.0 Page 21 2 YA20 3 YA22 Ashtons Cross resident concerned.. Ashtons Cross DS0000022412.V253273.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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