Care Home: Ash-Leigh House

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What the care home does well Staff were kind, friendly and caring. The staff team was small and changed very little. This meant people who lived in the home and staff got to know each other very well. People lived in a safe, clean, comfortable home.Ashleigh HouseDS0000073275.V378091.R01.S.docVersion 5.3 What has improved since the last inspection? The home looked better with a new carpet in the hall, stairs and landing. What the care home could do better: To help the manager decide if the home was right for a new person who wanted to live or stay there (and to make sure they would get the help they needed and wanted), better information was needed about them. To make sure people living in the home were getting the help they wanted to keep busy and do activities; new ideas should still be tried. Medicine records needed to be better to make sure medicines were given as prescribed by the doctor and so people living in the home who looked after their own medicines got the right help. To make sure staff got the help they needed to do their jobs and worked well as a team, yearly appraisals needed to re-start, training kept up to date and shift patterns looked at. To keep people who lived in the home safe, new staff needed to be recruited properly. To help the manager do her job well, she should be given time to do her management work. To make sure private records were looked after properly, they should be kept tidily and securely. To keep everyone safe, a record of any false fire alarms should be kept, with action taken quickly to sort them out. Key inspection report CARE HOME ADULTS 18-65 Ashleigh House Ashleigh House 2 Belgrave Crescent Eccles Manchester M30 9AE Lead Inspector Sarah Tomlinson Key Unannounced Inspection 15th October 2009 09:30 Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Ashleigh House Address Ashleigh House 2 Belgrave Crescent Eccles Manchester M30 9AE 0161 950 2721 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashley Smith Ms Serena Kirsty Williams Mrs Jacqueline Lingard Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only- Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia- Code MD The maximum number of people who can be accommodated is: Date of last inspection 12th June 2008 Brief Description of the Service: Ashleigh House is a private care home, registered with us (the Care Quality Commission) to provide care for up to 10 adults with mental health needs. Ashleigh House is a converted, Victorian semi-detached house. It has two floors. There are two lounges, a kitchen/dining room and a conservatory where smoking is permitted. There are 10 single bedrooms, 2 on the ground floor and 8 on the first floor. None are en-suite. There is a bathroom with a toilet, a shower room with a toilet and a further separate toilet on the first floor. There is a toilet on the ground floor. The home has a garden at the rear and a hard standing, tarmac area at the front for parking. The home is in a residential area of Salford, within walking distance of Eccles town centre. The current weekly fee is £351.01 (hairdressing, toiletries and social trips are extra). A copy of our latest inspection report is available from the home. 10 Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Our inspection, which the home was not told about beforehand, took place over 1 day (lasting 8.5 hours). It was carried out by one inspector. (References to ‘we’ or ‘our’ in this report mean the Care Quality Commission). During our visit we met 8 people who lived in the home and spent time talking with 5 of them. We watched how staff cared for them. We also looked around parts of the building and at some paperwork. We talked with 1 relative, 2 staff (a support worker and the deputy) and both joint owners. The manager was off sick. We have also used information from an Annual Quality Assurance Assessment form (AQAA). The home has to complete this each year. It includes information about what they think they do well, what they would like to do better and what they have improved upon since our last visit. This inspection was carried out as there had been a change in the home’s owners. Mr Ashley Smith and Ms Susan Kenyon used to be joint owners. Mr Ashley Smith now owned the home with Ms Serena Williams. There had also been a minor change in the spelling of the home’s name, from ‘Ash-leigh House’ to ‘Ashleigh House’. The manager, Mrs Jackie Lingard, had not changed. What the service does well: Staff were kind, friendly and caring. The staff team was small and changed very little. This meant people who lived in the home and staff got to know each other very well. People lived in a safe, clean, comfortable home. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 6 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 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. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Insufficient information about the needs of a new person staying at the home put at risk the manager’s ability to make a safe and informed admission decision and the staff team’s ability to understand and meet their needs. EVIDENCE: Nine people lived in the home on a permanent basis, with one other person staying for respite care at the time of our visit. We looked at how the manager found out about the help and support needed by new people who wanted to live or stay in the home. We were concerned about the admission process for the person staying for respite care. There was very little information to guide staff about the help and support they needed or wanted. Initially arranged at short notice, this person was now nearing the end of their stay. Information received prior to their admission had been nearly a year old, with no more up to date information obtained afterwards. No care plan had been developed with them by the manager or staff team either (showing their care needs and any risk issues or potential restrictions had been discussed and agreed). Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people living in the home were at risk of not being met as care records needed to provide staff with clearer guidance about agreed support plans and any risk management strategies. EVIDENCE: The deputy was generally very knowledgeable about the needs and associated risk issues (and how to manage or reduce these) of people living in the home. However, the 3 care files we looked at did not support this. Information about the help needed and wanted was difficult to find. As noted, one person’s file had no information at all about how staff were to look after them during their stay. The two other files we looked at had monthly review information. However, this did not describe what the person’s actual agreed care needs were and how they being met. For example, whilst Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 10 one person had a number of physical and intimate personal care needs, their personal care review information had only a general statement about staff being available for assistance, with no information about what actual assistance had been agreed. As a specialist mental health home, clear information about the mental health needs of people living in the home was needed. For example, if a person heard distressing, critical voices this should be recorded, with guidance about what they found helpful to manage these. Information about any known triggers or previous relapse indicators should also be included. These would help staff identify early signs of ill health, allowing preventative action to be taken. Any risk management decisions agreed to safeguard a person living in the home needed to be clearly recorded (in accordance with the Mental Capacity Act) and regularly reviewed. For example, if a person living in the home needed a staff escort when outside. To encourage the involvement and commitment of people living in the home, care plans should also include a positive focus, with people’s goals also included. The language used should be their own where possible. It should also be positive, respectful and easily understood. Staff completed individual daily reports regarding the health and wellbeing of the people who lived in the home. These varied in quality. There was regular use of the phrase “n/p”, meaning “no problem”. Abbreviations should not be used as they can be misunderstood. This phrase was also rather negative and gave no indication of whether the care being given was working. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 15, 16 and 17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily routines were flexible. Improvements in leisure, social and domestic activities would help people living in the home lead more fulfilling lives in and outside the home. EVIDENCE: With regard to daily routines, one person living in the home was out each day, some people attended day centres and some were retired. Most people living at Ashleigh House led unstructured lives, spending their time around the home. We discussed ways of ensuring the people who lived in the home were supported to lead stimulating and meaningful lives. This could include regular 1 to 1 time between a person and their key worker (both in the home and out Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 12 in the community). This time could be protected and promoted by being identified on the staff rota. Whilst staff shifts would permit this time outside the home during the day, this would not be possible in the evenings as only 1 staff member worked after 5pm. Opportunities to maintain and develop practical life skills varied. The people who lived in the home had their laundry done by staff as the washing machine and tumble dryer were in the cellar (with difficult access via very steep steps). All the housework and cleaning of communal areas was done by staff, with people’s rooms also mostly done by staff. With regard to food shopping and cooking, the joint owner did the main food shop, although two people who lived in the home helped staff to buy additional smaller items on a Friday. Staff had responsibility for preparing and cooking the main evening meal. However, people who lived in the home took part in weekly meal planning and were supported to make their own breakfast and lunch. Ways of involving the people who lived in the home more with food were discussed (e.g. ‘taste tests’ to decide preferred brands and themed meals as a way of introducing new and unfamiliar dishes (e.g. ‘Mexican night’). We also suggested reviewing the use of skimmed milk and white bread; with regard to better meeting some people’s nutritional needs (e.g. trying semi-skimmed milk in sauces and custards, and fortified white bread). People who lived in the home spoke positively about meals, describing food as good. Fresh fruit and drinks were available at all times. We discussed how staff recorded was meals were served, as there was some duplication (although there was also a need to show alternatives were being provided). We discussed seating arrangements (2 tables and 8 chairs), as there were not enough dining chairs for all the ten people who lived in the home to eat together (although one person preferred to eat in their room). We also discussed about staff eating with the people who lived in the home, which they did not usually do. This would help to make meals a more social, enjoyable event. Food safety would improve by staff having up to date food hygiene training (as this was out of date for the 3 staff whose training records we looked at). We also discussed guidance from the National Patient Safety Agency, advising staff had the skills to deliver effective first aid, in particular the management of choking. A relative confirmed staff made them welcome when they visited. People who lived in the home said they were able to do what they wanted each day and were given choices about their daily routines (e.g. as noted above, being able to eat in their room). They had been given keys to their rooms, which some people used. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living in the home were generally met. To better support this, improvements in assessing, recording and practice based on individual needs were required. EVIDENCE: Relationships between staff and the people who lived in the home were warm, friendly, caring and respectful. People who lived in the home spoke positively about staff. Both male and female staff worked at the home. Good practice was noted, as intimate personal care was provided, where possible, by staff of the same gender. Useful information was available about the preferred routines and likes and dislikes of the people who lived in the home. However, this needed to be kept up to date (as one person’s details had not been reviewed since 2007). Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 14 The physical and mental health of people living in the home was generally promoted. One person said they had recently attended a check up. Following an Occupational Health assessment, another person had been provided with grab rails to promote their safety and independence. Staff also described how some people living in the home attended specialist diabetic clinics, whilst others had accessed specialist continence advisors. We discussed having a clearer record of health appointments attended (with details of the reason why and the outcome). The current recording system (in the daily report and diary) did not allow health issues or medical conditions to be easily monitored over time, e.g. to review whether a person’s health was improving or deteriorating. We also discussed staff supporting people who lived in the home to access healthcare facilities in the community whenever possible (improving community participation), rather than appointments taking place in the home. We looked at accident records. These were appropriately completed. We discussed any serious injury (e.g. resulting in a visit to A&E) or any serious illness must be notified to us (under regulation 37 of the Care Homes Regulations 2001). We discussed the routine, weekly weighing of everybody who lived in the home. Unless a medical or health reason required this (which should be documented within a care plan), we felt this was unnecessary and did not promote people’s control over their own lives. It also took place in the communal lounge, which did not promote dignity and privacy. We looked at how medicines were handled. These were stored safely. However, as they were kept in the office, which was in the attic, staff had to bring them down 2 flights of stairs to administer. If suitable long term storage of medicines was not available downstairs, short term storage facilities (such as a lockable box or cupboard) should be considered to allow staff to lock medicines away safely in an emergency when they were downstairs. With no office on the ground floor, we also discussed where medicines could be administered to maximise the privacy of people who lived in the home. There was generally a clear audit trail of medicines entering the home, being administered and any returned to the pharmacist. Pre-printed medicine administration record sheets (MARs) were mainly used. These were generally in good order. However, we were concerned to find a person’s insulin was not recorded. Prescribed creams also needed to be recorded. A separate MARs could be used and kept with the cream (and signed when the cream was administered). We advised to reduce the risk of error; any handwritten MARs or any changes made mid-cycle on a pre-printed MARs should be signed and countersigned. The second check could be done at the time of the change if 2 staff were available or by the next member of staff to administer the medicine. Good practice was noted, as time-limited medicines such as eye drops were dated on opening. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 15 One person staying at the home had recently looked after their own medicines. We were concerned there was no documentation about this. To guide staff and also ensure the person’s health was not at undue risk, a person’s care file needed to show what had been agreed and what risk management strategies considered. Generally, care files should also show consent to medication had been obtained (where applicable), with an up to date list of current medicines. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the 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 were in place to protect people who lived in the home from abuse or harm and for taking their concerns seriously. EVIDENCE: Information about how to make a complaint was displayed on a notice board in the smaller lounge. We discussed a more suitable format may help this be better understood and be more meaningful. The people we spoke to who lived in the home knew who they would talk to if they were unhappy or had any concerns. No complaints had been received by either us or the home since our last inspection. No safeguarding alerts had been made since our last inspection. Good practice was noted, as long term staff had completed abuse awareness training. To continue safeguarding the people who lived in the home, new staff should also undertake this training. We discussed an incident where a person who lived in the home had bought an item via a member of staff. This matter had been dealt with by the manager who was currently off sick. We agreed confirmation of the action taken would be followed up after the inspection. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 17 We discussed the recent introduction (from the 1st April 2009), of the Deprivation of Liberty Safeguards (DOLs), which include a new specific legal role and responsibilities for care home managers. Good practice was noted, as the manager and deputy had attended DOLs training. The home confirmed no person living in the home was currently being deprived of their liberty. With regard to money held on people’s behalf, this was being stored safely with appropriate records kept. One person who lived in the home had a large amount of savings. We discussed the procedures required to access this and how withdrawals were audited. Decisions to restrict a person’s access to their money (because of financial vulnerability) needed to be clearly documented and regularly reviewed. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ashleigh House provided the people who lived there with a comfortable, safe and homely place to live. EVIDENCE: The home was comfortable and welcoming, with décor and furnishings that were domestic in style. We saw 5 bedrooms. These were lockable and personalised. With regard to accessibility, as a converted house most bedrooms and the unassisted bathroom and shower room were on the first floor. There was level access at the rear of the home. There were 2 bedrooms on the ground floor and 1 toilet. However, there were 2 steps to this toilet and 2 steps to the lounges, smoke room and rear exit. To maximise the independence of one older person who lived in the home, grab rails had recently been fitted by Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 19 these steps; a gentle ramp was also available to fit over the lounge steps if needed; and second hand rails were fitted to stair cases. Other physical aids had been offered but declined by this person (e.g. a raised toilet seat). The owners were aware the sufficiency of these aids needed to be monitored. They were considering an extension to the rear of the home. This would provide ground floor bathing or showering facilities plus additional ground floor bedrooms. Since our last inspection, the hall, stairs and landing carpet had been replaced. An unsafe floorboard had also been replaced in the office. The home was well maintained and no major repairs or issues were identified at this inspection. We advised the light bulb in the bathroom was replaced for a brighter one; the hot water in the wash hand basin in the shower room was checked at it seemed to run quite hot; the cellar door being unlocked and open access to cleaning products should be documented on the home’s health and safety risk assessment; and door closers adjusted where possible so fire doors closed into their rebates without banging. We discussed the appearance of the front of the home. People who lived in the home enjoyed sitting out there, under a covered area near the front door. Although a bench was provided, there was a large plastic bin for cigarettes, dead plants in pots and 2 large commercial rubbish bins immediately behind where people sat. Improving this area would make it more attractive and also help the building not stand out as care home. We found the home generally smelt fresh and was clean and tidy. The conservatory smoke room would benefit from more regular cleaning as it was very stained with nicotine. We discussed hand hygiene would be improved by providing liquid soap and disposable towels in communal wash hand basins (with bars of soap and hand towels retained for individual use in people’s bedrooms). Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who lived in the home benefited from a small, experienced, stable staff team. However, poor recruitment practice put this at risk. EVIDENCE: During our inspection, enough staff were on duty to meet the needs of people who lived in the home. Good practice was noted, as the staff team was small and stable, with little change. This enabled staff and the people who lived in the home to get to know each other well. Staff worked regular set shifts, with the team consisting of the manager, a deputy, 3 day staff and 3 night staff. Two staff were on duty during the day (7 days a week). There was 1 staff member during the evening and 1 overnight (who worked a waking night shift). The reason for waking night staff was discussed with the joint owner. This decision (to have waking rather than sleeping night staff), was the home’s and should reflect the needs of people Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 21 who lived there. A change from this was possible but would need to be agreed with all the people living in the home and their placing authorities, with the home being confident that people’s needs would be met. We discussed shift patterns as the manager only worked with the deputy and neither worked occasional weekend shifts. The management team should consider whether this maximised the effective and efficient running of the home. For example, entries in the communication book indicated staff did not always have consistent approaches with regard to promoting independence. The manager did regularly meet with staff for formal supervision, usually on a monthly basis (although the deputy had not received formal supervision since April 2009). However, to provide leadership, support and monitor care practices, we discussed the management team, in particular the manager, should occasionally work with all staff. We also discussed staff communication would