Inspection on 26/06/07 for Ashtons Cross

This inspection was carried out on 26th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashtons Cross 06/07/06

Ashtons Cross 17/03/06

Ashtons Cross 22/09/05

Ashtons Cross 24/03/05

Ashtons Cross 08/07/04

Ashtons Cross 10/03/04

Similar services:

Ruskin Lodge

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Cornmill Nursing Home

Vitalise Sandpipers Centre

Sue Ryder Care Birchley Hall

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

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 26th June 2007 10:00 Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 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.V335674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 15 PD One named service user under the age of 18. The key staff working with the service user should be at least 21 years of age. 7th October 2002 Date of last inspection 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. The current fees are £1795 to £3560 weekly. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The ‘key’ inspection was unannounced and was conducted over a period of 8 hours over two days. Day and recreation areas were seen as well as one bedroom. Records kept in the home were also viewed as well as staff records held at Margaret House, which is the administration sector for the organisation. In total the inspector spent time with residents and spoke with 5 in more depth. There were no visiting relatives on the day. The management team and coaching staff were also interviewed. Comment cards were sent prior to the inspection and a number of these were returned and are also used to collate the report. All of the key standards the home is expected to achieve were reviewed. Because of the specialist nature of the service there is a ‘trade off’ in terms of meeting some of the standards implicit in social care. This is because the structure of the ‘treatment’ programmes can be very intense and appear very limiting for residents in some instances. Judgments are, therefore, made with respect to the ‘outcomes’ for residents in terms of ‘learning’ as well as rehabilitation and adaptation skills, which assist residents to meet daily living needs. What the service does well: The initial assessment process for residents to be admitted to the unit is very comprehensive and involves all levels of staff at TRU. 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 and also visit the unit prior to admission or for trial visits. Residents interviewed had varying memories of the admission process. Some said they were ‘sent’ by referring authorities and had little choice but felt that staff were very supportive and assisted them in settling in to what was invariable described as quite intense rehabilitation programmes. All of the residents interviewed had a personal ‘care plan’ which consisted of a daily planner and targets for each day. These are worked out and agreed the day before with their primary or support coach. One resident discussed a Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 6 programme for assisting with managing cigarettes and another discussed personal goals around management of aggression. The individual nature of the care planning is exemplified by one resident with diverse needs around personal care and requires specialist communication strategies using pictures and hourly ‘orientation’ to assist in getting through the day. These strategies were also evidenced in the environment with orientation boards and prompts in the resident’s bedroom. The quality of life for this person was clearly enhanced by this programme. Invariably residents could identify how they had improved since coming to the unit: ‘I can manage my aggression better. I used to kick off at anything but now it takes quiet a lot to get me going. I’m looking forward to moving on to the community soon’. The home together with the other sites under the TRU banner operate an internal token economy system aim at rewarding met targets agreed on the care plan. All residents interviewed had a clear concept of this and were able to understand how it worked. Residents reported regular contact with their families and this is facilitated as part of the planning with most residents having regular periods of leave to go home. Staff reinforced the idea that family support and awareness is vital to progress made by residents and so contact is facilitated. The inspector spoke to residents who explained that the daily routine is individually planned through the daily diaries in conjunction with coaching staff. Each resident therefore has a routine for the next day, which includes behavioural targets and times of activities. For the purposes of experiencing a ‘normal day’ the diaries are written with respect to routine daily activities of living such as getting up, washing, having breakfast etc with the purpose of reinforcing accepted social norms and behaviours. There is an excellent range of work based and leisure activities for residents to choose from which can then be planned into individual programmes. There are workshops at Mgt House and at Lyme House as well as a variety of outings planned. What has improved since the last inspection? The last inspection evidenced that TRU’s adult protection policies were not in line with locally agreed social service policy. The managers have reviewed this and there has been contact made with the adult protection team various stages over the past year so that the service is now clear regarding its role and Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 7 the reporting of any allegations. This evidences that Ashton’s Cross are dealing with such allegations appropriately. Staff reported ongoing training in this area and abuse awareness is part of staff training at TRU for all grades of staff. The management have addressed the requirements made on the last inspection report. These included updating the information for residents[‘the service user guide’] and improving recruitment checks on staff so that that staff employed are