Inspection on 06/07/06 for Ashtons Cross

This inspection was carried out on 6th July 2006.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashtons Cross 26/06/07

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 6th July 2006 09:00 Ashtons Cross DS0000022412.V299438.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.V299438.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.V299438.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.V299438.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 15 PD 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. Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a ‘key’ inspection for the service and covered the core Standards the home is expected to achieve. The inspection was unannounced and was conducted over a period of 11 hours over two days. Day and recreation areas were seen. 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 manager and 6 care and ancillary staff were also spoken to interviewed. [Administration staff [at Mgt House] were also seen]. The inspector left some comment cards for residents and visitors. Five of these were returned. There were no adverse comments and respondents are satisfied wit the service at Ashton’s Cross. Two professionals [case managers] were contacted by phone. During the inspection a compliant received previously by CSCI was also investigated and the main outcomes are recorded in the ‘complaints’ section of the report. What the service does well: The resident interviews revealed that the information supplied by Ashton’s Cross is generally quite comprehensive. One professional consulted was very impressed with the whole of the admission process including written information available. One resident described an assessment process that included comprehensive assessments and home visits by the management team. Care planning documentation is thorough and well organised. 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. One resident discussed his care package and although only admitted for a few weeks was able to describe progress made. He stated that he felt ‘more Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 6 controlled’ and described a programme designed to ‘calm me down when I get upset’. 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. Most residents interviewed felt that the tight structure of the programme was beneficial. Residents reported regular contact with their families including visits home. Staff communicate well with families and keep them informed. One case manager reported that the residents family where delighted with the communication from staff and felt reassured by this. Relatives are also given a lot of feedback through reviews and formally through reports. There is psychology support available for all resident programmes and counselling sessions are built in as needed. Resident reported that this input was vital and gave appropriate professional support. There is a very good 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. One resident spoken to was involved in producing a newsletter for the home and felt he was developing useful computer skills. A copy seen gave news of current events on the unit including the TRU summer fair, group outings [delamere forest] and group meals. One external professional commented that TRU ‘operates in the real world’. An example given was that the administration building and workshops [at Mgt House] were set on an industrial estate rather than removed from normal surroundings [the latter being the usual model she was used to seeing]. Also residents are transported around in unmarked vehicles, which are unobtrusive and ‘normal’. The home offers in house medical support via a visiting GP, physiotherapy as needed and a nurse employed to give advice on medication management as well as medical issues. All residents receive a physiotherapy assessment and treatment plan [if needed] following admission. Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 7 The service is divided into two physically separate units, Beeches and Woodlands. All areas viewed were accessible to the service users although kitchens 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 and new carpeting in the woodlands lounge evidenced continued maintenance. Ashton Cross has very well maintained and accessible grounds. Some of which has been the subject of landscaping to form a walk around activity area. All areas seen were clean. The housekeeper completes an audit of standards on a regular basis. 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. The training programme in the home is very well structured, particularly around the clinical background of acquired brain injury and the behavioural techniques used by staff to work with residents. Comments received about the staff include: ‘Staff build me up so I can manage on my own’ ‘Staff do listen’ ‘The staff and service as a whole is very impressive’ ‘Sometimes there can be to many chiefs – but the commitment is very good’. 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. Care professionals spoken to were impressed with this system. What has improved since the last inspection? The recruitment process has been reviewed following requirements on the last inspection. All staff files seen were up-to-date in terms of the recruitment checks and references needed to ensure residents are protected. TRU have developed guidance on client sexuality and intimate relationships following recommendations. The document is broad and includes guidance on possible referrals for in house education and training for residents around social skills in this area. The site at Ashton’s Cross continues to develop with new activity areas and buildings under construction. Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 8 Following recommendations made in the last inspection report there has been some work completed on staff training in awareness of the protocols around the reporting of abuse allegations and locally agreed social service protocols. Health and safety records have been updated following requirements and recommendations made in the last inspection report around emergency lighting checks and updating of the electrical certificate. What they could do better: As part of the inspection a complaint was investigated. Part of this involved the inclusion in the Terms and conditions of residency of the ‘emergency discharge procedure’. Following discussion with the manager it is apparent that this requires to be reviewed in the light of the complaint findings. Medication management was reviewed and the in house medication officer was spoken to. There were no pharmacy leaflets available for resident information [pharmacy do not send them as routine] and it was recommended that the pharmacist supply these so that an information file is available on each medication given for staff and resident reference. It is also recommended that a thermometer be placed in the storage cupboard to monitor temperatures and ensure that medicines are stored below 25C. A complaint was received by CSCI from solicitors acting on behalf of a resident in the home and was investigated as part of the inspection. Following investigation the complaint was upheld. The Registered Person had discharged a resident without ‘reasonable notice’ being given [Regulation 40 of the Care Home Regulations] and without liaison with the clinical team so that proper follow up support could be planned. Issues arising out of the complaint include the need to review the emergency discharge procedure and the terms and conditions of residency. Requirements are made in this report under Regulation 5 [service user guide – terms and conditions] and Regulation 40 [Notice of termination of accommodation]. The outcomes has concerns for the manager as there was no proper consultation with the clinical team or herself over the decision to discharge a resident. This needs to be considered. Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 9 Under Regulation 26 of the care Homes regulations the Registered Provider must complete a monthly report for CSCI as part of the quality assurance process. Currently this is not being done. 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.V299438.R01.S.doc Version 5.2 Page 10 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.V299438.R01.S.doc Version 5.2 Page 11 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): 1,2,5 The quality outcome in this area is good. The information available describing the purpose and activity of the home is generally quite comprehensive and assists residents in their choice of whether to accept admission. The assessment process is very comprehensive so that the home has a good base for meeting needs. The Terms and Conditions of residency need reviewing in terms of the emergency discharge procedure to meet requirements EVIDENCE: The homes Statement of Purpose and Service User Guide are part of the information given to each resident prior to admission to the home. This was discussed with the manager with respect to a recommendation made on previous inspections for the tight structure of the daily routine, including house rules such as set times for retiring to bedrooms, be included in the guide. The manager reported that this has been included and the completed guide should be available in the near future. The resident interviews revealed that the information supplied by Ashton’s Cross is generally quite comprehensive. One professional consulted was very impressed with the whole of the admission process including written information available. One resident described an assessment process that Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 12 included comprehensive assessment by the neuropsychologist followed by a home visit by the unit management team. The resident was able to have 2 visits to the home with parents before making a decision to be admitted. Assessments seen on care files were very detailed including the preadmission assessments and further assessments once admitted including a psysiotherapy assessment for all residents. As part of the inspection a complaint was investigated. Part of this involved the inclusion in the Terms and conditions of residency of the ‘emergency discharge procedure’. Following discussion with the manager it is apparent that this requires to be reviewed in the light of the complaint findings [complaints and protection for details]. Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 13 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): 6,7,9 The quality for this outcome group is excellent. 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. Staff agree a structured care programme with residents that also includes setting personal goals and targets so that residents are able to exercise some choice and control over the overall care strategy. EVIDENCE: Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 14 Three care plans were seen. All were comprehensive and well organised. 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. 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. Professionals who had referred residents stated that the communication through these meetings was very good and comprehensive reports were available to monitor progress. One resident discussed his care package and although only admitted for a few weeks was able to describe progress made. He stated that he felt ‘more controlled’ and described a programme designed to ‘calm me down when I get upset’. Care programmes are designed so that specific goals and objectives can be worked on and measured. 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. For example choosing different activities and work placements. 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. 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. Most residents interviewed felt that the tight structure of the programme was beneficial. 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.V299438.R01.S.doc Version 5.2 Page 15 The concept of risk is clearly understood by the care team and comprehensive risk assessments were seen in the care files. One resident was assessed as at risk of running out onto the road when agitated. A programme whereby the resident used the space in the grounds to reduce tension was working well. Untoward incidences of aggression are assessed by the clinical team and there is always a plan formulated in terms of future management. Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 16 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): 12,13,15,16,17 The quality for this outcome group is good. 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 reported regular contact with their families including visits home. Staff reported that weekly contact is made by phone to relatives so that Primary coaches can give regular updates on progress. This was reinforced by comments from case managers. One case manager reported that the residents family where delighted with the communication from staff and felt reassured by this. Another resident spoken to described monthly trips home although this Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 17 was some considerable distance. [Unit takes referrals countrywide]. Relatives are also given a lot of feedback through reviews and formally through reports. The issue of intimate relationships developing in the home and issues around resident sexuality was again discussed with reference to recommendations on the last report. It was noted that policy guidelines are now available and these have been developed within a broad context outlining approaches to social skills in this area and how programmes at TRU can be set up to assist with both education and training. The guidelines are now being finalised. There is psychology support available for all resident programmes and counselling sessions are built in as needed. Resident reported that this input was vital and gave appropriate professional support. 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 however a very good 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. There are further onsite activity buildings being developed at Ashton’s Cross so that residents can have more choice and opportunity. One resident spoken to was involved in producing a newsletter for the home and felt he was developing useful computer skills. A copy seen gave news of current events on the unit including the TRU summer fair, group outings [delamere forest] and group meals. The home employs a gardener who also has a vocational role and is currently looking at 6 residents starting an NVQ in this area. 