Care Home: Ardsley House

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What the care home does well People said they were happy living at the home. Comments included: "I like it here" "I am happy with my home". People said they liked the staff and got on well with them. They said, "I like my keyworker, they help me a lot". "Staff are alright with us". "Staff are nice". "All staff are good to me in the home that I live in". "Happy with all staff and what they do for me". Some people had personal support plans that were very person centred and said how they wished to be supported. Staff had good knowledge of people`s personal support needs. Staff were positive about the training they had received. Comments included: "It was great, feel I learnt how to deal with conflict situations better". "We can request training and it is organised". What has improved since the last inspection? At our last inspection of the service we asked that people`s needs were reviewed and re-assessed to make sure the home could meet people`s needs properly. This has now been done and has involved the people who use the service and their care managers or social workers. This process has led to moves from the home for some people and has also identified where people`s needs have changed or increased. In response to this the service has requested additional funding from local authorities to provide additional staff when needed. People who live at the home were more positive about their choice of home and said a lot of the arguing that used to take place between people who live there had stopped. Comments included: "It`s a lot calmer here these days" "Things are a lot better now". There is now more choice of food available to people and alternatives if they do not like what is on the menu. Mealtimes are now arranged more flexibly to suit everyone`s needs. People who live at the home are now more aware of how to make a complaint if they are unhappy about something. They said they have their own copy of the complaints procedure and are now told the outcome of any complaint they make. In the AQAA, the manager told us of improvements that had been made to the environment of the home. She said, `We reviewed the dining area with the Area Manager to look at creating a more homely atmosphere at meal times and new dining room furniture has recently been purchased to make the dining area a more sociableevent. Enabling service users to sit wherever they wish at each meal time and not feel they need to sit on a table with people they may not wish to eat with everyday. Conservatory has now been reopened as a quiet area for service users to relax in. New carpets to the hallways and stairs have also been purchased to eliminate the odour that was present within the home. A hoist has been fitted within the home in the downstairs bathroom for a service user that now requires this. The entire house has had replacement windows throughout.` These improvements have made the home more homely and comfortable for the people who live there. There is a new manager at the home to provide leadership and support to staff and people who live there. Staff spoke positively of the support they had received from the manager. They said they now receive regular supervision meetings where they can discuss their role and responsibilities. They said they found the new manager approachable and that she listens to their suggestions. What the care home could do better: Work should continue on care plans and risk assessments to make sure people who use the service have detailed care plans and risk management plans, clearly outlining all their support needs. This will ensure that they receive person centred support that meets their needs fully. People`s health needs must be fully documented and monitored properly. This will make sure their needs are not missed or overlooked. People who live at the home should have plans in place to show how they want to be supported to develop their skills of independence. This will make sure their needs are more fully met. Some consideration should be given to how meals can be kept warm for people who take longer to eat them. This will make sure their meal remains appetising for them. Staffing levels must be kept under review to make sure that staff are available at Ardsley House to meet the needs of people who use the service. This will make sure their needs are fully met. They must also be reviewed to make sure there are enough staff available to provide support for activities and community activities. This will mean that people`s needs are better met. Safeguarding adults procedures must be followed at all times for all allegations of abuse and safeguarding adults and the CQC must be informed. This will make sure people are properly protected. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ardsley House 55a Royston Hill East Ardsley Wakefield West Yorkshire WF3 2HG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dawn Navesey     Date: 1 4 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Ardsley House 55a Royston Hill East Ardsley Wakefield West Yorkshire WF3 2HG 01924835220 01924872618 ardsley.house@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): J C Care Ltd Name of registered manager (if applicable) Mrs Linda Gander Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 16 The regjstered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability Code LD, maximum number of places: 16 Date of last inspection Brief description of the care home Ardsley House is owned by J C Care, which is a subsidiary of Craegmoor Health Care. The care home is registered to provide accommodation and care services for up to sixteen people who have a learning disability. However, two double bedrooms are being used for single occupancy, therefore fourteen people can live at Ardsley House at present. Two of the bedrooms have en-suite facilities, comprising of a toilet, hand washbasin and a shower. There are two communal bathrooms. Care Homes for Adults (18-65 years) Page 4 of 36 care home 16 Over 65 0 16 Brief description of