Inspection on 24/06/05 for Ashurst House

This inspection was carried out on 24th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashurst House 04/11/08

Ashurst House 07/11/06

Ashurst House 02/05/06

Ashurst House 01/08/05

Ashurst House 04/02/05

Ashurst House 07/09/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Ashurst House 9 Briton Road Faversham Kent ME13 8QH Lead Inspector Kim Rogers Unannounced 24th June 2005 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 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 Stationary 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. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashurst House Address 9 Briton Road, Faversham, Kent. ME13 8QH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01795 590022 Ashurst House Ltd Mrs Rachel Harris CRH 8 Category(ies) of LD (8) registration, with number of places Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service users must be aged between 18-65 years and have a learning disability.The Manager must have a National Vocational Qualification at level 4 in care and level 4 in management by 2005. Date of last inspection 4/02/05 Brief Description of the Service: Ashurst house is a large detached property in a residential road of Faversham. The property has been converted for its present use. The home is owned and run by the company Allied Care Ltd who are based in Surrey. The home is registered to provide personal care and support to up to eight adults aged 1865 years who have a learning disability. There are currently six Service Users living at the home whose age range is about 30-60 years.Accommodation is set over two floors. Stairs access the first floor. All rooms are for single occupancy and have en suite toilet facilities. Some rooms have en suite bathrooms and showers. All bedrooms are fitted with locks and have a television aerial point. There is a large lounge, separate dining room and kitchen. There is a second small lounge on the first floor. There is a small garden to the rear of the property. There is limited parking to the side of the property.The home is within walking distance of the railway station and bus stops. Local shops and facilities can be easily accessed. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced and carried out by Kim Rogers from 11.30am to 6.00pm on a Friday. All six Service Users were at the home during the visit. The Inspector spoke to the Manager, Rachel Harris, the senior staff, Neil Wheeler and staff on duty. The Inspector spoke to Service Users as a group and individually. The Inspector looked at some records ad looked around the home. The home was clean and tidy, some Service Users were making cakes, two Service Users were out shopping and one Service User went to the park during the visit. Two Service Users have moved in since the last inspection. Both seem to have settled in to their new home. Service Users looked happy and well cared for. A Service User told the Inspector ‘I like living here, I am happy here’ One Service User said ‘I like the staff’ A member of staff told the Inspector he likes working at Ashurst House. The senior staff said ‘There is lots of training on offer’ Some of the requirements from the last inspection were assessed. The Commission received no response or action plan from the home about meeting these requirements. The Manager gave the Inspector a copy of the action plan during the visit. Most of the requirements remain unmet even though the action plan said the requirements were met. It is of concern that there continue to be shortfalls in meeting National Minimum Standards. The Inspector was very concerned to see that there are still no approved guidelines in place for Service Users who challenge the service. This was a requirement made at the last inspection in February 2005. The Inspector was also concerned that staff have used restraint and physical interventions on a number of occasions without following any guidelines. These events were not reported to the Commission, as they should be. The recording of these incidents by staff showed little understanding of Service Users needs. Other accidents and incidents were not reported appropriately. This was also a requirement from the last inspection. It was worrying to hear that the Manager and the senior staff said they were unaware of these events of the past few weeks. This showed that communication and monitoring is poor. Care planning is inconsistent with care plans showing no monitoring or review. This means that Service Users do not received continuity in their care and support and that changing needs are not identified. A requirement was made at the last inspection for fire equipment to be checked regularly. No checks have been made since the last inspection. This means Service Users are at risk of harm. During the inspection the Inspector spoke by telephone to the Area Manager, John Connock, who agreed to immediately investigate these serious concerns. Due to the findings of this visit the Inspector was not satisfied that Service Users health and well being is being protected. In fact Service Users are at risk of harm if staff have no approved guidelines to follow when a Service User is aggressive or self harms. An immediate requirement was made for approved behavioural support guidelines to be developed in respect of Service Users Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 6 where necessary. These guidelines should be produced with the Service User and staff team and a suitably qualified person such as a psychiatrist or physiologist. When approved and agreed by all involved, any training needs for staff regarding recommended physical interventions should be organised. What the service does well: What has improved since the last inspection? What they could do better: Priority must be given to developing any necessary guidelines, especially when Service users self harm or are verbally or physically aggressive. This enables staff to provide continuity in the care and support they give as well as protecting Service Users from harm. Care planning must be more detailed and consistent so staff provide continuity of care and support. Service User plans, (care plans) need to improve. At present Service User plans are inconsistent and not regularly reviewed. