CARE HOME ADULTS 18-65
Ashview 330 Main Road Duston Northampton Northants NN5 6NJ Lead Inspector
Stephanie Vaughan Key Unannounced Inspection 19th February 2007 08:40 Ashview DS0000063513.V313867.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 Ashview DS0000063513.V313867.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. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ashview Address 330 Main Road Duston Northampton Northants NN5 6NJ 01604 591179 01604 591179 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) suehullin@tracscare.co.uk TRACS Miss Ntokozo Hlongwa Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No person falling within the category of MD, Mental Disorder excluding Learning Disability or Dementia, may be admitted to Ashview unless that person also falls within the category LD, Learning Disability ie Dual Disability. 6th February 2006 Date of last inspection 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 premises comrises a three bedroom bungalow with limited communal space. The home is located in a busy residential area of Northampton close to all main facilities and amenities. Current fees range from £ 1,600 to £2,065 per week with extra charges for clothing, toiletries and personal items. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Prior to this statutory inspection, a period of three hours was spent in preparation. This comprised reviewing previous inspection reports and associated requirements and recommendations; the service history, risk assessment, returned comment cards and other documentation. Since the last inspection the Commission have received no complaints about the home. However has received four Safeguarding Adults notifications, which are addressed in the main body of the report. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. This site visit to the home was conducted over a period of five and a half hours during which the inspector made observations and spoke to residents and staff. 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 of a sample of two residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. The Registered Manager was present during this most of this visit. The current fees range from £ 1,600 to £2,065 per week with extra charges for clothing, toiletries and personal items. What the service does well:
Individual plans of care are highly individualised and address the individuals specific needs and requirements relating to the management of health conditions, challenging behaviour, assessment of risk, personal preferences, activities and routines. Residents are generally involved in making decisions about their lives. They participate in weekly residents meetings where they make decisions about life at Ashview for example the activities and the menu. Residents spoken to confirmed that they had access to advocacy services and felt able to raise any concerns that they might have with the staff.
Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 6 Each resident has an agreed timetable of activity. The content varies according to the resident’s wishes and interests. Residents are supported to integrate with the local community and choose to attend local facilities such as the local church, sport, leisure facilities and public house. Staff were seen to relate well to residents, recognising their preferences and privacy. Meals and mealtimes were seen to be flexible residents were able to choose their food and where they wished to eat it. Alternatives were available for residents with specific dietary need. Residents have access to fresh fruit and salad. Residents confirmed satisfaction with all aspects of the food provided. Individual plans of care evidenced that residents have access to a range of medical and healthcare specialists including podiatrists and speech and language therapists. The management manage complaints well and ensure that complainants receive the information about the outcome of investigations within an appropriate timescale. Incidents relating to the Safeguarding Adults are managed well and in line with the Local Authority Guidelines. Staffing levels are maintained, recruitment practices are generally sound and staff receive the right training to enable them to care for the residents properly. The Registered Manager provides competent leadership to staff. This provides residents with a consistent level of support and stability. All residents confirmed that they felt well supported and one said that ‘the staff here are brilliant’. Comments cards were received from two residents and these indicated a good level of satisfaction with the service provided. Comment cards were also received from five other visitors to the home, all of which indicated a good level of satisfaction with the service provided by Ashview. What has improved since the last inspection?
