Inspection on 22/05/07 for Ashwood House (Leyton)

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Ashwood House (Leyton) 18-20 Church Road Leyton London E10 5JP Lead Inspector Stanley Phipps Announced Inspection 22nd May 2007 10:00 Ashwood House (Leyton) DS0000068068.V337648.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 (Leyton) DS0000068068.V337648.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 (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood House (Leyton) Address 18-20 Church Road Leyton London E10 5JP 020 8924 8388 020 8252 8156 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) Ashwood House Ltd Lisa Jane Willsher Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Ashwood House is a care home providing personal care and accommodation for seventeen service users who are younger adults (18-65), all of whom have a mental illness. The home provides a service to both men and women. It is a privately owned and managed facility and accepts service users on the basis that they meet the home’s criteria for admission. The home is located in Leyton and offers easy access to shops and a wide range of social and recreational facilities. It was registered in October 2006 and is a fully refurbished home that is set over three floors. The home is designed to eight service users on the ground and first floors with one service user having the benefit of a flat on the second floor. The vision is to accommodate more dependent individuals on the ground floor with the less dependent on the first floor, while the flat is to be used for assessing individual service user’s abilities for independent living. The accommodation is spacious and purpose built and meets all current building regulations. Each service user has an en-suite facility with adequate space for a computer, entertainment systems and other personal effects. Each of the lower floors has a separate dining and living room, a secondary lounge, communal bathrooms and toilets, smoking rooms, visitors‘ and, laundry rooms. There is also a separate laundry room in the basement, an activity room, a communal computer room and a multi-faith room. There is also a communal garden to the rear that is attractively set out with flowerbeds and shrubs with a small area for therapeutic gardening. A lift is also available to service users. The aim of the service is to provide a wide range of interventions and approaches in supporting individuals with mental health problems. There is dedicated and skilled staff are on hand to provide twenty-four hour care, which is enhanced with an activity coordinator. Opportunities are provided to engage service users in their care and to plan their future. The fees range from £650.00 to £750.00 per week and do not include personal clothing, toiletries and specialist therapies, which are variably priced. A statement of purpose and service user guide is available to all service users. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and the first for this service under the National Minimum Standards for Younger Adults and Care Homes Regulations 2001. It was carried out on the 22/5/07 over one day beginning at 10.00 a.m. and concluded at 21.10 hours. Throughout the course of the visit the registered provider and the manager from his other service were present. The registered manager for Ashwood House (Leyton) was unavailable at the time and had been for some time prior to the visit. It was reported that her availability should become clearer some time during the course of the summer. The current arrangement involves the registered provider managing the service in the interim – which is satisfactory. At the time of the inspection there were three service users in the home and the inspector had a chance to meet them all. They were pleased with the services that were currently provided, which were of a generally good standard. The home was not to full capacity and although there are good systems in place to ensure a quality service, some systems could not be fully tested e.g. quality assurance and staffing development. Given the newly registered status of the service a sound tack record could not be fully established and hence the highest possible outcomes for the service as a whole could not yet be attained. However, it must be noted that the registered provider successfully runs a similar, though smaller service (nine – bedded) in Ilford. The expertise gained from Ashwood House (Ilford) meant that strategic thought and planning went into developing Ashwood House (Leyton). People using the services at Ashwood House (Leyton) stand to benefit from this. An assessment of medication practice, activities, menus, policies and procedures, all records required by regulation, service user plans and the environment was undertaken. Discussions were held with staff, all service users, the registered provider and the manager (Ashwood House Ilford) during the course of the inspection. Formal interviews were also held with two members of staff. The inspection also considered verbal feedback from external professionals, along with comment cards from relatives, staff and service users. The registered provider informed in his comments during the draft stage of this report that he had carried out the improvements made in the report, which is positive. Apart from the staff training in diabetes the inspector was unable to fully validate this. What the service does well: Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 6 Providing service users with choice and, involving them in their care and individual development. Working positively with external professionals to ensure that service users get the best possible support to achieve their goals. Providing a stimulating environment that is equipped with good quality furnishings, designed with the safety of service users in mind. Have good support and strategic measures in place to minimise the risk of service users being repeatedly admitted into hospital. Provide activities that service users plan and are keen to engage with. Invest in staff training and development to ensure that service users are given good support in achieving their individual goals. 