Inspection on 07/12/06 for Little Ashmill RCH

This inspection was carried out on 7th December 2006.

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

The inspector found 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Little Ashmill RCH 29/11/07

Little Ashmill RCH 08/12/05

Little Ashmill RCH 04/08/05

Little Ashmill RCH 30/11/04

Little Ashmill RCH 08/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Little Ashmill RCH 21 Stanhope Way Great Barr Birmingham West Midlands B43 7UB Lead Inspector Mrs Maggie Bennett Key Unannounced Inspection 7th and 8th December 2006 08:50 Little Ashmill RCH DS0000043608.V322170.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 Little Ashmill RCH DS0000043608.V322170.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. Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Ashmill RCH Address 21 Stanhope Way Great Barr Birmingham West Midlands B43 7UB 0121 360 5842 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) Ashmill Residential Care Home Ltd *** Post Vacant *** Care Home 5 Category(ies) of Physical disability (5) registration, with number of places Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Age Range 18-65 years That the Laundry Floor is made impermeable. That the two damaged easy chairs in the lounge are replaced with chairs in good condition. 8th December 2005 Date of last inspection Brief Description of the Service: Little Ashmill is registered to care for five people between the ages of 18 and 65 who have a physical disability. The property is a detached house, which has been extensively modernised and refurbished to meet the needs of this service user group. It is situated in a residential area in Great Barr and has shops and a public house nearby. All service users have their own bedroom, which is provided with an en suite shower and toilet. All rooms are designed to be accessible to those using wheelchairs. There is a vertical lift to the first floor. The laundry is reached via an outside path and is therefore not accessible to the service users. Those using wheelchairs would be unable to prepare meals in the kitchen. Little Ashmill is comfortable and well equipped and because of its smaller size, achieves a homely atmosphere. Fees charged at the home range from £1,000.00 to £1,200.00 per week. Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a day and a half during a weekday. There were 4 service users living at Little Ashmill at the time, all of whom were seen during the 2 days. All of the key standards of the National Minimum Standards were inspected on this occasion. At the last inspection of the home a total of 18 statutory requirements were made. It was found on this occasion that 15 of those requirements had either been met or were in the process of being met. A further 9 statutory requirements were made following this inspection. Since the last inspection the Registered Manager has resigned and there is now an Acting Manager in place. Good progress has been made in a number of areas and service users spoken to during the inspection made very positive comments about all the staff and the quality of care they received. Prior to the inspection, a Pre Inspection questionnaire was completed by the Acting Manager and service users were assisted by staff to complete a survey seeking their views of the home. The care plans of the service users were seen during the inspection, along with daily records. Medication and administration records were checked. A tour took place of the building and various documents were seen in order to check the home’s health and safety procedures. Staff files were seen so that the home’s training record and recruitment processes could be assessed. Two members of staff were spoken to and discussion took place throughout the inspection with the Acting Manager. The Registered Person was also present during part of the inspection. What the service does well: Although no new service users have been admitted to Little Ashmill since the last inspection, there are good assessment procedures in place and all the present service users received the benefit of a proper assessment before they moved to the home. Service users are involved in the development and review of their care plans, which have been developed following person-centred planning principles. The key worker system now in place enables staff to establish special relationships and work on a one to one basis. Service users state that they are enabled to make choices and decisions about their daily lives. One person said: “They don’t force us to do anything. We can go to bed when we like.” The home has been proactive in accessing local facilities for service users and regular activities outside the home are offered. This includes the opportunity for an annual holiday, which was much enjoyed this year by 3 of the service users. The healthcare needs of service users are well documented and understood by the staff. Appropriate advice and support is Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 6 available from community based healthcare professionals. One of these healthcare professionals, spoken during the inspection, spoke highly of the “very caring” approach of the staff. Service users feel that they are listened to. One person, who said she was usually cheerful, pointed out that staff also knew when she was “miserable”. The building is homely and comfortable and provides a safe environment for the service users. There is a very friendly rapport between service users and staff. Service users spoke highly of the staff during the visit. One person said: “They are very, very good to me. We have a buzzer, so if we need any