Care Home: Ash Lodge Residential Home

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What the care home does well People who use this service have their needs fully assessed and have the opportunity to visit the home before they decide to move in, this means choice is promoted and people can make an informed decision about whether to move into the home. People can make their own decisions in life, with risk assessments being put into place where necessary. The care plans were up to date and gave a good description of the person`s needs and staff could clearly describe what the needs of the individual were and how these would be met. During the visit staff were observed interacting with people living in the home and this was carried out in a caring and sensitive way. People were asked if they would like assistance and staff showed an interest in their daily lives. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 6Choice and self-determination were promoted and on the whole people are supported in maintaining their independence. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. The home employs staff when the appropriate vetting has taken place; therefore people living in the home receive support from a staff team who are suitable. People live in a safe, clean and well-maintained home that meets all of their needs. People who live in a home, which is well managed with their views being taken into account. What has improved since the last inspection? People who use the service receive a good level of personal and healthcare support that ensures their needs are met. All staff has undertaken safeguarding training and there are good financial procedures within the home that protect people. The environment is well-maintained and new furnishings, fixtures and fittings have been purchased since the last inspection, ensuring that people continue to live in a homely and comfortable place. What the care home could do better: Risk assessments would benefit from being more descriptive and specific, as this would ensure that people have risk managed or reduced to a minimum. People who are more independent and live in the home take part in a variety of activities, enjoy a varied and healthy diet, but further development would take into account the social/recreational needs of all people, as this would ensure inclusion for those with more diverse needs. The home has a medication policy and procedure, however it is difficult to undertake an audit of the medication and to confirm that people are receiving their medication safely. None of the staff are trained to assess the moving and handling of people, this would ensure that a well-trained, skilled and competent staff group supported peopleTraining in relation to maintaining health and safety and supervision is undertaken, but it is not always up to date or as regular as it should be and this means safety may be compromised. People who live in the home are cared for by staff in sufficient numbers to meet basic need, however it is recommended that the staffing levels be reviewed to ensure that those with more diverse needs receive the same support as those who are more able. CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Ash Lodge Residential Home 262 - 264 Beverley Road Kingston upon Hull East Yorkshire HU5 1AN Lead Inspector Angela Sizer Key Unannounced Inspection 17th September 2008 09:00 Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ash Lodge Residential Home Address 262 - 264 Beverley Road Kingston upon Hull East Yorkshire HU5 1AN 01482 440359 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) healanda@aol.com Michael Joseph Healand Ms Amanda Jayne Bennett Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (20) Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration category of MD(E) is to enable service users already resident in the home to remain there when they reach the age of 65 years. 5th October 2006 Date of last inspection Brief Description of the Service: Ash Lodge is situated on Beverley Road, which is a busy main road into the centre of Hull. It is approximately two miles from the city centre. There are a variety of local amenities close by including shops, pubs, library, swimming baths and a park. The home is owned by a single provider and offers support to 20 younger adults who have mental health needs. The home has 18 single rooms, two with en-suite and one double without an en-suite. There are two lounges one of which is the designated smoking area; in addition there is a dining room. Outside to the rear of the building is a patio and parking area. The weekly fees are currently £314.50 - £351.50 - information supplied by the manager during the inspection visit on 17.09.08. The registered manager stated that upon or prior to admission people are given a service user guide and this contains the last inspection report. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This site visit took place over two days and took a total of 9.5 hours. A regulation inspector and an Expert by Experience visited the home as part of the process. Prior to the visit surveys were posted out to people living in the home, their representatives and social and healthcare professionals and information was gained from these and this has formed part of the evidence. The Annual Quality Assurance Assessment was returned to the CSCI (Commission for Social Care Inspection) prior to the visit-taking place. Several of the people living in the home were spoken to throughout the day about the care they receive and what it is like to live in the home, some of their comments have been included in this report. Three files of people living in the home were looked at during the site visit and three staff personnel files were looked at. One staff member was spoken to this was to find out what it was like working in the home and what training, support and supervision was offered to them. A tour of the premises was undertaken and a number of records were looked at to ensure that the correct maintenance has been undertaken. The Expert by Experience spoke to some of the people living in the home and had a look at the environment. The manager was given feedback after the visit. What the service does well: People who use this service have their needs fully assessed and have the opportunity to visit the home before they decide to move in, this means choice is promoted and people can make an informed decision about whether to move into the home. People can make their own decisions in life, with risk assessments being put into place where necessary. The care plans were up to date and gave a good description of the person’s needs and staff could clearly describe what the needs of the individual were and how these would be met. During the visit staff were observed interacting with people living in the home and this was carried out in a caring and sensitive way. People were asked if they would like assistance and staff showed an interest in their daily lives. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 6 Choice and self-determination were promoted and on the whole people are supported in maintaining their independence. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. The home employs staff when the appropriate vetting has taken place; therefore people living in the home receive support from a staff team who are suitable. People live in a safe, clean and well-maintained home that meets all of their needs. People who live in a home, which is well managed with their views being taken into account. What has improved since the last inspection? What they could do better: Risk assessments would benefit from being more descriptive and specific, as this would ensure that people have risk managed or reduced to a minimum. People who are more independent and live in the home take part in a variety of activities, enjoy a varied and healthy diet, but further development would take into account the social/recreational needs of all people, as this would ensure inclusion for those with more diverse needs. The home has a medication policy and procedure, however it is difficult to undertake an audit of the medication and to confirm that people are receiving their medication safely. None of the staff are trained to assess the moving and handling of people, this would ensure that a well-trained, skilled and competent staff group supported people. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 7 Training in relation to maintaining health and safety and supervision is undertaken, but it is not always up to date or as regular as it should be and this means safety may be compromised. People who live in the home are cared for by staff in sufficient numbers to meet basic need, however it is recommended that the staffing levels be reviewed to ensure that those with more diverse needs receive the same support as those who are more able. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&4 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use this service have their needs fully assessed and have the opportunity to visit the home before they decide to move in, this means choice is promoted and people can make an informed decision about whether to move into the home. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 10 EVIDENCE: During the site visit three files of people living in the home were looked at, this was to make sure that the home finds out what their needs are and to ensure that the home can meet them. It was confirmed that the home usually receives a community care assessment of need from the placing Authority, in addition the home also undertakes their own assessment and evidence of this was seen on the files looked at. The manager also stated that a visit to meet the person before they come to live in Ash Lodge usually takes place. “Usually I try to visit the person and do our own assessment and let them know if we could offer them a place”. The home’s own assessment covers areas such as personal details, past history both physical and emotional, social activities, cultural or religious needs, diet, medical, risk management, advocacy, relationships and other including financial. During the visit several people who live in the home were spoken to and confirmed that people are able to visit and test-drive the home before making a decision to move in. Some comments included; “yes I made my own decision to move here”, “I like it here”, “the manager came to see me before I moved in”. The manager also confirmed that prospective residents or their representative are able to visit the home, have a meal, meet the other people before making the decision as to whether they would like to move in. Prior to the visit-taking place surveys were received from several people living in the home and comments included; “the staff are very good to us”, “yes they treat us well and I like the staff”, “thank you to all the staff”. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 & 9 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People can make their own decisions in life, with risk assessments being put into place where necessary. However, risk assessments would benefit from being more descriptive and specific, training must be undertaken in relation to assessing the moving and handling of people, as this would ensure that people have risk managed or reduced to a minimum. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 12 EVIDENCE: During the inspection visit three of the files of people living in the home were looked confirming that the care plans were up to date and gave a good description of the person’s needs. There are two files in place; a working file that contains the care plan and daily notes and a general file that held other documentation such as personal details, others involved in the care, next of kin, the community care assessment, reviewing and monitoring and medical records. There is a lifestyle choice and preferences and this covered likes, dislikes, preferences for getting up and going to bed, room to be occupied. There is a healthcare-monitoring sheet that covered optical, hearing, dental, chiropody and general medical appointments. There is also a record of the person’s nutritional plan and risk management plan if required. People have their weight monitored on a monthly basis. The manager did state however, that if a person required closer monitoring that this would occur. One person is currently having their weight monitored on a weekly basis. The recording was up to date, clear and gave clear instruction to staff about what they should do and when. Several of the people living in the home were spoken to and they could confirm whom their key worker was and that they get to spend some time with them on a regular basis. Some comments included; “I see my key worker every week”, “I like all the staff, they are friendly and they help me a lot”. Evidence was seen on care files that reviews take place on a regular basis. The manager confirmed that all of the staff has attended training in relation to equality and diversity. During the visit staff were observed interacting with people living in the home and this was carried out in a caring and sensitive way. People were asked if they would like assistance and staff showed an interest in their daily lives. Choice and self-determination were promoted and on the whole people are supported in maintaining their independence. Several people were also spoken to confirming that they are able to get up and go to bed when they choose to. People were individual in their style of dress and confirmed that they chose their clothes and hairstyle etc. Some comments were; “I can do what I want to, I make choices about everyday issues”, “I like going to bed early because I like to get up early in the morning”, “I go out when I want to and the staff help me if I need them to”. One survey received stated; “Ash Lodge promotes all clients independence and well being and day to day care”. The home has a risk management procedure and there were various risk assessments in place including dietary, mental health or difficult to manage behaviour, communication difficulties, smoking and mobility. On the whole the risk management plans are good and cover a variety of issues, but these would benefit from some aspects being further expanded in relation to signs and symptoms for staff to look for and how to manage the risk and at what Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 13 point would other agencies need to be contacted. For example, one person refused food and a regular basis and the risk assessment stated, ‘sometimes doesn’t eat’ and the risk was ‘can refuse meals’. It would be helpful to staff if the risk management plan were detailed and specific about how to manage or reduce and at what point other agencies need to be contacted. None of the staff have undertaken training in relation to assessing risk, in particular the moving and handling of people. There was a procedure to follow in the event of a service user going missing. