Care Home: Ascot Villa

What the care home does well People are provided with a homely living environment so they are comfortable and safe in their surroundings. People are supported to choose daily what they would like to eat. People are supported to develop their independent living skills by taking part in household tasks. People are supported to keep in touch with their family so they maintain relationships that are important to them. Health and safety is well managed ensuring peoples safety. What has improved since the last inspection? Recruitment practice has improved so that only staff suitable to work with vulnerable people are employed to work in the Home. Double glazing windows have been fitted throughout the flat so it is warm and secure for people. What the care home could do better: Risk assessments needed some additional information so peoples well being and safety is promoted. Health action plans should include how health care needs will be met. A manager should be registered for this Home so it can continue to be developed in the best interest of people living there. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ascot Villa 13 Ascot Road Moseley Birmingham West Midlands B13 9EN     The quality rating for this care home is:   two star good 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: Donna Ahern     Date: 2 1 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 28 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 28 Information about the care home Name of care home: Address: Ascot Villa 13 Ascot Road Moseley Birmingham West Midlands B13 9EN 01214499845 01212478760 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dr Kandiah Somasundara Rajah care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The maximum number of service users who can be accommodated is: 3 The registered 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 categories: Learning disability (LD) 3 Date of last inspection Brief description of the care home Ascot Villa is situated on the ground floor of a three storey Victorian house in a quiet cul-de-sac in Moseley. The upper floors of the property are let to private tenants. There are three single bedrooms, one of which has an en suite, one lounge/dining room and a small kitchen. There is one bathroom with a WC, bath and overhead shower. There is an office. The laundry is situated within a small room off the lounge. To the rear of the property there is a garden. The home provides care and accommodation to three adults who have a learning disability, autism spectrum disorders and challenging behaviour. The fees charged start from Seven hundred pounds per week. Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home There is a range of information available on display for people living in the Home or visitors to read. The last inspection report was on display, and this enables people to access this information if they choose to read it. Care Homes for Adults (18-65 years) Page 5 of 28 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: two star good 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 focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. One inspector carried out this inspection over one day; the Home did not know we, the commission were going to visit. The previous inspection to this Home took place on 23rd May 2007 and an annual service review of the Home took place on 16th July 2008. One person was living at the home at the time of our visit. We case tracked this Care Homes for Adults (18-65 years) Page 6 of 28 persons care. This involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Time was spent observing care practices, interaction and support from staff. We spoke to the manager and two staff. We looked around some parts of the Home to make sure it was warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think they are doing well and where they need to improve. It also gives us some numerical information about staff and people living at the home. We also looked at notifications received from the home. These are reports about things that have happened in the home that the Home must tell us about. What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 28 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 9 of 28 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. Prospective people and their relatives would have the information they need to know so they can make an informed choice about whether they want to live at the Home. Evidence: We saw the certificate of registration on display in the hallway. One person was living there at the time of the visit. The person had lived at the Home for several years so it was not possible to assess the pre admission process. We saw that a detailed pre admission procedure is in place and if followed should ensure that full assessments are completed prior to any admissions. The service user guide and statement of purpose tell people what they can expect from the home and had been written in a style that is easier for the people living there to understand. We saw that the statement of purpose was in the process of being updated to include management and staffing changes. Care Homes for Adults (18-65 years) Page 10 of 28 Care Homes for Adults (18-65 years) Page 11 of 28 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. Staff have the information they need and a good understanding of how to offer care and support to each person, which should ensure peoples needs are met in a way they prefer. Evidence: We looked at the persons care plan. Care plans explain what each person needs are and the care and support they require to make sure these needs are met. The files looked at had a detailed profile on the person and had information about how staff should support the person in order to meet their individual needs in relation to personal care, communication, health care, social activities, likes and dislikes. We spoke to members of staff who support people we also observed the person being supported by staff. The staff demonstrated knowledge of peoples individual needs which was consistent with the information on peoples file. This indicates that staff know how to provide care and support to people so their needs are understood and Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: met. We saw minutes of care reviews which involve a range of professionals who meet with the person to ensure their needs continue to be met at the Home and that they continue to get the support of other professionals. We saw risk assessments, which had just been up dated and were about to be put on the persons file. We talked to the manager about these to ensure they