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. One external professional commented that TRU ‘operates in the real world’. An example given was that the administration building and workshops [at Mgt House] were set on an industrial estate rather than removed from normal surroundings [the latter being the usual model she was used to seeing]. Also residents are transported around in unmarked vehicles, which are unobtrusive and ‘normal’. Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 18 During the inspection a complaint was investigated the details of which are given under the complaints and protection heading in this report. The complaint highlighted TRU’s commitment to upholding residents rights of confidentiality but also highlighted how a resident had been discharged without due notice and without adequate support organised thus infringing some rights under the Care Standards Act and regulations. Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 19 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 The quality in this outcome group is adequate. Personal care is offered on an individual basis, which encourages independence and helps ensure appropriate standards so that residents are supported. There is an issue around same sex staff providing care to male residents, which needs addressing so that dignity is maintained. Health care is well managed including regular liaison with referring agencies so that health care needs are met. Medicines are well managed so that residents are protected by safe practice. 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. Following recommendations on the last inspection the issue of staff attending to personal care was again discussed with the manager. The manager was clear that only female staff would attend to female residents although this was not as clear when discussing the personal care of male residents [same sex staff carrying out care]. There was understanding of the need to preserve both Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 20 dignity and privacy but it was observed that one male resident requiring personal care and assistance with the toilet was being attended to by a female member of staff. There needs to be consistent practice in this area. The manager has not yet drawn up a policy statement. 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. The home offers in house medical support via a visiting GP, physiotherapy as needed and a nurse employed to give advice on medication management as well as medical issues. All residents receive a physiotherapy assessment and treatment plan [if needed] following admission. Medication management was reviewed and the in house medication officer was spoken to. One resident has started a process of self-medication by identifying medicines he takes and this will be developed further towards discharge. There were no pharmacy leaflets available for resident information [pharmacy do not send them as routine] and it was recommended that the pharmacist supply these so that an information file is available on each medication given for staff and resident reference. Photocopies of these sheets could be made available to residents – certainly those self-medicating. A copy of the British National formulary [BNF] is also recommended. Medication administration records [MAR] are signed by 2 staff members to reduce risk of error. The medication officer keeps an audit trail of items received and sent back although is in constant liaison with the supplying pharmacist to discuss ways in which medicines received can be recorded on Marr sheets [weekly supplies difficult to record on MAR sheet]. Medicines are stored satisfactorily and securely. It is recommended that a thermometer be placed in the storage cupboard to monitor temperatures and ensure that medicines are stored below 25C. Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 21 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 quality in the outcome group is adequate. The home has a complaints procedure and this is used by residents to raise issues of concern, which are acted on. Adult protection policy has been highlighted in the homes training programme and awareness has been raised. There is a need to continually reinforce this on a regular basis. EVIDENCE: There is a complaints procedure in the home and residents were aware of how to raise issues of concern. The complaints procedure is included in the homes literature. A complaint was received by CSCI from solicitors acting on behalf of a resident in the home and was investigated as part of the inspection: ‘TRU summarily expelled a vulnerable patient onto the street simply because his solicitors sought to enforce his legal rights to disclosure of his medical records thereby jeopardising his mental health and rehabilitation’. Following investigation the complaint was upheld. The Registered Person had discharged the resident in question without ‘reasonable notice’ being given Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 22 [Regulation 40 of the Care Home Regulations] and without liaison with the clinical team so that proper follow up support could be planned. The reasons for discharge were given as: ‘Due to substantial amount of fees being outstanding and in addition the company being involved in a litigation case with the clients solicitors making the situation untenable. As a result of these issues [the resident] was given 48 hours notice of discharge’. The Commission does not accept these reasons as valid for ‘emergency discharge’ and proper discharge arrangements could have been made. Issues arising out of the complaint include the need to review the emergency discharge procedure and the terms and conditions of residency. The emergency discharge procedure should be very specific and should be linked to risk factors and factors highlighted clearly in the care plan. The term ‘non compliance with terms and conditions of residency’ should be removed. The terms and conditions of residency includes a section on emergency discharge. This should also be reviewed in the light of the above comments. Requirements are made in this report under Regulation 5 [service user guide – terms and conditions] and Regulation 40 [Notice of termination of accommodation]. Following recommendations made in the last inspection report there has been some work completed on staff training in awareness of the protocols around the reporting of abuse allegations and locally agreed social service protocols. Senior mangers are also to attend further updates in October. Staff interviews still evidenced some confusion in this area however with staff still of the opinion that an internal TRU investigation would be initiated as opposed to external referral through the St Helens procedures. Following discussion it would be recommended that training in this area should be ongoing. The procedures are dated 2001 – it would be worthwhile contacting the adult protection officer at social services and checking whether these have been updated. Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 The quality in this outcome group is good. 