the care home Ardsley House is situated on a busy main road. It is set back with gardens to three sides. There is a good range of local amenities and shops and the area is well served by public transport. The home is within easy reach of major motorway links. There is ample parking available to the front and the rear of the house. The home is spread over two floors. There is no passenger lift or level access to the home, however some ground floor bedrooms are available. Respite care is not provided in the home. The fees for living at the home ranges from three hundred and ninety eight pounds and seventy nine pence to one thousand one hundred and sixteen pounds and twenty five pence per week. Additional charges are made for chiropody, hairdresser, toiletries, horse riding, gym, magazines and holidays. This information was gained from the manager in May 2009. Care Homes for Adults (18-65 years) Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Care Quality Commission (CQC) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This visit was unannounced and was carried out by one inspector who was at the home from 13:15 - 19:20 on the 14 May 2009. Care Homes for Adults (18-65 years) Page 6 of 36 The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people living there. And also to monitor progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home manager before the visit to provide additional information. This was completed well and gave us the information we asked for. Survey forms were sent out to people living at the home, staff and health care professionals. None of these have been returned in time for the preparation of this report. During the visit a number of documents and records were looked at and some areas of the home used by the people living there were visited. Some time was spent with the people who live at the home, talking to them and interacting with them. Time was also spent talking to staff and the manager. Feedback at the end of the visit was given to the manager. The last inspection of this home was on 12 June 2008. What the care home does well: What has improved since the last inspection? At our last inspection of the service we asked that peoples needs were reviewed and re-assessed to make sure the home could meet peoples needs properly. This has now been done and has involved the people who use the service and their care managers or social workers. This process has led to moves from the home for some people and has also identified where peoples needs have changed or increased. In response to this the service has requested additional funding from local authorities to provide additional staff when needed. People who live at the home were more positive about their choice of home and said a lot of the arguing that used to take place between people who live there had stopped. Comments included: Its a lot calmer here these days Things are a lot better now. There is now more choice of food available to people and alternatives if they do not like what is on the menu. Mealtimes are now arranged more flexibly to suit everyones needs. People who live at the home are now more aware of how to make a complaint if they are unhappy about something. They said they have their own copy of the complaints procedure and are now told the outcome of any complaint they make. In the AQAA, the manager told us of improvements that had been made to the environment of the home. She said, We reviewed the dining area with the Area Manager to look at creating a more homely atmosphere at meal times and new dining room furniture has recently been purchased to make the dining area a more sociable Care Homes for Adults (18-65 years) Page 8 of 36 event. Enabling service users to sit wherever they wish at each meal time and not feel they need to sit on a table with people they may not wish to eat with everyday. Conservatory has now been reopened as a quiet area for service users to relax in. New carpets to the hallways and stairs have also been purchased to eliminate the odour that was present within the home. A hoist has been fitted within the home in the downstairs bathroom for a service user that now requires this. The entire house has had replacement windows throughout. These improvements have made the home more homely and comfortable for the people who live there. There is a new manager at the home to provide leadership and support to staff and people who live there. Staff spoke positively of the support they had received from the manager. They said they now receive regular supervision meetings where they can discuss their role and responsibilities. They said they found the new manager approachable and that she listens to their suggestions. What they could do better: Work should continue on care plans and risk assessments to make sure people who use the service have detailed care plans and risk management plans, clearly outlining all their support needs. This will ensure that they receive person centred support that meets their needs fully. Peoples health needs must be fully documented and monitored properly. This will make sure their needs are not missed or overlooked. People who live at the home should have plans in place to show how they want to be supported to develop their skills of independence. This will make sure their needs are more fully met. Some consideration should be given to how meals can be kept warm for people who take longer to eat them. This will make sure their meal remains appetising for them. Staffing levels must be kept under review to make sure that staff are available at Ardsley House to meet the needs of people who use the service. This will make sure their needs are fully met. They must also be reviewed to make sure there are enough staff available to provide support for activities and community activities. This will mean that peoples needs are better met. Safeguarding adults procedures must be followed at all times for all allegations of abuse and safeguarding adults and the CQC must be informed. This will make sure people are properly protected. Care Homes for Adults (18-65 years) Page 9 of 36 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: There have been no new admissions since our last inspection of the home. The home has an admissions procedure in place and in the AQQA the manager described how any new admissions to the service would be managed. The manager also said in the AQAA,There have been no new admissions to the service in the last 12 months however:At Ardsley House we can provide clear and up to date information to any prospective service user/representative about the service we provide at the time of receiving the enquiry. We have a comprehensive statement of purpose which details aims and objectives and our philosophy of care.The compatabililty of a new service user with existing service user of Ardsley House will alway be a main priority. At our last inspection of the service we asked that peoples needs were reviewed and re-assessed to make sure the home could meet peoples needs properly. This has now Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: been done and has involved the people who use the service and their care managers or social workers. This process has led to moves from the home for some people and has also identified where peoples needs have changed or increased. In response to this the service has requested additional funding from local authorities to provide additional staff when needed. Staff at the home are also in the process of reviewing peoples assessment information and developing care plans for any additional identified needs. In the AQAA, the manager said, We have commenced holding regular reviews with other MDT (Multidisciplinary team) professionals and any points raised by service users are reviewed and evaluations of care plans undertaken with the Service user. People who live at the home were more positive about their choice of home and said a lot of the arguing that used to take place between people who live there had stopped. Comments included: Its a lot calmer here these days Things are a lot better now. Care Homes for Adults (18-65 years) Page 13 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to make decisions about their lives and are involved in planning their care and support. Evidence: In the AQAA, the manager said, Each service user has a named key worker and is involved in developing an individualised person centred plan detailing current needs/goals/aspiration and staff intervention required. We have made more information about how to express needs and choices, service users are encouraged and supported to actively make decisions about their lives. Based on the above we are in the process of fully reviewing some of the original person centred plans to reflect the changing needs/opinions/abilities and goals of individuals. We looked at care plan and risk assessment records for some people who live at the home. We found them, in the main, to be person centred and individual to each person. Some plans had clear and detailed instruction on how the needs of people who Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: use the service are to be met. They had some good information about how people should be supported with personal care and communication needs. There were however, still some shortfalls with the care plans and risk assessments. Some plans did not give the detail of how care needs are carried out. Terms such as do silly things do not accurately describe someones behaviour and staff were not consistent in what they would do to manage the behaviour. This could lead to peoples needs being missed or overlooked. Some care plans had conflicting information on peoples support needs. For example, it was not clear if a person preferred a bath or a stand up wash. The manager said she has recognised that care plans and risk assessments still need more detail and is in the process of reviewing them with staff. People who use the service said they had been involved in developing their plans of care and support. One person said, I did mine with my keyworker. Plans were also signed by people who use the service to show they were in agreement with them. Staff were,in the main, familiar with what was written in peoples care plans and could talk confidently about the support they give. They had good knowledge of peoples individual support needs and could describe peoples routines well. People are encouraged to make choices and decisions about what they do. Staff said they encourage people to choose what to do, where to go out, what to eat and what to be involved in around the house. In the AQAA, the manager said, All service users at Ardsley House are supported and encouraged to take an active role in making decision and promoting their independence as much as possible. We saw people being offerred choices of what to do throughout the visit. People were also encouraged to plan for outings and chose where to go on shopping trips or days out. People who live at the home said they had regular meetings called Your Voice meetings where they are encouraged to have their say. A person who lives at the home is the homes representative for meetings within the organisation and attends them on behalf of others at the home. This person also attends staff meetings to make sure any information, suggestions or requests are communicated to the staff team. People said this worked well and they felt listened to. People are also supported to access advocacy services when needed. This is good practice and protects peoples interests. Care Homes for Adults (18-65 years) Page 15 of 36 Care Homes for Adults (18-65 years) Page 16 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make some choices about their lifestyle. In the main, social, educational, cultural and recreational activities meet peoples expectations. They also benefit from a good, healthy and varied diet. Evidence: In the AQAA, the manager said, We are continuing to develop individual programmes of weekly activities that reflect new personal choice and that will encourage/promote independence. These structured programmes are and will continue helping