Inspection on 30/10/06 for Aston House

This inspection was carried out on 30th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aston House 04/03/09

Aston House 02/09/08

Aston House 22/11/07

Aston House 20/03/06

Aston House 11/08/05

Aston House 22/03/05

Aston House 16/08/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOME ADULTS 18-65 Aston House 45 Hampton Park Road Hereford Herefordshire HR1 1TJ Lead Inspector D Lewis Unannounced Inspection 30th October 2006 10:00 Aston House DS0000024691.V312559.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 Aston House DS0000024691.V312559.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. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aston House Address 45 Hampton Park Road Hereford Herefordshire HR1 1TJ 01432 267996 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Mark Zylinski Mrs Lesley Ann Pinwell Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20.03.06 Brief Description of the Service: Aston House is a substantial detached property set back from the road in a residential area of Hereford city. The house has 10 single bedrooms, 3 double bedrooms, shared lounge, dining room, bathroom facilities and a good sized garden with a conservatory. The home is registered to offer services for up to 16 adults who have experienced some mental or emotional health problems. For some service users it is their ongoing home, for others it may be less permanent, on the way to more independent living, but for all the aim is to provide a normal, homely and supportive environment. Mr Mark Zylinski, the registered provider, has owned the home since 1988. He is a qualified psychologist and visits the home on a regular basis. The registered manager is Mrs Lesley Pinwell, who has worked at the home for 15 years. Lesley became the home’s manager in 2004 and has completed the registered manager’s award. Information provided by the home shows that fees charged by the home range from £315 - £499 per week, with no additional charges. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s first inspection of 2006-7. It was a Key Inspection. This means that the inspector checked all of the standards which have most impact on service users. The inspector also took into account any other information about the home which was received since the last inspection in March 2006, including questionnaires to service users and to relatives / supporters. The inspector received 13 replies from service users and 12 replies from relatives. The inspector was in the home from 10 a.m. until early evening. The inspector met and talked with 3 of the service users; with several staff on duty; and (briefly) with the registered provider. All were welcoming and gave useful information. The inspector was assisted by an Expert by Experience (in this report known as “the Expert”). This is someone with personal experience of using mental health services, who has been trained to accompany CSCI (Commission for Social Care Inspection) inspectors during inspections. Their aim is to observe what happens in the home and talk to service users, to acquire a service users’ point of view of the home. The Expert talked with many service users and provided a report of her findings. Parts of her report have been included in this report. What the service does well: What has improved since the last inspection? The home had begun to record activities for each service user, so they could get a clear idea of who needed more support with this. The home had provided a week’s holiday for 10 service users, which the home had paid for. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 6 Staff had talked about the complaints procedure at a residents’ meeting. A smoke extractor had been fitted in the conservatory / smoking room, making it a more pleasant environment for service users. What they could do better: The home must ensure that every service user is clear about what fees they are paying and what services they receive in return. The home should do more to enable service users to be involved in decisions and as independent as possible, particularly regarding their personal money and decisions about their care. The home should have enough staff to support all service users with their personal and social needs. Service users should always have a choice of food which they like and which suits their dietary requirements. The home must make sure medication is always managed safely and all staff who give it out are trained to do so, to reduce the risk of accidental harm to service users. The home must be maintained in a safe condition for service users. The home needs to make sure that required checks are done on all staff in the home before they begin work in the home, to reduce the risk of unsuitable staff being employed in the home. Staff need more training to ensure good quality care is consistently given to service users. The home needs a way of regularly checking the quality of the service provided by the home, to ensure it improves and keeps improving. More work is needed on some safety checks and tests, to reduce the risk of accidental harm to service users. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 7 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. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 8 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 Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 9 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, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ needs are assessed before and after they moved to the home, to ensure the home could meet their needs. Each service user has previously had a written contract, although these were not always accurate. These should have been amended, but the records were not available to be checked during the inspection. EVIDENCE: The inspector saw assessments of service users’ needs, which had been updated regularly. Since the last inspection, CSCI had addresses concerns with the registered provider about extra charges made to 4 service users, for services which they were not receiving. The registered provider had met with CSCI (Commission for Social Care Inspection) to discuss this matter. It had been agreed that over time the charges had become inaccurate as people’s use of transport, access to holidays etc. had changed so the registered provider acknowledged they were now out of date and should be changed. The registered provider felt it would be necessary to charge “top-up” fees to the individual service users, so wrote to the purchasers of care for 3 of these service users. One purchaser had agreed to pay the extra fees for 2 service Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 10 users. One purchaser was still considering the matter. The extra charges had been withdrawn from the 4th service user. From the point of view of CSCI, the matter has been largely a question of contractual arrangements. These appear to have been resolved, at least with Herefordshire PCT (although Powys has yet to respond). Therefore CSCI believed that the matter was resolved, apart from how the registered provider would manage the agreement with service users as to what is a fair arrangement concerning payments made by them in the past. At the inspection, the registered provider told the inspector that contracts had been changed for all service users who had been affected by the extra payments. He also said that all service users had been issued with a letter stating nobody was being charged extra for transport etc. At the end of the inspection, after the registered provider and senior staff had left the building, the inspector asked for copies of these contracts and the letter. However staff did not have access to the contracts, and knew nothing of the letters re. extra charges. A service user asked did not know of this letter. After the inspection, the registered provider supplied copies of letters (sent to these 4 service users, dated June 2006) stating that extra charges had stopped with immediate effect (apart from the service user funded by Powys, who was asked for a top-up fee). He also supplied copies of their new contracts, stating that their contributions were zero, except for the service user funded by Powys. These contracts were dated November 2006. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service user plans are in place and up to date, but are not always used as the basis for practice. Risks to service users are assessed, and service users are free to come and go as they please. Service users make many of their own choices, but in some cases are restricted from what would be considered ordinary choices. EVIDENCE: The inspector sampled service user plans, which covered mental and physical health needs and social/recreational needs. They also covered financial issues and key worker contact time. They had been updated as needed during 2006. Separate records were kept of health needs and appointments. The inspector was not satisfied that the service user plans were always a reliable indicator of what was done on a daily basis, e.g. some people’s food Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 12 preferences were recorded, but in discussion with service users it was apparent that these were not always catered for. Some service users were aware of their service user plans and the goals in them. Some were too preoccupied by their mental health needs to be able to discuss this with the inspector. The service user plans included updated risk assessments, including consideration of service users’ mental health. Service users did not feel restricted in their lives and came and went from the home as they pleased, although most had basic routines which staff would support them with and remind them about if necessary. Service users were able to make their own decisions on a day-to-day basis in some areas. However 10 of the 16 service users did not look after their own money; the registered provider, Mr Zylinski, was their appointee. He said that he was considering whether this could change and whether more service users could manage their own money. A previous recommendation that these accounts be independently audited had not been acted on. Choice of food was also limited (see standard 17). There was a record of an agreed restriction (a service user who gave his cigarettes to staff for rationing, to enable him to manage his money / smoking habit). However the inspector could not find a record in the service user plan of another agreed restriction (for a service user to restrict alcohol intake). Aston House DS0000024691.V312559.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The outcomes for service users vary widely. Those who are active, independent and motivated are able to lead busy, active lives in the community, with plenty of activities of their choice. For those who are less motivated or independent, there are insufficient staff to provide them with the support and encouragement they need to lead a fulfilled life. Relatives are welcomed in the home, but communication with them could be improved. Food is well liked by some service users, but there is little real choice and vegetarian alternatives are not well planned. EVIDENCE: The inspector saw some records of activities offered to and / or undertaken by service users; and spoke with service users about their daily lives. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 14 Records showed that some service users were involved in a range of leisure / education /occupation activities. Service users confirmed this. Levels of activity varied according to motivation, interest and personal preferences. Some service users mainly stayed in the home, others were leading active lives. One person had been helped by staff to apply for voluntary work and felt he had enough to do – he attended many activities without staff support. Another person said they would like more staff input, doing things together. “I am usually left to myself all day.” Another service user comment was “I could do with a bit more attention from the staff, I’ve got a lot of spare time to fill in.” A relative’s comment was “Not enough staff to ensure residents can be accompanied on walks or for one-to-one talks”. The Expert commented that “The house was very quiet, no TV on and not many staff around in the living quarters. The staff that were on were busy in the kitchen and the office” “There didn’t seem to be a lot of stimulation for activities or interests actually on site, although the local Mind group offers a variety of activities and is well used”.” It would really benefit from people coming in to bring entertainments and activities, although there were games available and no one used them, but maybe they would need encouraging.” “There was little evidence of any activities, an art therapist came in once a week and that was all. Most of the residents said they watched TV’s in their rooms and didn’t bother with the main living room.” After the inspection, the registered manager (who was not present on the day of the inspection) explained that some residents prefer the home to be quiet, and this depends on who is around on any particular day. The home had begun to record all activities individually for each service user, including activities offered but declined. Typical entries showed that a service user had been offered 9 organised activities in 4 months. There were also weekly activities schedules, but some of these planned activities were things such as “washing dishes” and “wiping doors”. The home should ensure that all service users, especially those less able or less motivated, have regular support with good quality activities. Service users said families were made welcome in the home and visits to families were supported. Daily routines were flexible, with no set times e.g. for getting up, meals etc. The Expert found that “Generally all the resident residents enjoyed a lot of freedom and could choose to do what they wanted.” The inspector and the Expert joined service users for lunch. Opinions on the food provided were varied. It appeared that what was provided was good, as long as you liked it, but no choice was offered. The record of food provided showed what appeared to be a balanced diet. However there were no options recorded. The vegetarian provision was not always recorded and was a bit repetitive. Service users said staff wrote the menus; service users could Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 15 choose something different if they were around when the food was being prepared. Service user’s comments included “Sometimes fruit salad is served instead of stodge, after a heavy first course.” “Meals are brilliant.” “Fresh vegetables accompany every meal.” As well as “Food a bit too much on plate – I hate wasting food.” “I don’t like potatoes, but I just take them off the plate” “I would like more healthy choices e.g. salads.” Likes and dislikes were recorded in service user plans, but did not appear to be reliably translated into action. The Expert observed that “I shared their mealtime – lunch – and was worried that there was no choice of menu. The meals were all the same and served up plated. It was freshly cooked but there was no food option at all. One resident who didn’t like the meal just had bread and butter. There was also no opportunity to make meals outside meal times, but residents kept food in their rooms for snacking between meals.” Aston House DS0000024691.V312559.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service user plans record what help is needed with service users’ personal and health care needs, and these are mostly met, although some service users could benefit from more one-to-one attention to encourage them more with their personal hygiene and appearance. Medication is mainly well managed, but staff must ensure they maintain high standards at all times and do not slip into poor practice. EVIDENCE: Service user plans and conversations with service users indicated that personal care needs were mainly being met. Some service users needed reminding and encouraging with personal hygiene / grooming. This was recorded in service user plans. The Expert noted that “….some of the residents wore dirty clothes and looked quite unkempt.” Perhaps more attention and one-to-one input from staff could make a difference here. Service user plans indicated that healthcare needs were being met and recorded. Service users said staff supported them with health needs. The Expert noted that “The home has a mixture of disabilities ……... their physical Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 17 needs were catered for. One resident complained that he hadn’t seen his psychiatrist for two years, but he had a regular CPN visiting.” The inspector saw medication storage, records and administration. All were satisfactory, except that some cod liver oil prescribed for one service user had been labelled with another service user’s name. While cod liver oil is relatively harmless, this practice is unsafe and is effectively theft. Prescribed medication is the property of the person it was prescribed for, and must never be used to treat any other person. One staff member, who gave out medication, was not on record as having had medication training. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users know of the complaints procedure, and feel able to talk to staff about concerns. Relatives are largely unaware of the complaints procedure. The home has a policy on protection of vulnerable adults. Not all staff have had relevant training, which increases the risk of poor practice going unnoticed. EVIDENCE: The inspector checked the record of complaints, which included details of complaints and how they were resolved. Service users said they could talk to staff if they had concerns. The complaints procedure had been discussed in a residents’ meeting in September. Of the relatives who responded to the questionnaire, only 2 out of 12 said they were aware of the home’s complaints procedure. The home had an adult protection policy and almost all staff had been trained. All permanent care staff had done some form of Adult Protection training in the last 3 years. It would be good practice for all care staff to have updated training (some had) and for support staff to also have this training. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is adequately maintained, but bedroom space is limited and there are no ensuite facilities. There are sufficient communal areas to allow for smokers and non-smokers, and for visitors to meet their relatives in private. The home is generally clean. EVIDENCE: The inspector saw parts, but not all, of the home: most communal areas and some bedrooms. It appeared to be mostly adequately maintained, clean and comfortable (but see comment below re. bathrooms). However there was no evidence of checks on the safety of the electrical installation in the main house. Some bedrooms were on the small side and none have ensuite facilities; as the home was registered before the introduction of these standards, this is acceptable, but it would be good practice to consider possible upgrading of rooms. The Expert noted that “The home is an attractive large house in a smart residential area with well kept gardens and a smart décor. There is nothing to distinguish this house from others in the area and the residents could happily live here without stigma.” “None of the rooms were en-suite and this did bother some of the residents. One complained that the bathrooms Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 20 were left messy with wet towels left around. I did inspect a bathroom that was full of wet towels and not too savoury.” “The rooms were quite small and there was a limited amount of space for belongings, but there was plenty of other spaces for residents to do whatever they wanted. A very nice conservatory smoke room, a comfortable lounge and a large dining room.” “The home was well furnished and clean…” “Residents could see their visitors in their rooms or in the garden where there was a pleasant seating area but there was no private visiting areas in the home itself.” Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff in the home receive training, but not consistently enough to ensure that good quality care is always provided to service users. Staff have had no formal training in mental health. There are minimal staff on duty, which restricts the amount of support and encouragement available to service users. The home has sometimes employed staff before full checks have been done on them, which increases the risk of employing unsuitable staff. They need to ensure that all required checks are always done on all staff or volunteers in the home. EVIDENCE: The home has 16 service users. Rotas indicated normally 2 care staff on duty during the day, with an occasional “floating shift” for a specific purpose. Comments from service users and relatives indicate this is not a sufficient number, with comments such as “Not enough staff for one-to-one activities”, “Staff are sometimes too busy to be supportive” “I am mainly left to myself; I would like staff to approach me more”. The inspector asked staff about time for one-to-one activities or contact with key clients, trips out of the home etc. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 22 Staff were mainly of the opinion that it was difficult to fit in such activities due to lack of staff. Floating shifts were rare and to leave the home with a service user therefore left the other staff member in charge of the remaining 15 service users, which was not acceptable. At night there was one person on duty in the home and a senior on call. This is a low level of staffing, but had previously been accepted with the assurance of the registered provider that extra staff would be brought on duty if necessary, e.g. if a service user became mentally unwell. However the inspector checked the rota for a recent period when a service user had become mentally unwell, with very erratic behaviour, resulting eventually in a hospital admission. No extra staff had been on duty and staff confirmed this. The home had in the past allowed staff to start work before satisfactory CRB (Criminal Records Bureau) disclosures had been received; the home must ensure this never happens again. CRB (Criminal Records Bureau) disclosures had now been obtained for all staff, and the inspector confirmed this by sampling staff records. However a staff member who left the home in 2004 had returned to work in 2006, but a new CRB (Criminal Records Bureau) disclosure had not been obtained; her disclosure dated from 2003. Staff training records showed some significant gaps. Records of training for the relief staff and support staff were sparse. All permanent care staff had done food hygiene training, but the record suggested one relief carer and the cook had not had such training. All staff who handle food must have this training. Less than 50 of care staff held a NVQ (national vocational qualification) in care at level 2 or above, but 2 further staff were working towards this qualification. Not all staff had first aid training and some was out of date. The record of staff training indicated that a relief staff member who gave out medication had not received training. Relief and support staff had not had training in Adult Protection. Other than the registered manager and a relief carer, staff had not done mental health training. Other than one person with “physical intervention” training and one other with “Breakaway” training, staff had not been trained in physical intervention techniques. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 23 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, 39, 41, 42 The home has a suitably qualified and experienced registered manager. The home has not yet developed a full quality assurance system. Not all required records are available for inspection, which means the inspector is unable to confirm that improvements had been made as described by the registered provider. Some aspects of health and safety management are not sufficient. EVIDENCE: The registered manager is suitably qualified and experienced. She holds the Registered Manager’s Award and has done further specialist training in mental health. She was well regarded by staff and service users. Questionnaires had been given to service user and to visitors to the home, to ask their opinions on the home generally, staff, furnishings, activities etc. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 24 Replies had been collated by the registered manager and senior staff to identify and act on areas of concern. However there was no full system for measuring the quality of the service as a whole, and findings had not led to a development plan for the home. Some records were in place but others were inaccessible to the inspector, contrary to regulation 17. The inspector checked health and safety records. There were general risk assessments for the home, including those covering electrical safety, food hygiene, manual handling and fire. However the risk assessment for fire was extremely brief – approximately 4 sentences. There was no risk assessment for gas safety. There was evidence of some routine maintenance, including legionella precautions, a CORGI gas safety certificate, and electrical appliance tests, all from 2006. The home did not have an electrical installation certificate of safety, which the registered provider agreed to obtain. Most fire safety checks, tests and training were being done, but there was not a clear record of which staff had taken part in fire drills so it was not possible to see that all staff had taken part in at least one drill per year, as required. Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 25 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 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 1 X 2 2 X Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15, 16 Requirement Service user plans must identify service users’ dietary requirements, and these requirements must be met. Service user plans must describe any restrictions on the service user which have been agreed with the service user. The home must provide sufficient staff, day and night, to ensure service users are supported with activities and with personal care and are kept safe. (Previous timescale of 30/06/06 not met) 4 5 YA17 YA17 16 17 Service users must be offered a choice of meals. Records of food provided must include any special diets prepared for individual service users. Medication must not be given to a service user to whom it does DS0000024691.V312559.R01.S.doc Timescale for action 31/12/06 2 YA6 15 31/12/06 3 YA13 16, 18 31/01/07 31/12/06 31/12/06 6 YA20 13 30/11/06 Aston House Version 5.2 Page 27 not belong. 7 8 YA20 YA32 13, 18 18 All staff who give out medication must have suitable training. 31/12/06 At least 50 of care staff must 31/03/07 be qualified to at least NVQ (national vocational qualification) 2 in care. Staff must not be employed in the home until the information required in schedule 2 of the Care Homes Regulations 2001 has been obtained. (Previous timescale of 20/03/06 not met) 30/11/06 9 YA34 19 10 YA35 18 Staff must receive training appropriate to their work. Specifically, this must include induction meeting Skills for Care standards; prevention of and response to aggression; and infection control. (Previous timescale of 31/08/06 not met) Further specific training required includes mental health, adult protection, and food hygiene. 31/03/07 11 YA39 24 The home must evaluate the 31/01/07 results from the quality assurance process and draw up a development plan. (Previous timescales of 30/05/05 and 31/12/05 and 30/06/06 not met) 12 YA41 17 All required records must be complete and up to date. In particular, records must be maintained of any additional charges paid by any service DS0000024691.V312559.R01.S.doc 31/12/06 Aston House Version 5.2 Page 28 users and the purpose for which this money has been used. The records must detail the specific goods / services provided, with evidence of the precise amounts spent on each occasion. The records must cover the period from which the first additional payment was made in each case. 13 YA41 17 All required records must be available for inspection in the care home at all times. Fire drills must take place at least twice a year, and all staff must take part in a drill at least once a year. (Previous timescale of 30/06/06 not met, although drills had taken place) 15 YA42 13 Adequate risk assessments must be in place, covering all safe working practices in standard 42.2 and 42.3. The home must ensure electrical safety; specifically, they need an electrical installation certificate of safety. There must be a staff member on duty at all times who is qualified in First Aid at Work, unless a full risk assessment confirms that a lower level of first aid cover is suitable for the needs of the service. 31/12/06 30/11/06 14 YA42 23 31/12/06 16 YA42 13 31/01/07 17 YA42 13 31/03/07 Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 29 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 YA5 Good Practice Recommendations The contracts for service users should accurately reflect the services actually provided. (Repeated from March 2006, unable to be checked) 2 YA7 Accounts of service users’ finances, where the registered provider is their appointee, should be independently audited. (Repeated from March 2006) 3 4 YA17 YA22 The home should consider alternatives to serving meals ready-plated, to allow for more service user choice. The home should ensure that all relatives and representatives of service users are aware of the home’s complaints procedure and of CSCI inspection reports. A basic training programme for staff in relevant mental health topics should be formalised to identify and deliver core topics. (Carried forward from August 2004) 5 YA35 Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aston House DS0000024691.V312559.R01.S.doc Version 5.2 Page 31 - 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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