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. The summary of this inspection report can be made available in other formats on request. Ashwood House (Leyton) DS0000068068.V337648.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 Ashwood House (Leyton) DS0000068068.V337648.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. JUDGEMENT – we looked at outcomes for the following standard(s): (1,2,3,4,5) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users and their relatives have access to information in making a decision about the suitability of the home. They benefit by having detailed assessments carried out on them and have opportunities to view the service before deciding to live there. Once admitted service users are assured that their needs would be met and, having a statement of their terms and conditions ensures that the provider’s obligations are made clear to them. EVIDENCE: Service users have access to information through the home’s statement of purpose and service user guide, the latter of which is given to each individual. Feedback received from service users confirmed that the service user guide provided them with accurate information about the home. The documents do make reference to the specialist services that are provided at Ashwood. One individual said that his social worker helped in identifying the home for him and drew the information to his attention, which he was grateful for. Both documents were in formats that were suited to the communication needs of the service user group. However, the registered provider advised that the documents could be made available in alternative formats, if required. It was positive to see that equality in practice is covered in the statement of purpose. The admission documents of all service users were assessed and found to be very detailed. There was evidence that information was gathered from referring agencies prior to admitting service users to the home, which is part of Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 9 the admissions process. The three service users were involved in their assessments and the input of relatives was also, key to the overall process. Service user plans were developed from these assessments, which outlined the actions required to achieve each of the individual’s objectives. As part of delivering a safe service, risk assessments were linked to the service user plans to ensure that service user’s independence was promoted without compromising their safety. This is good practice. The home does not accept emergency placements and so admissions to the service are unrushed. This ensures that service users along with their relatives /social workers are given the opportunity thoroughly examine the suitability of the home. Due consideration is given to the admissions criteria and the ability of the staffing expertise/skills to meet the needs identified from the assessments. It was noted that the registered persons are keen to stay within their eligibility criteria, and so seek the views of service users already living in the home, regarding new admissions. It was clear from the relatives’ comment cards and from talking to service users that they were confident that their (SU) needs could be met at Ashwood House. The registered persons have a system in place to ensure that every service user is given an opportunity to visit the home prior to deciding to live there. In doing so they get to meet with the staff team, and experience what it like to live in the home. This could take the form of coming in for tea e.g. one person had four visits, to being enabled to have weekly stays. In this way service users have the opportunity to view the operations of the home on a wider scale. Feedback from service users indicated that this was a positive experience as it gave them an opportunity to compare their previous experiences with their current and prospective home. From assessing the files of service users, copies of contracts were on file for each individual. In each case the service user signed their contract and, this ensured transparency and user involvement. The contracts detailed information about fees and the rights/obligations of service users and, the registered provider. This therefore gives some protection to both parties and is in keeping with the national minimum standards for the service user group. The documents seen were in a format that the service users could relate to, which is positive. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 10 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): (6,7,8,9,10) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users benefit from having their needs (including their mental health needs), reflected and reviewed in their individual plan. In doing this, they are actively involved in the process as part of determining what is best for them. They are given opportunities to participate in various aspects of the home and are supported to maximise their independence within a risk management framework. Policies and procedures along with a thorough staff induction ensure that their (SU) confidentiality is promoted and preserved. EVIDENCE: From the initial stages, all service users are involved in planning their care, which ensures that they are not only aware, but accept responsibility for their direction. As part of this they have the benefit of a key worker that works closely with them in setting up and reviewing their individual plan. All plans viewed were updated and in some cases, reviews had already been carried out, which also included the input of a social worker. The plans were noted to be individualised detailing the specific needs of service users and were borne out of the assessments carried out initially with them. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 11 Staff interviewed had a good knowledge of the service user plans as well as the expertise in developing them. As such they were used as working tools and changes are carried out only with the consent/involvement of the service user. During the course of the inspection, a diverse need had been identified and followed through by staff in the home, however the service user expressed the wish for it not to be carried through in her plan. This was respected, but the registered provider was conscious that this could be re-examined at a subsequent review for the individual. All service users knew about their individual plan and, were very aware of their care coordinators and the external professionals involved in their care. A monthly report is conducted on service users’ progress and their plans are reviewed quarterly. As a part of promoting independence, plans are also in place to assist service users to budget their finances. There is also an activitymonitoring chart, which records service users’ levels of engagement and this feeds into reviews carried out with them. As a compliment to the service user plan an: ‘approach plan’ is developed, which identifies the signs of relapse with agreed actions to reduce the levels of distress to service users, when they become unwell. There was also evidence of a behavioural plan for one individual, which was complimented by an external professional. There is information on advocacy services for the benefit of service users that may wish to use such services. At the time of the visit, service users had the input of their relations and in many respects, were able to articulate their needs. Two individuals were managing their finances independently although, they may choose to use the security storage in the home for keeping, possessions for example benefit books. Support is available to enable individuals to manage and safeguard their finances, but staff ensures, that as much of the control remains with the individual. Accurate records were in place to evidence this. Where restrictions were in place, appropriate risk assessments informed why and how such decisions were taken. There was evidence that service users were involved in various aspects of the home, e.g. menu planning, activities, outings, how they spend their time and the frequency of their meetings. It was noted that they had access to a range of policies and procedures, a copy of which is kept in their main lounge. Service users spoken to felt expressed that the format of these policies were suitable and could be easily related to. Given that the home was relatively new quality assurance systems such as service user surveys were not carried out. However, service users were informally consulted and in their meetings about various matters in home. It was clear that the foundation was in place to enable service user participation in the home. One example was where the current service users were asked how best they would like to use their activity room. This is a positive start, which should ogre well as the service develops. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 12 At Ashwood House risk assessments form an integral part of promoting service user safety and independence. As such they were in place for each individual living at the home. More importantly, risk assessments were reviewed, linked to the service user’s plans and generally kept updated. On examining the risk assessments closely, clear actions were recorded to keep the risks to a minimum and this forms an important part of safeguarding adults. In a discussion with an individual, there was an awareness of a limitation that was in place, however the basis was understood and agreed to with the person concerned. A missing persons procedure is in place at the home and staff had knowledge of this. This is a positive aspect of the homes operations. A policy on confidentiality is in place for the benefit of service users and staff. From interviews held with two staff members, they demonstrated a sound understanding in how information held on service users, should be handled – both internally and, with external bodies. Service users’ records were securely maintained and updated. The home’s confidentiality policy makes clear how and when information is shared with third parties. This ensures that service users best interests are considered at all times. Ashwood House (Leyton) DS0000068068.V337648.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): (11,12,13,14,15,16,17) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users benefit from having a range of opportunities for their personal development. They are also encouraged to participate in; their community, appropriate activities and, are able to maintain and develop social and personal networks of their choosing. Service users are supported to exercise their rights, which are respected and promoted by staff in the home. Ashwood House provides meals that are reflective of service users’ choice and nutritional requirements. EVIDENCE: Service users are supported to develop practical life skills, and one of the ways of doing this is by agreeing a roster among them in doing tasks like washing up and handling their laundry. Staff work closely with service users as individual skill levels are varied, but everyone has the opportunity to contribute and learn. For some, it develops their confidence. It was noted that the service users retained some control in that they decided that Sunday is their rest day and this is positive. All service users are encouraged to identify and develop their goals and in terms of life skills, another area that they get support in, is budgeting. Specialist therapeutic techniques such as cognitive behavioural Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 14 therapy, reflexology and homeopathy can be made available from external sources, subject the funding and agreement of the service user and, the direction of medical advice. The home uses art, craft and music internally to support individuals in maintaining their wellbeing. All service users have the opportunity to pursue their spirituality or belief. As part of encouraging service users’ development, there is a communal computer that service users can tap into and it is planned that this would be used for education and entertainment. Service users have access to the internet where they could explore areas that they would like to develop. There are also plans to have a library on the first floor and a variety of books had already been purchased in consultation with service users. One service user was at the time writing