help, we only have to buzz.” This person summed up how she felt about Little Ashmill: “I don’t think I’d want to move anywhere else. If I moved I would have to come all the way back again.” What has improved since the last inspection? What they could do better: As noted above, the home have found it difficult to engage social workers in the required service users’ six monthly reviews. The home have been advised that the six monthly review should always go ahead, as service users must have an opportunity to be involved in a formal review of their care. Although the home have offered a variety of opportunities for outside leisure activities, very few “in house” activities are being recorded. Care plans seen at the inspection provided very little indication of service users being engaged in activities while they were at the home. This seemed particularly true of evenings and weekends. It is acknowledged that it may be the service user’s choice to go to bed at 6.00 p.m., but if so this needs to be clearly recorded and there must be evidence that a variety of options are offered. Where service users are paying for outside activities, such as Day Centre attendance, there must be evidence that this has been agreed with the funding Authority and, in the case of the particular service user in question, with The Court of Protection. The home must provide a daily menu, which must be produced in consultation Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 7 with the service users. The home’s Adult Protection Procedure is not in line with the local Walsall Social Services Procedure and this must be updated. It was disappointing to note that recruitment procedures, which had improved at the last inspection, were not up to standard. It was found that two staff had been employed without evidence of satisfactory Criminal Records Bureau and Protection of Vulnerable Adults checks. This could place service users at risk. Although staff spoken to at the inspection said that they were happy working a 12 hour day, they should sign their agreement to this. Records of induction for new staff showed a 2 week induction period only. All new staff must undergo the 6 week induction training, to Skills for Care specifications. Staff also need to take part in infection control training. 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. Little Ashmill RCH DS0000043608.V322170.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 Little Ashmill RCH DS0000043608.V322170.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): Standard 2. Quality in this outcome area is good. There a good assessment procedures in place, which help to ensure that no prospective service user moves to Little Ashmill unless they can be assured that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new service users have moved to Little Ashmill since the last inspection in December 2005. All the present service users moved to the home when it was first opened. All service users were properly assessed before they were admitted and were given opportunities to look around the home before they made the decision to move in. The home have a comprehensive assessment tool and are aware that full assessments must be received from social workers prior to any new admission. Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. Quality in this outcome area is good. There are clear and up to date care plans in place, the quality of which has improved since the last inspection. Service users have been involved in the compilation of their care plans, which have been developed following person centred planning principles. The key worker system enables staff to establish special relationships and work on a one to one basis. Although there is evidence of regular reviews with staff at the home, these meetings have not always been recorded. There are risk assessments in place, which must also be regularly reviewed. This judgement has been made using available evidence including a visit to this service. Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 11 EVIDENCE: The Care Plans of all 4 service users were seen at the inspection. The plans have greatly improved since the last inspection and now give a clear, up to date picture of each individual’s personal, social support and healthcare needs. This includes details of the specialist requirements of each person. All service users have been involved in compiling their care plans and have copies of them in their rooms. Where possible, service users have signed their care plans. Two of the service users are able to read their care plans. The service users who are unable to read have their care plans read and explained to them. The home are now operating a key worker system and two of the service users spoken to were aware of who their key workers were. Staff spoken to gave a good account of their understanding of the key worker role. Care plans are now informally reviewed with the service user on a monthly basis. It is recommended that these review meetings be recorded. The Care Plan must also be formally reviewed at least every six months and updated to reflect changing needs. Where social workers have been requested to carry out six monthly reviews and have not done so, the home should record this. Where it has not been possible to involve the social worker, the home must still ensure that service users have the opportunity for a review. Service users spoken to confirmed that they are able to make decisions about their daily lives. One person said: “They don’t force us to do anything. We can go to bed when we like.” Two of the service users attend local day centres, 1 has recently been unwell and