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: Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 24 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 kitchens 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 and new carpeting in the woodlands lounge evidenced continued maintenance. 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 of which has been the subject of landscaping to form a walk around activity area. There is ongoing building work as more activity units are being built so that together with Lyme House and Mgt House there will be more choice of activities and work based projects throughout the organisation. Service users reported that accommodation is comfortable and that privacy is respected. Rehab programmes encourage residents to maintain standards of cleanliness in rooms. All areas seen were clean. The house keeper completes an audit of standards on a regular basis. Ashtons Cross DS0000022412.V299438.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 The quality in this outcome group is good. There is appropriately trained and experienced care staff employed so that residents feel supported and that their needs are understood and met. Following review the recruitment processes in the home are robust and the necessary checks required prior to employment are carried out and provide protection for residents. EVIDENCE: The staffing on the day of the inspection consisted of 8 care staff of different grades, the manager and 1 psychology staff and 2 programme coordinators [RPC’s]. There is also admin support and ancillary staff. This for 13 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 and residents said that the turnover of staff had reduced over the past 8 months and staffing is now more consistent. 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 Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 26 of the staff. One of the case managers of a resident also said that the primary coaches were very knowledgeable when contacting her for weekly updates on the resident in question. The training programme in the home is very well structured, particularly around the clinical background of acquired brain injury and the behavioural techniques used by staff to work with residents. All staff undergo 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 induction training programme includes a prolonged ‘shadowing’ component which staff reported as being particularly useful. Comments received about the staff include; ‘Staff build me up so I can manage on my own’ ‘Staff do listen’ ‘The staff and service as a whole is very impressive’ ‘Sometimes there can be to many chiefs – but the commitment is very good’. Following requirements on the last inspection report the staff files seen were up-to-date and included all necessary recruitment checks including Criminal records [CRB] disclosure and references. Ashtons Cross DS0000022412.V299438.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 The quality in this outcome group is good. The manager of the home has the experience and qualifications to ensure that Ashtons Cross is run satisfactorily and that residents best interests are maintained. The quality systems in place ensure good monitoring and ongoing improvements take place so that resident care can be progressed and procedures are appropriately managed to ensure smooth running of the home. EVIDENCE: The Registered Manager of Ashtons Cross is Karen Conner. Karen has been in post for 4 -5 years. She is currently undertaking an NVQ qualification in management [nearly completed]. Carrying on from the previous inspection she has completed a review of the homes service user guide and information supplied to residents prior to and following admission. She is also involved with staff training initiatives in the organisation. As with all staff that work for TRU Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 28 she has come through the organisation experiencing all staff roles and training in order to become the manager of Ashton’s Cross. The complaint investigated on this inspection has concerns for the manger as there was no proper consultation with the clinical team or herself over the decision to discharge a resident. This needs to be considered. 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 house keeping audit was being conducted during the inspection. One of the residents spoken to assists with the health and safety audit in the home in conjunction with the health and safety officer. 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. Care professionals spoken to were impressed with this system. 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. Issues from the previous inspection have mainly been addressed although some still outstanding have been again included in this report. Generally the home has a good record of meeting any statutory requirements made. Health and safety records have been updated following requirements and recommendations made in the last inspection report around emergency lighting checks and updating of the electrical certificate. Under Regulation 26 of the care Homes regulations the Registered Provider must complete a monthly report for CSCI as part of the quality assurance process. Currently this is not being done. Ashtons Cross DS0000022412.V299438.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 2 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 3 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 X 12 4 13 3 14 X 15 3 16 2 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.V299438.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 YA5 Regulation 5 Requirement The Commission requires evidence of a review of discharge policy, which incorporates a review of the emergency discharge procedure and the Terms and Conditions of Residency [following the complaints investigation as part of this inspection]. Unless impracticable to do so the registered person shall not terminate the arrangements for the accommodation of a service user unless he has been given reasonable notice of his intention to the service user and the person who appears to be the next of kin. The Registered Provider must complete a report for CSCI, which meets the requirements of this regulation, and submit this on a monthly basis. Timescale for action 11/08/06 2 YA16 40 11/08/06 3 *RQN 26 30/08/06 Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 31 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. There should be some policy guidance around the principals involved in carrying out personal care for residents including guidance around the need for carers of the same sex. A thermometer is recommended in the medicine storage cupboards to monitor and ensure medicines are not stored over 25C. Medication information sheets should be obtained from pharmacy for staff and resident information. A copy of the BNF should be purchased. The training around adult protection and abuse should be ongoing and reinforced regularly. Social Services adult protection team should be contacted regarding updating policies. 2 YA18 3 YA20 4. YA23 Ashtons Cross DS0000022412.V299438.R01.S.doc Version 5.2 Page 32 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 © 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.V299438.R01.S.doc Version 5.2 Page 33 - 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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