a computer game and there was evidence of a number of his educational achievements on his wall. This individual has qualifications in electronics and is encouraged to continue in this area. For others, opportunities for educational and/or vocational opportunities were being explored. Most of the service users spoken to had access to the community facilities some more independently than others. Staff were instrumental in identifying community resources based on service users’ interests. On the day of inspection, one person went out for an appointment and did some personal shopping on his way back. Service users also engage with the community by using the bank and post office. One service user had recently joined an African and Caribbean group and had attended one session, which he reportedly enjoyed. He also attends a disco and is keen to join a dance group – something he also enjoys. At the time of the visit, service users were not actively pursuing their religious persuasions/beliefs, but staff were providing opportunities for them to so do. Service users were therefore becoming more integrated into their community. The home employs an activities coordinator on a part time basis currently, to provide stimulation and development opportunities for service users. They are planned in relation to their interests. This could take place in the form of a group discussion, an art session, making models, playing pool, computing or simply identifying other areas that they would like to get into. The inspector saw examples of two different aspects of model making by individual service users and the quality was exceptional. It was remarkable that staff enabled service users to creatively use their skills in what interested them most. There was also evidence of a range of recreational activities, such as sky television, board games e.g. scrabble, dominoes and video games. Service users spoken to were quite pleased with the range of activities available to them. They were also aware that this is a developing area and, importantly, they were a part of it. One such development is to have therapeutic gardening in the rear garden and an area has been already set, aside for this. At least one of the three individuals has expressed an interest in this, which is positive. Service users also had the experience of group trips and had been out to lunch Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 15 in Hyde Park on the 18/4/07. Arrangements were also in place for service users to attend cinema shows and staff work flexibly to enable and support such outings. There was strong evidence to confirm that the management and staff support service users to maintain relationships with relatives and friends. There was family input in all three cases and this had a positive impact on the outcomes for the respective service users. One individual visits his brother regularly and looks forward to this. Feedback received from relatives indicated that they were pleased with the relationship and professionalism of the staff working in the home. Sound arrangements are in place for service users to meet with visitors in private and service users reported that they could and do choose their friends. During the course of the inspection it was clear that the rights of service users were respected throughout most aspects of their lives. Service users’ responsibilities for their part in the home are detailed in their service user plans. Most individuals were actively and positively engaged in various aspects of the home, as they enjoyed retaining key elements of their independence. One individual had input from an advocate in relation to his finances. Service users were addressed by their preferred names, asked whether it was okay to access their rooms and most importantly had their wishes carried out. From the written and verbal feedback received, service users expressed the view that staff respected them. In some cases where there were restrictions, service users were part of making that decision. Service users have unrestricted access throughout the home and though they are engaged in various chores – they are involved in the decision-making around this. Staffing engagement and interaction with service users was of a good standard and this included, respecting when an individual wished to spend time on his/her own. All service users open their mail independently and would seek assistance from staff as and when required. Menus were in place, and in discussions, service users confirmed that they are involved in choosing them. They were also reflective of the cultural and the diverse needs of the service user group. It was positive to see the level of involvement that service users enjoyed in preparing their meals. One individual was observed preparing lunch and was extremely pleased to be doing so. There was a strong sense of community during the evening meal and staff ensured that the occasion was relaxed and this included having a meal with the service users. It was also noticeable that staff worked with service users in promoting healthy eating habits with discreet prompts and guidance. There were low fat/weight control menus in place. The medical conditions of service users were also taken into consideration in planning diets with them. Feedback received from relatives and service users indicated a high level of satisfaction with the meals provided in the home. There was a good supply of food in the home. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 16 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): (18,19,20,21) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users enjoy personal support in a manner that is best suited to them. Sound arrangements are in place to provide for their physical and emotional health needs. This is generally enhanced by the staffing input and support with medication, although this could improve. Policies and procedures are in place to ensure that service users’ wishes regarding death and dying are take into account. EVIDENCE: Three of the service users spoken to confirmed that they were happy with the way in which staff provided personal support to them. This is coordinated through the key-worker system used in the home. All service users have their individual style of dress, which was consistent with their choice, culture and personality. Staff were sensitive when making interventions to support individuals where certain choices were inappropriate and this is positive. It was noted that the staffing combinations would enable service users to get support from similar ethnic and cultural backgrounds. It was positive however, to see that where this was not possible staff were willing to be educated on the areas that they knew nothing about. As an example, one staff member expressed her strategy in getting to know the cultural needs of a service user, in relation to his food, music and dress. It Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 17 involved getting to know the individual’s likes and dislikes and how the various aspects of impacted on their wellbeing. This is positive and would go a long way to promoting diversity amongst the service user group. However, the registered persons would need to consider how it would promote opportunities for male service users, should they wish to have same gender care. Most of the staff were indeed females and this may be satisfactory so long as the male service users are happy with working with them. If not, the home would be struggle to provide an alternative. In assessing the records of three individuals, it was noted that the staffing involvement was more intense in some cases, but even so it was with the agreement of the individuals. The management and staff were well aware of the need to balance service users’ rights and choice with their health and safety, and this is positive. Service users are given good support to ensure that their health needs are provided for. They were all registered with a GP and records assessed indicated that are in place for them to see other health professionals such as the dentist, chiropodist and the opticians. Information was posted on the notice board to offer service users a choice of where they would like to receive their health care e.g. for eye care - Optical World – a company offering free–eye tests and sunglasses, for individuals on jobseekers allowance. On the day of the inspection one service user went off to have bloods done and to pick up medication. Another was observed going of to the ENT clinic independently. It was clear that the home is keen on supporting service users to participate in their healthcare. Sound records were maintained where service users attended health related and professional appointments e.g. CPN, GP, ENT and the psychiatrist. Service users may also see professionals privately in their rooms or in one of the offices at Ashwood House. It was noted that service user plans contained details of the emotional healthcare needs of service users. More importantly and in most cases staff, understood the individual conditions of service users and, have demonstrated how and when interventions and referral to external professionals are required. Good arrangements are in place for: monitoring the mental state and, managing the associated behaviours presented by service users. The registered persons could enhance staff understanding of handling diabetic emergencies as an additional safeguard for service users. Evidence had been submitted during drafting of this report to confirm that the current staff team had training in diabetes. At the time of the visit, three service users were receiving support with medication. A satisfactory medication policy was in place to include guidance on promoting service users’ independence with their medication. As part of quality assurance, medication audits were carried out on 28/2/07, 28/3/07 and 18/5/07. The home uses a compliance system that is filled out by senior staff member with a second member of staff countersigning. A medication log was maintained and this was generally accurate. However, there was cause for Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 18 concern in relation to the amounts of drugs that were held, which were surplus to requirements. The excess storage of drugs presents a risk in several forms and as well as unacceptable levels of wastage and as such needs to stop. The registered provider informed that the problem arises from drugs being sent to the home despite not being ordered on a repeat prescription. He was advised that he needed to speak with the GP and the pharmacist to ensure that a solution to this problem is achieved. He also advised that he is seeking to change the system to the Boots ‘monitored dosage system’, which would reduce the risk of excessive amounts of drugs being stored in the home. Staff handling medication, did have training in the handling of medication and from interviews held, were aware of the safe practices in drug administration. Medication storage was also generally satisfactory. Feedback from service users and their relatives indicated that they were satisfied with the support provided by the home with medication. A policy on death and dying is in place and is available to the both service users and staff. The home has recently been opened and as such the process of dying and outcome of a death has not been realised. However, it was clear that service users would be allowed the opportunity to say how they would like to spend their final moments in the home should they have this experience. The guidelines also equip staff with clear procedures in making service users and their relatives comfortable should this eventuality arise. The home has the capacity to ensure that specialist advice and support is arranged to support service users and their relatives who may become distressed, during periods of ill health. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 19 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) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users and their relatives are assured that when complaints are raised – that they would be acted upon. Sound arrangements are in place to ensure that service users are protected from abuse. EVIDENCE: A satisfactory complaints procedure is in place at the home and all service users were aware of this. From discussions held with service users, they felt able to raise issues of concern, should they feel the need to. They also demonstrated an understanding of their right to complain and the complaints procedure is widely advertised throughout the home and, in their statement of purpose. One individual stated; “I can see the manager, raise my complaint in a CPA meeting, with my social worker or with staff, formally and informally”. Feedback from relatives indicated that they too were aware of their right to complain. One relative wrote: ‘I have had no reason to complain- the home is perfect’. The management and staff encourage service users to raise concerns where possible and in service user meetings that are held regularly. Most of the staff had safeguarding adults training which is positive and reassuring that service users are in safe hands. A satisfactory policy on safeguarding adults is in place at the home and this includes clear guidance on ‘whistle-blowing’. Staff as part of their induction are, taken through the safeguarding adults guidelines of the home and a copy of the Local Authority Safeguarding Adults protocol is kept in the home for the benefit of staff. Staff interviewed showed a sound awareness in: how to raise an alert and the reporting procedures necessary to promote the safety and wellbeing of service users. Most of the staff also had training in dealing with challenging behaviour and a policy on dealing with aggression - verbal and physical is in place. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 20 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): (24,25,26,27,28,29,30) People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users live in a clean, purpose built and suitably designed home that matches their needs and lifestyles. They enjoy using their facilities, which are homely and personal, particularly in relation to their bedrooms. Communal spaces are designed with service users in mind enabling diversity, privacy and independence. The home is fit for its purpose. EVIDENCE: The service is newly registered and designed for service users with mental health needs. It was literally spotless, with systems in place to ensure that it remains that way. Service users are an integral part of keeping the home in a good state and it was evident that they were proud of their involvement in personalising it. The registered persons ensured that the furnishings, fittings were of a good quality and specialist facilities e.g. a passenger lift with disabled access between all floors, complimented this. A lot of thought also went into safety of service users e.g. security cameras on exit doors and the side gate entrance and, clearly marked safety signs. The environment was stimulating, airy, bright and the three service users were quite pleased with it. The home met the requirements of the local fire, environmental health and safety and, the building Acts and Regulations. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 21 All bedrooms exceeded the national minimum requirements of 12 square metres with en-suite facilities and is designed in such a way that adaptations could be made to facilitate the specialist needs of service users should this be required. Although the home was not fully occupied, there was enough evidence to indicate service users felt that it was their own and this was true for both the personal and communal spaces. They were particularly pleased with their bedrooms. The fittings and furnishings in the bedrooms were of a high standard and service users were allowed to bring in their personal effects and to personalise their rooms as much as possible. From the bedrooms viewed, there seemed to be no limit to the creativity and individualisation of bedrooms. Service users were also allowed choice in setting out their rooms and the registered persons thought not only of comfort, but entertainment and personal development. All rooms had internet access, four double sockets, and sky connection for which an additional fee is chargeable. All bedrooms promoted the privacy of service users. Despite each bedroom having en-suite facilities, there are toilets and bathrooms on each floor (ground and first) that were cited close to dining rooms and other communal areas. There are disabled toilets on the ground and first floors with sensor lighting. Service users therefore have options available to them, should they require this. The toilets and baths are designed to promote the safety and privacy of service users. There is a range of communal spaces on the ground and first floors, which included; dining and communal lounges, visitors’ rooms, laundry and kitchen facilities and smoking rooms. To add to this there is a computer, activity and multi-faith room in the home. Staff have adequate facilities for storing their personal belongings and there is a large rear garden for the benefit of service users. There are also laundry facilities and additional storage space in the basement of the home. It was clear that the home provided various spaces to enable a range of activity as well as peace and quiet should this be required. It is a credit to the registered persons to have thought through in detail the specifications of the environment. The service is not aimed at providing for individuals with physical disabilities, however, it is built and designed in such a way that could be readily modified. In essence if a service user developed a physical disability while living there, it is more than likely that the environment could be adapted to enable the service user to continue living at Ashwood House. It is true to say that it may also depend on the severity of the disability, but equally there is scope to modify the building, including the private spaces to provide for some level of physical disability. The laundry facilities were above average and designed to promote the service users independence as far as possible. It was also designed to ensure that Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 22 service users could develop their skills in this area. An infection control policy is in place and service users and staff are encouraged to work within this e.g. hand-washing. The laundry equipment is designed to cater for soiled linen and appropriate arrangements were in place for maintaining them. The layout of the home is such that foul linen is well away from food preparation and so the risk of the spread of infection is minimised. The services and facilities do comply with the Water Supply Regulations 1999. It must be noted that the feedback received from relatives and external professionals was extremely positive about the cleanliness and quality of the environment. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 23 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): (31,32,33,34,35,36) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users receive care and support from staff team that is clear about their responsibilities, enthusiastic and motivated in working with them. Service users’ welfare and best interests are promoted by ensuring that: the staffing levels reflect their needs and by the provision of training and supervision for staff to enable them to fulfil their roles. The recruitment of staff is generally satisfactory, but could be improved. EVIDENCE: Staff interviewed were aware, of the aims and philosophy of the service and more importantly understood their role in delivering the service. They also had a good understanding of the service users’ needs and were able to identify the interventions required to meet them. There was evidence that they worked with the service user plan is enabling them to meet their personal goals. Staff had sighting of the General Social Care Council’s code of conduct and was observed to be working in line with the guidance. All service users spoken to were confident with the staffing ability to meet their needs. It must be said that similar sentiments were shared by, relatives and external professionals. In observing practice staff demonstrated their ability to positively engage and interact with service users. It is fair to say that even at times when a service user became anxious, staffing interventions were timely, sensitive and evenly Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 24 tempered to achieve a positive outcome. The three service users were generally relaxed and from looking at their records, there was evidence that staff demonstrated good tact and skill when engaging with them. It was noted that up to seventy per cent of the staff had achieved at least an NVQ Level 2 in Care, which provided them with a good understanding of the basic principles of care. One of the comments received externally was, ‘staff are managing well with the challenges placed on them’. From examining the rosters, there was evidence that the combination and numbers of staff were adequate to meet the needs of service users. Service users expressed satisfaction with the staffing input in relation to their care and support. One service user wrote; ‘the interaction of clients and staff is at close corners every day’. The rosters generally show three staff in the morning with two starting earlier, two in the afternoon with one sleeping in at night. This is adequate for the current numbers and needs of the service user group. The registered provider was very clear about his plans to review the staffing levels as the numbers and needs change. Regular staff meetings take place and although the turnout has been low, there are plans to continue with strategies to improve attendance. A strong team is being developed and this is positive. The staffing recruitment is ongoing and has been generally satisfactory. There were a couple of cases in which two references could not be evidenced, and to date one had been provided to the Commission. The registered persons are required to ensure that a minimum of two satisfactory references are obtained and retained on the staff files. All other areas of the home’s recruitment practices were robust and in line with the national minimum standards. Service users are generally safe, but this could be enhanced by the carrying out the action detailed above. Service users were not actively involved in staff recruitment, however this is something that the registered provider could look into in the future. All staff are subject to a probationary period and at the time of the visit, some were going through that process. A training and development plan is in place for the staff, although dates could be added to this document. This covers key aspects of induction training as well as training that is specific to the needs of the service user group e.g. a certificate in mental health, NVQ Level 3 in Care and challenging behaviour. Some of the planned training includes: three staff to go onto the NVQ Level 3, two for the Certificate in Mental Health, four for NVQ Level 2, fire evacuation, risk assessment, safeguarding adults, first aid and medication. There is a training budget in place and staff are involved in determining the various aspects of training to enable their development. Views received from external professionals confirmed that staff had a good understanding of service users needs, which is positive. There have been regular team meetings since the home opened and the attendance was noted to be variable. During the inspection the registered providers discussed strategies to improve the turnout as it is felt that it is Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 25 important, given the fact that the service is still being developed. Handovers take place regularly and formal supervision is carried out for all levels of staff. Staff interviewed informed that the found supervision to be supportive and useful in helping them to develop. Given that the service is relatively new, staffing appraisals had not been carried out however, systems are in place to facilitate this. All staff were aware of the grievance and disciplinary procedures and there are protocols for managing physical aggression towards staff. Service users receive support and direction from a supported staff team, which is positive. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 26 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): (37,38,39,40,41,42,43) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Good management systems are in place to provide a quality service at Ashwood House. This includes systems for; quality assurance, record keeping, reviewing policies and procedures, financial management and, the promotion of health and safety in the home. EVIDENCE: The registered manager and registered provider have both achieved their NVQ Level 4 in care/RMA award. They work closely to not only develop the service, but also to ensure that it is carried on in line with regulation. A job description is in place for the registered manager and this sets out her responsibility for ensuring that the service is operated in line with the stated aims and objectives. She is very experienced in managing this type of service i.e. mental health and is committed to delivering a good service. There was evidence from the training plan that she kept updated with various aspects of training that was pertinent to the service delivery. At the time of the visit, she was not available and the registered provider was managing the service. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 27 In discussion with the staff they were satisfied with the direction given by the registered manager and most felt that she was approachable. Staff commented that they felt motivated in their jobs and are encouraged to contribute to the development of the service. There is a clear statement on equality and diversity within the service and staff understood the implications of this in providing support to the service users. There is a system in place for getting the views of service users and stakeholders and this is complimented by the complaints and compliments policies of the service. Given that the service was in its first year of operation, all of its quality assurance mechanisms could not be tested. However, there are systems in place to ensure that service users views are gathered and the development plan for the service was very much current. Service users quarterly reviews were being carried out as well as regular reviews with social workers during what could be considered as the transitional stage. Regular monthly provider reports are also being carried out on the service and the policies and procedures were in date. It is fair to say that there are adequate arrangements in place to monitor the quality of the service and this included gathering the views of relatives. The service has an updated set of policies and procedures that is in line with current thinking and practice. Staff adherence to the policies is monitored through supervision and team meetings at the moment, with annual appraisals to come on stream later this year. Service users also have access to these policies so that they are have an awareness of what is expected of staff in delivering the service and how they impact upon their care. Staff feedback is obtained in various forums formally and informally. One of the positives identified at the inspection was the service users’ awareness of their ‘right of access’ to information held on them. All records viewed were updated and secure. In so doing they protected the safety and interests of service users. As stated earlier the service is relatively new and the requirements for health and safety prior to registration had been satisfied. It is quite early in the life of the service and from the inspection there were no breaches to health and safety. This would be tested more rigorously at a subsequent inspection. It must be stated that a comprehensive set of health and safety policies were in place as well as arrangements to monitor their compliance. It was good to see that service users were encouraged to contribute towards recycling waste in the home, which is positive. All appliances and equipment were in their first year of life and hence either had their guarantees or arrangements for their repair. Risk assessments for safe working practice topics were in place and staff had the benefit of health and safety training. The registered provider has demonstrated the ability to plan and develop the service, which was evidenced from the business plan presented at the inspection. He overseers the financial conduct of the registered manager, Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 28 through monitoring and in formal supervision. Private arrangements are in place to audit the business accounts and the insurance cover was in line with the minimum requirements set by this standard (NMS 43). It is anticipated that feedback from service users’ surveys would inform the development plan for the service in the ensuing year. Service users and relatives spoken to were aware of the overall structure of the home and in checking the finances held for individuals – they were found to be in order. In concluding there are good systems in place to ensure financial accountability and transparency of the service. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 29 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 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 4 29 3 30 4 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 3 3 3 3 3 3 3 Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 30 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 YA19 Regulation 12,13 Requirement Timescale for action 15/08/07 2. YA20 13(2) 3. YA34 19(1)(c) The registered persons are required to make suitable arrangements to ensure that staff have a sound understanding in managing diabetic emergencies. The registered persons are 15/08/07 required to keep stocks of medication in amounts that are required, only to adequately meet the needs of service users. The registered persons are 15/08/07 required to maintain robust recruitment practices with regard to references at all times. 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 YA18 Good Practice Recommendations The registered persons should aspire to provide a more flexible and diverse staff team in relation to same gender care – particularly in relation to male service users. Ashwood House (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 © 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 (Leyton) DS0000068068.V337648.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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