Inspection on 23/07/08 for Askham Place

This inspection was carried out on 23rd July 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Askham Place 25/07/07

Askham Place 18/05/06

Askham Place 20/12/05

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 06/02/2009.

CARE HOME ADULTS 18-65 Askham Place Benwick Road Doddington Cambridgeshire PE15 0TG Lead Inspector Shirley Christopher Unannounced Inspection 23rd July 2008 9:10 Askham Place DS0000024299.V369354.R02.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 Askham Place DS0000024299.V369354.R02.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. Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 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) www.askhamcarehomes.com Askham Care Homes Limited Mrs Christine Hurlock Care Home 15 Category(ies) of Physical disability (15) registration, with number of places Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 2007 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 home provides for up to 15 people under the age of 65 with a physical disability, and is currently full. Fees charged range between £975.91 and £1127.83 per week, depending on the assessed needs of the individuals. Copies of the most recent inspection reports are available on request from the administration office in the home, and in the reception area. Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We, The Commission of Social Care inspection carried out a key unannounced inspection on the 23 July 2008, arriving at 9:10 am. Prior to the inspection we asked the home for some information. They completed an annual quality assurance assessment, (AQAA) which provided us with information about how the home are meeting national minimum standards. The document states where the home has improved and where improvements have been identified. We also circulated surveys to service users, staff and relatives. We looked at some records, including staff files and resident’s files. We spoke to a number of residents, relatives and all the staff on duty, including the manager, deputy, trained staff, care staff and ancillary staff. What the service does well: What has improved since the last inspection? What they could do better: Comments taken from surveys were used to consider what the home could do better. One relative stated that some care staff were not good at their jobs and did not understand the needs of the clients. They felt training made no difference when the care staff did not have the right attitude. Another resident spoken to supported this. One resident stated that some staff could be off hand. Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 6 During our inspection all the staff were spoken to and some made general comments about other staff indicating that some staff do not act as part of the team and put their own needs first. This was also picked up from staff surveys. Some staff stated that some staff did not respond well to authority and followed their own agendas. We looked at one care plan in depth and it was comprehensive in dealing with medical issues but looked less at how to maintain and encourage the person’s independence. The long-term goal of this person was to go home and it was difficult to see how the home was facilitating this. 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. Askham Place DS0000024299.V369354.R02.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 Askham Place DS0000024299.V369354.R02.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 Quality in this outcome area is adequate People have their needs assessed before admission to the home and can expect staff to have the skills and expertise to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that the statement of purpose is available upon request and has been updated since the last inspection. She stated that all residents are issued with a service user guide and this is kept in their bedrooms. One resident’s file was looked at. This file included a pre admission assessment completed by the home and a further assessment completed by the discharge hospital team. The homes assessment was brief and did not provide evidence of who was involved in the original assessment. It also gave very little information about the resident’s cultural, ethnic, or social needs, concentrating more on their medical needs. Some of the information in the assessments was contradictory such as person needs assistance with personal care, whilst the other assessment stated they were independent. Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 9 The AQAA stated that residents usually come to the home for a trial period, as a respite care admission with a view to a long-term placement. Askham Place DS0000024299.V369354.R02.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): 6,7,9 Quality in this outcome area is good Goals are identified as part of the care planning process but evidence of how these goals are put into practice to ensure residents independence is being promoted are not evident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We case tracked one person and looked at their records which included their medical and social care plan. The main care plan is kept in the office. This includes a consent form for residents to sign to state that they are aware of their care plan and have been involved in drawing it up. A second care plan is kept in the resident’s bedroom. This is a summary of their needs, choices and preferences. The key worker writes these up with the resident. The information in the care plan was detailed and gave a good insight into the person’s needs and how they were to be met. The plan showed other agencies are involved to ensure that the residents needs are being met such as the Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 11 dietician, GP and specialist nurse. Care plans were being reviewed monthly but it was not always possible to see how goals identified were being evaluated and/or achieved. This resident was spoken to and was able to tell us what they used to do when they were physically well and what they were able to do for themselves since their health had stabilised in the home. The resident did not