CARE HOME ADULTS 18-65
Ashwood 12 Dudley Road Northbourne Bournemouth Dorset BH10 6BS Lead Inspector
Stephanie Omosevwerha Unannounced Inspection 11th January 2006 02:30 Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 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 Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 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. Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ashwood Address 12 Dudley Road Northbourne Bournemouth Dorset BH10 6BS 01202 770242 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) Mr Jonathan Ashwood Van-Wyk Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service user to be accommodated in the second floor room must not be dependent on staff for means of their escape in the event of a fire. 3rd August 2005 Date of last inspection Brief Description of the Service: Ashwood is a semi-detached family house situated in Northbourne, a suburb of Bournemouth. It is registered to provide personal care for three adults with learning disabilities and there were no vacancies at the time of the inspection. The home is located close to shops, bus routes and other local amenities. The homes statement of purpose includes the following aim; to support young adults to learn new skills and maintain and increase their independence. In pursuing this aim the registered person assists and supports service users to attend or undertake further education and employment opportunities as well as access the local community and its amenities. The building has no features that distinguish it from other similar properties in the street. The premises are spacious benefiting from a loft conversion and there is accommodation on three floors. The three service users have single bedrooms on the first and second floor. A bathroom and WC are easily accessible. Communal space is shared with the registered providers and this includes a lounge, kitchen/diner, conservatory, ground floor shower room and WC, utility area and gardens to the front and rear of the property. The registered providers work full time in the home and one has previous experience of working for a local authority in services for adults with learning disabilities. The domestic nature and character of the home enables service users to benefit from living in a family environment. Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection of the home and took place over approximately 3 1/2 hours. It was the second annual inspection of the home carried out as part of the planned inspection programme for care homes undertaken by CSCI. The inspection also addressed the requirements and recommendations made at the previous inspection. The inspector initially met with Mrs Van Wyk (the registered provider’s wife) and examined various records and documentation including menus, medication, risk assessments, records relating to relief staff, adult protection procedures and minutes of residents meetings. The inspector also viewed the lounge, kitchen/diner and the laundry room. The inspector returned to the home later in the evening and met will all three service users after they had returned from their day-time activities and spent approximately 1 hour talking to them. What the service does well:
Ashwood offers a small family type environment providing a great deal of flexibility promoting individual choice. Observation during the inspection showed service users felt relaxed in the environment and were able to freely access all communal areas. Service users were able to fully participate in household routines such as washing up, hoovering and helping in the garden and contribute ideas for the running of the home such as planning their annual holiday and taking on an allotment. The home aims “to support young adults to learn new skills and maintain and increase their independence” and there were plenty of opportunities for service users to do this. For example service users did their own laundry and ironing, they made their own breakfasts and lunches and helped themselves to drinks when they wanted, they were able to retain and administer their own medication and they were able to access public transport independently. All the care is provided by the registered proprietor and his wife which means they have a good knowledge and understanding of service users individual care needs and are able to offer an excellent consistency of care. Service users expressed a great deal of satisfaction about their care and felt there was a real family atmosphere in the home. Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 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 Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 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): The key standard was assessed and met at the previous inspection. EVIDENCE: Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 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): The key standards were assessed and met at the previous inspection. EVIDENCE: Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 10 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): 16 and 17. Ashwood offers a small family type environment providing a great deal of flexibility and participation in the home’s daily routines promoting individual choice and independence. The meals in this home are good and ideas for increasing service users participation in meal planning and preparing have been explored providing further opportunities for service user involvement and choice. EVIDENCE: Discussion with the proprietor indicated routines in the home were flexible accommodating individual’s needs. For example service users helped themselves to their own breakfasts and evening meals were generally eaten together but times could be adjusted to enable service users to attend evening activities. Service users confirmed routines were adjusted to suit their needs and felt their rights were respected, e.g. they could spend time in the privacy of their rooms, bath and shower when they choose and go to bed when they wanted. Observation on the day showed that service users had freedom of movement around the premises and were able to help themselves to drinks when they wanted.
Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 11 The proprietor said service users were responsible for keeping their own bedrooms clean and also participated in household tasks such as washing and drying up, hoovering and cleaning bathrooms. They each had an identified day when they could do their laundry and ironing. Discussion with service users confirmed they took part in all these tasks. A sample of menus was viewed as part of the inspection. This showed service users were offered a varied and nutritious diet. The proprietor said service users likes and dislikes were well known and this was taken into account when preparing the menu. Service users usually helped themselves to their own breakfasts and made their own packed lunches. The evening meal was generally cooked by the proprietor mainly because service users were out at their daytime activities. However, the minutes of the last resident meeting indicated that service users had recently discussed a plan to each choose a recipe, which they would then budget, purchase the ingredients and prepare the meal. Service users told the inspector they enjoyed the food in the home and were looking forward to the opportunity of preparing their own meals. Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 12 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): 20. The home encouraged service users abilities to retain, administer and control their own medication whilst ensuring appropriate systems were in place to minimise any risk or harm to them. EVIDENCE: Only 2 of the residents are currently taking medication and one of these only involves the use of a nasal spray. These service users are currently selfmedicating and the inspector was shown a copy of the risk assessment ensuring an appropriate management framework was in place. The home has satisfactory policies and procedures for administering medication and the proprietor confirmed an awareness of these. A record was kept of any homely medication taken and the inspector viewed a sample of these records. There was evidence that advice was sought prior to these being administered e.g. ensuring that a paracetamol based product could be taken with the service user’s current prescribed medication. Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 13 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. Residents are encouraged to voice their concerns and are confident their views will be listened to and acted upon. The registered providers have a good knowledge of protecting vulnerable adults and safeguarding their welfare. However, the home’s written procedures need to be updated to ensure they reflect current practice. EVIDENCE: At the last inspection a recommendation was made suggesting that Mr Van Wyk carry out training concerned with assertiveness to develop a better awareness of defining behaviours and finding different solutions to manage these. Although the registered proprietor was still trying to identify an appropriate course other practices had been put in place to try and resolve the situation. This included Mrs Van Wyk spending more time in the home so both proprietors could have breaks in their weekly schedules. They also said that raising the issues in the inspection had made Mr Van Wyk more aware of the potential impact of his behaviour when working with the residents. Service users reported to the inspector that the situation had improved feeling they had been listened to and their views were acted upon. The home has policies and procedures in place concerning the protection of vulnerable adults. These included challenging behaviour, physical intervention and management of residents’ monies. The inspector viewed the home’s reporting procedure, which did not reflect the current arrangements for notifying the local authority where the home was located. This needs to be updated to ensure the correct procedure is followed. Mrs Van Wyk confirmed she had undertaken training in the protection of vulnerable adults and demonstrated an awareness of legislation. A copy of the Department of Health guidance “No Secrets” was available in the home.
Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 14 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): 30. The home is kept clean and hygienic with systems in place to ensure service users are protected from spread of infection. EVIDENCE: The inspector observed the home to be clean and hygienic. The proprietor is aware of procedures to control the spread of infection. A separate laundry room was viewed that is accessed by the hall ensuring any soiled articles do not need to be carried through the kitchen. The laundry room is domestic in scale and provides an impermeable floor and wall finishes that were readily cleanable. Separate hand washing facilities are provided. Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34. The home does not employ any staff and the registered proprietors provide all care. Appropriate procedures are now in place for vetting relief staff safeguarding the welfare of service users in the home. EVIDENCE: The home does not currently employ any staff but is owned and managed by the registered proprietor and his wife who provide 24 hour care to the residents. When it has been necessary for them to have a break, a regular relief worker provides cover in the home. There was a requirement made at the last inspection to ensure the proprietor has obtained all the information and documents specified in paragraphs 1 – 7 of Schedule 2 of the Care Homes Regulations 2001. These are now in place and were shown to the inspector. Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 16 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 and 39. The home is well run and enables service users to meet its stated aim “to support young adults to learn new skills and maintain and increase their independence.” There was evidence that service users views were taken into account when planning areas for future development. This needs to be formalised in a written plan to monitor how targets identified are going to be achieved. EVIDENCE: The home is managed by the registered proprietor and his wife. Both have previous experience of working with people with learning disabilities and prior to registered as a care home, they had been registered as adult placement carers. Mr Van Wyk had also undertaken voluntary work with adults with learning disabilities and Mrs Van Wyk worked for a local authority managing a service for adults with learning disabilities. Mrs Van Wyk has the Registered Managers award and Level 4 NVQ in care, Mr Van Wyk has undertaken NVQ Level 3 in ‘Promoting Independence’. Mrs Van Wyk told the inspector she was currently looking at training courses to update both her and Mr Van Wyk’s
Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 17 practice. She has approached the local authority, a voluntary organisation and a local college to find out about the availability of course that would best meet their requirements. A recommendation was made at the last inspection that a system of recording service users views/ideas was developed. This could then be used to form the basis of an annual development plan to monitor quality in the home. The registered provider has introduced more formal residents’ meetings since the last inspection. The minutes of these were shown to the inspector. It was noted that several action points had come out of the meetings e.g. residents participation in menu planning and meal preparation, obtaining an allotment that residents could work on and planning an annual holiday. The registered proprietor had further plans to re-decorate some of the living environment. An annual development plan now needs to be drawn up based on these ideas to monitor the quality of care provided by the home. Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 18 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 N/A 33 X 34 3 35 N/A 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X 3 X 2 X X X X Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No 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 YA23 Regulation 13 Requirement The registered provider must update the home’s adult protection procedures to ensure the correct reporting procedure is followed. Timescale for action 31/03/06 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. Refer to Standard YA22 Good Practice Recommendations It is recommended that the registered provider carry out training concerned with assertiveness to develop a better awareness of defining behaviours and finding different solutions to manage these. It is recommended that the registered provider develop an annual development plan based on the views of service users setting out the home’s aims and goals for the forthcoming year. 2. YA39 Ashwood DS0000004011.V278319.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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