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 7 All potential risks to Service Users must be identified and assessed. These risks must be managed and where possible reduced. Risk assessments and care plans must be reviewed regularly to reflect any changes in a persons needs and to ensure the interventions are right. Assessments must be carried out before a person moves into the home. The assessment process is crucial if the home is to ensure it can meet a persons needs. Communication between staff and between staff and the Manager must improve. Monitoring and auditing by the Manager needs to improve. The Manager said she was unaware of some recent serious incidents. Recording of incidents could be better. All incidents and accidents must be reported to the Commission in writing within 24 hours. The lounge could be improved to make it look and feel more homely. From the last inspection, the Service User Guide needs updating, all Service Users should have a contract with the terms of their stay. Fire equipment at the home must be checked regularly as required at the last inspection. 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. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,5 Service Users have some information about the home to help them make a decision about moving in. Service Users cannot be sure all their needs will be assessed so Service Users cannot be sure this home will meet their needs. Service Users are not aware of the conditions of their stay. EVIDENCE: The home has a Statement of Purpose and Service User Guide. The purpose of these documents is to enable Service Users and significant others to make an informed choice about how their care needs are to be met by the home. It is important therefore that all the required information is present so Service Users are fully informed about the services and facilities on offer. The Manager said that she sent this information about the home to the two new Service Users before they moved in recently. At the last inspection a requirement was made that the Service User Guide be in line with the National Minimum Standards as some omissions were noted. The Manager said she has addressed these omissions but could not produce an updated Service User Guide. 3 copies of the Service User Guide that had been given to 3 Service Users had not been updated and still contained omissions. One of the omissions is ‘Service Users views of the home’. Service Users views are especially important to include as current Service Users have ‘tried and tested’ the facilities at the home. This is an outstanding requirement since the last inspection. Details of respite care is now included in the Statement of Purpose, Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 10 however the home does not meet National Minimum Standards regarding the provision of respite care. The Inspector sampled 4 Service User plans (care plans). All contained an assessment pro forma. Some were completed more than others so information was limited in some. One included an assessment by a care Manager. None of the assessments were signed or dated. The Inspector was concerned to note that there was no assessment of one Service Users mental health needs or behavioural needs even though there had been incidents relating to these needs. These assessments by the home are crucial as the assessment forms the basis of the Service User plan. This is the agreement between the Service User and the home about how the home intends to meet the person’s needs. Due to the nature of some of the Service Users needs it is vital the home carries out detailed assessments to ensure it does not offer a place to someone whose needs it cannot meet. One assessment seen was not carried out by the Manager and was incomplete with the majority of paperwork blank. The Service users date of birth was recorded differently between documents. Compatibility with other Service User should also be a strong consideration as there have been several incidents of aggression between Service Users. The home has given notice to 2 Service Users to leave the home since it opened in September 2004. The Manager commented that notice was given to one Service user, as ‘their behaviours were not what we were told’ This emphasises the need for the Manager to carry out more detailed assessments before a person moves in. A requirement was made that detailed assessments are carried out before a Service User moves into the home and the compatibility with current Service Users is considered as detailed in Standard 2. Not all Service Users have a detailed Service User plan. Some pro formas used were incomplete. Some had only basic minimal needs detailed although during the visit it was evident that needs were far more complex than detailed. The home has produced no specialist support guidelines as required at the last inspection. Staff are not communicating any changing needs or incidents to each other. For some staff English is a second language. All Service Users speak English. Written reports and comments by staff showed they have little understanding of Service Users needs. The Manager stated that one Service Users behaviour was ‘just attention seeking’ Staff recorded in an incident report ‘the Service User defied an order from staff ’ Service Users do not have access to advocacy services. The home is intended for long term care and support but also offers a respite service to one Service User. The home must demonstrate that all standards relating to respite care are met of this service is to continue. 