Following a Requirement made at the last inspection staffing levels are maintained by staff who are known to the residents and who have the right skills to manage their needs. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 7 The review of outstanding policies has now been centralised to ensure that they are consistent with the national policies for Tracscare. Following requirements made at the last inspection the loose glass has been removed from the picture frames displayed in the main entrance. The shower unit has now been replaced to ensure that water is dispensed at safe temperatures. 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. The summary of this inspection report can be made available in other formats on request. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashview DS0000063513.V313867.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. The routine admission procedures have not been followed which has resulted in adverse outcomes for both the new and existing residents. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been one new admission to the home since the last inspection. This resident was transferred as an ‘emergency’ from another home within the group. As a result the Registered Manager was unable to conduct the routine preadmission assessments necessary to establish whether the residents needs were able to be met at Ashview or to assess the impact of the new resident on the existing residents. There was no opportunity for introductory visits to enable residents to meet and to begin to establish relationships prior to the admission. There was no evidence that the residents had had any real choice in his agreement to move to Ashview. Detailed individual plans of care and risk assessments have been developed to manage to residents needs. However two of the residents have conflicting needs, which has led to two serious incidents between these residents in August and October 2006. The Commission recognise that appropriate
Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 10 measures have been taken to address these incidents and prevent re occurrence and that no further incidents have occurred. However strongly recommend that the appropriate preadmission processes are followed whenever possible to avoid future conflicts. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Residents are supported to maximise their independence and quality of life. Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has an individual plan of care that is generated from a full assessment of need. The plans of care provide detailed instruction to staff about the resident’s personal support and health care needs. Individual plans of care are highly individualised and address the individuals specific needs and requirements relating to the management of health conditions, challenging behaviour, personal preferences, activities and routines. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 12 Individual plans of care contain robust risk assessments for the management of general risks such as the ability to have a key for their bedroom door to the more specific risk related to individual activity. Any restrictions placed on residents were seen to be in their best interest and to be supported by appropriate risk assessments. Residents have access to key workers and Individual plans of care are regularly reviewed. There was some evidence that where possible the residents are involved in the development and review of individual plans of care. Residents are generally involved in making decisions about their lives. They participate in weekly residents meetings where they make decisions about activities and the menu. Residents spoken to confirmed that they had access to advocacy services and felt able to raise any concerns that they might have with the staff. Residents are supported to manage their own finances when appropriate and arrangements are specified within the individual plan of care to ensure that this is done in a way that is acceptable to the resident. Residents are supported to take risks within their lives and these are supported by robust risk assessments. Examples include use of a trampoline, cycling, other sporting activities and leisure activities such as gardening. Residents are able to make other lifestyle choices such as smoking and going to the pub. One resident spoken to said how he wished to go to a nightclub and that having discussed this with staff arrangements were being made to facilitate this. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15, 16 & 17 Residents are supported to enjoy fulfilling lifestyle. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has an agreed timetable of activity. The content varies according to the resident’s wishes and interests. Two of the residents have regular attendance at college where one attends to develop Life Skills; the other pursues interests such as horticulture, information technology and the study of subjects such as geography and history. One resident is involved in work activity with regular attendance at the Industrial Rehabilitation Workshop. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 14 Residents are supported to integrate with the local community and are supported to attend local facilities such as the local church, sport, leisure facilities and public house. Whenever possible residents are supported to maintain links with their family and friends. Residents are able to attend social events arranged with other residents from other homes within the group and by local organisations. Daily routines are flexible and are arranged around the resident’s schedule of activities. It was established that times of rising and retiring to bed and meal times are flexible and residents confirmed this. Staff were seen to relate well to residents, recognising their preferences and privacy. There are no specific policies pertaining to the promotion of equality and diversity, however the residents do have a charter of rights and their care is tailored well to meet their individual needs. Meals and mealtimes were seen to be flexible residents were able to choose their food and where they wished to eat it. Alternatives were available for residents with specific dietary need. Residents have access to fresh fruit and salad. Residents confirmed satisfaction with all aspects of the food provided. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Personal and healthcare is generally managed well, however inaccuracies in the medication systems have the potential to put residents at risk. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individual plans of care contained detailed instruction to staff about how the residents were to be supported in their personal care. Daily records indicated that care was being provided as specified. Residents are able to make decisions about their appearance eg clothing and appeared reasonably well presented. Recruitment is ongoing and the Registered Manager is mindful of the need to maintain a staff group consistent with the gender and culture of the residents. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 16 Individual plans of care evidenced that residents have access to a range of medical and healthcare specialists including podiatrists and speech and language therapists. Residents have access to General Practitioners for routine and specific consultations. Residents well being is monitored according to their individual needs. Medication systems were reviewed and in general appeared to be well maintained. Each resident having a medication profile and appropriate Medication Administration Records. Associated records indicated that the medication systems were audited on a daily basis and that these should be in good order. However a random sample was checked, all three residents were prescribed Lorazepam at regular intervals, or to be given as necessary. A comparison between the individuals remaining stock and the Medication Administration Records indicated shortfalls for all three residents. The Registered Manager stated that it was most likely that the medications had been administered but not recorded. One of these incidents was confirmed by information recorded within the daily records. The Registered Manager has agreed to review the medication systems to ensure that medication is administered to residents safely and to ensure that routine audits are accurately conducted. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Residents are able to voice their concerns and are protected form abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission have received no concerns about this service since the last inspection. The pre inspection documentation indicated that the service has received six complaints, which were investigated and found to be upheld. All complainants received a response within 28 days. The complaints policy is on display in the main entrance of the home and therefore is now accessible to the residents and their representatives. Residents spoken to confirmed that they would know who to speak to if they were unhappy about something and were confident that appropriate action would be taken to address their concerns. The Commission have received notification of two incidents relating to the of Safeguarding Adults. Both of these incidents occurred between residents. On each of these occasions the management have involved the appropriate agencies and acted upon the advice that has been issued. Individual care plans and risk assessments have been reviewed and amended to reduce and manage the risks and to ensure the protection of residents.
Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 18 Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 The standard of the environment is basic which impacts on the quality of residents’ lives. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents are all full grown men with individual needs for space and privacy, which is not particularly well accommodated by the environment at Ashview. The standard of the environment is adequate, comprising a three bed roomed bungalow within a residential setting. Each resident has a separate bedroom of varying proportions and the communal area comprising a lounge diner is limited in size. The dining areas is cramped, being partitioned and with no access to natural light. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 20 The Commission are aware that the company had some plans to extend and improve the facilities for residents at Ashview, which were due to be completed by April 2006. However these have yet to commence and the general maintenance of the building has deteriorated with the delay. The building is subject to heavy usage and the standard of décor is currently poor, although not hazardous at the present time the laminated flooring throughout the premises is becoming worn and there are exposed cracks to the ceiling in the sitting area. The home appeared to be clean and hygienic and generally free from offensive odour. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Staffing levels are managed to meet the needs of residents. Recruitment practices and staff training ensure that residents are in safe hands. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ashview has some vacancies for care staff and recruitment is ongoing. The Registered Manager confirmed that staffing levels are maintained to cater for the residents’ needs, including 1: 1 supervision and attendance at activities. At present there are three staff on duty throughout the day and during the evenings at weekends. Two staff are on duty during weekday evenings and one waking male on duty at night. This is consistent with the guidance issued by the Residential Forum, carestaffing tool. With the exception of cover at nighttimes where it is indicated that there should be two staff on duty at night. However the Registered Manager confirmed that risk assessments are in place regarding the current night staffing levels.
Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 22 There was evidence that the Registered Manager follows appropriate recruitment practices. Staff files indicated that povafirst clearances were obtained prior to commencement of employment in the home and that staff were supervised until the Criminal Records Bureau Clearances was obtained. Staff files evidenced that two references were obtained prior to appointment, however it was noted that one of the references included in the file was a verbal reference. On enquiry the inspector was informed that this staff member had been appointed by other senior staff within the group, however agreed to follow up this deficit and ensure that staff files contained the required documentation. Staff files evidenced appropriate induction training for new staff and the file of the most recently employed staff member contained evidence of appropriate mandatory training that had been undertaken in previous employment. However there was no evidence that existing staff have had access to timely mandatory training. On enquiry the inspector was informed that recent training had been conducted for all staff, including basic food hygiene, first aid, fire safety administration of medication, movement and handling and health and safety. However the management of staff training is centralised and the records of which are held elsewhere. This was discussed with the Registered Manager who agreed to ensure that in future staff files would contain evidence of the required training. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Residents’ benefit from consistent management, which is responsive to their needs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager conducts regular residents satisfaction surveys a sample were viewed an indicated a good level of satisfaction. This is consistent with the Comment Card responses sent to the Commission prior to this inspection. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 24 Since the last inspection the Commission have also received four comment cards from visiting professionals and one form a visitor to the home all indicate satisfaction with the service provided at Ashview. The policies and procedures continue to be reviewed. This has now been centralised to ensure that they are consistent with national polices for Tracscare. However there is no current policy on Equality and diversity and this should be addressed. However the Registered Manager was able to confirm that she had attended recent training on Equality and Diversity. Two requirements were made at the last inspection relating to health and safety and the environment, both of these have now been met. No further hazards were identified. Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 25 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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 33 34 35 36 3 3 X 3 X X 3 3 X 3 3 3 3 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 3 X
Version 5.2 Page 26 Ashview DS0000063513.V313867.R01.S.doc 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 YA20 Regulation 13.2 Requirement Medication systems must be reviewed to ensure the safe administration of medication at all times. Timescale for action 01/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA2 YA20 YA24 Good Practice Recommendations Routine admission procedures should be followed at all times Routine audits of the medication system should be conducted with accuracy. The Responsible Individual should notify the Commission about their plans for the development of the premises in order to meet the conflicting needs of the existing residents and maintenance issues. Staff files, within the home should contain evidence of the required mandatory training. A policy for the promotion of Equality and Diversity should be made available to staff. 4 5 YA35 YA39 Ashview DS0000063513.V313867.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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