the service users to plan their days and include activities of daily living such as laundry, household chores and cooking. We looked at peoples support plans and did not see much evidence of how people are supported to develop their independence skills. We also talked to people about this Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: and in the main, they felt they did not get much opportunity to practice these skills. It is recommended that people who use the service have plans in place to show how they want to be supported to develop their skills of independence. We looked at activity records for some people who live at the home. These showed there were a variety of activities on offer to people, especially when the activities coordinater is on duty. These include, going to the gym, horse riding and creative activity in the day centre building in the homes grounds. There appeared to be less activity on offer to people when the activities co-ordinator was on holiday. Records showed that people were generally going on short trips out of the home to the local garage shop, the post office shop and walks around the garden. Staff said they did not at times feel they had enough staff to provide a decent level of activity for people. Their comments included: No people do not do enough. A lot of people need more motivation and encouragement to get involved and we dont have the staff to do that. Dont have enough staff really, especially when (names of the people) need one to one support. Lack of staff sometimes stops people from going out places. On the day of the visit, some people were supported to go out on short trips to the local shops. One person did some baking for staff. Others were watching TV or spending time in their rooms. Some people who use the service have been supported to find employment and said they really enjoyed this. Records also showed that some trips out to places of interest did not have enough staff to support people and meet their needs properly. People who need one to one support were not given this and the gender of staff available to people who may need personal support was not taken into consideration. This does not meet peoples needs properly. Staffing levels must now be reviewed to make sure there are enough staff available to provide support for activities and community activities. This will mean that peoples needs are better met. There was plenty of social interaction between the staff and people who use the service. It was clear that staff and people who use the service get on well. However, we noticed that staff referred to people as Mr or Miss and then their surname. It was not clear if this was their preferred term of address and if it wasnt then it did not respect peoples dignity and choice. This way of addressing people should be reviewed to make sure peoples preferred terms of address are used. Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: In the AQAA, the manager said, Meal times are encouraged to be relaxed and flexible to suit the service users schedules, they are consulted on the menus and variations or alternative meals are available. We looked at menus at the home. These are planned around peoples likes and dislikes. Staff said they can always make an alternative to what is being cooked if people dont like it and snacks are readily available. Staff record what is eaten. People who use the service said the menus and available choice was much improved and that they could now have breakfast at whatever time they got up. The kitchen at the home is still kept locked for safety reasons. This has been risk assessed and shows all people who live at the home are in agreement with this. One person said, Its not a problem, means its safer for (names of the people). However, improvements have been made in that cold drinks and snacks are available in the dining area for people to help themselves to. Warm drinks are offerred regularly to people too. Some people need some support with their meals. We saw staff offer this discreetly and in an encouraging manner. One person who can take some time to eat their meal was given staff support. However, due to the time it can take the persons meal can become cold. Some consideration should be given to how this persons meals can be kept warm and therefore remain appetising. People who live at the home spoke highly of the food. One person said, Its beautiful. Another said, Its always very nice. Care Homes for Adults (18-65 years) Page 19 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples general healthcare needs are, in the main, well met and based upon their individual needs. They must however, be monitored better. Evidence: In the AQAA, the manager said, All service users have a person centred care plan in line with the company policies and procedures which is based on the pre assessment but is expanded upon with the involvement of the service users or their representative.Within this person centred plan is an individual Health Action Plan completed with the service user, the service users GP for historical medical information, families and other health professionals involved in their support. All service users have access to the NHS services and other medical professionals dentist, chiropodist, community learning disability nurses, opticians, hairdressers and appointments are made on a regular basis or when required staff support service users to attend any out patients appointments.We have ensured that no health appointments are missed and follow- up appointments are made and service users are supported to understand the reason for the appointments. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: The importance of privacy and dignity are reinforced through our induction process and NVQ training and within the person centred plans. Despite the gaps in care planning as mentioned in the individual needs and choices section of this report, staff had good knowledge of peoples personal support needs. Staff were thoughtful, discreet and respectful of peoples dignity when attending to any needs. People who live at the home looked well cared for, well dressed and groomed. Good records are kept of health appointments and their outcomes. Staff make sure that people are given support to attend appointments to meet their health needs. People are referred to health professionals when needed. For example, dieticians, physiotherapists and community nurses. However, staffs knowledge on some peoples medical conditions was lacking. Staff did not know the effects of a persons condition on them and why they took medication for this particular condition. The persons records did not say what the persons condition was and the home manager was not aware of it. This could lead to the persons needs being missed or overlooked and their on-going needs as part of the condition not being recognised or monitored. Also, staff could not say how people who required support with bowel management were given this. They were unable to consistently say how they would know someone had a problem with constipation and records showed that this condition was not being monitored through any recording system or care plan. This leaves the person at risk from having their needs missed. Peoples health needs must be fully documented and monitored properly to make sure their needs are being met fully. Staff said they had received some training on meeting the specialist health needs of people who use the service such as dementia, epilepsy and autism. One said they were looking forward to some planned further training on dementia, which they had been told was a full days course and would be more in depth than what they had done previously. In the AQAA, the manager said, Ardsley House has a full and comprehensive medication polices and staff receive full accredited training before administration of medication and a competency assessment is completed following this training and reviewed on a regular basis. Medication errors are reported appropriately where applicable and a medication error evaluation form is completed as part of an investigation in to the error in order for us to learn from the mistake and promote openness amongst the team. Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: We have ensured all staff are trained in the administration of medication and that competency assessments are conducted. We have improved the systems around administration of medication by allocating a Senior Support Worker responsibility for improving the layout of the MAR sheets in the file and putting them in alphabetical order rather than as previously seen in room number order which caused confusion in the administration. The home uses a monitored dosage pre-packed system for medicines. There are good ordering and checking systems in place. We checked some medication administration records (MAR) sheets. These were found to be in good order. Staff said they did not administer medication unless they had been trained to do so. Care Homes for Adults (18-65 years) Page 22 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns but are not always protected from abuse. Evidence: In the AQAA, the manager said, We are able to listen and act upon all complaints openly and transparently. All staff are aware of the complaints policy. Service user your voice meetings provide a forum to allow complaints and concerns to be aired. An easy read complaints procedure is available in our service user guides. We monitor complaints regularly and keep record of a monthly check on complaints held in Home Managers office. This includes copies of relevant investigations and outcomes of each complaint. When we asked how the service had improved, the manager said in the AQAA, Complaints are dealt with immediately and the manager ensures that complaints are reported to the Area Manager and the complaints manager at Craegmoor. The complaints procedure for the company has recently been revised and we now have a complaints manager who monitors complaints and ensures relevant and appropriate action is taken. People who use the service said they now had a copy of the complaints procedure. One Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: said, I have my own copy and staff have gone through it with me. They also said they received a letter as follow up to any complaints made, telling them how their complaint had been dealt with. In the AQAA, the manager also told us, All staff undertake regular Safeguarding Adults training with annual updates - the compliance of our training is reviewed by the Area Manager on a monthly basis to ensure compliance is maintained to ensure service users are protected from abuse, neglect and self-harm. Staff are appropriately trained in the management of de-escalation and breakaway techniques in order to support service users and maintain everyones welfare and prevent risk of harm. We have implemented a de-brief form to be completed following incidents of violence/aggression to enable us as a staff team to reflect on incidents, triggers and ways we could better deal with incidents to prevent re-occurrence. She also said she was planning to make improvements to the service, saying they are planning To complete a SGA(Safeguarding adults) assessment of incidents monthly per service users to assist with understanding whether action taken to prevent reoccurrence has been positive in reducing incidents and what additional action may be required. Staff were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe the different types of abuse. Some were familiar with the whistle blowing procedure and said they would have no hesitation in using it if they thought they needed to raise concerns outside of the home or organisation. There have been a large number of safeguarding adults incidents in the service since the last inspection. These have been properly reported and acted upon. For example, one to one staffing is provided for someone whose behaviour can be a risk to others. However, on the day of the visit, it came to light that a serious allegation had been made that put people who use the service at risk. This allegation was under investigation