detail the support people need to be safe whilst still being enabled to be independent. The risk assessment in place to support the person accessing the community independently needed some further information so it is clear at what point staff would become concerned about their personal safety and what steps staff would take to address this. Care Homes for Adults (18-65 years) Page 13 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the Home experience a lifestyle that promotes their independence and is reflective of individual needs and interests. Evidence: We looked at care plans and daily records to establish that people are leading meaningful lifestyles and taking part in activities that they enjoy. We also spoke to two staff members and observed care and support on the day. Care plans detail what the person likes to do. They enjoy going for walks, shopping, taking part in light household tasks, watching television and have an interest in electrical items in general and will visit electrical stores to pursue this interest. We were told that different educational and training opportunities have been explored but the person did not want to take part in these. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: The Person was relaxed in their home environment. There are no other people living there at the moment so the routines of the Home are very much based around the needs of the individual. They seemed relaxed and freely accessed all areas of the home choosing to go to their own bedroom, the kitchen or sitting in the communal lounge. We looked at care plans and spoke to staff to establish that the person is asked what they want to do. We saw that nighttime recordings indicated that the person is supported to stay up late to watch a television programme and often goes to bed after midnight recordings such as made self toast and fried egg went to bed at 1.50 am were seen. We did see that a lot of the recordings although detailed, indicated that the days are very similar for the person with little variety. We were informed that this is the choice of the individual living there. People are supported to maintain close links with their family. We could see that people are asked about how often and when that contact should be. We spoke to staff about this and they recognise the importance of maintaining links with peoples family and friends. We saw that tinned, frozen and supplies of fresh food were available. We were told that the person chooses each day what they want to eat. A lot of shopping is done at the local shop which the person likes to do most days. This means choice of food and eating times can be flexible. Staff said they record what the person eats on the daily records so they can ensure a healthy diet is provided. Environmental health had carried out an inspection of the kitchen and storage areas and had awarded a five star which means food is stored and prepared in a hygienic and safe manner. We saw and brought to the managers attention that some areas of the kitchen needed a clean to ensure good standards of hygiene are maintained. Care Homes for Adults (18-65 years) Page 15 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective systems in place to meet peoples personal and health care needs. Evidence: Care plans looked at had good detail about how to meet peoples personal care needs. There was information about how much support people required from staff and also detailed how people should be encouraged to do as much for themselves in order to maintain their independence. We saw that people were dressed in age appropriate clothing and people were well groomed, this indicates that people are supported to maintain a good self-image. We saw that each person has a Health Action Plan in place but these consisted of health statements and had not been made into an active document. We recommended that these should detail the health care needs of an individual and the support they receive to meet these needs. We could see from reading recordings of contact with professionals and talking to staff that people were receiving the input they require from health care professionals. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Medication is stored in a locked cabinet in the office. The cupboard was found to be clean, tidy and well ordered. The Medication Administration Records (MAR) had been signed for indicating medication had been given as required. Copies of prescriptions are retained so that staff can check the right medication has been received from the chemist. There were no controlled drugs. None of the people self-administered their medication. The AQAA informed us that staff have had training in the safe handling of medication. The Home aims to encourage people to take more control over their medication. Care Homes for Adults (18-65 years) Page 17 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective systems in place to listen to and respond to complaints about the service. Arrangements are in place so people should be protected from harm. Evidence: The complaints procedure was available on display in the hallway. We have not received any complaints about this Home and no complaints have been made directly to the service since our last visit. Staff spoken with to demonstrated a general understanding of their duty to safeguard people and how to report concerns on to senior managers. The adult protection guidelines were in the process of being reviewed and renamed safeguarding so staff have up to date procedures to follow. Whistle blowing procedures were also available for staff to refer to. We looked at training records to determine that training in safeguarding vulnerable adults had been provided. Consideration should be given to discussing safeguarding and whistle blowing procedures in staff meetings to ensure that knowledge and understanding in this area is constantly checked. The AQAA informed us that a new inventory form has been introduced and this is signed by the person and a staff member. We saw Inventories of peoples belongings on their case files. This should ensure that peoples personal items are protected. We saw records of expenditure of personal Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: money. Care Homes for Adults (18-65 years) Page 19 of 28 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. People live in a clean, safe and comfortable home, which promotes their well being, and meets the assessed needs of people. Evidence: Ascot Villa is a ground floor flat accessed via a communal hallway. There is a narrow hallway that leads to communal rooms and peoples bedrooms. The home would not be suitable for people who use a