is currently not attending and the fourth person chooses not to go. Advice is available from a local Advocacy Service and this has been used by one service user in the past. There is evidence from care plans that service users are able to make individual choices. An example was given of a service user who was enabled to make their own decision as to whether or not to accept surgery. All service users have their own Bank Accounts and are supported in the management of their finances. The home does not act as appointee or agent for any of the service users, this being handled either by the service users’ family, Social Services or, in one case, by the Court of Protection. There are individual risk assessments on all service users’ care plans. These need to be regularly reviewed at the same time as the care plans and the findings of the reviews recorded. Following an accident to a service user, the home reviewed its risk assessment with regard to the kitchen and measures have been put in place to minimise the risk. None of the present service users would wish to go out alone and all need assistance outside of the home. There is a Missing Person Procedure in place. Little Ashmill RCH DS0000043608.V322170.R01.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): Standards 12, 13, 14, 15, 16 and 17. Quality in this outcome area is adequate. Service users have opportunities to engage in educational and social activities. They use local facilities, including the nearby Pub, where they often have a meal. There are generally good opportunities for leisure activities, particularly outside of the home. This includes an annual holiday. These occasions are much enjoyed by the service users. It does seem that more could be offered in the way of daily activities within the home and there needs to be more evidence that service users are consulted and offered a variety of options on a daily basis. Service users are assisted to maintain family links and friendships and are offered advice with regard to intimate relationships. Service users’ rights to privacy and autonomy are upheld. The meals provided are of good quality, but service users could be more involved in menu planning. Records must be kept of the food provided. This judgement has been made using available evidence including a visit to this service. Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 13 EVIDENCE: Two service users attend a local College and Day Centre. One person is being assisted to develop their reading and writing skills. A number of local facilities are used by the service users, including the Pub. Ring and Ride is used for some trips out and service users also have access to Ashmill’s mini bus, when it is available. All service users are on the electoral register. Any staff time with service users for activities outside the home are recognised by the Registered Persons as part of staff duties. Little Ashmill offers the service users a number of leisure activities, both inside and out of the home. A birthday party had been held the night before the inspection and service users were going to a Pantomime at the weekend. There were also plans to go Christmas shopping to Merry Hill the week following the inspection. Three of the service users enjoyed a holiday this year, when they went to “Skylarks” in Nottingham. Staff spoken to during the inspection said that when service users were at home during the day-time a number of activities were offered, including art work, quizzes and walks out, including trips to the Pub. Records in service users care plans, however, did not reflect the fact that activities were offered on a daily basis. Neither was this evidenced during the inspection, when no activities took place during the afternoon. Two service users watched a video in one of their rooms, whilst the other two watched T.V. Daily records seen at the inspection for the week 28th November to 6th December 2006 did not record any “in house” activities, other than watching T.V. or D.V.Ds. On some occasions service users were recorded as going to bed at 6.00 p.m. This may be the service user’s choice, but if so this needs to be clearly recorded and the home must be able to evidence that service users are given a variety of options to choose from and are not going to bed early simply because there is nothing else to do. Service users are assisted to maintain links with their families and friends. Some families visit and one service user telephones a relative regularly. If service users do not wish to see particular visitors, their wishes are respected. During social visits outside of the home, service users have the opportunity to meet with people who do not have their disability. The home has a clear policy on service users’ rights to develop and maintain intimate personal relationships of their choice. All service users have attended a training course with regard to sexuality and related issues. All service users have their own rooms and are provided with keys. During the inspection staff were observed to always knock before entering a room. Service users open their own mail, or with assistance, if needed. During the course of the inspection staff were observed to interact well with service users. Service users confirm that they are able to choose whether to be alone and whether or not to join in an activity. There is unrestricted access to the home, Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 14 apart from the kitchen and laundry, which are not safely accessible without staff assistance. Two of the service users said that the food provided at Little Ashmill was of good quality. At the time of the inspection, however, there