Inspection on 27/06/06 for Ashview House

This inspection was carried out on 27th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashview House 12/12/07

Ashview House 25/01/07

Ashview House 16/01/06

Ashview House 11/05/05

Ashview House 29/10/04

Ashview House 20/05/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Ashview House Riverview High Road Vange Basildon Essex SS16 4TR Lead Inspector Michelle Love Key Unannounced Inspection 27th June 2006 08:00 Ashview House DS0000018107.V300765.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 House DS0000018107.V300765.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 House DS0000018107.V300765.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashview House Address 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) Riverview High Road Vange Basildon Essex SS16 4TR 01268 583043 01268 583675 Ashview House Limited Manager post vacant Care Home 13 Category(ies) of Learning disability (13), Physical disability (3) registration, with number of places Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: Ashview House is a care home providing personal care and accommodation for up to thirteen residents who have a learning disability, including up to three people with physical disabilities. The home is a two storey detached house situated in a cul-de-sac, in a residential area and is close to the local amenities. There are parking facilities available to the front and side of the building, and the home has a garden with a bird aviary and chicken coop. Three mini buses are available to transport the residents to their activities and to college. The range of weekly fees charged to residents was not detailed in the homes pre inspection questionnaire. A breakdown of individual resident’s costing package was requested and provided to the inspector. The range of weekly fees is currently £954.11 to £1892.00. Additional charges incurred by residents relate to chiropody, transport, holidays, personal toiletries and some leisure pursuits i.e. cinema/bowling/going to the pub/visiting fast food outlets. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced `key` site visit was conducted by Michelle Love, inspector and lasted approximately 11.5 hours. On the day of the site visit all residents were observed to be at Ashview House. During the day several residents were observed to access the community, either accompanied by support staff or independently. A tour of the premises was undertaken and a number of records pertaining to care plans/risk assessments/healthcare records, staff employment files, records of staff training, menu’s/nutritional records and the homes medication storage facilities and records were inspected. The inspection was conducted primarily with the acting manager, however both senior and support staff were very helpful and co-operative throughout the day. Following the inspection a number of questionnaires/surveys were forwarded to visiting professionals and resident’s relatives, requesting their views as to the running of the home. The outcome of these surveys has been incorporated into the main body of the report. What the service does well: What has improved since the last inspection? The acting manager has been in post since January 2006. This has proved invaluable and has provided some stability and consistency for both residents and support staff. An activity programme has been devised and implemented at the care home. Collation of information has involved seeking individual residents and their representatives’ views. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 6 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. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 7 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 House DS0000018107.V300765.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a Statement of Purpose and Service Users Guide, however this needs reviewing and updating. No new residents have been admitted to the care home since the last inspection. EVIDENCE: The homes Statement of Purpose and Service Users Guide, needs to be updated and reviewed. Both documents are currently in pictorial format and are located within the homes office. The acting manager was advised that a copy of both reviewed documents must be forwarded to the Commission. The inspector was advised by the senior in charge of the shift, that no new residents have been admitted to Ashview House since the last inspection. The inspector was advised that prospective residents are formally assessed and information from placing authorities sought. Contracts of residency were available for residents and these depicted the terms and conditions of occupancy etc. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A plan of care is available for all residents and includes risk assessments, however systems as highlighted previously remain muddled. It is unclear as to how residents are empowered and encouraged to make decisions and how they participate in the day-to-day running of the home. EVIDENCE: On the day of the site visit, three individual plans of care and associated documentation were inspected. In general terms information relating to residents social, physical, healthcare and emotional care needs were recorded. Some individual elements of the care plan were more detailed than others i.e. one care plan made reference to their communication needs, however it did not specify as to whether or not the resident is able to verbally communicate, whether non verbal signs i.e. makaton/picture board or other terms of reference are utilised. One care plan makes reference to the resident’s cultural needs being of Hindu origin. No information was recorded to indicate that staff had explored how the resident’s cultural needs can be met and what this may entail. It was surprising to note that different care planning formats were in situ for individual residents. The care plan for one resident, only made Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 10 reference to two elements i.e. to monitor the resident’s weight/follow a healthy eating plan and to promote the individuals personal hygiene. Another care plan made reference to one resident having a physiotherapy exercise regime carried out twice daily. On inspection of daily care records there was no information recorded evidencing that this was actually being carried out in line with the person’s care plan. Risk assessments were not devised for all areas of assessed risk. The care plan for one resident detailed that they exhibited challenging/inappropriate behaviours on occasions; no risks were highlighted detailing the specific nature of aggression, possible triggers and how these are to be managed by support staff. Manual Handling assessments were evident but had not been reviewed or updated for a long time i.e. October 2004. Another residents care plan made reference to them being at possible risk of pressure sores and having bed rails in place. No risk assessments had been devised for these areas. Residents spoken with advised that they are not always consulted and that they are not always included in the decision-making processes within the home. It is unclear as to how those residents with complex/limited communication needs are `given a voice` and given opportunities to express their wishes and desires. Some surveys forwarded to the Commission for Social Care Inspection indicated that visiting professionals are not always able to meet with individual residents in private and on some occasions there appears to be insufficient support staff available to speak with. Additionally some surveys indicate that they are not always notified of significant events. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A programme of activities has been implemented over the past two weeks. Family and friends are welcome to visit the care home. EVIDENCE: It was positive to note that an activity programme has been implemented over the past two weeks and that formal assessments detailing individual residents needs, wishes and personal preferences have been devised with the resident and/or their representative. Records indicate that some residents attend formal day care provision/adult education placements, however the latter has now terminated for the summer break. No alternative provision has been made in relation to what activities will replace college. The activity programme for two residents makes reference to them attending speech and communication. Following discussions with support staff the inspector was advised that neither resident has received speech and communication for some time. On the day of the site visit it was noted that activities for one resident did not occur. When challenged as to why this was the case the acting manager blamed the inspector by stating that as a result of Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 12 the inspection the resident had not participated in arts and crafts. No alternative had been scheduled in place of life skills at Briscoe’s. This is unacceptable as both the senior in charge and acting manager were advised that despite the site visit being undertaken, to ensure that the residents’ needs were the priority. The inspector was advised by both residents and by support staff that there are only three people within the home who can drive the homes minibus, however on occasions as a result of a shortage of drivers some outings, trips and college courses are curtailed and do not happen. This is unacceptable and the registered provider must ensure that wherever possible alternative measures are undertaken to ensure that residents do not miss out. Additionally the acting manager was advised to ensure that the activity programme is reviewed on a regular basis to ensure that these remain appropriate for the individual resident. Support staff advised that on some occasions they are assisting individual residents with `total communication`, however staff do not have appropriate training. The home operates a four weekly menu for meals. On the day of the site visit some residents were observed to have their breakfast at 09.30 a.m./09.45 a.m. and 11.30 a.m. It was surprising and inappropriate to see that lunch was served to residents at 11.55 a.m. Residents were given ravioli and bread and butter. Some residents were observed to not be given any choice and one resident confirmed this and stated that they would have preferred to have had a sandwich. Some residents were observed to be out when lunch was served, however the ravioli and bread and butter was plated and covered. One resident was noted to have their lunch at 15.30 p.m. and then their dinner at 18.30 p.m. The inspector was also advised that food menu’s are not consistently being followed. One resident’s care plan made reference to them needing to have a healthy diet/have their weight monitored and that they should have limited amounts of wheat. It was of concern that they were given ravioli and bread/butter and it was of no surprise that later they became incontinent. Nutritional records for this resident do not evidence that they are having a healthy diet or having their weight monitored. The resident was last weighed in December 2005. Concern was raised at the site visit in relation to the homes food budget. The inspector inspected the homes petty cash summary for week ending 4.6.06, 11.6.06, 18.6.06 and 25.6.06. Records indicate that the food budget is adequate for the numbers of residents residing at the care home. It was also positive to note that takeaway meals which replace the main meal are funded by the home and residents do not have to contribute to these costs. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have access to a range of healthcare professionals. The home’s medication administration procedures are poor and not in line with guidelines. EVIDENCE: Residents care plans/associated documentation evidence that residents can have access to a range of healthcare professionals as and when required i.e. Community Nurses, Consultant Psychiatrists, GP’s, Chiropodists, Dentists etc. Specialist equipment is available for residents i.e. wheelchairs, grab rails and hoists. Following the site visit a number of surveys were forwarded to resident’s representatives and visiting professionals to seek their views as to Ashview House and the service provided. It is of concern that correspondence forwarded to the Commission details that on some occasions appointments by professionals have not occurred or professionals have been left waiting for staff/residents to attend. Additionally it has been stated that some support staff have demonstrated a poor knowledge of individual resident’s needs and it is not uncommon to be told by support staff “ sorry I do not know” or that they have not been in post long or simply say they do not have access to certain information. It can only be deduced from this information that support staff do Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 14 not have access to resident files and are not actively encouraged to familiarise themselves with case notes. Professionals involved have stated that there is seldom any feedback from the home with regard to recommendations and whether they have been carried out or not. This is not good practice and needs to be reviewed for the future. It is unacceptable for resident’s appointments to be cancelled without very good reason and for residents healthcare needs not to be met. On inspection of the homes medication administration records no omissions were observed whereby the records were not signed by staff to indicate that medication had been administered to and received by residents. The acting manager was advised that the list of staff names/initials and signatures of those staff able to administer medication should be updated as soon as possible. On observation of the evening administration of medication to residents, it was concerning to observe that a senior member of staff had decanted five resident’s medication into pots. The pots were stacked one on top of the other and no names were observed on each pot. This is considered very bad practice and not in line with Royal Pharmaceutical Guidelines for the Safe Administration of Medication in Care Homes. Both the acting manager and senior member of staff were advised that where boxes/bottles of medication are opened, these should be signed and dated once started. The homes storage facilities were observed to be satisfactory. It was positive to note that medication profiles for individual residents had been devised. The inspector noted that two residents are able to self-administer their medication, however these have not been reviewed since August 05. The home does not have a copy of the Royal Pharmaceutical Guidelines for The Safe Administration of Medication in Care Homes. According to the homes training plan only four members of staff have undertaken and attained medication training. The acting manager advised that 5x staff attended medication training on 7.6.06. The homes pre inspection questionnaire details that 4x staff are the only people to administer medication, however there is no evidence to indicate that two of these staff have actually undertaken training in this area. The senior administering medication on the day of the site visit (p.m.) advised that they had not received medication training since 2003. Additionally the number of people able to administer medication to residents is not seen as sufficient. The acting manager confirmed that on occasions he has had to return to the home when off duty so as to administer resident’s medication. This is unsatisfactory and needs to be reviewed for the future. As part of good practice procedures those staff who are currently administering medication without appropriate training should cease to administer medication to residents until they have attained appropriate training. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints and protection of vulnerable adults policy and procedure available. EVIDENCE: A new complaints book has, been introduced to the home by the acting manager since the last inspection. One entry was recorded and this related to care practice issues. The acting manager advised the inspector that he is in the process of conducting an investigation into the allegations. The acting manager must forward information relating to the outcomes of the investigation to the Commission and include evidence of statements taken etc. Some of the surveys sent back from residents relatives/visiting professionals highlighted that not everyone is aware of the home’s complaint procedure and how to make a complaint/compliment. The home was observed to have a copy of Thurrock County Councils Protection of Vulnerable Adults procedures. The acting manager was also advised to obtain other Protection of Vulnerable Adults procedures, which relate to other resident’s placing authorities. The homes training matrix indicates that 7x members of staff have attained Protection of Vulnerable Adults training and 4x members of staff have undertaken training relating to Conflict Management. The registered provider must ensure that all staff working at the care home receive training relating to both elements as soon as possible. Some of the resident’s within the care home display various degrees of challenging/inappropriate behaviours and it is of concern that not all staff have an understanding of physical, verbal aggression and self-harm. The acting manager advised that the registered Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 16 provider has purchased a video pertaining to Protection of Vulnerable Adults. The inspector informed the acting manager that the video would be a useful tool to enhance existing training but not to be used solely. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home provides residents with a comfortable environment. EVIDENCE: On the day of the site visit the home was observed to be clean, odour free and no health and safety issues were highlighted. Of those individual residents rooms inspected, all were observed to be personalised and distinctive with their personal effects and were reflective of resident’s hobbies and interests. Although no health and safety issues were raised at this inspection, the inspector was advised that lighting within the first floor hallway (nearest office) remains unsatisfactory as some bulbs continue to not work/fuses blow. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home are not always met and on occasions there are insufficient staff on duty. Residents residing at Ashview House are not protected by the home’s recruitment procedures. Gaps exist in relation to both mandatory and specialist training for support staff. Supervision for support staff has been implemented by the acting manager but is not yet in line with National Minimum Standards recommendations. EVIDENCE: The inspector was advised by the acting manager that current staffing levels are 4x support staff on duty each day between 07.00-22.30, 2x waking night staff each night between 22.00-07.30 and 2x 1-1 support staff Monday to Friday 10.00-18.00 and 1x 1-1 waking night staff between 22.00-07.30 each night. The acting manager’s hours are supernumerary to the roster. On inspection of four weeks staff rosters it was evident that staffing levels as detailed above are not being maintained on a regular basis and that staffing levels are not always appropriate to meet resident’s needs. This is of concern and must be addressed as a priority as continued non-compliance could result in future Immediate Requirement Notices being issued. As highlighted at the previous inspection to the home staff rosters continue not to specifically Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 19 identify those members of staff providing 1-1 support for individual residents. Additionally the staff rosters do not identify all the codes used i.e. F and SK. Staff rosters also continue to evidence that some staff are consistently working long days/excessive hours i.e. week commencing 25.6.06 some staff were noted to work between 48-64.5 hours. One staff member was observed to be working three consecutive long days (07.00-22.30 each day, a total of 15.5.hours). No specific structure/guidelines are in place relating to those staff who are providing 1-1 support for resident’s. The inspector noted on the day of the site visit that their roles were `blurred` and often throughout the day they were left with the responsibility of supporting other residents and not just those who require 1-1. On inspection of four staff recruitment files it was evident that the acting manager is not ensuring that the home’s recruitment procedures are robust and protecting residents. Gaps were noted in relation to employment histories not being fully explored, no photographs for three members of staff, Criminal Record Bureau checks received after commencement of employment and POVA 1st checks not undertaken for some employees, no written references available on three staff files and no job descriptions or record of induction available. A staff training matrix was readily available. Records detail that some staff have received mandatory training since the last inspection i.e. manual handling and medication. Current records indicate that 1x member of staff has not attained manual handling, some gaps exist in relation to food hygiene, fire awareness, health and safety, protection of vulnerable adults, first aid and infection control. It is of concern that the majority of staff at the care home have not received training relating to the specific needs of residents i.e. autism, physical disability, total communication, cerebral palsy, sensory impairment. The pre inspection questionnaire indicates that only 3x members of staff have currently attained NVQ Level 2 or equivalent. Supervision records indicate that since the last inspection the acting manager has commenced and undertaken some supervision sessions with staff. The acting manager was advised that staff should receive regular supervision i.e. 6x times annually. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 and 39 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has an acting manager, however it is clear that he is struggling to impose a clear sense of direction and leadership, which staff understand and which is seen as positive. Although there is no formal quality assurance system in place, feedback is sought from staff and residents. EVIDENCE: The acting manger has been in post since January 2006. Following the site visit, a manager’s application to be formally registered with the Commission for Social Care Inspection has been forwarded. From discussions with the acting manager, support staff and from evidence of comments made by visiting professionals it is evident that he is struggling to impose clear management systems and structures, which will ensure that the home is well managed and well run. At present a `blame culture` is being apportioned to all sides in relation to why there continues to be certain failings. The acting manager must look at ways of ensuring that more time is spent `on Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 21 the floor` monitoring support staff/senior staff, looking at what care practices are being adopted, supervising and advising staff where necessary and also looking at his own practices and management skills. The acting manager must look at ways of managing support staff without appearing to be intimidating and/or aggressive. It is evident that individual residents needs are not always being met and that information on care plans are not always being followed. This is unacceptable and must be addressed as a matter of priority and urgency. Additionally the acting manager must ensure