wheelchair as there is limited space to move around. The bathroom is domestic in layout with limited space for people to move about. We were told that a new bath panel will be fitted soon to improve the standards in the bathroom. There is a combined lounge dining room. One of the bedrooms leads directly off this area but was unoccupied at the time of the visit. The kitchen has limited space, additional storage for food is provided in a cupboard off the hallway. Staff told us that people had been supported to personalise their bedrooms. The bedroom we looked at was spacious and had lots of personal items. The two unoccupied bedrooms also provide spacious facilities. One of the bedrooms has an en Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: suite facility which should ensure enhanced privacy for the occupant. The AQAA informed us that new double-glazing has been fitted throughout the Home since our last visit which improves the standards for people living there. Care Homes for Adults (18-65 years) Page 21 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practice is robust and protects the people who live there. Staff receive the support they need to do their job. Evidence: We watched the way that people interacted with staff on duty, which indicated that good relationships exist between people living there and the staff supporting them. We looked at the staffing rota for the week of the visit and the previous week. These showed that there is usually two staff on duty during the day and one person in the evening and during the night. The manager works mainly 9-5 and provides hands on care when required. She is also responsible for the registered home next door so she works between both houses. We asked about emergency measures and back up for staff who may be working alone. We were advised that this is provided by staff in the registered home next door and out of hours the manager and owner is on call. We spoke to two staff during this visit who demonstrated that they had a good understanding of peoples individual needs. We spoke to staff about the training they had received and they said that they had Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: completed training in mandatory areas including safeguarding, medication, health and safety, first aid and fire. We looked at the staff training matrix, which confirmed mandatory training had taken place but many areas now require updates. We saw a training scheduled with updates planned through May, June and July. This should ensure that staff continue to have the up to date knowledge and skills required to meet peoples individual needs. We looked at staff recruitment records for the two most recently employed people. We requested that for one person up to date information of their work permit arrangements were provided and evidence kept that they only work the required hours. This information was sent to us shortly after the visit. It is recommended that systems are reviewed to ensure that all of the information needed is available in the Home. Criminal Records Bureau checks (CRB) had been made and written references received before employees began work so that people were protected from the risk of having unsuitable staff work in the Home with them. We advised that the manager familarised herself with the guidance on CRB checks (for new and employed staff) to ensure the Home continues to operate thorough recruitment practice and policy. Staff told us that they receive regular supervision with the manager. This was confirmed by looking at records and ensures staff have the opportunity to reflect on their practice and consider their individual training needs. Regular staff meetings take place, which provide an opportunity for staff to discuss good practice and development issues. The manager said the frequency of these had dropped a little but monthly meeting are now scheduled to take place. The AQAA informed us that 5 of the 6 staff have achieved a National Vocational Qualification in care. This should contribute towards ensuring that the staff team have effective knowledge of social care. Care Homes for Adults (18-65 years) Page 23 of 28 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. Arrangements in place ensure the well being of people living in the Home. Evidence: The manager has several years experience of working with people who have a learning disability. She has been the deputy manager at Ascot Villa for five years and the acting manager since October 2008. She said that she would be making an application to register as the manager with CQC. The manager assisted us with the inspection process. She was open and welcoming and demonstrated a commitment to continue to improve standards for people. The requirements we made in the last inspection report had been met which demonstrated a commitment to comply with the regulations. There are quality assurance systems in place including an auditing system. An independent consultant carries out monthly visit to the home to monitor and report on standards. Reports are available of these visits. Reports seen were detailed and should Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: ensure that the provider takes responsibility for monitoring the Home. We saw that systems are in place for the recording and reporting of accidents and incidents to the commission. We looked at some health and safety records including fire records, water temperature checks and general risk assessments. The systems in place that we seen for monitoring health and safety are generally thorough and should ensure peoples health and safety are promoted. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 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 9 Additional information should be added to the risk assessment in place for access to the community so peoples safety and well being is promoted. Health action plans should be active documents that detail the health care support given and ensure health care needs are well met. Consideration should be given to discussing the safeguarding and whistleblowing procedures in staff meetings so knowledge and understanding is constantly checked. Systems in place for recruitment should be looked at so that all the information needed is up to date and available in the Home. An application to register a manager should be made so the Home can continue to be run and developed in the best interest of people living in the Home. 2 19 3 23 4 34 5 37 Care Homes for Adults (18-65 years) Page 27 of 28 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. 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. 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