CARE HOME ADULTS 18-65
Ash View 330 Main Road Duston Northampton NN5 6NJ Lead Inspector
Stephanie Vaughan Unannounced 11 July 2005 08:30 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. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ash View Address 330 Main Road Duston Northampton 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) NN5 6NJ 01604 591179 01604 591179 Compass Care Limited Vacant Care Home 3 Category(ies) of LD Learning disability x 3 registration, with number MD Mental Disorder x 3 of places Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: No person falling within the category of MD, Mental Disorder excluding Learning Disability or Dementia, may be admitted into the home unless that person also falls within the category LD, Learning Disability ie Dual Disability. Date of last inspection 21/06/04 Brief Description of the Service: Ashview is a residential home providing care to three young adults with learning disability and diagnosed mental health needs. The size of the premises contributes to the friendly informal atmosphere within the home. The home is located in a busy residential area of Northampton close to all main facilities and amenities. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection was conducted over a period of four hours during which the inspector made observations and spoke to all of the residents. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where one resident was selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. A selection of staff files viewed and staff were spoken to in passing. Prior to the inspection a period of 30 minutes was spent in preparation, which included a review of previous inspection reports, previous requirements, the service history and comment cards received from residents and their representatives. Three comment cards were received from residents and these indicated a good level of satisfaction with the services provided at Ashview. One comment card was received from a resident’s representatives, which indicated satisfaction with the service provided. Seven requirements and one recommendation were made following the previous inspection and all of these have been met. What the service does well:
Residents confirmed that they are supported to make decisions on all aspects about their lives. Any limitations are made in the best interest of residents and based on detailed risk assessments that are included within the individual plan of care. Individual plans of care contain an individual programme of activities. Activities listed included attendance at a local college, and voluntary work placements. Residents also have access to a range of communal leisure activities such as the local library, photography, swimming and bowling sessions. In addition residents are able to choose individual activities and have scheduled individual sessions with staff support Daily routines are flexible, given the needs of residents and the programmed activities, however the activities programme identified period where residents are able to relax. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 6 Privacy and dignity is managed well at the home, residents’ wishes regarding their preferred form of address and access to their personal accommodation is respected. The living accommodation is homely, comfortable and safe, the home is subjected to heavy usage by the residents due to the nature of their disability. However it is generally well maintained and the management have access to a dedicated maintenance person who is able to address maintenance issues in a timely fashion. A sample of the resident’s individual accommodation was viewed and these areas are appropriately furnished and evidenced personalisation. The home is clean and hygienic throughout Staff files evidenced appropriate recruitment processes, including references and Criminal records Bureau Clearances. In addition staff files evidenced appropriate training in induction, Fire Safety, Food Hygiene, Health and Safety, Safe Administration of Medication, Movement and Handling and other training associated with the needs of residents. Staff files also evidenced regular staff supervision and annual appraisal. The conduct and management of the home is good ensuring residents satisfaction What has improved since the last inspection?
The Statement of Purpose has been reviewed following a requirement made at the previous inspection. The document now contains all of the required information; however there have been recent changes to the ownership of the home that are to be reflected within the Statement of Purpose. Residents’ contracts have been amended since a requirement made at the last inspection and now contain all the necessary information. The care plans have been reviewed following a previous requirement regarding the content and detail of the instruction to staff. These now contain the required information and evidence access to meaningful education, training and occupation; planning for personal support; independence; condition related needs and specialist input. Individual plans of care evidenced that residents are involved in the care planning process, regular review and staff signatures to evidence that they are aware of the needs of the residents. In addition all residents now have risk assessments in place to support them to manage their own finances.
Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 7 Risk assessments now provide detailed instruction to staff about the actions that need to be taken to reduce or manage an identified risk. The residents have recently acquired bicycles and management are currently developing of the associated risk assessments. Access to the local community has improved since the home has changed ownership, with the provision of dedicated transport. Individual plans of care now contain detailed information to staff regarding the support required to maintain personal hygiene and appearance. Files also evidence access to appropriate health care facilities and specialists e.g. Community Learning Disability Teams, chiropody, opticians and medical services. Improvements to the medication systems have been made following a requirement at the last inspection. All staff that have responsibility for the administration of medications have received appropriate training. Individual protocols have been developed for residents who require prescribed medication to be given as required. These provide instruction to staff regarding the actions to be taken to ensure that medication is given only when other interventions have failed. Medication administration records now contain medication profiles for each resident and the medication administration records are now accurately maintained. All policies, including the medication policy are currently being reviewed by the senior management following recent changes to the ownership of the home. The home has recently obtained up to date information on the Protection Of Vulnerable Adults and have taken appropriate action regarding a possible incident of financial abuse. The incident is currently being investigated by the appropriate authorities Following changes of ownership, the home has recently had a new kitchen fitted. The previous inspection identified that the home only provided one waking night staff; whereas one resident’s placement agreement identified that two waking night staff should be provided. Following an associated requirement suitable risk assessments have been developed and agreed with the placing authority, for the existing staffing levels. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 8 Since a recommendation made at the last inspection, the policy for the procedure of dealing with Challenging Behaviour has been amended to provide detailed instruction to staff and the use of medication only as a last resort. Following a requirement made at the last inspection the fees payable by one resident have been reviewed and records amended to ensure accurate charges are stipulated and made. Corrective action has been taken to address incorrect charges. What they could do better: 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. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 5 Residents and their representatives have access to appropriate written material and are assessed to ensure that the home can meet their individual needs and expectations. EVIDENCE: The Statement of Purpose has been reviewed following a requirement made at the previous inspection. The document now contains all of the required information; however there have been recent changes to the ownership of the home that need to be reflected within the Statement of Purpose. Discussion with the acting manager identified that this was to be addressed at the next management meeting due to be held in the near future. There have been no recent admissions to the home however detailed preadmission and care management assessments are included in the residents’ individual plan of care. Residents confirmed that the home was able to meet their needs and expectations. Residents’ contracts have been amended since a requirement made at the last inspection and now contain all the necessary information. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Improvements have been made to the care planning process and the individual plans of are now evidence that the individual needs and choices of residents are supported. EVIDENCE: The care plans have been reviewed following a previous requirement regarding the content and detail of the instruction to staff. These now contain the required information and evidence access to meaningful education, training and occupation; planning for personal support; independence; condition related needs and specialist input. Individual plans of care evidenced that residents are involved in the care planning process, regular review and staff signatures to evidence that they are aware of the needs of the residents. Residents confirmed that they are supported to make decisions on all aspects about their lives. Any limitations are made in the best interest of residents and based on detailed risk assessments that are included within the individual plan of care.
Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 12 In addition all residents now have risk assessments in place to support them to manage their own finances. Risk assessments now provide detailed instruction to staff about the actions that need to be taken to reduce or manage the identified risk. The residents have recently acquired bicycles and are currently waiting for the development of the associated risk assessments to be put in place to ensure the safety of residents. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 & 16 Residents are supported to maintain their personal lifestyles, however improvements should be made to ensure that residents are able to maintain good relationships between themselves. EVIDENCE: Individual plans of care contained individual programme of activities. Activities listed included attendance at a local college, and voluntary work placements. Residents also have access to a range of communal leisure activities such as the local library, photography, swimming and bowling sessions. In addition residents are able to choose individual activities and have scheduled individual sessions with staff support. Access to the local community has improved since the home has changed ownership with the provision of dedicated transport. Residents confirmed that they were supported to maintain links with family and friends wherever possible and had the opportunity to make friends. However there was one recorded incident of bullying between residents. There was a detailed record of the events and a satisfactory resolution. However
Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 14 neither a care plan or risk assessment had been developed to prevent a reoccurrence of this situation. Daily routines are flexible, given the needs of residents and the programmed activities, however the activities programme identified period where residents are able to relax. Privacy and dignity is managed well at the home, residents’ wishes regarding their preferred form of address and access to their personal accommodation is respected. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Residents receive appropriate support to maintain their health and personal care. EVIDENCE: Residents spoken to confirmed that they receive appropriate support to maintain their personal care. Individual plans of care evidenced residents preferred routines for rising and retiring to bed. Staff were seen to relate well to residents and to be supportive and competent in the management of challenging behaviours. Individual plans of care now contain detailed information to staff regarding the support required to maintain personal hygiene and appearance. Files also evidence access to appropriate health care facilities and specialists e.g. Community Learning Disability Teams, chiropody, opticians and medical services. Improvements to the medication systems have been made following a requirement at the last inspection. All staff that have responsibility for the administration of medications have received appropriate training. Individual protocols have been developed for residents who require prescribed medication
Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 16 to be given as required. These provide instruction to staff regarding the actions to be taken to ensure that medication is given only when other interventions have failed. Medication administration records now contain medication profiles for each resident and the medication administration records are now accurately maintained. All policies, including the medication policy are currently being reviewed by the senior management following recent changes to the ownership of the home. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 17 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) 22 & 23 Residents concerns are addressed and they are protected from abuse EVIDENCE: The home has an appropriate complaints policy, which is accessible to residents’ and, their representatives. The acting manager retains a copy of any complaint and these demonstrated that complaints are managed well by the home, with a full investigation and a record of the outcome. Copies of correspondence to the complainant were included and evidenced that the complainant was informed of the outcome of the investigation. The home has recently obtained up to date information on the Protection Of Vulnerable Adults and have taken appropriate action regarding a possible incident of financial abuse. The incident is currently being investigated by the appropriate authorities. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 18 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 & 30 The living accommodation is homely, comfortable and safe, however improvements must be made to ensure residents safety in the garden. EVIDENCE: The premises comprises a three bed roomed bungalow in keeping with the local community. The home is suitable for its stated purpose and offers a homely and comfortable environment. The home is subjected to heavy usage by the residents due to the nature of their disability. However it is generally well maintained and the management have access to a dedicated maintenance person who is able to address maintenance issues in a timely fashion. A sample of the resident’s individual accommodation was viewed and these areas are appropriately furnished and evidenced personalisation Following changes of ownership, the home has recently had a new kitchen fitted. The home is clean and hygienic throughout.
Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 19 However the garden shed was in a serious state of dilapidation and in particular one of the panels from the door was missing leaving the sharp end of several nails exposed. Both the garden and the shed are accessible to residents. An immediate requirement was made at the time of inspection for this to be made safe. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 20 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) 33, 34, 35 & 36 Residents are protected by the homes recruitment and management practices. Staffing levels are adequate to meet the agreed needs of residents. EVIDENCE: The previous inspection identified that the home only provided one waking night staff; whereas one resident’s placement agreement identified that two waking night staff should be provided. Following an associated requirement suitable risk assessments have been developed and agreed with the placing authority, for the existing staffing levels. In addition the home has access to a nighttime floating support worker within the group of local homes. Staff files evidenced appropriate recruitment processes, including references and Criminal records Bureau Clearances. In addition staff files evidenced appropriate training in induction, Fire Safety, Food Hygiene, Health and Safety, Safe Administration of Medication, Movement and Handling and other training associated with the needs of residents. Staff files also evidenced regular staff supervision and annual appraisal. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 21 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, 39, 40, 41 & 42 The conduct and management of the home is good ensuring residents satisfaction. EVIDENCE: The acting manager has applied to become registered with the Commission for Social Care Inspection and the application is currently being processed. The home conducts quarterly surveys to assess the satisfaction of residents and examples of completed survey forms were seen to confirm satisfaction with the service provided. Since a recommendation made at the last inspection the policy for the procedure of dealing with Challenging Behaviour has been amended to provide detailed instruction to staff and the use of medication only as a last resort.
Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 22 Following a requirement made at the last inspection the fees payable by one resident have been reviewed and records amended to ensure accurate charges are stipulated and made. Corrective action has been taken to address incorrect charges. Staff have access to appropriate mandatory training and appropriate records are maintained regarding accidents and incidents. Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 23 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 3 3 x x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 2 3 x Standard No 31 32 33 34 35 36 Score x x 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Ash View Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 3 3 3 x DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 24 Regulation 13 (4) Requirement The shed, located in the back garden must be made safe Timescale for action 13/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 15 Good Practice Recommendations The home should develop processes and documentaion to reduce the potential risk bullying between residents Ash View DC51 C08 S63513 Ash View V237603 110705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection First Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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