checked as fit to work with vulnerable adults. What they could do better: The home has installed CCTV cameras in all communal areas and this has been a new feature since the last inspection. There are obvious issues that need to be addressed as this infringes on privacy and dignity for residents. The arguments have been raised in the past with respect to other services in the group [Lyme House] and requirements have been made by the Commissions at the time to have the cameras removed so it is a concern that they have been installed at Ashtons Cross. Some comments received from residents include: ‘We’ve got used to it but it’s a bit like big brother. Its starting to encroach on our privacy’ ‘I think it’s for security. Not sure. Don’t bother me - a little bit maybe. Don’t like being looked at. They just arrived. Don’t remember them asking us’. ‘Feel my privacy is being invaded. No need for them. What are they for? When I get up in the night to go to loo can feel them watching when I’m in the corridor. Feel embarrassed. Not asked about putting it in. just appeared. Feel they could trust me more’. ‘ Bothered me when I arrived. But now OK. Got used to them. Keeps people from behaving badly’. ‘Like big brother’. Does feel restrictive’. The comments are generally negative or ambiguous. The argument from the Commissions perspective is that the cameras are infringing on residents right to privacy and must be removed. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 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 Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1,2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents at the home are assessed thoroughly prior to and during the early stages of the admission process and this helps to formulate a rehabilitation programme. 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 and also visit the unit prior to admission or for trial visits. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 11 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. Residents interviewed had varying memories of the admission process. Some said they were ‘sent’ by referring authorities and had little choice but felt that staff were very supportive and assisted them in settling in to what was invariable described as quite intense rehabilitation programmes. Some could remember being given admission information in written form and this could be referred to when needed and was helpful. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are consulted at each stage of the rehabilitation process, which is well structured and has clear aims and objectives so that care meets individual needs. EVIDENCE: All of the residents interviewed had a personal ‘care plan’ which consisted of a daily planner and targets for each day. These are worked out and agreed the day before with their primary or support coach. One resident discussed a programme for assisting with managing cigarettes and another discussed personal goals around management of aggression. The daily care records are supplemented by the more in-depth care plans which give more specific instructions. For example around communication for one resident, which listed ‘give only 2/3 pieces of information at a time’ and ‘be prepared to repeat’. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 13 The individual nature of the care planning is exemplified by one resident with diverse needs around personal care and requires specialist communication strategies using pictures and hourly ‘orientation’ to assist in getting through the day. These strategies were also evidenced in the environment with orientation boards and prompts in the resident’s bedroom. The care plan listed these interventions and evaluated progress on a regular basis. Although essentially a rehabilitation unit this residents outcomes could be measured in quality of life which was clearly enhanced by this programme. Coaching staff clearly had a positive relation ship and had supported the resident in both personal care as well as socially on outings and holidays. The care at Ashton’s Cross is very structured around previously agreed goals and targets for each resident. The therapy team sets some goals although this follows discussion. Some of the goals are ‘self determined’. These are personal targets that residents set for themselves in terms of progressing through the care programme. Because these are self determined they are open to choice and the resident exercises some control over the care programme. The aim of the therapy is to try and predetermine any problems that may arise for residents and plan set ways of adapting and dealing with issues. Staff interviewed felt that frustrations generally arose from lack of adequate planning. Residents interviewed invariably felt the frustrations of daily life at Ashton’s cross: ‘There’s to many rules’, ‘its like were not trusted at times’, ‘ it can feel very invasive’. Although these residents were frustrated by some of the limitations of life in the unit they could see benefits from the programme overall and were able, to varying degrees, state how they had progressed: ‘I can manage my aggression better. I used to kick off at anything but now it takes quiet a lot to get me going. I’m looking forward to moving on to the community soon’. Although the structure of the programmes sets limitations on, for example, going out spontaneously, this can be addressed by preplanning and residents are asked to complete an ‘outings form’ so that such an event can be planned into the programme and this gives residents the opportunity to work through any problems that may arise in terms of risk and to work through these and devise pre planned responses. The home together with the other sites under the TRU banner operate an internal token economy system aim at rewarding met targets agreed on the care plan. All residents interviewed had a clear concept of this and were able to understand how it worked. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 14 Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11,12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a very structured lifestyle, which affords very good opportunities to develop social skills, and adaptive strategies, which are key to personal development. EVIDENCE: Many of the activities are often away from the unit and so residents are often not on site if visitors wished to call unannounced. The structure of each day is also very tight so that visiting would disrupt planned activity. Staff reported that visitors are encouraged to pre plan their visits therefore. Residents reported regular contact with their families and this is facilitated as part of the planning with most residents having regular periods of leave to go home. One resident interviewed said that he went to see his mother at weekends and now leave is being negotiated during the week as progress on his programme was maintained. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 16 Staff reinforced the idea that family support and awareness is vital to progress made by residents and so contact is facilitated. Relatives are also given a lot of feedback through reviews and formally through reports. Staff reported that relationships on site do occur although the implications of this are discussed in detail with respect to the needs of the overall rehabilitation programme. The manager was able to give an example of this in the past. Sexual relationships would not be allowed on site but are supported off site. There are policy statements / guidance for staff around the issue of intimate relationships. As with everything within TRU this would indicate a planned and structured approach to this aspect of life. The unit admits both male and female residents. The female residents are admitted to the Woodland unit [home has 2 residential units] and male residents are located on Beeches unit. There are however 2 males accommodated on Woodlands and there was some discussion around good practice guidance here. Staff are aware of risks and assessments are carried out. The female bedrooms are situated on one corridor. There is no sharing of bathroom facilities although day space is shared. The inspectors spoke to residents who explained that the daily routine is individually planned through the daily diaries in conjunction with coaching staff. Each resident therefore has a routine for the next day, which includes behavioural targets and times of activities. For the purposes of experiencing a ‘normal day’ the diaries are written with respect to routine daily activities of living such as getting up, washing, having breakfast etc with the purpose of reinforcing accepted social norms and behaviours. There is in addition an excellent range of work based and leisure activities for residents to choose from which can then be planned into individual programmes. There are workshops at Mgt House and at Lyme House as well as a variety of outings planned. Every Sunday, for example, there is an outing planned and residents can participate as part of a larger group. The unit has developed more on site activity units and although not currently in use, they are planned to be on line in the near future. Residents clearly felt they benefited from access to these opportunities to develop and maintain workbased skills. The provision of food is again planned individually through weekly and daily planners. Residents discussed their choice of diets and this is worked out with coaches and budgets planned in to shop and then cook. Some meals are communal and staff get involved in the preparation and cooking of these. Each of the units has their own kitchen facilities. Sessions are observed / supported with staff presence. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 17 Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to health care on an ongoing basis and receive support from care staff so that personal care can be maintained. EVIDENCE: Most residents are able to attend to their own personal hygiene needs and the staff role tends to be helping to set agreed goals and prompts in this area. One resident was reviewed who does require a degree of personal care to carried out by staff. The care plan was clear about staff interventions as well as how much the resident should be encouraged to do themselves. From the evaluations and staff discussion it was evident that some progress had been made and that the resident was able to perform more personal care tasks as the care programme has progressed. The unit takes referrals from all over the country and many receive funding from health authorities that then review progress made on the unit through regular case conferences. One resident discussed the monthly reviews by the nuoropsychologist. There is medical input into these reviews as well as updates from coaching staff. The home offers in house medical support via a visiting Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 19 GP, physiotherapy as needed and a nurse employed to give advice on medication management as well as medical issues. The care files contain regular assessments and notes from medical and other therapists. One resident reviewed had received a lot of support from a speech therapist. Residents felt that medical and therapy support was very good. Residents were mixed in their opinions of the coaching staff with respect to general support and approachability. The general feeling was that staff are supportive and have residents needs as their priority. All of the residents spoken with were able to identify their primary coach and felt comfortable with them. There are no residents who self medicate on the unit. This was discussed and it was explained that self-medication programmes are more of a priority as residents approach the community in terms of rehabilitation. There have been self-medication programmes at Ashton’s Cross and these have been individualised for that person. The risk assessment tool used for this purpose was seen and discussed. The medication records were seen and these were clear in their recording of medication given. The policy is for two staff to sign for medications. There is a clear auditing process and one medication was checked and the stock was found correct. Medication issues are over seen by a Registered Nurse who works for TRU and advises on these issues as well as monitors staff training. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure and the service accesses local adult protection policy so that residents are protected. EVIDENCE: The last inspection evidenced that TRU’s adult protection policies were not in line with locally agreed social service policy. The managers have reviewed this and there has been contact made with the adult protection team various stages over the past year. There have been four cases that the manager has referred to adult protection. One was because of allegations made by a resident regarding staff in another care home whilst on holiday. The other three were allegations regarding staff at Ashton’s Cross. These had been dealt with appropriately with the correct referrals made. As a result of one of the referrals a member of staff was dismissed and reported through the correct channels [The Protection Of Vulnerable Adults – POVA - register]. This evidences that Ashton’s Cross are dealing with such allegations appropriately. Staff reported ongoing training in this area and abuse awareness is part of staff training at TRU for all grades of staff. The locally agreed policies were available. Residents spoken with varied in there understanding of the complaints procedure and this was also reflected in the feedback from the surveys sent Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 21 out. Residents did feel that they could discuss and raise issues of concern however. The complaints file evidenced that residents do complain and that the management respond to any issues of concern. An example of this was one resident who had concerns about working with a particular member of staff. This had been listened to and dealt with appropriately. The manager explained that any concerns expressed are treated formally and responded to. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service continues to grow in terms of facilities offered to residents and these are maintained satisfactorily. The instillation of CCTV encroaches on residents right to privacy. EVIDENCE: There was work in progress during the inspection on new buildings which will be used for activities and therapy. This evidences the companies continued commitment to expand on site work and activity units for people who use the service. There are two residential units at Ashtons Cross. Day areas were seen and one of the bedrooms. These areas are maintained satisfactorily. Residents are expected to clean their own areas and coaching staff support this and maintain standards if needed. One resident showed the inspector the laundry facility which residents use and this was clean and spacious. With sufficient machines available. The flooring Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 23 was carpeted and it would be recommended that this is replaced in future with suitable hard flooring that can be more easily maintained and cleaned. Residents felt that the accommodation was generally suitable and that there was sufficient day space and bathroom / toilet facilities. The home has installed CCTV cameras in all communal areas and this has been a new feature since the last inspection. There are obvious issues that need to be addressed as this infringes on privacy and dignity for residents. The arguments have been raised in the past with respect to other services in the group [Lyme House] and requirements have been made by the Commissions at the time to have the cameras removed so it is a concern that they have been installed at Ashtons Cross. The inspector spent time talking with residents and staff regarding the instillation of the cameras. Management were of the opinion that the cameras were ‘more of a help than a hindrance’ and that ‘they served their purpose’. The purpose of the cameras were described as being able to observe adverse incidents on the unit and then to provide feedback to residents. It was also felt by the managers that residents feel much safer because of the cameras. An incident was described where by a resident tried to bring some cannabis onto the unit and was seen on CCTV. The management did say however that the resident would have been discovered anyway due to normal checking procedures. The management have conducted a recent survey of the residents feelings on CCTV but the findings from this are not conclusive of support for the cameras and it is noted that at least six of the resident feel that their privacy is being invaded. The inspector received the following comments from residents during discussions: ‘We’ve got used to it but it’s a bit like big brother. Its starting to encroach on our privacy’ ‘I think it’s for security. Not sure. Don’t bother me - a little bit maybe. Don’t like being looked at. They just arrived. Don’t remember them asking us’. ‘Feel my privacy is being invaded. No need for them. What are they for? When I get up in the night to go to loo can feel them watching when I’m in the corridor. Feel embarrassed. Not asked about putting it in. just appeared. Feel they could trust me more’. ‘ Bothered me when I arrived. But now OK. Got used to them. Keeps people from behaving badly’. ‘Like big brother’. Does feel restrictive’. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 24 ‘Don’t bother me. I think its good – if somebody is sick you can see them on the monitor. Don’t feel invaded. I would be concerned if it was my room which is private. ‘No client allowed out on their own. Everybody is watched. We get used to it. CCTV is for my own safety – if I have an accident’. ‘I would feel any different if it wasn’t there. No less safe. It was just put in – I don’t remember having any meetings’. The comments are generally negative or ambiguous. The argument from the Commissions perspective is that the cameras are infringing on residents right to privacy. The intense rehabilitation programmes at TRU do mean that resident’s expectations around privacy are different than in other care environments but the instillation of cameras do not appear to improve any outcomes for residents on the unit. The existing programmes encourage behaviour change in a positive way and the existence of CCTV cameras does not seem to have any place in this environment. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are recruited and trained appropriately so that they can carry out there work and meet the needs of residents. EVIDENCE: The staffing on the days of the inspection consisted of 16 staff of different grades [managers, psychology staff, coaching and administration]. This for 14 residents. The staff ratio is very high and is important to carry out the coaching role that plays a vital part of the care system at TRU. Staff interviewed were very knowledgeable about the residents in their care and displayed a high level of competence in discussing the care programmes. Residents expressed a high level of satisfaction when talking about the ability of the staff. Staff interviewed stated that turnover of staff is still an issue but this has settled down over the past year. Residents felt that coaching staff were consistent. The training programme in the home is very well structured, particularly around the clinical background of acquired brain injury and the behavioural Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 26 techniques used by staff to work with residents. All staff go through the same training programme, which is ongoing, and covers staff needs at different levels of clinical competence from induction to primary coaching and advanced training. The training programme includes a prolonged ‘shadowing’ component which staff reported as being particularly useful. This has now been broadened to include NVQ training for staff and all staff at Ashtons Cross were reported to be enrolled on an NVQ programme. The recruitment processes were reviewed. Staff records were viewed at Mgt House with the administration staff and records inspected contained all of the required checks to ensure that staff are fit to work with vulnerable adults. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good management structures and systems in place so that resident’s views are represented and that the service is run in their best interests. EVIDENCE: The Registered Manager of Ashtons Cross is Karen Conner. Karen has been in post for 5 years. She is undertaking an NVQ qualification in management. Since the last inspection she has completed some work on updating the service user guide following recommendations made at the time. She is also involved with staff training initiatives in the organisation. As with all staff that work for TRU she has come through the organisation experiencing all staff roles and training in order to become the manager of Ashton’s Cross. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 28 The manager was able to discuss the various quality audits that are conducted on a regular basis including facilities audits, health and safety and staffing. The audits conducted by the various managers and directors for regulatory purposes were also seen and are completed with attention to detail. The manager conducts a 4 weekly audit of staff responsibilities and this is also reinforced through the mentoring system. Staff reported regular mentoring on site. The organisation as a whole has Investors in People status. Care reviews are held monthly and form part of not only clinical update but also act as a quality assurance tool in terms of ensuring that the service is able to demonstrate development for each resident set against measurable targets and goals. The review process is attended by the resident and all concerned with the care and support. Both verbal and written feedback is given to all parties including family and funders of the care. Case conferences are also held 3 monthly and referring health professionals, social workers and family can all attend. Yearly objectives are identified in the development of the organisation and the unit and an annual report is produced outlining achievements and targets for the forthcoming year. The service conducts resident satisfaction surveys [ for example the survey on CCTV usage] and these opinions are considered in the service plans. The home has applied for a variance to their registration since the last inspection so that they could admit a resident who was under the age of 18. The work completed in terms of meeting extra standards in this area was noted. The requirements made on the previous inspection have all been addressed and the service has a good record of meeting statutory requirements and guidance. On this visit the issue of the CCTV has been of major concern and it is a surprise that this has continued to be installed despite previous discussions. The health and safety management and records reviewed included environmental health report for the kitchen facilities, first aid policy and practice and checks on fire equipment and all were satisfactory. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 29 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 3 2 4 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 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 4 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 X Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 30 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 YA24 Regulation 12(4)a Requirement The CCTV cameras installed in the home in all day areas must be removed to ensure privacy for residents. Timescale for action 01/08/07 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 YA30 Good Practice Recommendations It is recommended that the when upgrading the laundry area the carpet is replaced by suitable hard flooring which can be readily cleaned. Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashtons Cross DS0000022412.V335674.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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