by the manager but no plans had been put in place to protect the people involved. Action was taken on the day of the visit to make sure people were protected and that the matter was reported properly. The delay in taking action, had however, put people who use the service at risk. Safeguarding adults procedures must be followed at all times for all allegations of abuse and safeguarding adults and the CQC must be informed. This will make sure people are properly protected. Records are kept of the finances of people who live at the home and their monies are kept safe. Care Homes for Adults (18-65 years) Page 24 of 36 Care Homes for Adults (18-65 years) Page 25 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is homely, comfortable and safe for people who live at the home. Evidence: In the AQAA, the manager told us of improvements that had been made at the home. She said, We reviewed the dining area with the Area Manager to look at creating a more homely atmosphere at meal times and new dining room furniture has recently been purchased to make the dining area a more sociable event. Enabling service users to sit wherever they wish at each meal time and not feel they need to sit on a table with people they may not wish to eat with everyday. Conservatory has now been reopened as a quiet area for service users to relax in. New carpets to the hallways and stairs have also been purchased to eliminate the odour that was present within the home. A hoist has been fitted within the home in the downstairs bathroom for a service user that now requires this. The entire house has had replacement windows throughout. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: These improvements have made the home more homely and comfortable for the people who live there. The manager also said in the AQAA, Service users are encouraged to choose their own furniture and can decorate and personalise their rooms as they wish service users are involved in decisions about the decoration and are encouraged to create their own pictures to decorate the home. Daily checks are carried out to maintain the cleanliness of the home and contractors complete services when required. We have a Health and Safety committee who meet every three months to discuss environmental issues and ongoing improvements to the home. A service user representative also attends these meetings. A tour of the home was carried out. Communal areas, bathrooms and bedrooms were visited. The home looked clean, homely and well maintained. Clinical waste is properly managed. Staff have received training in infection control as part of their induction and were able to say what other infection control measures are in place. Hand washing and hand drying facilities were available in all areas of the home. Liquid soap or paper towels were available. This ensures good hygiene practice. One staff member said that protective gloves were no longer available in peoples rooms and were now stored in a cupboard in the corridor. This practice should be reviewed to make sure staff have protective equipment available to them when they need it. Care Homes for Adults (18-65 years) Page 27 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained and competent to meet the needs of the people who use the service but there are not enough staff at times to meet peoples needs properly. People are protected by the homes recruitment procedures. Evidence: People who use the service spoke highly of the staff. They said, I like my keyworker, they help me a lot. Staff are alright with us. Staff are nice. All staff are good to me in the home that I live in. Happy with all staff and what they do for me. One person said, Some of the staff do not respect me but others do. People who do not use verbal communication smiled and looked happy when we asked if they got on well with staff. In the AQAA, the manager said, We are now currently fully staffed within the home, and staffing levels have increased from 3 to 4 staff on shift throughout the day with one of the staff members being a senior support worker. The home no longer uses Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: agency to provide support staff. The home has a stable bank of staff who all know the services users and are trained in the same as regular staff. However, we looked at rotas and saw that the 4th staff member on shift works some of their shift in the adjacent registered home Ardsley Cottage. We pointed out to the manager that this arrangement does not meet the needs of the people at Ardsley House. There are occasions when there are only 3 staff available to the people who live at the home and at times two of the people need one to one support which leaves only 1 staff for others who live at the home. Staff also said they did not feel they have enough staff at times to meet peoples needs properly. Their comments included: We manage but its busy on a morning, getting people up and laundry and things to do as well. Enough I suppose, but there are occasions when we need an extra pair of hands, especially when there is an incident and people need more support. As mentioned in the Lifestyle section of this report, staff did not feel they had enough staff to provide a good level of activity. The manager said they were in the process of applying for extra funding for some people who use the service as their needs had changed. On the day of the visit, the manager made arrangements for staffing levels to be increased to make sure there were 5 staff on duty at Ardsley House. We requested that a copy of the new rota was sent to us. Staffing levels must be kept under review to make sure the needs of people who use the service are properly met. In the AQAA, the manager also said, We have robust recruitment policies and procedures that are implemented at point of interest from a potential candidate. We have a thorough interview and selection process in order to short list candidates. We involve service users in supporting the Home Manager to show potential candidates around their home and gain feedback where able in order to