2 Service Users have moved in since the last inspection. The Manager said that trial visits are planned to meet the needs of Service Users. There was no record of any trial visits. As mentioned some Service User plans were sampled. All contained a contract from Allied care, which should detail the conditions of a persons stay. None of the contracts were in line with the National Minimum Standards for example none included the fee for living at Ashurst House, who pays it and what it includes. No contract was signed or dated by the home or the Service User. Rules and responsibilities of Service Users were not included for example the Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 11 rules for smoking and alcohol. The contract stated that 3 months notice would be given by the home although the Manager said that a current Service User has been given 28 days notice to leave. There was no evidence that Service User have been involved in drawing up these contracts. Contracts seen are not in a format suitable for some Service Users. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9,10 Service Users cannot be sure this home will meet their needs. Service Users rights to make decisions are not always supported. EVIDENCE: Each Service User has an individual Service User plan file. Some were more detailed than others so care planning is inconsistent. Some plans had blank pages included. Personal goals are not recorded. No review or monitoring of the Service User plans was evident even though some Service Users needs have changed since the last inspection. This means that changing needs of Service Users are not identified, recorded and communicated to staff. Some staff including the Manager were unaware of some of the detail of some Service User plans. Staff were able to tell the Inspector about some Service Users needs but none of this was recorded. Continuity of care is limited due to ineffective and inconsistent care planning. Some of the Service users personal details were not accurate including dates of birth. There are no guidelines in place for Service Users who challenge, are aggressive or self-harm. More than one Service User can be aggressive. The guidelines in place for one Service user were developed by the previous placement and were out of date as noted at the last inspection. It was evident after talking to staff and reading incident reports that staff are not following Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 13 even these guidelines. The Manager said that no restraint had been used at the home since the last inspection. However the Inspector read several incident reports in Service User plans when restraint and physical interventions had been used. On one occasion three male members of staff restrained a Service User for ‘10-15 minutes’ then again for ‘15-20 minutes’. The Manager and senior staff said they were unaware of these incidents of the past few weeks. These incidents had not been reported to care Managers or to the Commission. The Manager has not developed individual guidelines with this Service User, staff and relevant professionals. This was a requirement at the last inspection. This was of serious concern as Service Users are at risk of harm. The Inspector made an immediate requirement that guidelines be produced for Service Users who challenge the service, which set out specialist requirements and planned interventions focussing on positive behaviour and current good practice. A suitably qualified person must approve any behavioural support guidelines then training planned to ensure staff are competent in any necessary intervention techniques. The Inspector spoke to the area Manager for Allied care by phone who agreed to fully investigate these poor practices. Some restrictions on choices and freedom are now recorded but some are not recorded. This must be addressed for example why some Service Users do not have unrestricted access to communal areas of the home and why the front door is kept locked. There was no evidence that Service Users have been involved in developing Service User plans. Formats are not suitable for all Service Users as all are typed. Some risk assessments were seen in Service User plans. None were signed or dated with no evidence that Service Users had been involved. There was no sign that risk assessments are reviewed. The Manager said that all Service Users are funded on a one to one basis. An hour before the inspection started the Inspector saw two Service Users shopping in the town. One Service User has absconded from the home on more than one occasion recently and caused self-harm. The other Service User can be verbally and physically aggressive with apparently no trigger, (said the Manager and senior staff). The Manager said that these two Service Users are funded on a one to one basis for 15 hours a day and 8 hours a day respectively. There was a risk assessment in place for one Service User going into town. It stated that this must be on a one to one basis with staff. Both Service Users said they were in town together with only one member of staff. Although Service Users are funded on a one to one basis, from some of the incident reports read it was clear that Service Users do not always have this close support. Staff said they support Service Users to make decisions. They said this includes decisions about how to spend their day. Staff said they offer opportunities and ideas for outings. Service Users do not have access to independent advocacy service to support the decision making process. Daily records lacked detail of how staff support Service Users to make decisions. The Manager said that she has identified a training need for staff relating to recording. Some staff are due to attend Makaton training, a form of alternative communication. One incident report showed that a Service User was not Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 14 enabled to make a decision about when to have a bath. Information about Service Users is held in the duty office, most on open shelving. The Inspector observed that on occasions, staff left the office unattended and unlocked. One incident was recorded that a Service User entered the office and threw files on the floor. Information about Service Users must be held securely and in line with data Protection Act 1998. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,17 Service Users feel part of the local community. Service Users are offered a healthy diet although nutrition is not monitored. . EVIDENCE: One Service User told the Inspector that they like to go out. They said they had been to Whitstable recently for a picnic. They said they ‘go out a lot’ Staff have use of a mini bus to access facilities in the community. Before the inspection started the Inspector saw two Service Users shopping in the town. On their return to the home both Service users said they were shopping in town with only one member of staff. This was contrary to what the Manager said. The Manager said the two Service users are supported on a one to one basis. One Service User who was at home was making cakes. Another Service User played cards in the afternoon while another went for a walk in the park with two staff. The Manager said that two Service Users now attend adult education classes one day a week in literacy and cooking. Staff said they support Service Users were necessary with cooking and cleaning and general household tasks. The support depends on Service Users needs. This support to develop daily life skills must be detailed in Service User plans. One Service User said he likes to go to the pub. Service Users at this home tend to socialise Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 16 with each other and have limited opportunity to develop relationships and friendships with people who do not have disabilities. The Manager should give thought to this. The Manager said that one Service user ‘has no hobbies or interests’ although it was evident that this Service user is interested in writing, art and drawing and music. No Service User at this home has an appropriate job. The Manager said this was because ‘no Service User is interested’. The Inspector saw no evidence of choices, support and opportunities given regarding supported employment. As mentioned Service Users access local shops and pubs. Staff said that one Service User likes to go to a local café and has his own mug there. Staff said they support Service Users to go swimming locally and continue to research horse riding facilities. The Inspector looked around the kitchen, which was clean and orderly. As noted at the last inspection the fridge temperature remains too high. The kitchen remains locked unless staff are present. As required at the last inspection this restriction and the reasons for it must be detailed in individual Service users plans. This past requirement remains unmet. Staff said that menus are planned on a weekly basis with Service users. Staff said that fresh fruit and vegetables are always available. Some Service users are supported to plan and prepare meals. Staff said that this depends on their needs. Service users eat in a small dining room. Some Service users require support with their meals and this was detailed in their service user plans although not observed. Nutrition is not monitored by the home although some Service users have nutritional needs. Weight charts were seen in 3 Service users plans sampled. Two were blank and one had one entry for 12/01/05. One Service user had seen a dietician in the hope of losing weight although their weight is not being monitored. The Inspector noted that some incidents have occurred during mealtimes in and around the dining room. There was no action recorded by the Manager to prevent these types of occurrences reoccurring. Thought must be given to the why such incidents happen around mealtimes and in the area of the dining room and what can be done to prevent or reduce such incidents. Service users should enjoy their meals and mealtimes. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 17 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 standard(s) 18 Service users cannot be sure that their personal care needs will be met and that they will be supported in the way they prefer. EVIDENCE: Service users personal care needs and their preferences about how they are supported were not detailed in all Service user plans. Staff talked to the Inspector about how they support Service users but this detail was not recorded on Service user plans. Service users were dressed in their own clothes and have individual styles. The home has no technical aids to maximise independence regarding personal care for example there is no bath chair. The Manager should give thought to this as some Service users have limited and decreasing mobility and one is elderly. Daily records completed by staff did not record the support and care given by staff when helping with personal care so it was difficult to establish if Service users have choice and control. The daily records for a service user showed regular verbal and physical aggressive behaviours. This was not detailed in the pre assessment or the service user plan. One incident report stated that ‘staff told Service user X that his bath was ready. X said ‘I’m not having a bath’ so securicare (a form of physical intervention) was used to take X up to his room to calm down’ Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 18 The Inspector discussed this incident with the Manager and the senior. The senior said that he would have asked the Service user about the bath later on rather than insist. Unfortunately this approach is not consistent within the staff team with no written guidelines for staff to follow as required at the last inspection. The Manager said that staff look at the mood of some service users and record this. No mood charts were seen in Service user plans. Health care and medication was not assessed at this inspection. This will be looked at in detail at the next inspection. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 19 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 standard(s) 23 Service users are not protected from abuse or self-harm. EVIDENCE: Some Service users at this home are verbally and physically aggressive to staff, themselves and each other. This was not recorded on any assessment seen. This means that Service users have been admitted to this home without these challenging needs being assessed. Two service users have been given notice by the home to leave in the last 9 months due to challenging behaviours. Risk assessments have little detail of how to reduce risks and where possible eliminate them. The risk assessments that were in place were not being followed for example two Service users were out in the community with one staff although risk assessments for both Service users stated that they both should have one to one support at all times. No guidelines are in place for Service users who may be verbally or physically aggressive; this was a requirement of the last inspection. Some behavioural management guidelines were in place for one Service user produced by the previous home. It was clear from incident reports that staff were not even following these guidelines. This leads to lack of continuity and places Service users and staff at risk. At the last inspection the Inspector noted that restraint and physical interventions had been used without the necessary guidelines in place. The Manager had not reported this restraint to the Inspector, as the Regulations require. The Manger told the Inspector that no restraint had been used since the last inspection in February 2005. However, the Inspector was concerned to read several incident reports when staff had used restraint. No approved guidelines were followed and none had been reported to the Inspector. There was no action taken detailed to prevent incidents happening again. On one occasion three male members of staff ‘ put X to the floor and held him there till he calmed down’ Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 20 The incident report detailed that a Service user had been held on the floor for 10/15 minutes then held down again for 15/20 minutes. After one incident the police were called to the home and attended. The Inspector was very concerned about these incidents and discussed them with the Manager and senior staff on duty. Both said that they were unaware of these incidents of the last four weeks. This was of further concern to the Inspector. During the inspection the Inspector spoke to the Area Manager by telephone about these serious concerns. The area Manager was unaware of the incidents. The Inspector required that the area Manager investigate this poor practice and report the findings and recommendations to the Commission in writing. An immediate requirement was made that approved guidelines be in place for all Service users who may be physically and verbally aggressive to them selves, other service users and staff. Guidelines should be drawn up with the Service user, staff team, Manager and appropriate health professionals and suitably qualified persons. Guidelines should be closely and frequently reviewed. Any necessary physical intervention must be detailed and staff trained in appropriate techniques. Any use of restraint must be reported in writing to the Commission. Until this home meets these requirements Service users remain at risk. The Commission will monitor progress closely by working with other agencies and by making monitoring visits. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 21 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 standard(s) 24,25,26,27,28,29 Service users live in a comfortable clean home. There is enough communal space. Service users have enough toilets and bathrooms. EVIDENCE: The home is in a residential street of Faversham close to shops and amenities and the railway station. Parking in the road is restricted to permit holders only. The home has parking space for about 3 cars. There is a large lounge and small dining room on the ground floor. On the first floor is a small quiet lounge and duty office which doubles s as a sleep in room for staff. Bedrooms are on both floors and all have at least a wash hand basin and WC. Some have en suite bathroom facilities. All bedrooms are singles. Service users said they are happy with their rooms. One Service user invited the Inspector to look around their room. The room was personalised and clean. The Service user said that staff have erected a bird box and seed holders on a tree just outside the window. He said he likes to watch the birds from the window. Bedrooms are fitted with locks. Stairs access the first floor. There are steps down to the kitchen, which is kept locked. The front door is also kept locked. As mentioned previously in this report the reasons for this must be clearly documented in Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 22 service users plans. The rear garden is accessed via the laundry by a slope. The home continues to admit service users for respite. There continues to be no separate facilities for service users who are at the home for respite. This was a requirement of the last inspection. If the home is to continue to offer respite care then the standards relating to this, YA1, YA2, YA3, YA6, YA24.5, YA29.4 and YA33.5 must be met. The ground floor of the home is suitable for wheelchair users apart from the kitchen. Furnishings are of good quality and domestic in nature. The lounge does not have a home like feel. It is a large room with sofas pushed up against walls. It appears stark and unwelcoming. Service users lives would be enhanced by a more home like environment. On the day of the visit the home was clean. Staff carry out the cleaning at the home as there is no dedicated cleaner. The maintenance man, who has planted some bedding plants, is developing the small garden to the rear. Some Service users were enjoying the sunshine in the garden on the day of the visit. Staff organised a barbeque in the garden during the afternoon. The home has sufficient toilets and bathrooms on both floors, which are all lockable. All bedrooms have their own WC. Bathrooms and toilets seen were clean. There are currently no aids or adaptations at the home to maximise Service users independence. This includes no hoists or assisted baths to aid independence with personal care. Thought should be given to this as some Service users have limited and decreasing mobility and sensory needs. The home has a computer in the staff office. The Inspector understands that the computer is for the use of staff. Staff and Service users who smoke use the rear garden. The home has a separate laundry that was not inspected at this visit. There is no sluice facility. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 23 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33 Service users are not supported by competent staff. Communication between staff is poor placing Service users at risk. EVIDENCE: There are 13 care staff and 3 senior staff and the Manager. At night there is a waking staff and a senior staff sleeps in. There were 6 staff at he home during the visit including the Manager. All 6 Service users were at home. One of the senior staff spoke to the Inspector with knowledge about the home’s aims and objectives. He spoke with understanding of Service users needs. The Inspector observed service users being confident to joke with this senior staff. Sadly this understanding of Service users needs was not consistent through the staff team. Daily records and incident reports by staff showed little understanding of Service users needs. One report by staff read the Service user ‘defied an order by staff’ The Manager described one Service user as ‘just attention seeking’ The Inspector concluded that staff are not competent in understanding and supporting Service users needs. The senior staff said he has an NVQ qualification at level 3 in care. He said ‘there is lots of training on offer’ The Inspector saw a training needs analysis. Future training planned in June 2005 included, food hygiene, Makaton, manual handling and understanding epilepsy. Most of the Service users at this home are funded for one to one staff support. However, one to one staff support is not always provided. Two Service users were shopping in the town on the morning of the visit supported by only one Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 24 staff. The home has sufficient staff, however some incident reports by staff evidenced one to one support was not in place. It was clear on reading incident reports that staff are not following any guidelines to ensure continuity in care and support. Different staff and senior staff are dealing with incidents differently so support is not consistent. The Inspector read several incident reports in Service user plans. Most were serious events over the past few weeks. Incidents include verbal and physical aggression by Service users to other Service users and staff, incidents of self harm, damage to property by Service users, use of restraint by up to three members of staff. On one occasion the police were called to the home. None of the incidents had been reported to the Commission or Care Managers. The Manager and senior staff said they were unaware of these incidents, although they have both been working at the home for the past few weeks. The Inspector was not only concerned about the amount of incidents but also that none had been reported and the Manager said she was unaware of them. The Inspector spoke by phone to the area manager who said he was also unaware. Communication between the staff team must improve if consistent care is to be provided. The last staff meeting minutes were dated 4/4/05. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 25 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,42,43 Service users health and safety is not fully protected. This is not a well run home. EVIDENCE: The Inspector saw copies of certificates to suggest that the registered Manager, Rachel Harris has now completed NVQ level 4 in care. The standards require that NVQ level 4 in management also be completed. Most of the requirements from the last inspection of 4/2/05 remain unmet. The Manger said that she was unaware of some serious incidents at the home of the past few weeks. It is the Registered Managers responsibility to ensure that the written aims and objectives of the home are met. This is not being achieved. The Manager has not developed nor implemented necessary behaviour management guidelines for some Service users as required at the last inspection. This has placed Service users at risk. The Manager has not ensured that staff are following the homes policies and procedures. For example the recording and reporting of accidents and incidents. Contracts for Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 26 Service users are not in place as required at the last inspection. There is evidence of a lack of audit and monitoring by the Manager. There is a serious lack of communication between the staff team and Manager. The Manager made comments to the Inspector including, the Service user ‘is just attention seeking’ and ‘ his seizures are no different to anyone else’s’. Regretfully this all questions the skill, fitness and competency of the Registered Manager. The area Manager and Allied care Ltd, the Registered Provider must also take responsibility for their lack of audit and monitoring of the service. The area Manager carries out monthly visits to the home and reports have been sent to the Commission as required under regulation 26. The purpose of these visits is to monitor practice. However, the area manager was also unaware of the serious incidents and unmet requirements. The Inspector viewed the fire log-book. No checks have been carried out on the fire equipment at the home as required at the last inspection. Again the Manager and senior were unaware of this. Lack of safety checks of fire equipment places Service users at further risk of harm. Some accidents wee recorded in Service user plans. Accidents and incidents dated 5/4/05, 11/4/05, 19/4/05, 22/4/05, 31/5/05 and 3/6/05 relating to one Service user had not been reported to the Commission. Other incidents relating to other service users had also not been reported. The area manager had not picked up these issues during his monthly visits to the home. It is the registered Providers responsibility to ensure the safe running of the service. This must include effective health and safety monitoring. This monitoring is not effective which is of concern as this places Service users at risk. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 1 2 x 1 Standard No 22 23 ENVIRONMENT Score x 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 2 x 1 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 2 x Standard No 11 12 13 14 15 16 17 3 3 2 x x 2 2 Standard No 31 32 33 34 35 36 Score 2 x 1 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashurst House Score 1 x x x Standard No 37 38 39 40 41 42 43 Score 1 1 x x x 1 1 H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 28 YES 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 YA1 Regulation 5 Requirement The Registered Person must produce a suitably detailed Service User Guide. A copy should be given to Service Users and a copy sent to the Commission.This remains unmet. The Registered Person must develop an individual contract of terms and conditions of residency with each Service User.This remains unmet. The Registered Person must ensure that any restrictions on freedom and choices made in the best interests of Service Users are detailed in Service User plans. This remains not fully met. The Registered Person must ensure that behavioural support guidelines are in place where necessary based on current good practice. Guidelines should be authorised and agreed with the Service User.Staff must be competent when using any physical intervention techniques.This was unmet. Incidents detrimental to the health and safety of Service Users including any use of Timescale for action 30/03/05 2. YA5 5 30/03/05 3. YA6 12 30/03/05 4. YA23 13(7) 30/06/05 Immediate 5. YA23 37 28/02/05 Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 29 6. YA14 16(2)m 7. YA20 13(2) 8. YA20 13(2) 9. YA20 13(2) 10. YA42 12 11. YA34 19 12. YA33 19(5) restraint must be reported to the Commission in writing within 24 hours. This remains not met. The Registered Person must ensure that staff enable Service Users to find and keep appropriate jobs or to continue their education and training. This is not fully met. The Registered Person must ensure that Service Users control and administer their own medication within a risk management strategy.Service Users consent to medication must be recorded.Not inspected at this visit. The Registered Person must ensure that there is a record of staff competency appraisals relating to medication administration including the administration of rectal medicines. Not inspected at this visit. The Registered Person must ensure that all medication is administered in line with the Royal Pharmaceutical Society Guidelines.Not inspected at this visit. Competency appraisals for all staff relating to fire safety must be carried out.All fire equipment at the home must be checked at suitable intervals.This remains not met. The Registered Person must audit staff files to ensure all documents required under Schedule 2 of the Care Homes Regulations are obtained in respect of each member of staff.Not assessed at this visit. Staff must have the suitable skills for the job including communication skills. Not met. 30/03/05 30/03/05 30/03/05 30/03/05 30/05/05 30/04/05 30/05/05 Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 30 13. YA2 14(1)(a) 14. 15. 16. 17. 18. 19. YA6 YA9 YA17 YA18 YA33 YA43 15 13(4) 12 12 18 12 No service user should be admitted to the home unless a detailed assessment has been carried out. All Service users must have a detailed service user plan which is regualrly reviewed. All potential risks to Service users must be assessed and where possible eliminated Health needs including nutrition and wight must be mo iored and recorded in Service user plans Personal care needs must be detailed in Service user plans The registered person must ensure that staff are competent to do the job. The area Manager is to investigate poor practice, lack of communication and lack of monitoring by the Manager and send a report with recomendations to ithe Comission. 30/06/05 30/06/05 30/06/05 30/06/05 30/06/05 30/06/05 30/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA37 YA32 YA7 Good Practice Recommendations The Registered Manager must be qualified to NVQ Level 4 in Care and NVQ Level 4 in Management by 2005. 50 of care staff should be qualified to at least NVQ level 2 by 2005. The Registered Person should help Service Users, if they wish, to participate in local independent advocacy/ selfadvocacy groups and /or to find peer support from someone who shares the person’s disability, heritage or aspirations. The home should provide separate premises including communal day space, facilities and equipment for Service Users on respite or short stay unless benefits for both groups can be demonstrated. H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 31 4. YA24 Ashurst House 5. 6. 7. YA42 YA29 YA10 The Registered Person must ensure that the refrigerator is maintained at the correct safe temperature for food storage. Staff and Service Users should be involved in the review and development of policies and procedures, which should be produced in formats suitable for Service Users. All information and records relating to Servce users should be held securely. Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 Page 32 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashurst House H56-H05 S57495 Ashurst House V229813 040605 Stage 4.doc Version 1.30 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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