was no current menu and no indication that service users had been consulted about what they would like for the main meal of the day. The main meal is taken in the evening during the week and on this occasion service users were served lamb chops with fresh vegetables, mashed potatoes and gravy. The meal looked very appetising. One service user chose to eat in their room. It was noted that service users who needed assistance to eat were helped in a sensitive and discreet way. The Acting Manager is hoping to involve service users more in the ordering and purchase of food and has made enquiries of a local Supermarket with regard to service users ordering on line. The kitchen was clean and in good order and ample stocks of food were seen, including fresh fruit and vegetables. Fridge and freezer temperatures are taken daily. The temperature of the cooked meats must also be taken daily. Little Ashmill RCH DS0000043608.V322170.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): Standards 18, 19 and 20. Quality in this outcome area is good. The healthcare needs of the service users are well documented and understood by the staff. Appropriate advice and support is obtained from visiting healthcare professionals. The administration and recording of medication is generally sound and service users are protected by the home’s policies and procedures. A minor discrepancy, noted on the day of the inspection, was dealt with immediately by the Acting Manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care Plans seen during the inspection provide clear evidence that service users are consulted about how they wish to be guided, moved, supported and transferred. This was confirmed by the two of the service users, who explained how they were assisted with personal support. All service users have their own rooms and all personal care giving takes place in private. It is not possible to provide intimate care by a person of the same gender for the Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 16 male service users. The Acting Manager states, however, that he does hope to employ a male member of staff in the near future. All service users have the technical aids they need to assist their independence. Specialist support is available from community based healthcare professionals. The healthcare needs of service users are clearly documented within their care plans. There was an example on one service user’s care plan of good information on epilepsy and what staff should do if the service user had an epileptic fit. The home refer to appropriate healthcare professionals when needed. At the time of the inspection a referral had been made for support from the Community Psychiatric Nurse for one service user. One service user is being assisted to manage recently diagnosed diabetes. It is recommended that all service users are given the opportunity to attend local “Well Woman” and “Well Man” clinics for routine screening. Service users are always accompanied on any outpatient or other appointments. It was noted that one service user had not been given the opportunity for a dental appointment for some time. A visiting District Nurse spoke highly of the home and of the “very caring” approach of the staff. She said that staff were always “on the ball” and that Little Ashmill was a “lovely home”. The medication and accompanying administration record sheets were inspected. The administration sheets now contain a photograph of the service user. The home uses a monitored dosage system and there are no service users who take charge of their own medication. All service users have consented to take their medication and this is recorded in their care plans. Records are kept of all medicines received, administered and leaving the home. Any unused medication is returned to the Pharmacist and appropriate records kept. It was noted that an administration record sheet had been altered, by sticking a label over the printed instructions. This practice must cease. If any alterations are made, this must only be following the advice of the G.P. Any handwritten instructions must be signed and dated. Controlled drugs are stored, administered and recorded correctly. Staff who administer medication have taken part in accredited medication training. It was noted that one service user was requesting paracetamol on a regular basis. This was not prescribed, but was being given on a “homely remedy” basis. The Acting Manager stated that he would be seeking advice from the G.P. with regard to this. The temperature of the medicines’ refrigerator is taken daily and recorded. Little Ashmill RCH DS0000043608.V322170.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): Standards 22 and 23. Quality in this outcome area is adequate. There is a complaints procedure in place and service users can be assured that any concerns they have will be listened to. This procedure needs to be more specific about the stages and timescales of the complaints process. The home’s Adult Protection Procedure must be amended as the current document is not in line with the Walsall Social Services Adult Protection Procedures. Staff have a good understanding of their responsibilities with regard to the Protection of Vulnerable Adults and this helps to protect service users from abuse, neglect and self-harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Complaints Procedure in place, but this does not contain details of the stages to be followed and timescales. Neither does it contain the correct address of the Commission for Social Care Inspection. All service users have been given a copy of the Complaints Procedure and a copy is also available