Inspection on 04/03/09 for Aston House

This inspection was carried out on 4th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Aston House 02/09/08

Aston House 22/11/07

Aston House 30/10/06

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 18/06/2009.

CARE HOME ADULTS 18-65 Aston House Hampton Park Road Hereford Herefordshire HR1 1TJ Lead Inspector Debra Lewis Unannounced Inspection 4th March 2009 09:00 Aston House DS0000024691.V374458.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.V374458.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.V374458.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aston House Address 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) astonhousecare@aol.com Mr Mark Zylinski None registered 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 (2) Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd September 2008 Brief Description of the Service: Aston House is a large detached house set back from the road in a residential area of Hereford. The house has 10 single bedrooms, 3 double bedrooms, shared lounge, dining room, smoking room, meeting room and bathroom facilities. It has a good-sized garden. The home is registered to offer services for up to 16 adults who have experienced some mental 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 home is currently without a registered manager. A new manager has recently been appointed. At the time of the inspection the Commission had not yet received her application to be registered. Information about the home, including fees, will be available in a service users’ guide when it is updated. Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for the service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a Key Inspection. This means that we (the Commission for Social Care Inspection) checked all of the standards that have most impact on service users. It was unannounced, which means that the home manager and staff did not know we were coming. This report includes what we found during the visit to the home, as well as any relevant information that we have received about the home since the last inspection. This includes details from a report about the home that was given to us by the registered provider, Mr Zylinski. We were in the home from 9am until 5pm. We met and talked with many of the people living in the home, with several staff on duty, with the new manager and with Mr Zylinski. We looked at the building and whether it is well kept and safe. We checked records that staff keep, for example about what care they are giving to the people living in the home. We looked at what had changed since the last inspection. We found the service provided had improved since our last visit. Some of the improvement work was still in progress. What the service does well: Staff have started to involve people more with their care plans. Staff do not tell people living in the home what they cannot do, unless it is to protect them from harm. The food is good and people living in the home like it. The home has good relationships with relatives of people living there. People living in the home are being given support with trying out new activities, or doing more of the things they enjoy. The home is comfortable and clean. People living in the home like the staff, and staff in the home care about the people who live there and treat them well. People at Aston House say they are happy with their care. Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 6 The home is making a real effort to make the service better for people living there. What has improved since the last inspection? Since the last inspection, the owner has employed consultants to help improve the service in the home. Many changes have been made, or are beginning to be made. Staff have begun to work with people living in the home to write down clearly what support they need from staff, in new care plans. There is now a kettle and fridge in a part of the kitchen, which is for people living in the home to use, so they can get drinks and snacks whenever they want. There are now more staff available, including an activities organiser, so people living in the home are getting more support with activities. There is a new large screen TV and lounge furniture. People’s health care support is being recorded better, so staff can easily see what treatment people have had, and what is needed. Medicines are being kept more safely in general. Staff have been trained in safeguarding adults, so are more able to take the right action if they are concerned about people living in the home being treated badly. The smoking room extractor has now been installed, and the laundry has been improved, making the home more pleasant. Staff are getting more training, such as induction training for new staff, mental health and food hygiene training. This will help them give a better service to people living in the home. The owner has begun to make positive changes in the home, based on what people have said in a recent survey, and based on feedback from other people such as the Commission, staff in the home, and an external consultant. The home is being kept safer for people living there. Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aston House DS0000024691.V374458.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.V374458.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Accurate written information about the home is not yet available for people who may want to move in. The home has a new system to help them check what support people need before they move in. EVIDENCE: The home’s statement of purpose and service users’ guide were out of date and due for revision. This meant that accurate information about the home was not easily available to people who may want to live there. This had not been a priority as the home currently had no vacancies, but the registered provider said the documents would be updated in the near future. No new people had moved into the home for over a year, so it was not possible to fully assess whether the home was now doing the required assessment of what people needed before they moved in. The home was in the process of setting up a new assessment and care planning system, which included the home’s own written assessment of people’s needs. Each person had a statement of terms and conditions signed in June or July 2008. Generally there were no charges for extras other than hairdressing, dry cleaning, chiropody, dental/optical treatment, clothing and personal effects. Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 10 Basic toiletries, transport, newspapers and an annual holiday were included. One person was paying £40 per week from their own money, as their placing authority had not agreed to a fee increase. Aston House DS0000024691.V374458.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. 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. Some, but not yet all, people who live in the home have been involved with planning their care so staff know what support they need. People usually make their own choices about what they do, in and out of the home. EVIDENCE: We looked at some care plans and risk assessments. We also talked with people living in the home, with staff and with the owner, about the care people need and about how staff provide the care. The home is introducing a new system of regularly assessing what support people need, and planning their care. Not all people’s needs were recorded on the new system yet. Parts of the planning format were largely irrelevant to the needs of people in the home, as they related mainly to nursing care or care of older people, but were being retained in case they should ever be needed. Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 12 The system was detailed and was more time consuming to complete than that previously used, as it was more “person-centred”. People living in the home said they had been involved with this process. One person had written parts of their own plan. At the time of the inspection it was not always easy to find details of care needed, partly because of the transition between the old and new systems. For example, one person’s dietary needs were unclear; they had a health condition requiring a special diet, but conflicting details of their dietary needs were recorded in two separate places, and there was not yet a related care plan. Written risk assessments were also part of the new planning system and where the new system was in place we saw how the home was assessing the risks and actions associated with a range of independent activities, such as taking their own medication and going out in the community without staff. The home had liaised well with local mental health professionals about a particular situation involving a person living in the home. The home was beginning to enable people living there to make more of their own choices and decisions. For example, staff no longer bought bulk supplies of toiletries; and people living in the home were now able to make drinks and snacks whenever they wanted, without compromising food hygiene, as there was now a fridge and drink making area for their use. Some people are able to take responsibility for their own personal money but the provider acts as appointee for half of the people using the service, receives benefits on their behalf and holds some money for each in safekeeping. We saw the records that are being kept about this. They accounted appropriately for the money and had been subject to a professional audit in 2008. We found that the benefits of people for whom the provider was appointee were being paid into the home’s business account, as was all of the money being held in safekeeping. We discussed this with the provider who agreed to open a separate account specifically for people’s personal money. He confirmed within 48 hours of the inspection that he had done so. Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some people in the home lead varied and independent lives. The home now checks what support is needed by people who are less independent, and tries to enable them to take part in more enjoyable activities. Family and friends are welcome in the home, and people living in the home like the food. EVIDENCE: We talked with people living in the home, with staff and with the manager. We looked at care plans and records of activities. We saw food being served and looked at menus and records of food provided. We found that some people were very independent and were able to attend college or work, and to take part in hobbies and activities, without any support needed from staff. Other people needed more staff support, for example because of lacking confidence or motivation. We found that the home had begun to assess everyone’s social and recreational needs, and to plan how Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 14 they could give support where needed. For example, one person who had in the past not taken part in much enjoyable activity, was now trying out new activities. In addition the home was employing a part time activities organiser, who arranged outings and also was doing aromatherapy hand massages, which were very popular with the people we spoke with. There were now several “floating” shifts each week, which enabled more activities to be arranged and supported by staff, such as quiz nights. The home had a new large screen TV. Family and friends were welcomed at Aston House and there was evidence of regular visits to or by families, when this was possible. We saw friends visiting the home. Daily routines in the home were not restrictive, for example people could come and go as they wished, held keys and opened their own post. The home was beginning to look at ways to promote more independent choice and less routine, for example by enabling people living there to keep snacks in their own fridge and to make drinks whenever they wanted. The home now had two cooks, covering every day’s lunch and evening meal. Food was nutritious, and appetising, of good quality and people living in the home said it was very good. We saw that the cook on duty had a good rapport with people living in the home, who were asking about food for the day and telling him their preferences. We saw that he was flexible about what food was being provided. Special diets were catered for. For some people their dietary needs were clearly recorded in their plans but for others it was less clear what they needed. Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. People living in the home get the support they want with personal care. They also usually get the support they need with health care and with their medication, but this still needs some improvement to make sure that the right care is consistently given. EVIDENCE: We talked to staff and people living in the home, and looked at care plans and medication records. Personal care was not needed much by people living in the home. Where it was needed we saw evidence that it was being provided sensitively, according to how the person wanted it. For example, a care plan included reference to that person’s choice of whether to have male or female staff assisting them, and they confirmed that they were happy with how they were supported. Health care needs were being recorded better than in the past. We saw evidence of some health needs being managed well and of the actions taken, Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 16 such as medical appointments, being well recorded. This practice was not yet consistent, for example one person’s dietary needs, which were important to their medical condition, were not clearly recorded and the cook agreed he would like clearer guidelines on this. We saw some evidence of people with specific medical needs, where staff were giving sensitive support. Medication was generally being safely managed. Improvements had mostly been made as required previously. One person had been managing their own medication, but at the last inspection the pharmacist inspector noted that this was not being done safely. This had been addressed. However the pharmacist inspector had also commented on another person looking after their own medication, where the storage arrangement may not be safe. On this occasion we found the same situation, and it had not been mentioned in the risk assessment that covered this person looking after their own medication. We made an immediate requirement for the home to ensure this was safely stored, and the registered provider contacted us shortly after the inspection to confirm they had done so. Medication records were generally being kept well, but we saw a handwritten instruction on a MAR (medication administration record) chart which had not been signed by anyone to show who authorised the entry. The manager said she did regular weekly checks of the charts to ensure they were accurate, but the unsigned entry had been made after her latest check. We were told that some audit checks were being done, but not recorded, where people look after their own medication. We advised these should be recorded. Where people need “as required” medication, the guidance for staff was in place but sometimes had not been reviewed for over a year. We advised these guidelines should be updated. Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. People living in the home feel able to raise concerns they may have. Most staff have been trained so they know how to recognise and respond to signs of possible abuse. EVIDENCE: We looked at records of concerns and complaints, and talked to staff and people living in the home about how the home manages concerns raised by people living there. We looked at records of staff training about safeguarding people from abuse, and talked to staff about their understanding of this issue. We looked at financial records where the owner manages money on behalf of some people living in the home. People living in the home said they could tell staff if they had any concerns. Most were aware that there was a specific complaints procedure. The record of complaints showed some minor concerns had been reported. A new format had been introduced (but not yet been used) which should help to remind staff to record what actions they take in response to concerns, which would help to ensure concerns are taken seriously. Since the last inspection most staff, including the cleaner, have attended training in safeguarding. It should also be done by relief staff and by the cook, as all staff should be aware of signs of possible abuse and of how best to Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 18 respond if they were concerned about anyone in the home. This was discussed with the owner, who agreed to arrange this training. The home has a suitable policy on safeguarding. Staff we spoke with were familiar with safeguarding procedures. Aston House DS0000024691.V374458.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is now being maintained in a safe, clean and comfortable condition. EVIDENCE: We toured the building and saw some bedrooms and most shared areas of the home. The house is homely, well-decorated and comfortably furnished. It would be good practice to upgrade the premises, when possible, to provide a more modern level of service for the people living in the home, for example by reducing shared bedrooms and providing ensuite facilities. The smoking room now had an extractor so was a more pleasant area. Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 20 Bedrooms were mostly lockable except for one that was used as access to a fire exit. Some fire exits led through bedrooms, which reduced the privacy of the people living in those rooms. There were sufficient shared areas including a large TV lounge with new sofas and large screen TV, a small smoking room outside and a quiet room used for meetings or visitors. Dirty laundry does not go through the kitchen or food areas. The laundry area had been refurbished since the last inspection and looked better, which was good as it was often used as a shortcut to the garden or smoking room. The home was hygienic; all staff except 2 relief staff had done food hygiene training. Aston House DS0000024691.V374458.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home generally like the staff and feel they are supported. Staff have qualifications and are now beginning to do more training, which will mean they become more skilled at supporting people in the best way. There are enough staff now to allow more activities to take place at some times in the week. EVIDENCE: We talked to people living in the home, staff, the registered provider and the manager. We looked at the staff rota and at records of staff training and recruitment. Staff in the home were mostly either working on their NVQs (National Vocational Qualifications) or had completed them, meaning they had the basic skills required for care work. People living in the home said they liked the staff. Surveys indicated that everyone living in the home felt that staff either “always or usually” listened and acted on what they said. Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 22 The home had recently recruited 2 new care staff and a part time activities organiser. In addition, the registered provider (owner) had been spending more time in the home to help improve staffing levels and make changes within the home, including providing training for staff. There were also now 2 cooks so care staff did not have to be caught up with food preparation, as they had been when there was only one cook on his days off. Overall there were usually a manager and 2 care staff on duty, plus 3-4 “floating shifts” per week which was enabling staff to give more personal attention to people in the home who needed more support or staff input. The home had done the necessary checks on new staff before they started work in the home, to reduce the risk of employing people unsuitable for care work. We noted that 2 new staff had started work with the bare minimum check rather than the full Criminal Records check. This is a permitted procedure only when the service is likely to have insufficient staff unless people start work urgently. The manager explained that the time before the full checks were done had been used for training the new staff. The rota and other records supported this. The home should make sure that they do not slip into relying on the minimum checks as a matter of routine. Staff had begun to do more training relevant to their work. New staff were now doing structured induction training, beginning with in-house procedures and moving on to induction based on nationally recognised standards. Two existing staff had started to do mental health training in-house, doing coursework from a level 2 certificate in community mental health. This was being delivered by the owner and was not being externally verified, but it was a structured programme with relevant content. 2 other staff who had started this training had left the home. It was planned that the new staff would do this training after their induction. Of the remaining care staff, 3 seniors, one had done an Open University course in mental health. The others were described by the owner as very experienced. It would be beneficial for them to do mental health training, at a higher level appropriate to their role and experience; this would further raise the quality of work done with people living in the home. The owner had been unable to find suitable training in managing challenging behaviour / aggression. Staff had attended a course that turned out to be unsuitable for working with the people living at Aston House. The owner had found some general training in conflict management, which was being used until they were able to find training that was more suited to the home’s specific needs. Aston House DS0000024691.V374458.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has been without a registered manager for over two years, which has allowed some standards to slip in the past. It now has a new manager in post, who is not yet registered. The service is beginning to be developed, based on input from people living in the home and others concerned with their support. The home is mostly kept safe for people living there. EVIDENCE: The home has been without a registered manager since February 2007. The home recruited a new manager last year, who left before becoming registered with the Commission for Social Care Inspection. Another new manager has now been appointed, from within the Aston House staff team. She had only Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 24 been in post as manager for 3 weeks at the time of the inspection. She was doing the relevant training in leadership and management. She did not yet have mental health training but had worked in the home for 6 years. Staff and people living in the home said they thought she would make a good manager. She said she planned to apply for registration promptly, to avoid prolonging the time the home continues without a registered manager. The home has now started to undertake a process of quality assurance, including gathering opinions from people living in the home. Some changes had been made as a result of the surveys, which were sent out in December 2008. The home also returned its AQAA to us, which is their report on the service they are providing. It gave a recognisable picture of the service we saw, although more consideration of improvements they could be making would make it more useful. Management of safety in the home has been a concern in the past, but on this occasion we mainly found it was being properly managed. For example, fire safety checks and training were being done routinely, and maintenance work was being carried out on equipment. The fire risk assessment we saw was not up to date, but the owner contacted us shortly after the inspection to tell us he had updated the fire risk assessment. A medication risk assessment did not address potential risks, which had been previously identified. Some more attention to risk management would ensure the home is always as safe as possible for people living there. Aston House DS0000024691.V374458.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 2 2 X 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X Aston House DS0000024691.V374458.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 YA20 Regulation 13(2) Requirement Where people living in the home manage their medication make sure that the risk assessments are up to date with suitable monitoring that people are taking their medicines correctly and can store their medicines safely in a lockable space. This is to help make sure the medication the doctor has prescribed is taken correctly and is stored in a way that is safe for everyone in the home. (Repeated from September 2008. An immediate requirement was issued on the day of the inspection and the owner contacted us to confirm that appropriate action had been taken.) Timescale for action 05/03/09 Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 27 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 YA1 Good Practice Recommendations The statement of purpose and service users’ guide should be fully revised and updated to ensure they are accurate, and produced in formats which are easily accessible to people living in the home and people who may be considering moving in. This is so that people who live in the home, or are considering doing so, have accurate, up to date information on which to base their choice. (Repeated from November 2007 and September 2008) 2 YA6 You should ensure that care plans are all updated so they are more person centred and give a clear and comprehensive account of each person’s needs and preferences. A week-by-week record of the sums of money received on behalf of people and of the fees paid should be maintained. This is to ensure that there is a full audit trail available of people’s personal money which is handled by the provider. The new manager should apply for registration without any delay. All staff should be trained in health and safety to ensure they are aware of possible consequences of unsafe practices. (Repeated from September 2008 and not checked on this occasion) 6 YA42 Staff involved with assessing risks should have training in risk assessment / risk management, to enable them to accurately and reliably identify and address potential risks to people living in the home. 3 YA7 4 5 YA37 YA42 Aston House DS0000024691.V374458.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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