be further supported by shifts overlapping (e.g. by 15 minutes), so a handover could take place. Communication within the team was supported by team meetings. However, only the manager, deputy and 1 support worker attended the last one. Ways of organising meetings to enable more staff to attend, facilitating meaningful team discussion and support and skill sharing, should be considered. In addition, the manager needed to be mindful of the number of hours worked by staff, as 1 person worked two 14 hour shifts plus some staff had other jobs outside the home. Two new support staff had been employed since our last inspection. Their recruitment files had been taken home by the manager and were not available. We agreed copies could be forwarded to us after our inspection. At our last inspection we had advised a statement requiring applicants to disclose their full employment history and explain any gaps was included on the application form. This had been done. However, the layout of the form was still unhelpful. Dates of employment had not always been given and it was unclear what current or most recent employment was. In order for the home to ensure staff were suitable, full employment information must be received. The design of the application form should facilitate this. If a candidate did not complete the form correctly, this should be followed up. Of the 2 application forms we saw, one did not have a clear employment history, with no written record to show this had been investigated at interview. References were also unsatisfactory. Due to an unclear employment history, it appeared a reference had not been obtained from one new starter’s last care employer. Only one reference was supplied for the other new staff member. We were also concerned about inappropriate criminal record checks. One new starter had been incorrectly allowed to start work before their POVAFirst check was received (which was dated 2 months after their start date). A CRB disclosure reference number was provided for the second new starter. Although we were unable to confirm the issue date and no POVAFirst check had been provided. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 22 The home was aware of the new forthcoming additional legal requirement for staff to be registered with the Independent Safeguarding Authority (new staff initially, from July 2010, and then existing staff later). With regard to training, new staff shadowed colleagues and completed the Skills for Care common induction standards workbook. A new staff member said they had not yet started the workbook and had not yet received formal supervision. It was unclear whether they needed to complete medication and food hygiene training. We looked at the training information for 3 existing staff. Annual fire safety training was due to take place shortly. As noted, food hygiene training needed updating and the manager needed to confirm whether first aid training was up to date. As a specialist mental health home, training about mental health was also needed. Staff received individual folders with information about mental health. Some people who lived in the home had specific physical health care needs, e.g. diabetes, catheter care. The district nurse had provided training regarding the latter but no record had been made to confirm who had received this. With regard to NVQ training, the AQAA confirmed 6 of the 7 staff had attained at least an NVQ level 2 care award. The home’s commitment to achieving training above our minimum standard was evident as 1 staff member had achieved the level 3 award, whilst a further 2 staff were currently completing this award. Staff development would be further supported by re-starting annual appraisals, as these had not taken place since 2007. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the current management systems did not support the safe and efficient running of the home. EVIDENCE: As noted, since our last inspection there had been a change in ownership. The home was now jointly owned by Mr Ashley Smith and Ms Serena Williams. Mr Ashley Smith had been a joint owner since 1996. Ms Williams replaced the other previous joint owner, Ms Susan Kenyon. The actual change in partnership had occurred in February 2008; although we were unaware of this until January 2009 (we should have been notified as soon as practicable, Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 24 regarding the need to cancel Ms Kenyon’s joint ownership, with an application to register Mr Smith and Ms Williams as the new joint owners). There had also been a minor change in the spelling of the home’s name, from ‘Ash-leigh House’ to ‘Ashleigh House’. As noted, the manager, Mrs Jackie Lingard, had not changed. Mrs Lingard had qualifications in both management and care, having completed the Registered Managers Award and an NVQ level 4 award in care. She also had over 9 years experience of working within the mental health field. We were concerned the manager had no specific hours to carry out her management duties (as when at work Mrs Lingard was always counted within the staff/resident ratio). As noted, Mrs Lingard had recruited staff without all the proper checks in place. We discussed with the joint owner that in order to carry out her management duties effectively, some of Mrs Lingard’s hours should be supernumerary. We were concerned about some aspects of the home’s record keeping. As noted, confidential staff recruitment records had been taken out of the home. Private staff supervision records were also held un-securely (in an unlocked drawer, to which all staff had access). As noted, some care records were also not in good order or up to date. With regard to supporting effective and efficient office management, the home