Care Home: 99 Ashley Road

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What the care home does well The home offers individual person centred support to the service users in a comfortable non-stigmatising domestic setting. This is achieved through thorough pre-admission assessment and a consistently high level of heeding and responding to the needs and views of the service users. The manager and staff team are motivated and experienced within the client group and express a desire for continual improvement. They have begun to have the systems in place to evidence service quality. The staff team has been in post for some time, works well together with a high level of mutual respect for each other and the service users. The home encourages service users to engage in the community and to be as independent as possible. It is supporting service users to obtain increased daily living skills where possible. Residents are involved in a variety of meaningful activities including college courses, and social and leisure pursuits. The home`s quality assurance questionaires informed us that relatives and family members feel welcome in the home and the service users are supported to maintain family links. `I have asked XXX if I can move in too as it`s home from home, very cosy and a great family atmosphere`. `I feel 100% that he isin the best hands`. `First class in all areas-telling me all that`s going on and life down to the smallest detail`. The service users said, `I enjoy the courses that I am doing, like pottery and art work and also gardening`. `I like my room`. `The food is very nice`. `I enjoy walks` `I am happy here at 99`. One of the strengths of the home is its regular communication with Care Managers. Stakeholders said the home is co-operative and helpful and is one of the better units in keeping them informed. We were told the manager is very approachable and proactive in communicating and seeking advice. What has improved since the last inspection? Since the last inspection more individualised support, person centred care plans and risk assessments have been put in place involving the service users with their key workers. All the Service Users have individual risk assessments regarding harm or abuse from others. The home has a simple format complaints procedure in the dining room notice board. All staff are trained in SOVA and aware of the whistle blowing procedure. A new training matrix has been implemented with appropriate training to meet the needs of the service users. Recording of Service User`s financial transactions has been reviewed and new paperwork has been implemented. Policies and procedures are reviewed and quality audits are taking place by staff outside of the home. A part of the home has been redecorated and upgrading is on-going with new grab rails in place where appropriate. CARE HOME ADULTS 18-65 99 Ashley Road New Milton Hampshire BH25 5BJ Lead Inspector Joy Bingham Unannounced Inspection 13/08/08 09:20 99 Ashley Road DS0000012387.V368964.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 99 Ashley Road DS0000012387.V368964.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. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 99 Ashley Road Address New Milton Hampshire BH25 5BJ 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) 01425 628308 99ashley@tiscali.co.uk Ashfield Care Homes Ltd Mr Nicholas Cook Care Home 10 Category(ies) of Learning disability (0) registration, with number of places 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 10. Date of last inspection 22nd August 2006 Brief Description of the Service: 99 Ashley Road is a care home registered to provide personal care and accommodation for 10 service users with a learning disability. It is owned by Ashfield Care Homes Ltd, a subsidiary of Allied Care Ltd, which has a number of other registered properties in the area. 99 Ashley Road is located on the outskirts of the town of New Milton, with relatively easy access to the shops and other public amenities. The home is a detached property with car parking for 6-8 vehicles to the front of the building and a well-maintained and accessible garden to the rear. All bedrooms are occupied on a single basis; none of these have an en-suite facility. There are two aided bathrooms on the ground floor plus a staff shower room with toilet and a further residents’ wc. On the first floor there are two bathrooms and one wc. There is one lounge area, which can be subdivided to provide two smaller areas, and a separate dining room. Fees range from £600 - £2,500 per week, which covers all costs apart from toiletries of choice and personal effects. 99 Ashley Road DS0000012387.V368964.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 this service is 2 star. This means the people who use this service experience good quality outcomes. The purpose of the inspection was to find out how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included the Annual Quality Assurance Assessment (AQAA) completed by the home, and surveyed comments from 9 residents and 9 staff. An unannounced visit to the home was carried out on 13 August, lasting just under seven hours. During this time we were able to have a partial tour of the premises, including three bedrooms, the lounge/dining room, kitchen, laundry, two bathrooms, shower room and a wc. We had private discussions with the manager and three of the staff, passing contact with the majority of the residents of the home and private conversations with two service users. We were able to speak with only a limited number of selected stakeholders due to their annual leave. We sampled staff and care records, policies and procedures that relate to the running of the home. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection (CSCI). What the service does well: The home offers individual person centred support to the service users in a comfortable non-stigmatising domestic setting. This is achieved through thorough pre-admission assessment and a consistently high level of heeding and responding to the needs and views of the service users. The manager and staff team are motivated and experienced within the client group and express a desire for continual improvement. They have begun to have the systems in place to evidence service quality. The staff team has been in post for some time, works well together with a high level of mutual respect for each other and the service users. The home encourages service users to engage in the community and to be as independent as possible. It is supporting service users to obtain increased daily living skills where possible. Residents are involved in a variety of meaningful activities including college courses, and social and leisure pursuits. The home’s quality assurance questionaires informed us that relatives and family members feel welcome in the home and the service users are supported to maintain family links. ‘I have asked XXX if I can move in too as it’s home from home, very cosy and a great family atmosphere’. ‘I feel 100 that he is 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 6 in the best hands’. ‘First class in all areas-telling me all that’s going on and life down to the smallest detail’. The service users said, ‘I enjoy the courses that I am doing, like pottery and art work and also gardening’. ‘I like my room’. ‘The food is very nice’. ‘I enjoy walks’ ‘I am happy here at 99’. One of the strengths of the home is its regular communication with Care Managers. Stakeholders said the home is co-operative and helpful and is one of the better units in keeping them informed. We were told the manager is very approachable and proactive in communicating and seeking advice. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 7 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. 99 Ashley Road DS0000012387.V368964.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 99 Ashley Road DS0000012387.V368964.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. Prospective service users’ needs and aspirations are thoroughly assessed. They are given ample opportunity and information to ‘test drive’ the home, and for the home to form a judgement about their compatibility with others already living there. Clear written information about the services the home offers, collating the content of all the legal requirements, is not made readily available. Evidence to demonstrate what the service was providing in a costed and specific contract between the home and the purchasers was not available. EVIDENCE: The information provided by the home in the AQAA informed us that prospective service users needs are always assessed prior to them being offered a place in the home to ensure that the home can meet their needs. An individual assessment is carried out by the manager in the service user’s own home or current situation prior to admission. Also a Primary Care Team Cross Border Transfer form is submitted to the relevant Specialist Health team. The admissions procedure includes developing a person centred plan with a new service user shortly after they arrive. Prospective service users are given the opportunity: • For the manager and staff to visit their home. • For the service user to visit 99 Ashley Road. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 10 • • To move in to the home on a trial basis, for a period of 3 months. To have overnight / short stay visits prior to moving in. At the time of the inspection there was a vacancy and the assessment of a new resident was underway with initial meetings being held between the relevant parties. The manager expressed his clear commitment to ensure that any new admission would be compatible for sharing with the current people living at the home. Three files were inspected and records of thorough assessments were evidenced. Transition notes are also kept by the home. The manager told us that the Service Users are provided with a Service User information pack including a Service User Guide and Statement of Purpose presented in a style that is suitable to the service user and that they can understand. We asked for and were given a printed copy of the home’s brochure which we were told is the document the home would initially give to any interested party. We found that some content of the brochure is contradictory e.g. ‘the home offers a less structured and slightly slower pace of life’ on page 1, but is a ‘highly structured home’ on page 2. It lacks necessary detail such as shared living for both sexes, any information about the homes facilities, and reference to the legal information required to be included in the statement of pupose and service user guide. We recommended that the manager review the information required by law to be offered about the home’s service and ensure that people are made aware of all the aspects of the service provided by the home. The manager was unable to provide information about the terms of the specific purchase for each service user, detailing what was purchased, what fees covered and the cost of facilities and services not covered by the fees. We spoke with someone at the head office who agreed to supply the information to the home to be retained there. One requirement of the last inspection was that the registered person must ensure that any charges made to service users outside their terms and conditions, including transport, are clearly recorded stating the reasons and circumstances under which they will be charged. The need for this information features as a requirement at the conclusion of the report. In the survey returns all of the service users needed support to complete the forms, and were helped by family or their support workers. Two were unable to answer the questions. Seven of the service users said they had had enough information to make the decision about moving in and confirmed they had been a part of making that decision. 