make decisions about appointments. We looked at recruitment records These showed that recruitment is properly managed by the home; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. Induction training is based on the Skills for Care common induction standards. Staff said their induction had been good and prepared them well for their job. One said, I really enjoyed it and after the training I feel as if I get it now. Staff said they worked alongside experienced staff to get to know the needs of the people who use the Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: service. We also looked at training records and these showed that most staffs training was up to date or if updates were needed, they were planned. Staff were positive about the training they had received. Comments included: It was great, feel I learnt how to deal with conflict situations better. We can request training and it is organised. Some staff have achieved an NVQ (National Vocational Qualification) in care at level 2 or above. This means they are qualified to carry out their job. The manager told us that others are due to commence this once they have finished their induction. Care Homes for Adults (18-65 years) Page 30 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is overall well managed, the interests of the people who use the service are seen as important to the manager and staff and are, in the main, properly safeguarded. Evidence: In the AQAA, the manager said, The Home Manager is skilled and experienced to enable her and staff team to meet the needs of service user and support the staff team and has sound knowledge of meeting the stated aims and objectives of the service. The Manager is currently processing her CSCI (Commission for Social Care Inspection) (now CQC) Registered Managers application and is going to commence her Registered Managers Award to improve on her knowledge and ensure Best Practice continues on completion of her probationary period. The Home Manager operates an open door policy and is always available to support Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: and advise both service users and staff.The home is managed in an open and transparent way and the Home Manager is committed to providing positive leadership and a relaxed atmosphere. The manager is new since our last inspection of the service. She has 5 years experience of working with people who have a learning disabilty. She has achieved an NVQ (National Vocational Qualification) in care at level 2 and as mentioned above is due to commence the registered managers award. Staff spoke positively of the support they had received from the manager. They said they now receive regular supervision meetings where they can discuss their role and responsibilities. They said they found the new manager approachable and that she listens to their suggestions. Records we looked at showed that regular health and safety checks are carried out. In the AQAA the manager said relevant health and safety policies and procedures were in place, and reviewed. They also said equipment has been serviced or tested as recommended by the manufacturer or regulatory body. Records showed that certificates on gas and electrical safety were up to date. The organisation provides a comprehensive manual of policies and procedures for staff to refer to. We looked at accident reporting and spoke to staff about this. Staff were clear on their responsibilites and how to report and record accidents or incidents. The manager usually makes sure that the CQC is informed of any events that affect peoples welfare. However, as mentioned in the Concerns and Complaints section of this report this had not happened concerning an event that became apparent on the day of our visit. The organisations area manager conducts monthly provider reports with detailed requirements for improvement. The manager receives regular supervision from the area manager to support her in her role. The organisation seeks the views of people who use the service by sending out a questionnaire so that they can get feedback on how people think the service can improve. We looked at some of the questionnaires returned. They were overall, very positive about the service. The manager said she is planning to now extend this to include relatives of people who live at the home and any visiting health or social care professionals, to gain their views on how the service can improve. Care Homes for Adults (18-65 years) Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 18 Staffing levels must now be 01/06/2009 reviewed to make sure there are enough staff available to provide support for activities and community activities. This will mean that peoples needs are better met. 2 19 12 Peoples health needs must be fully documented and monitored properly. This will make sure their needs are not missed or overlooked. 30/06/2009 3 23 13 Safeguarding adults 01/06/2009 procedures must be followed at all times for all allegations of abuse and safeguarding adults and the CQC must be informed. This will make sure people are properly protected. 4 33 18 Staffing levels must be kept under review to make sure that staff are available at Ardsley House to meet the 01/06/2009 Care Homes for Adults (18-65 years) Page 34 of 36 needs of people who use the service. This will make sure their needs are fully met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 People who use the service should have detailed care plans and risk management plans, clearly outlining all their support needs. This will ensure that they receive person centred support that meets their needs fully. People who live at the home should have plans in place to show how they want to be supported to develop their skills of independence. This will make sure their needs are more fully met. Some consideration should be given to how meals can be kept warm for people who take longer to eat them. This will make sure their meal remains appetising for them. 2 11 3 17 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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