Inspection on 29/08/06 for Ashwood House

This inspection was carried out on 29th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashwood House 22/01/08

Ashwood House 17/01/06

Ashwood House 12/07/05

Ashwood House 11/01/05

Ashwood House 13/07/04

Ashwood House 09/01/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Ashwood House 51 Foxhill Norwood London SE19 2XE Lead Inspector Cheryl Carter Unannounced Inspection 29th August 2006 10:00 Ashwood House DS0000006880.V299655.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 Ashwood House DS0000006880.V299655.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. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood House Address 51 Foxhill Norwood London SE19 2XE 020 8771 7742 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) Beacon Care Ltd Mr Lee Patrick Elkin Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 12 Adults of either sex with a learning disability 3 of whom may be wheelchair users. 17th January 2006 Date of last inspection Brief Description of the Service: Ashwood House is a large detached three/four storey converted house set in a residential area of Upper Norwood. Beacon Care owns the property. The home is located within a short walking distance of Upper Norwood town centre and Crystal Palace Park and therefore has excellent bus and rail links. The home is registered to care for twelve younger adults with learning disabilities, three of whom are registered as wheelchair users. The premises are accessed externally by a ramp that leads from the side of the front of the house. The service users have access to a small garden at the rear of the property. The communal areas, bathrooms and toilets are easily accessible and there is a lift to access the other floors of the house. The staff team support and encourage the service users to lead individual and independent lives within the home. Service users are encouraged and supported in undertaking employment, educational and leisure activities both within the home and the local community. The home supports service users to maintain independence in all areas of daily living. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over seven and a half hours on 29th August 2006. The inspection was carried out with the help of the Manager, and staff on duty. The inspector spoke with two support staff and three of the service users who were in the home at the time of the visit. Records relating to care planning, staff records, medication, health and safety and staff training were seen the communal areas of the home were also inspected. What the service does well: 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 House DS0000006880.V299655.R01.S.doc Version 5.2 Page 6 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 House DS0000006880.V299655.R01.S.doc Version 5.2 Page 7 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, 3, 4, 5 Quality in this outcome area is good. The judgement was made using available evidence including a visit to this service. The Registered Manager goes out the to assess the prospective service to ensure that the service can meet their needs. Information relating to these assessments was evident of the files tracked. EVIDENCE: The Statement of Purpose and Service User Guide have been updated in line with this standard. When a referral is made the manager visits the prospective service users to make the assessment to ensure that the service can meet their needs. Once the decision is made the service user can visit the home. Each service user has a contract and terms of conditions to reside at Ashwood House. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 Page 8 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, 9, 10 Quality in this outcome area is good. The judgement was made using available evidence including a visit to this service. The care planning system provides the opportunity for service users to be fully involved and supported in planning their futures. The home is proactive in supporting people to make decisions and take responsibility for their lives. Risk assessments are used positively to further opportunities for independence. EVIDENCE: A sample of care plans were examined and these provide evidence of further improvements the home has made in providing person centred approach to care planning. Key workers identify with their service users short medium and long-term goals. Staff at the home are proactive in ensuring that reviews are held six monthly or annually or if a need is identified on an ongoing basis. Care plans contain details of weekly and daily routines and the support that is required for any tasks that are undertaken, details about relationships, family contacts, health professional involvement, communication needs, work, self help skills and ability to travel independently. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 Page 9 Care plans also include details about budgeting, weight monitoring and any domestic tasks. The manager of the home has also introduced a 24 hour management plan for each service user and this is written in the first person with the service user detailing how and what support he/she needs. And how the support is to be provided. This document is very helpful not only to the permanent staff but also to any temporary staff coming to work in the home. The manager has exceeded this standard. The home has monthly meetings but staff and service users do not necessarily wait for a meeting to discuss issues that arise. The inspector saw recordings of decisions made by service users about their lives and the way the home is run. Service users have one-to-one time with their key workers. The service users spoken to were very positive about the relationships and support they receive in the home. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 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): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. The judgement was made using available evidence including a visit to this service. The care at Ashwood House is based on the values of giving choice and independence to service users. The lifestyle at the home are based upon the assessed needs and identified wishes of the service users. Service users enjoy a wide variety of activities and community links ensure service users are informed about the opportunities that are possible. EVIDENCE: All service users are supported to develop their independent living skills and there care plans and goal-setting plans describe the level of support required for a range of tasks. These efforts have enabled individual service users to improve their skills, improvements are evident from the changing care plans and also from talking to service users. The weekly routines show that a variety of opportunities and activities are being undertaken including attendance at day centre and college courses. The home provides leisure and entertainment including cinema, bowling, videos, music systems, and attendance to the Gateway club. Neighbours are Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 Page 11 invited to the Home’s BBQ, and some service users are members of the church group. From talking to service users, staff and examining care plans it is evident that the daily routines are based on personal needs and wishes and promote independence and choice. Two service users spoken to confirmed that they got helpful advice from staff but made up their own minds. Menus are planned and all service users have an opportunity to contribute to planning and preparing meals. Menus seen provided evidence that service users enjoy a well-balanced diet that offers choice. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 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): 18, 19, 20, 21 Quality in this outcome area is good. The judgement was made using available evidence including a visit to this service. The home has a medication administration and storage system that is safe and complies with the regulations. EVIDENCE: The medication administration and storage system was examined and was found to be in order. All medication was correctly stored and the records were accurate and up top date. All service users are assessed in relation to their ability to self-medicate and to support this practice if implemented. Only staff that have received training in the safe handling of medication are allowed to give medication. The physical and emotional health needs of service users are set out in their care plans and identified in their daily management programmes. The home has a policy on death and dying. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 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, 23 Quality in this outcome area is good. The judgement was made using available evidence including a visit to this service. The home has a complaints procedure. Staff has received training in the protection of vulnerable adults. EVIDENCE: The manager has produced a complaints booklet that is very visual and colourful and service user friendly. The staff team have recently had training in the Protection of Vulnerable Adults and whistle blowing. The manager said that adult protection is kept on the agenda and discussed at staff meetings every month. All staff have read and are familiar with Bromley’s inter agency guideline on adult protection. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 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): 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is adequate. The judgement was made using available evidence including a visit to this service. The home provides a relatively good standard of communal accommodation that promotes independence but also supports group living. The home is clean and this contributes to the quality of care and support being provided. EVIDENCE: The communal areas of the home were inspected and these were clean and in some parts well maintained. The kitchen, which was referred to in the previous inspection, has not yet been refurbished. The inspector was informed that the finance for the kitchen has been approved and is currently obtaining quotes. The registered provider must ensure that all parts of the home inside and outside are kept clean and reasonably maintained. (Req.1) The home provides spacious accommodation that allows service users to live comfortably as a group but also retain a degree of privacy and quiet if they wish. There are aids to maximise service user’s independence with Hoists, wheelchairs and access to the Occupational Therapists when it is appropriate. The home was clean throughout with no offensive odours. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 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): 31, 32, 33, 34, 36 Quality in this outcome area is good. The judgement was made using available evidence including a visit to this service. The home provides training and induction for new staff to ensure they provide the appropriate support and understanding for the service users living at Ashwood House. The home’s recruitment procedures comply with the regulations to make sure that service users are protected. EVIDENCE: At the time of the inspection there were sufficient staff on duty to meet the needs of the service users. The rotas showed that these levels are maintained. All staff has CRB and POVA checks. Of the twelve staff employed at the home eight have already completed NVQ2 training. The manager of the home Holds a diploma in management and is currently undertaking NVQ4. The home’s recruitment procedures comply with the regulations and help ensure service users are protected. Record show that staff is receiving regular supervision in line with this standard. Staff training has improved. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 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, 38, 39, 40, 41, 42, 43 Quality in this outcome area is good. The judgement was made using available evidence including a visit to this service. The home is well managed and has a value base that is promoted by the manager and is empowering to service users. The home provides a safe environment. EVIDENCE: The home is professionally managed with clear commitment to meeting the needs of the service users and promoting choice and independence. The manager’s approach to managing the home is structured and well organised. The inspector saw tasks, checks, procedures that have been completed in relation to the well being of the service users. The manager receives supervision from the group manager. The manager of the home need to develop a quality assurance monitoring system and copies of the report should be sent to the Commission. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 Page 17 (Recommendation 1) The appointed visitor carries out the monitoring visits monthly and reports are sent to the Commission. Records relating to service users were stored securely. The home has appropriate Employers Liability Insurance. Fire safety equipment has been serviced and tested as required. Staff evidenced being provided with regular fire safety training. Staff said that they receive regular supervision. Servicing records relating to lifts and hoists, portable appliance testing and the have been appropriately maintained. Hazardous substances had been stored securely and accidents had been recorded and reported as required. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 3 Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 Page 19 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 YA24 Regulation 23.2d Requirement The registered provider must ensure that all parts of the home inside and outside are kept clean and reasonably maintained. Timescale for action 31/10/06 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 YA39 Good Practice Recommendations The registered provider must develop an effective quality assurance system, based on seeking the views of service users in order to measure the success in achieving the aims, objectives and Statement of Purpose of the home. Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Ashwood House DS0000006880.V299655.R01.S.doc Version 5.2 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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