99 Ashley Road DS0000012387.V368964.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are involved in creating a support plan; they know their needs and wishes are reflected in this and they are supported in making decisions and taking appropriate risks in order to live as independent a life as possible. EVIDENCE: The manager informed us that a key worker system operates at the home. All of the residents, even those with significant communication difficulties, are able to express themselves and are supported to make their views known. The manager said that all the staff listen to the residents and make plans with them using the person centred planning training that all the staff have received. We saw that house meetings are held weekly and residents are encouraged to contribute ideas for trips, entertainment, and occupational skill attainment. Key workers have weekly meetings with their clients, and key workers review the support plans and risk assessments according to the wishes and needs of 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 12 the service users. The AQAA from the home told us that reviews are undertaken regularly with family and where possible, with care managers or their representatives. Two of the residents we spoke with in private told us that they can do what they want. They both agreed they were satisfied with living at the home and the freedom they have to come and go and join in if they choose to. One service user had been out walking that morning on his own in the community which he liked to do; the other had been horse riding. The survey returns demonstrated a unanimous agreement that all the service users could make decisions about what they want to do, during the day, in the evenings and at weekends. Their personal files evidenced the individual personal profile including character traits, motivations and likes/dislikes. The plans described individual factors requiring prompting from staff, special monitoring with guidance to the staff on the action that was expected and what needed to be recorded. Risk assessments where the home was avoiding curtailing a person’s freedom and strategies to manage difficult behaviour were in place, with regular reviews. The risk assessments had been thought through and well defined. They showed involvement of the service user and stakeholders and their advocates. Three residents were invited to show us into their bedrooms and these rooms evidenced their own clear choice of interests. They were personalised with photographs, equipment, furnishings and reflected relationships that were important to them. 99 Ashley Road DS0000012387.V368964.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, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are able to take part in peer, age and culturally relevant activities, and participate in the local community. They retain the links they wish to have with family members and are supported in developing these links when they choose to. Their rights to develop friendships outside of the home are recognised. EVIDENCE: The home informed us that reviews, house meetings and key worker meetings feed into the process for defining the needs and wishes of the service users and as a result they are attending college courses at the local college run by the Adult Learning Disability team. They also attend the Nedderman centre, Lymington community centre and other centres. The courses are age appropriate and give them opportunities for personal development. Activities include pottery, horse riding, horticulture, art and design and drama. They also attend Brockenhurst Gateway and access local shops, libraries, video stores, pubs and cafes. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 14 We were told that all service users go on holiday every year and for individual days out. This year there are plans for some of the residents to have a week’s holiday in Weymouth and others to go to Devon. One service user said, ‘staff manage my money every week and support me on how to purchase as I have a problem managing my money.’ The home’s quality assurance questionaires informed us that relatives and family members feel welcome in the home and the service users are supported to maintain family links. • I have asked XXX if I can move in too as it’s home from home, very cosy and a great family atmosphere. • I feel 100 that he is in the best hands. • First class in all areas-telling me all that’s going on and life down to the smallest detail. The service users said: • I enjoy the courses that I am doing, like pottery and art work and also gardening. • I like my room • The food is very nice • I enjoy walks • I am happy here at 99 Stakeholders commented that the home appears to be run in an open and cooperative way, and that the service users they have responsibilty for are settled and appear content. One said that this is the first home where the service user has not been moved on ‘from pillar to post’, and ‘is the most settled they have ever been’. ‘I am totally satisfied’. We were told that family contact is encouraged and whenever possible families are consulted for care meetings and reviews etc. The home has a policy that family members are free to visit at any time during normal hours. The home also supports service users to make visits to parents and relatives, and currently are supporting the re-establishment of a limited realtionship with a family member living at a distance. The home’s AQAA informed us that there is a cook who works alongside the house meetings to ensure meal requests are met and mixed with healthy foods for a balanced diet. Alternatives are always available and residents are encouraged to make their own tea and coffee and snacks, where appropriate. The service users can choose to eat when and where they wish (although they are encouraged to be ready for trips and activities, hospital appointments etc), but they mostly eat together in the dining room. At least once a week they choose a take away meal to eat out or to be delivered. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 15 While we were in the home we saw that service users had access to the kitchen, and while being monitored indirectly, they were free to make themselves hot drinks. One resident told us they did not want to use the kitchen and didn’t like the food much. When asked what he did like to eat it was evidently very limited in value and nourishment. We checked the staff response to this and it was evident they were aware and were attempting to widen his range. One service user told us that he did not like going to a particular place as something had happened there that he did not like. He explained what that was. This was communicated to the manager who followed it up with a member of staff. They were aware that the resident did not like going there and was respecting that choice but it was surprising that the staff member had not discovered the reason why when it had been communicated without hesitation by the service user. 99 Ashley Road DS0000012387.V368964.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents receive needed support with personal care and emotional/mental health needs. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: We saw that in the three files we sampled service users’ individual personal care needs are recorded in their care plans. Records of medical attention received and any outcomes are maintained on file. There was evidence of monitoring the service users’ needs and following up appointments with doctors, nurses, dentists and hospitals etc. The home accesses outside professionals where required. The manager said that the staff are trained to spot situations or triggers where service users are getting frustrated, angry or emotionally upset and support them as required. Critical health issues that need it are monitored on a daily basis such as seisure episodes and these are logged on daily monitoring sheets. Care Managers commented that the home communicates matters, keeping them informed of even the smallest thing, and ‘is one of the better units at 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 17 keeping them informed.’ ‘Communication is very good’. ‘They always communicate-it’s very good’. The home has a policy and procedure for administering medication and dealing with medicines. A member of staff showed us the system and location of the drugs and records. A record is maintained of current medication for each person and these were orderly and up-to-date. We were told that all staff are trained in the procedure for drug administration. We noted a laminated information sheet individually created for each person that was incorporated into the drug records, detailing the reason for each medecine and their effects and possible side effects. There were clear protocols for the administration of as required medication. We discussed with the manager the choice of support worker to service user in the area of personal care functions and he confirmed that where possible these preferences are respected and sensitively handled, such as in cross gender care. There was evidence of flexibility in getting up and retiring times, and guidance when prompting in personal care is needed. All of the residents have their own bedroom where people can be assisted in private. There are no ensuite facilities at 99 Ashley Road. However the home is amply supplied with two aided bathrooms on the ground floor plus a staff shower room with toilet and a further residents’ wc. On the first floor there are two bathrooms and one wc. 99 Ashley Road DS0000012387.V368964.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. 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. The service users have numerous avenues to express concerns/complaints and are listened to. They are protected from neglect or abuse by staff training and regular reviews. EVIDENCE: We were told that house meetings take place every week and the service users are asked if they have any complaints and are encouraged to talk about their views. This also happens at reviews and at key workers meetings and at any time that a service user would like to talk. The manager said that for service users who have difficulty in expressing themselves there are plenty of staff at 99 who have been with the home for some time and are able to spot difficulties or frustrations and can help them to express themselves in order to get their needs met. The home liaises with family and friends in order to access and utilise historical information that they wish to share with the service. Relevant information is recorded on support sheets. Issues are discussed at staff meetings each month and at handovers every day so that a consistency of approach is maintained and staff are aware of any current issues. The home has a complaints procedure that all staff are aware of, and all staff are trained in safeguarding of vulnerable adults (SOVA). There is a copy of the Hampshire County Council SOVA procedure in place as well as the companies 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 19 own Protection of Abuse procedure. There is a copy available of No Secrets and Valuing People. We spoke with three of the staff in private and they each expressed kind attitudes and good values about working in the care sector. They were aware of the potential for abuse in the residential sector and responded positively about challenging any poor or abusive practice. We saw that the Service Users have individual risk assessments regarding harm or abuse from others and were told that each have been given a copy of the complaints and abuse procedure. There is a simple format complaints procedure on the dining room notice board. In a quality assurance audit recently a service user said ‘if I have a complaint I can easily approach the staff’. Another said, ‘I can ask the staff if I have any problem or complaint and they try to sort it out for me’. Another said, ‘I can speak to the manager and deputy if I feel unhappy.’ The AQAA informed us that in the last 12 months there has been no formal complaint received about the service, one incident where restraint was used and one safeguarding incident that led into a staff disciplinary process. These incidents were discussed with the manager who was open and informative about the action for each one, and he confirmed a satisfactory conclusion had been reached. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a comfortable and safe environment, in normal domestic housing. The home is clean and hygienic. EVIDENCE: 99 Ashley Road is situated in a residential area and is a large house, suitable for its stated purpose and in keeping with the local community. It is free from any stigmatising signposting, and is accessible to all its service users. It is subject to inspection by the fire service and the environmental health department. The latter inspection took place recently and the resulting report was inspected. The manager confirmed that each of the requirements had been complied with. A partial tour of the premises took place, seeing in three bedrooms by invitation of the residents, the lounge, dining room, bathrooms and shower room, kitchen and past the laundry that was locked but the window in the door 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 21 enabled us to view the facilities. 99 Ashley Road is comfortable and homely. Two of the residents we spoke with said they liked the home. One was spoken with in his room and the air was very stale indicating the room may not have been ventilated for some time. He agreed to open a window and leave it open for a while. A survey return commented that, ‘the home is clean and homely’. Parts of the home have been recently redecorated and the manager confirmed there is an on-going programme of renewal and redecoration. We were told that the home has access to a trained maintenance man that deals with any maintenance issues. A part time cleaner is employed and a laundry assistant. Windows are openable with window restrictors on the first floor. The house was well aired and free from offensive odours. The laundry is well equipped with hand wash facilities and appropriate machinery. Access to the laundry is not through a food area. We saw that some of the furniture was worn and tired. The light cords in bathrooms and toilets are discoloured and the level of electric lighting in the hallways and stairs appears to be low. The manager explained that new light fittings have been purchased and are ready to be fitted which will improve the lighting. The walls are bare, lacking pictures and homely touches. We discussed this with the manager who explained about the issues of movable items and the potential hazard involved but recognised also and agreed that some ‘softening features’ can be fixed and made secure. The main window in the dining room was steamed up through the centre of the double-glazing and was functioning rather like a curtain and spoiling the view from the dining room into the garden. At the rear of the house there is a pleasant garden, with a swing seat and garden furniture. The front of the house is laid out for easy car parking. We observed that at times when most of the service users where at home the communal areas felt a little cramped, and the noise level rose. The mix of strong characters with raised voices and the essential presence of staff members made the house feel quite small for the number and needs of the people there. A stakeholder commented that the home can feel over crowded at times. The home has recently identified a need to change the transport provided to suit the changing needs of people living at the home. There have been two people carriers in use. The home has purchased a 12 seater transit which is being adapted for ease of access, and we were told that one of the people carriers will also be retained. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 22 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 34 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by the home’s recruitment practices, and benefit from competent, well supported and supervised staff. EVIDENCE: The daytime staff roster was seen in the office and normally involves four support workers on duty from 8 am to 10 pm. The manager is additional to the roster. At night from 10 pm to 8 am there is one member of staff sleeping in a bedroom dedicated for this purpose and a second member of staff on ‘awake’ duty. Currently there are thirteen staff members employed. Opportunity was taken to talk privately with three staff members. They confirmed that morale among the team was very good and that the staff group work very well together as a team. They were knowledgeable about the needs of the service users and expressed confidence in their ability to support where needed. They confirmed that supervision takes place regularly, is recorded and contributes to the training needs analysis. They said that the training relevant for their role is accessible to them. Staff said: 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 23 • • • • • ‘I can’t think of anything to improve’ ‘morale among the staff is very good, about 9 out of 10’ ‘I’d give the home 10 out of 10. I am really enjoying working here’. ‘yes, I think we are well supported’ ‘if there was anything I would like to see improve it is the size of the office as it is the hub of the place and is tiny’. • ‘more tailored courses would be good for the service users’. • ‘a better sleep in room would be nice!’ • ‘I would like to think of how to stimulate the service users to motivate them to experience a wider range of activities.’ Written surveys from the staff commented: • Our training is kept well up-to-date and relates to our job roles. • We support each other and give our service users good care and support in their daily lives. • This is a happy relaxed home to work in, with good supportive staff and happy service users. • Every month we always have a staff meeting. Any issues are discussed in the meeting to help improve the services we do. Anytime we can approach our manager. • The staff is very experienced. The standard of care is very good. We meet all the different needs of our service users. • We regard the service users as individuals and plan activities with them. • The provider gives us a good training-a good support coming from the company, right support and activities for the service users. • We have well trained staff and manager. We found that the personal staff records were available and kept securely in the office which is locked when not in use. Three staff records were inspected and found to contain all the necessary documentation. Files were indexed and orderly. Thorough recruitment processes had been followed. We were told that all staff have completed an induction period in the home, shadowing other staff before they lone work, and staff receive an annual appraisal and monthly supervision (following a standard agenda) with the registered manager. Staff surveys were 100 in agreement that all employment checks had been completed, that they knew what to do if they had concerns, that the training was relevant and covered diversity and equality. The home scored 83 on the staff always having the right experience, and 91 on always having enough staff, 91 on effective communication routes, and 91 on the comprehensive nature of the induction. Staff meetings are held monthly and are subject to the quality management process. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 24 Surveyed responses from the service users were 100 positive about the staff that they listen and act on what they say, and treat them well. One survey said, ‘the staff is good to me!’ All staff have received training in equal opportunities and anti-discriminatory practice and an Equal Opportunities policy is pursued by the Manager. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home that is client centred. Service users are aware their views are significant in the home’s functioning and its development. EVIDENCE: The registered manager has been in post for four years. He readily assisted throughout the inspection and was able to provide most of the information that was required in a knowledgeable, open and transparent way. He expressed familiarity and open mindedness around the issues of equality of opportunity and diversity. He is supported by a whole-time deputy who takes a lead on health and safety, the house and garden, and shares staff supervisions and appraisals. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 26 The AQAA informed us that monthly provider assessment visits by a senior manager are unannounced, comprehensive and are developing in a positive way according to the needs of the service and various matters that arise. The records from these regular monitoring visits (Regulation 26) and in-depth audits (2-3 times a year) were sampled. The home provides opportunities and positive encouragement for service users to voice their views on the running and management of the home in weekly house meetings when general issues including activities and meals are discussed. Minutes were available on the home’s notice board. As well as many formal feedback opportunities their views are heeded in a variety of ways including key worker contact, and informal suggestions. The AQAA states that in the last 12 months the home has introduced a robust Quality assessment management system that provides evidence of service performance, and this was seen on the day. Stakeholders commented that the manager expresses an open and cooperative attitude that is proactive in consultation and will ask advice. The home appears to be very helpful and flexible in its approach. Family members are reported to be happy about the home and confidant that their relative is cared for. In relation to general health and safety, none of the service users require direct assistance with moving and handling, although on-going monitoring of mobility is necessary. Risk assessments have been produced about identifiable hazards. We were told there are currently no control of infection issues. The home has up-to-date policies on: • Control of substances hazardous to health • First aid • Fire safety • Control, storage, disposal, recording & administration of medicines • Disclosure of abuse & bad practice (Whistle blowing) • Health and safety The AQAA states that risk assessments of the building are maintained by the manager, cared for by operational systems, and appropriate staff training. All fire checks including drills, gas checks, legionella and electrical testing are up to date and certificated. The Environmental Health Officer has inspected the home, and all staff are trained in Health and safety, Infection Control, Risk Assessment and Food handling. The accident book was inspected. All necessary notifications are made to the CSCI. 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 27 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 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 X 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? no 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 YA5 Regulation 17(2) Schedule 4. 8 Requirement A record of the care home’s charges to each service user and definition of what they purchase must be maintained in the care home and kept available for inspection. Timescale for action 17/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 99 Ashley Road DS0000012387.V368964.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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