that clear roles are devised for both himself and the deputy manager. The Commission is concerned that the deputy manager appears weak and ineffectual and will not be able to provide sufficient support to the overall management of the home. The Commission for Social Care Inspection recognises that over the past 12 months the home has experienced some major upheavals and concerns related to poor care practices, however continued non-compliance to meeting the National Minimum Standards, Care Homes Regulations for Younger Adults must be addressed. Although there is no formal quality assurance system in place to seek the views of residents, support staff, residents’ representatives and/or visiting professionals, Regulation 26 visits are conducted to the care home once monthly by the operations manager. Additionally resident/staff meetings have taken place. Recorded minutes relating to resident/staff meetings were noted at the time of the site visit. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 22 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 2 2 N/A 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 1 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 2 2 3 X X X X Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 4&5 Requirement The registered person must ensure that the homes Statement of Purpose and Service Users Guide is reviewed and updated. The registered person must ensure that comprehensive and detailed care plans are devised for all individual residents and that these are reviewed regularly. Previous timescale of 01.05.06 not met. The registered person must ensure that residents are empowered to make decisions and are consulted. The registered person must ensure that any restrictions of freedom, choice and power to make decisions are recorded. Ensure that all risks are identified for all areas and recorded within the care plan for residents. Previous timescale of 01.04.06 not met Ensure that all residents DS0000018107.V300765.R01.S.doc Timescale for action 01/09/06 2. YA6 15(1) 01/09/06 3. YA7 12(2) 01/08/06 4. YA8 17(1)(a), Sch 3(q) 13(4)(c) 01/09/06 5. YA9 01/09/06 6. YA13 16(2)(m) 01/09/06 Page 24 Ashview House Version 5.2 (n) 7. YA17 16(2)(i) 8. YA18 13(1)(b) 9. YA20 13(2) 10. YA20 18(c)(i) 11. YA23 13(6) participate within a meaningful and stimulating programme of activities. Ensure that these are reviewed regularly to reflect residents changing needs. The registered provider must ensure that appropriate wholesome meals are provided for all residents. The registered person must ensure that all residents receive treatment, advice and other services from healthcare professionals. This refers specifically to appointments not being cancelled and unattended. The registered person must ensure that appropriate arrangements are made for the safe administration of medicines. The registered person must ensure that all staff working at the care home receive appropriate training. This refers specifically to medication training. Ensure that residents are safeguarded against abuse and not placed at risk. This refers to all staff receiving appropriate training relating to protection of vulnerable adults and dealing with aggression. 01/08/06 01/08/06 01/08/06 01/10/06 01/11/06 12. YA24 23(2)(p) 13. YA33 18(1)(a) Previous timescale of 11/02/06 not met. The registered person must 14/08/06 ensure that there is sufficient lighting in the care home and that it is in full working order. The registered person must 01/08/06 ensure that at all times there are sufficient numbers of staff on duty at all times. Previous timescale of 01.03.06 not met. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 25 14. YA33 18(1)(a) 15. YA34 17(2), 19, Sch 2&4 The registered person must 14/08/06 ensure that there are sufficient numbers of staff on duty. This refers specifically to staff not working excessive hours/long days. The registered person must 14/08/06 ensure that robust recruitment procedures are adopted and that all records as required by regulation are sought and readily available. 16. YA35 17. YA36 Previous timescale of 01.03.06 not met. 18(1)(c)(i) The registered person must ensure that all staff receive appropriate training. This refers to both mandatory and specialist training. 18(2) Ensure that all staff receive regular supervision. Previous timescale of 01.03.06 not met. The registered person must ensure that the manager is fit to run the care home. 01/12/06 01/09/06 18. YA37 9 14/08/06 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. 4. Refer to Standard YA13 YA14 YA17 YA20 Good Practice Recommendations Ensure that alternative activities are provided in place of adult education. Ensure that the home provides sufficient drivers to enable residents to access the community and to pursue leisure interests and hobbies. Ensure as part of good practice procedures that residents are weighed on a regular basis in line with there care plan/care needs. As part of good practice procedures update the list of staff DS0000018107.V300765.R01.S.doc Version 5.2 Page 26 Ashview House 5. 6. YA20 YA20 7. 8. 9. 10. YA20 YA32 YA33 YA35 names/signatures and initials which depict those staff able to administer medication to individual residents. Ensure that where bottles and packets are opened these are dated and signed. Where assessments are devised for those residents who self medicate, these should be reviewed regularly and individual residents reassessed to ensure that they remain competent. The home must obtain a copy of the Royal Pharmaceutical Guidelines for the Safe Administration of Medication in Care Homes. 50 of support staff should attain NVQ Level 2 or equivalent. The staff roster should identify at all times those support staff who provide 1-1 support for residents. All newly appointed staff should receive an induction. Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Ashview House DS0000018107.V300765.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!