would also benefit from having a photocopier and a facsimile machine. The quality of the home was monitored by a range of methods. People who lived in the home completed annual satisfaction surveys. We discussed surveys should also be sent to relatives and stakeholders (e.g. Community Mental Health Teams with whom the home worked with). Group meetings were held with the people who lived in the home, although the minutes on the lounge notice board showed these had not taken place since 2008. We discussed the new monthly quality monitoring reports being completed by the owners. Although very detailed, a monthly summary of the joint owner, Mr Smith’s, daily visits may be more useful. With regard to safe working practices, the home had provided details in their AQAA showing all safety and maintenance checks were up to date. During our inspection we looked at maintenance records for the gas heating and portable electrical appliances. These were satisfactory. The electrical installation and wiring test record (NICEIC) was not available. Details were provided shortly after our inspection confirming this was in order. We also looked at fire safety records. We were concerned a regular (weekly) false alarm, whereby the smoke detector was set off in the hallway with cooking, was neither being recorded nor action taken to address the cause. We also advised fire drills did not need to take place if a false alarm had ensured everyone had practiced a safe evacuation procedure (although a record should be kept of who takes part, with any new person living or working in the home included). We advised Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 25 the monthly fire alarm check needed to include the testing of 2 alarm points (in rotation) as well as the panel. With regard to security, there was a need to monitor the front door after an intruder gained access earlier in the year. Nothing had been stolen and no damage caused. Under regulation 37 of the Care Homes Regulations 2001 we should have been informed. The home had since tried different practical ways of improving security. None had been particularly successful as people who lived in the home used this exit continually to access the front garden, often leaving the door slightly ajar. Since our last visit, the home had received an inspection visit from an Environmental Health officer (EHO). The home confirmed they had since met the 13 requirements and 1 recommendation made. After our inspection we confirmed the EHO did not require warning notices to be fixed by steps and the only 2 smoking notices that had to be displayed was one discreetly in the smoking room and one near the entrance to the home (e.g. on the lounge notice board). The home was aware keeping signage to a minimum helped promote a homely environment. Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X 2 2 x Version 5.3 Page 27 Ashleigh House DS0000073275.V378091.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Care plans, with clear details of needs and goals, must be in place to guide staff about the care each person who lives in the home wants and needs. To ensure the health of people who live in the home, medicine records must show all prescribed medicines; Plus, any decision to self medicate must be properly documented. 3 YA34 19 To safeguard the people who live 30/11/09 in the home, two appropriate references must be received for new staff; Plus, new staff must not start work until an appropriate POVAFirst certificate or an appropriate criminal record disclosure is received. 4 YA42 23 To ensure everyone’s safety, the cause of the frequent sounding of the fire alarm must be investigated and remedied. DS0000073275.V378091.R01.S.doc Timescale for action 31/01/10 2 YA20 13 30/11/09 30/11/09 Ashleigh House Version 5.3 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA3 Good Practice Recommendations To enable the manager to make an informed decision about a person referred by Social Services or the Community Mental Health Teams, sufficient assessment information should be obtained prior to them being offered a place. To ensure the people who live in the home were being stimulated and supported to be as active as they wished; new activities both in and out of the home should continue to be offered. To make sure food is handled safely, all staff involved in food preparation should have up to date food hygiene training. To make sure people who lived in the home received appropriate treatment in an emergency (e.g. choking) there should always be one staff member on duty who is trained in first aid. To promote the health of people who lived in the home, the recording of health appointments should be reviewed to support easier monitoring. To enable the people who lived in the home to have control over their lives and maintain their dignity, the practice of weighing them all each week should be reviewed. To reduce the risk of error, handwritten medicine records should be signed, checked and countersigned. To ensure an effective staff team, with the people who lived in the home supported by staff of complimentary skills, shift patterns should be reviewed. DS0000073275.V378091.R01.S.doc Version 5.3 Page 29 2 YA13 3 YA17 4 YA17 5 YA19 6 YA19 7 8 YA20 YA33 Ashleigh House 9 YA36 To enable staff to receive feedback about their performance against their job description and agree a career development plan, annual appraisals should be restarted. To enable staff to access information easily, care files should be well organised and easy to use. Confidential staff files should be kept securely. 10 YA41 Ashleigh House DS0000073275.V378091.R01.S.doc Version 5.3 Page 30 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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