Inspection on 20/12/05 for Askham Place

This inspection was carried out on 20th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Askham Place 23/07/08

Askham Place 25/07/07

Askham Place 18/05/06

Askham Place 03/05/05

Askham Place 01/02/05

Askham Place 25/05/04

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

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

CARE HOME ADULTS 18-65 Askham Place Benwick Road Doddington Cambridgeshire PE15 0TG Lead Inspector Mrs Shirley Christopher Unannounced Inspection 20th December 2005 10:30 Askham Place DS0000024299.V261323.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 Askham Place DS0000024299.V261323.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. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Askham Place Address Benwick Road Doddington Cambridgeshire PE15 0TG 01354 740269 01354 741996 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) Askham Care Homes Limited Care Home 15 Category(ies) of Physical disability (15) registration, with number of places Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th April 2003 Brief Description of the Service: Askham Place is a purpose built single storey home providing nursing and personal care for up to 15 service users aged between 18 and 65 with a physical disability. The home was first registered in September 2001, and is close to the small Cambridgeshire village of Doddington near March. The home is in the grounds of Askham House, a service for older people under the same ownership as Askham Place and shares kitchen and laundry facilities. The recently appointed manager has left since the last inspection and the management of the home is temporarily been overseen by the head of care, with support from the registered manager of Askham House Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 20 December 2005 at 10.30 am and lasted approximately four hours. In that time 4 care staff, the activities coordinator, a domestic, two catering staff, the head of care, the manager of Askham House and the administrator were spoken to. The inspector toured the home and joined a number of service users at the table throughout lunch. Five service users were spoken to. A number of records were inspected including some maintenance records, 2 staff files and 2 service user files. These were mostly satisfactory. An immediate requirement was made in respect of one staff file, which did not contain all the information required by the Care Home Regulations 2001 and in particular a current CRB and POVA check. What the service does well: What has improved since the last inspection? What they could do better: Generally the records inspected were satisfactory, but of the most recently employed care staff, one file did not contain all the information required by the care home regulations 2001 including an up to date criminal records check and POVA 1st check, and identification. Gaps in employment history must be fully explored with a written explanation for those gaps and written references must be dated from when they were sent out to when they were received back. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 6 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. Askham Place DS0000024299.V261323.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 Askham Place DS0000024299.V261323.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): 2,3,4 The home has adequate assessments in place to help them determine if they are able to meet service users’ needs. EVIDENCE: The home completes a pre admission assessment for all new admissions, which were seen on file, and were satisfactory. For service users coming in for respite, there is an initial assessment and then an ongoing 72-hour assessment upon admission. Needs are kept under review and staff receive training appropriate to the defined needs/health states of the service users. Prospective service users may have the opportunity to test drive the home by coming in for a period of respite care or day care. The home had revised its Statement of purpose at the time of the last inspection and a copy is readily available within the home. Askham Place DS0000024299.V261323.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): 6,9 Adequate information is provided in the service users’ care plans to enable staff to give appropriate support and care. EVIDENCE: Two service user plans were inspected. One was for a person who had come to the home for respite care and the other was a permanent service user. Generally information on both was comprehensive. Care plans and assessments were in place for the permanent service user. Care plans detailed how to meet the service users health, physical and social care needs. There was active evaluation of care plans, which were reviewed monthly, although some gaps were identified. No evidence was seen of consultation with the service user in respect of the care plans seen and its review. The risk assessments in place were comprehensive and separate risk assessments were seen for day and night. A further risk assessment was in place for maintaining positive health status. The latter had been reviewed monthly, where as the others had not been reviewed for more than a year. Evidence of statutory review was noted, but no minutes were available. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 10 The second file inspected was for a person receiving respite care. This included the initial assessment and 72 hour assessment after admission. Information is updated as part of every visit. Some service users were spoken to and made positive reference to care staff. Care staff were observed giving appropriate support. Bedrooms had locks and signs to say whether you could enter or not. Several service users were in their bedrooms and were not disturbed. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,14,15,17 A range of activities are provided for service users and their participation in activities is documented. EVIDENCE: The home employs an activities coordinator who works 4 days a week. Although she has had no specific training in the provision of activities, she was originally employed as a care worker and has undertaken all the mandatory training. She has a lot of enthusiasm for the job. There is an activities file, which looks at life styles and interests, important people, dates, events, family life, working life, hobbies and interests. Care plans are in place addressing service users social needs and risk assessments are also in place. A number of service users had nothing recorded under life styles and interests. They had moved to the home quite recently, but information about their social needs should have been assessed as part of the pre admission assessment. Activities range from one to one activities, such as swimming, shopping and meals out to structured activities in house such as arts and crafts. Service users have manicures and aromatherapy. The home has access to two minibuses and activities were being provided on the day. A trip to the Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 12 pantomime was booked. The head of care stated that a Christmas fair had been held to raise monies for outings, such as the pantomime and for trips to the seaside. Information about family support was provided as part of the care plan and visitors according to the wishes of service users. The mealtime was observed and was served in a relaxed, untimely way. Supervision of service users was appropriate. The cook stated that she orders most of the food from fresh and homemade cakes and puddings are served. The main meal is served at lunchtime and snacks are readily available, although service users do not have access to the kitchen. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21 Health care records were adequate, but some gaps in recording were identified. Safe practices in the storage, recording and administration of medication would be improved by external medication audits and training. EVIDENCE: The care plans inspected covered how staff were expected to meet the physical care needs and medical needs of service users and generally documentation was of a good standard and provided evidence of weight and nutritional assessments, skin care and manual handling assessments. Records showed a good use of other health care services, although some gaps were identified in the recording of dental, optical and screening services. (No dates were seen for 2005.) There was also a sheet for collaborative care, which provided evidence of GP, occupational and physiotherapy input. The medication was not checked. Records were seen in respect of the service user files inspected and evidence of clear recording was provided. Evidence of internal medication audits was seen, but the pharmacist does not carry out external audits. The manager stated that she was having a meeting with the GP and dispensing pharmacist in the new-year and the inspector asked for this to be discussed. Medication training for staff is done in house and again it would be beneficial if external training was sourced. The Inspector will contact the pharmacist working on behalf of the CSCI requesting that he carry out a Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 14 full audit, particularly as the home have a lot of service users coming in for respite care. No one currently self-administers but the head of care stated that their capacity to do so would be assessed prior to admission and they have a policy in place for self-administration. Each service user has a lockable drawer in their bedroom. Although this is a home for younger adults it is important to establish service users wishes in relation to long-term illness and in the event of their death. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Adequate systems are in place. Care staff receive training in the protection of vulnerable adults. EVIDENCE: The head of care confirmed that no complaints have been received since the last inspection and that all staff had undertaken training in the protection of vulnerable adults. Several staff confirmed this. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 16 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): 26,30 The environment is fit for purpose and well maintained EVIDENCE: The home was clean and maintained to a high standard and is appropriate for the needs of the service users. It is purpose built, and offers a comfortable setting for the service users, with large communal facilities. All the bedrooms have en-suite shower rooms and ceiling tracking linking the bedroom and bathroom, ensuring moving and handling is done safely and with as much dignity as possible. Maintenance records for the overhead hoists were in place. There are adequate numbers of domestic staff and the lady spoken to confirmed she had just completed an NVQ in cleaning. The housekeeper supervises her. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 17 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): 33,34,35,36 The prerequisite documentation must be in place before the employment of new staff. EVIDENCE: The home was well staffed on the day of the inspection and care staff spoken to confirmed that these staffing numbers are maintained in the home. Staffing levels are reduced slightly in the evening. Most care staff spoken to were working a long shift, but stated they got breaks, including lunch and additional days off. This shift pattern ensures consistency and continuation of care for service users. Care staff confirmed that they had completed all the mandatory training. A refresher course in first aid is planned for January 2006 and Food Hygiene in February 2006, so some of the newer members of staff have not done this training as yet. Care staff spoken to confirmed that they had received training in the protection of vulnerable adults and completed a session on peg feeding. Staff confirmed that they had not done medication training and are asked sometimes by trained staff to administer it. Care staff have also done specialist training in Huntingdon’s disease and multiple sclerosis. Care staff confirmed they were well supported and are given regular supervision, ongoing support and participated regularly in staff meetings. Two staff files were requested of staff employed since the last inspection. These were unsatisfactory. One had two written references, an application Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 18 form, medical declaration and a form of identification, (not including a birth/marriage certificate, or passport. A CRB was on file but from a previous employer and no POVA 1st was in place. The administrator writes on the application form the date she sent the references, but no date was seen when the references were returned. The inspector was therefore unable to establish if they were received back before her employment. For this member of staff her induction record was not completed, although she had been in post for four months. Certificates were seen for relevant, mandatory training, but these were from her previous employers and although recent, may not be service specific. Some training needs to be such as manual handling. A second file was satisfactory and contained all the relevant information. One reference was dated. An application form was in place, but did not give a full employment history. The candidate must provide a written explanation for this. On this file the staff member had been in post a month longer and had received a detailed appraisal and most of the mandatory training. Some gaps were identified in the induction record. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 19 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): 37,42 The home has adequate policies and procedures in place. Designated staff are identified to ensure maintenance and health and safety checks are up to date. EVIDENCE: At the last inspection positive comments were made about the new manager in post. Unfortunately she has subsequently left. In the interim the head of care is providing management support and has some management time and some care time. She has been at the home for a number of years and is supported by Marie Rankin the registered manager of Askham House, an extremely experienced nurse. All the care staff spoken to stated that they were well supported and there was good teamwork. A number of records were inspected and were mainly satisfactory. The health and safely rep was met and records seen included the daily, weekly and six monthly checks. The fire records were in order, as were the servicing records for the hoists. Water temperature records were also seen and were satisfactory. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 20 Service user finance was checked in respect of one service user. Monies are clearly accounted for with receipts kept for any transaction. The administrator has power of attorney for one service user. Another service user does not have their own bank account and money is paid in to a main account for Askham Place, and then monies made available for personal spending. The inspector was concerned about this arrangement and will take advice. Requirements have been made around the staffing files. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 21 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 3 3 3 4 3 5 x 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 3 25 x 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x X 3 X LIFESTYLES Standard No Score 11 3 12 x 13 X 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 2 2 3 x X X X 3 X Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 22 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 13(1)(b) Requirement Timescale for action 28/02/06 2 YA20 13 (2) 3 YA34 19(1)(b) 1 YA35 18(1)(c) (i) The registered person must ensure that health care records demonstrate that service users receive regular treatment and, or advice from health care professionals when required External medication audits and 28/02/06 medication training for all staff responsible for the administration of medication must be provided. Staff must not be employed at 20/12/05 the home until all the necessary documentation is in place. An immediate requirement was left at the home Staff must receive training 28/02/06 appropriate to the work they are expected to perform. Staff induction records must be completed in full. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 23 No. 1 2 Refer to Standard YA21 YA32 Good Practice Recommendations Last wishes of service users should be established. The activities coordinator should receive training appropriate to her job role Askham Place DS0000024299.V261323.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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. 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