have the opportunity to do a lot of things they would have done in their own home and this resulted in the person feeling bored. They said that they would like to read but did not have any magazines. Reading was identified as one of their hobbies on the care plan. An entry in the daily records stated that this person has asked to ‘self care’ but there was little evidence of how they were being encouraged to do this, other than making their own bed. Notes stated ‘all personal care given’, which suggests the person is not enabled to meet their own care needs. The resident did state that they felt staff were good and knew how to meet their needs. They stated that her privacy was respected and they were aware and had been involved in their care plan. The manager stated that they had signed up to the dignity of care at work and operated a zero tolerance. The AQAA stated that equality and diversity are addressed through stringent employment processes and clears policies and procedures. The AQAA stated that staff receive training around recognising different cultures and last year the home held a cultural evening which they wished to repeat. Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 12 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): 12,13,14,15,16,17 Quality in this outcome area is good Regular social and leisure opportunities are provided for people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection a number of visitors were in the home and they told us that they were always made welcome. They stated there were no restrictions on visiting times. The home employs a person specifically to plan and provide activities. The maintenance man and some of the other staff are designated drivers for the homes minibus. Public transport and black cabs are difficult to access, thus limiting the number of residents who can go out at any one time. The home has volunteers and advocates who visit and the friends of Askham Place have been set up. This is to raise funds for social events. The activities co ordinator stated that she spends time with residents establishing Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 13 what they like doing, what they use to do and what they are able to do now. She said several outings a month are planned and there is always something provided every day. They recently had a float in the village carnival, a trip to see Chubby Brown, Linton zoo, a trip on the canal, quiz night and carousel. A barbeque is planned for the weekend. Annual holidays are booked for residents. A wide range of organisations visit the home such as the local Scouts, PAT a pet and Sporting Chance. A newsletter is produced by the home. Family and friends are encouraged to join in planned social events. The activities co-ordinator keeps notes about peoples social activities and has photographs of previous activities with a description of the activity and any obstacles or hazards. She evaluates the activity to see if it is worth repeating. Relatives who completed surveys welcomed the activities provided at the home, but some felt their relatives would benefit from going out more. This was echoed by a number of residents. The cook confirmed that the environmental health department visited last year and awarded the kitchen 4 stars. The cook showed a good understanding of the resident’s dietary needs and there is written information in the kitchen. She stated that the menu is discussed with residents and their food suggestions are put on the menu. She said there is a generous budget. Residents can have a cooked breakfast if they wish but she said realistically they don’t because they have a main meal at lunchtime and usually a cooked tea. Times of meals are flexible and are recorded on the care plan. On the day of inspection the menu was beef curry and rice or beef stew with dumplings, green beans and carrots. Omelette was an alternative. Trifle was for pudding. For tea there was soup, cheese on toast, sandwiches and cakes. Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good Health care needs are understood by staff and well documented. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Care plan inspected gave good details about meeting resident’s health care needs. Staff spoken to showed a good understanding of residents needs. The care plans in residents rooms specified what residents preferred routines and choices were such as preferred rising and retiring times, number of pillows, and dietary requirements. The AQAA stated that the home has an excellent relationship with other specialist professionals and specialist trainers. It also stated that the home has an in-house physiotherapist. The home has clear policies and procedures for the administration of medication and uses a recognised training programme for the teaching of the safe administration of medication through a series of workbooks. Medication is supplied by Lloyds the pharmacist. The manager said they provide training and regularly audit medication. Lunchtime medication was observed as it was Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 15 being administered. The nurse left the trolley unattended for about five minutes whilst she took medication to one of the bedrooms. Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. Residents know how to complain and policies and procedures are in place to assist staff in dealing with these complaints efficiently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has clear guidance for dealing with complaints and safeguarding issues. All staff and residents spoken to felt able to raise concerns although some staff stated concerns raised had been dismissed. The manager has a record of complaints and a record of concerns, which are dealt with immediately where possible. The AQAA stated that there is an open door policy and most things are dealt with immediately, or within 7 days. The manager stated one resident has fortnightly documented meetings to raise concerns/issues they have and there are regular meetings between key workers and residents. The home had been involved in a number of meetings held under the protection of vulnerable adults. These resulted in the dismissal of a member of staff. Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good The environment is comfortable and suitable for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the communal areas of the home and one bedroom. No maintenance issues were identified and the home was clean and fresh. Maintenance records were comprehensive and up to date. This is a purpose built building on one level which is accessible to all of the residents. The AQAA stated that rooms exceed minimum room sizes and appropriate equipment is supplied, such as en suite bath or shower facilities, specialist baths, overhead tracking and specialist nursing profile beds. The outside space is well maintained. The activities co-ordinator stated that residents go out for a walk but do not do this independently. The AQAA stated ‘that each room has its own garden area where competitions are held for the tallest sunflower, biggest pumpkin. ‘ Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is good. Staff are employed in sufficient numbers and are well supported but staff differences compromise the well being of the team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels were considered appropriate on the day of inspection. The rota showed that there were 2 trained staff and 5 care staff on duty in the morning and 1 trained staff member and 4 care staff on duty in the afternoon. Staff are supported by a full time activities coordinator and ancillary staff. The home is fully staffed and do not use agency staff. All the staff on duty were spoken to and gave feedback about training, supervision, induction, meeting residents needs, adult protection and the current management arrangements at the home. Staff generally stated that they were well supported. All but one member of staff had received an annual appraisal. All staff had regular supervision and had plenty of opportunities to undertake training. The range of training provided was comprehensive. A Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 19 number of staff felt more staff were necessary if they were really going to promote residents independence and felt a lot of time was spent helping residents with their personal care. Staff stated that the privacy and dignity of residents were respected and gave examples of how this was achieved. We asked staff about the manager and whether she was doing a good job. Askham Place has had a high turnover of managers. Most staff said the manager was doing a good job and felt able to raise concerns, felt well supported and said the manager was a good organiser. Several staff said that some of the care staff are not so good, putting their own needs before those of the residents. This was said to cause disharmony on the shift. We asked for examples and were told staff talking exclusively to each other and not the residents. Most staff felt the manager had implemented a lot of changes which were for the better. Some staff stated that there had been a lot of conflict within the team and this had largely been resolved. One staff felt that confidentiality was not maintained. She said supervision/appraisals are completed in the main office, which is at the front of the home and there are constant interruptions. A separate member of staff had stated that one staff told other staff off in public. Three staff flies were inspected and contained the necessary pre requisite checks and were satisfactory apart from some staff of them did not contain a photograph. Interview notes are kept. Evidence of staff induction was provided and this was linked to Skills for Care. Induction records were basic and resembled a tick list, which did not prove competence. The manager has identified this in the AQAA as something that needs to improve. Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good Residents benefit from a well organised and well managed home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is now registered as the manager. She is a qualified nurse and has the Registered Managers Award. She is an NVQ assessor and has just supported 3 staff doing their level 3 NVQ. She has good organisational skills. We asked about the homes quality assurance system and saw feedback from surveys circulated in 2007. These were from staff. Surveys dated July 2008 were also seen from relatives. No feedback from residents was seen. The manager has completed an annual business plan, which includes a summary of Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 21 the home and vision for its future such as staff development. The manager provided evidence of staff appraisal, supervision and regular meetings with staff, relatives and residents. Records are well organised. The home has a very experienced administrator and a full time maintenance person. The owner who is also the registered person regularly supports the home. A sample of records were inspected including staffing rotas, accident records, infection control audit, staff files, residents records and maintenance records. These were satisfactory. Fire records were up to date, although the fire risk assessment was not seen. The home has 15 overhead hoists, and 2 stand hoists. These had full service histories. Electrical wiring and the gas safety certificate were up to date. Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 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 32 33 34 35 36 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 x 2 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000024299.V369354.R02.S.doc Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Askham Place Score 3 3 2 x 3 x 3 x x 3 x Version 5.2 Page 23 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 YA12 Regulation 12(1)(b) Requirement The home must look at how it facilitates the independence of residents, through education and the promotion of vocational skills to ensure that all of their needs are met. Medication must not be left unattended as this puts residents at risk Timescale for action 30/08/08 2 YA20 13(2) 23/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Askham Place DS0000024299.V369354.R02.S.doc Version 5.2 Page 25 - 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. 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