in the hall of the home. No complaints have been received by the home or by the Commission in the last 12 months. An advocacy service is available locally if needed and this has been used by one of the service users in the past. The home have a procedure and policy in place with regard to Adult Protection. They must to ensure that this is in line with the Walsall Social Services updated Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 18 procedure and the Department of Health guidance, “No Secrets”. An allegation of abuse was made by a service user at the home earlier in the year and this was dealt with in an appropriate manner by the Registered Persons and Acting Manager. An investigation was carried out by Birmingham Social Services, who concluded that no abuse had taken place. The Acting Manager and staff spoken to during the inspection are aware of their responsibilities under the Protection of Vulnerable Adults Guidance. The majority of staff have taken part in Adult Protection Training. There is a restraint policy in place, but following a risk assessment of all service users, the Registered Persons do not feel that there is a need for any physical restraint at Little Ashmill and the policy at present is, therefore, that it is not used. The home take charge of some monies on behalf of service users. An inspection of these showed very clear records and evidence of regular audits. It is recommended that the Acting Manager be provided with a breakdown of individual service user’s benefits. It was noted from the records that one service user is paying for his own day care. The home must consult with the person’s social worker and the Court of Protection to ensure that they are aware of this and agreeable to the person’s money being spent in this way. A review meeting involving the service user should be held where this is discussed and records must be kept. Little Ashmill RCH DS0000043608.V322170.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): Standards 24 and 30. Quality in this outcome area is good. Little Ashmill provides a homely and comfortable environment in which to live. The building is well maintained and recent improvements have been beneficial to the service users, particularly the provision of double glazed windows to the ground floor. There are good standards of hygiene within the home, although staff would benefit from infection control training (see Standard 42). This judgement has been made using available evidence including a visit to this service. EVIDENCE: Little Ashmill was found to be clean, comfortable and warm at the time of the inspection. The building has been designed to specifically meet the needs of people with a physical disability. A number of improvements have taken place to the environment since the last inspection, including the provision of double glazed windows to the bedrooms and kitchen on the ground floor. One Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 20 bedroom is currently unoccupied and there are plans to completely redecorate this room. There is wheelchair access to all communal areas, but service users are unable to use the laundry and kitchen, as neither are safely accessible to wheelchair users. Throughout the home there are a number of items of equipment to assist service users. These include a vertical lift, an assisted bathroom, en suite showers, a call alarm system and lowered light switches. There is storage and recharging facilities for wheelchairs. Flashing light fire alarms have been provided in rooms where service users are hard of hearing. A risk assessment was carried out where a bed had been placed against a radiator. The bed has now been moved to the centre of the room. All the bedrooms were seen during this inspection and it was noted that there is unavoidable wheelchair damage to some walls and doorways. The Acting Manager stated that there were plans to refurbish these areas in the near future. Service users spoken to said that they were happy with their rooms. One person said she would prefer a room on the first floor. There is a very pleasant, landscaped garden to the rear of the property, which service users say was much enjoyed during the summer months. In their returned surveys, 4 service users said that the home was “always” fresh and clean. The home’s laundry is not safely accessible to service users and has to be approached via the garden. The laundry is satisfactorily equipped and includes a washing machine with a sluicing facility. There are policies and procedures in place for the control of infection (see also Standard 42, regarding staff training). Little Ashmill RCH DS0000043608.V322170.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): Standards 32, 33, 34 and 35. Quality in this outcome area is adequate. Service users are very satisfied with the care they receive and some speak highly of the staff group. Staff are making good progress in achieving NVQ awards. Staff rotas now ensure that there are sufficient staff on duty, although care staff need to agree in writing to working in excess of eleven hours a day. Recruitment procedures are not satisfactory and could place service users at risk. The Acting Manager recognises the importance of training and is developing a satisfactory training programme. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Little Ashmill is beginning to develop a stable staff group. No new appointments have been made since December 2005. Staff observed during the inspection had a good rapport with the service users and spoke with enthusiasm about their work. Two of the service users spoken to felt that they were well cared for by the staff. One person said: “They are very, very good to me. We have a buzzer, so if we need any help, we only have to buzz.” This Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 22 person also felt that staff were sympathetic and understanding, she said that generally she was happy, but the staff “know when I’m miserable.” Staff have taken part in a number of relevant training courses, including Dealing with Discrimination, Epilepsy, Managing a Diabetic Patient and Mental Health Awareness. The home have a good professional relationship with visiting healthcare professionals (see Standard 19 above). The four senior care staff are currently undertaking the NVQ3 award and another member of staff is undertaking NVQ2. Of the 11 care staff working at the home, 50 trained to NVQ2 has not yet been achieved, but good progress is being made. The Acting Manager stated that he was now requesting staff to sign an agreement to take part in required training. New rotas have been introduced following discussion with the staff. Staff now work a 12 hour day. Staff spoken to during the inspection said that they were happy with this new arrangement. The Acting Manager must ensure that staff sign their agreement to working in excess of 11 hours. Rotas show that there are now 3 care staff on duty between 8.00 a.m. and 8.00 p.m. Overnight there are 2 waking night staff on duty. The Manager’s hours are supernumerary. There is always a senior member of staff On Call in the event of an emergency. Specialist services are available from community based healthcare professionals. The present staff group does not reflect either the cultural diversity or gender composition of the service users, but this is difficult to achieve in such a small home. Staff meetings are now regularly held and notes were seen to verify this. Staff communicate with service users using a variety of methods, to suit the individual service user. Staff are to train in British Sign Language in the New Year. The files of 2 members of staff were seen in order to check recruitment processes and practice at the home. Neither of the files contained all of the required documentation. Application forms did not contain a full employment history. Although one file stated that written references had been provided, these were not available in the file. The two files did not contain evidence of satisfactory Criminal Records Bureau or Protection of Vulnerable Adults checks. Staff must not be confirmed in post until all the required checks have been made and satisfactory results received. Other required documentation, such as copies of birth certificates and passports were available in the files. The Registered Person was present during the second day of the inspection and she was under the impression that the required checks had been made and that verification of this would be at Head Office. She undertook to supply this evidence to the Commission within the next few days. No new staff appointments have been made since December 2005, but the Acting Manager states that he intends to involve service users in staff selection in the future. Not all of the staff files seen contained evidence that staff had been given copies of the General Social Care Council Code of Conduct. The Acting Manager stated that he would ensure that this was done and that he Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 23 would go through the Code with staff at supervision sessions. All staff receive copies of their terms and conditions. The Acting Manager is developing a training matrix for the staff team as a whole and this was seen on the computer at the inspection. There is a dedicated training budget. The home must ensure that any new staff receive induction training to Skills for Care specifications. On the files seen at the inspection there was only evidence of 2 week initial induction training. Each member of staff must have an individual training and development assessment and profile on file. Although not inspected on this occasion, it was noted that staff supervision is improving, but the home are not yet achieving the required 6 supervision sessions per year for its staff. Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 24 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): Standards 37, 39 and 42. Quality in this outcome area is adequate. The Acting Manager is experienced and competent and is working hard to improve services and provide an increased quality of life for the service users. The Registered Person and Acting Manager regularly seek the views of service users and staff and use the results of their questionnaires to inform future planning. There are good systems in place to protect the health and safety of service users and staff. Training is needed in infection control and several staff need updated training in health and safety areas. It is acknowledged that the Manager is actively seeking this training. This judgement has been made using available evidence including a visit to this service. Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 25 EVIDENCE: There is currently an Acting Manager in place at Little Ashmill. He worked for 5 years at the Company’s larger home, Ashmill in Birmingham, latterly as Deputy Manager. He has already commenced the Registered Manager’s Award. The Acting manager is aware of his overall responsibilities and has done a great deal towards pulling the home together after a period of instability. He has implemented a number of new systems and is respected by both the service users and staff. The manager’s hours are supernumerary, thus enabling him to fulfil his managerial duties, but he does spend time with the service users. He also takes part in periodic training with the staff group to update his skills. The Registered Person carries out an audit of the home on a six monthly basis. Questionnaires are sent to service users, staff and visiting social and healthcare professionals. This information is drawn together and informs the home’s annual development plan. Staff records show that staff have received training in fire safety, first aid, moving and handling and food hygiene. Certificates seen shown that some staff are in need of refresher training in these areas and the Acting Manager is arranging for this to take place. Staff must also take part in infection control training. There is a fire risk assessment in place and currently the Acting Manager is developing an updated version in line with the Regulatory Reform (Fire Safety) Order 2005. Fire alarms are tested weekly and the emergency lights are tested each month. The last fire drill took place in March 2006, they should take place at least every six months. During the inspection evidence was seen of the regular servicing of the boiler, the electrical system and electrical equipment. The water system is regularly checked for legionella. All substances that are hazardous to health are stored appropriately and an analysis of each product is kept. The lift is regularly maintained. Records show that the maintenance of some of the hoists is overdue. The temperature of the water at outlets accessible to service users is taken regularly and recorded. As with the fire risk assessment, the Acting Manager is currently updating the written statement of the policy, organisation and arrangements for maintaining safe working practices in the home. As stated in Standard 35 (above) all new staff must receive induction training to Skills for Care specifications, which will include training in safe working practice topics. Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 26 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 27 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 Requirement Service users’ plans of care must contain evidence of six monthly reviews and of regular reviews of risk assessments. (Previous timescale of 31/01/06 not met). Where is has not been possible to involve the social worker, the home must still ensure that service users have the opportunity for a formal six monthly review. Written records must be retained in individual care plans to verify the fact that service users are offered a variety of options of leisure activities whilst they are in the home. The home must provide a daily menu, following consultation with the service users. Records must be kept of the food provided. The temperature of cooked meat and fish must be taken prior to serving and recorded. Timescale for action 31/01/07 2. YA14 16(2)(n) 31/01/07 3. YA17 Schedule 4.13 31/01/07 4. YA17 13(4)(c) 08/12/06 Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 28 5. YA20 13(2) Medication administration records must not be altered, by sticking labels over instructions. Any alterations approved by the G.P. must be handwritten and signed and dated. (This was dealt with at the inspection). The home’s Complaints Procedure must give details of the stages to be followed and timescales. It must contain the correct address and telephone number of the CSCI. The home’s Adult Protection Procedure must be updated to ensure that it is in line with Walsall Social Services Adult Protection Procedure and the Department of Health guidance, “No Secrets”. (Previous timescale of 31/01/06 not met). Where service users are paying for facilities outside of the home, such as Day Care, this must be agreed with the person’s social worker and in this case with the Court of Protection. A review meeting to discuss this issue must be held and its findings recorded. The home must provide evidence that proper recruitment checks are made before new staff are appointed. New Staff must not be confirmed in post until all the required checks have been made and satisfactory results received. All new staff must receive induction training to Skills for Care specifications. Each member of staff must have an individual training and development assessment and profile on file. DS0000043608.V322170.R01.S.doc 08/12/06 6. YA22 22 31/01/07 7. YA23 13(6) 31/01/07 8. YA23 12 31/01/07 9. YA34 19 11/12/06 10. 11. YA35 YA35 18(1)(c) 18(1)(c) 31/01/07 31/01/07 Little Ashmill RCH Version 5.2 Page 29 12. YA42 13(3) 18(1)(c)(i) Staff must receive training in infection control. All staff must have up to date training in fire safety, first aid, moving and handling and food hygiene. (It is acknowledged that the Acting Manager is actively seeking this training at present). (Previous timescale of 31/01/06 not met). 31/01/07 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. 2. 3. 4. 5. Refer to Standard YA6 YA19 YA19 YA20 YA33 Good Practice Recommendations It is recommended that the findings of informal monthly review meetings be recorded. It is recommended that all service users are given the opportunity to attend local “Well Woman” and “Well Man” clinics for routine screening. It is recommended that at their informal reviews service users’ be consulted about dental checks. It is recommended that when service users regularly request to take a “homely” remedy, this be discussed with the G.P. It is recommended that staff sign to say that they agree to work in excess of 11 hours a day. Little Ashmill RCH DS0000043608.V322170.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Little Ashmill RCH DS0000043608.V322170.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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