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 15 12, 13, 14, 15, 16 & 17 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who are more independent and live in the home take part in a variety of activities, enjoy a varied and healthy diet, but further development would take into account the social/recreational needs of all people, as this would ensure inclusion for those with more diverse needs. EVIDENCE: Surveys received from relatives indicated that people are enabled to state their views and make decisions within the home. Some comments were; “before each shift the staff do a handover on each resident”, “Clients are encouraged to mention any suggestions about the home”. Several people who live in the home were spoken to about community links, education and occupation. Currently no one was actually employed, but several people took part in college, centre or local community activities and pastimes. In-house activities are offered on a regular basis and included themed nights for darts, dominoes, videos, bingo, arts and crafts, music and special sporting occasions. Some comments from people during the visit were; “we play Bingo and darts, have DVD nights and sometimes we have a party for birthdays”, “the other week we went to Bridlington and had fish and chips, it was lovely”. The Expert by Experience spoke to several people living in the home confirming that the majority of people enjoyed living at Ash Lodge, some comments included; “the majority of clients I spoke to enjoyed living at Ash Lodge. They had their own rooms. They went out by choice and did their own shopping and some went out to buy other things”. However, some people who were less mobile commented about not going out so much and the Expert by Experience commented; “that one person who requires the use of a wheelchair when going out has had this decreased due to the staff member leaving”. There was written evidence confirming that activities, outings and community events take place. However, the home will need to look at appropriate leisure, interests and hobbies for all of the people living in the home. There were no restrictions on receiving visitors to the home, although the Manager and staff preferred that mealtimes were avoided. From speaking to people it was clear that they could receive visitors when they chose to and also Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 16 if they do not wish to receive visitors then the staff would support this. One person spoken to commented, “Sometimes I like to see my sister”. Some people had family members that visited regularly and assisted them to go out or to spend time at home. Risk assessments were in place for anyone considered at risk on leaving the home, but these did not restrict movement or choice for the person. People were able to keep their rooms locked and either held a key or asked staff to open the room for them. Rules on smoking and consuming alcohol were clearly made known to service users on admission, were listed in the terms and conditions of residence and the contract and everyone respected them. A rotating four weekly menu was compiled by the home Manager after consulting service users in meetings or as part of the quality assurance activities. Menus offered a choice alternative and a choice of specified dessert. Vegetarian meals were provided. The main meal of the day is served at teatime and a lighter option served at lunchtime. One survey received from a person living in the home stated, “the food is really enjoyable”, “it’s lovely, there’s a choice for the evening meal and it is a lighter meal at lunchtime”. During the visit several people living in the home were spoken to about the menu and choice of food and it was confirmed that choice is offered and their wishes and preferences are taken into account when preparing the menu. The Expert by Experience also spoke to several people about the food they receive and commented; “there was a lot of positive comments about the food, the staff and the choice of what to do”. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service receive a good level of personal and healthcare support that ensures their needs are met. The home has a medication policy and procedure, however it is difficult to undertake an audit of the medication and to confirm that people are receiving their medication safely. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 18 EVIDENCE: During the site visit several people who lived in the home were spoken to confirming that staff offer support in the way they prefer and some comments included; “the staff are very good”, “they treat us well”. Staff were observed when interacting with people and this was carried out in a caring and sensitive manner. Staff called people by the name they prefer and they were observed to knock on the person’s door before entering. People who live in the home are enabled to maintain their individuality and this was apparent by the way they dress and their bedrooms were personalised having trinkets, photographs and personal items in them. Three of the files for people who live in the home were looked at confirming that their physical and emotional health needs are met. Annual health care checks are undertaken and written records were up to date to confirm this. Surveys were received before the site visit and some comments included; “good place to live”, “I’m well looked after”, “I am happy here and would like to stay”, “I’m happy with the care I get here”, “nice home”. The home maintained good relationships with the local GPs, clinics and CPNs for providing additional specialist support. There had been situations when people required the Manager or the staff to be their advocate, in order to obtain the required services to ensure their continuing or improving good health. People have a written health care plan element within their general care plans. Diary notes and records of health care appointments or visits showed evidence of how these needs are met. Changes in health care needs were recorded and evidence was available in the form of reviews of care and health plans. Reviews had been held every six months. Medication administration was the responsibility of trained, and deemed competent, designated staff. The home had a medication administration policy and procedure, although it does not have a self-administering policy and currently none of the people living in the home would be able to selfadminister if they so wished. It was confirmed by looking at written records that all staff that administer has undertaken the medication training course offered by the Local Authority, this comprises of completing a workbook which is assessed and verified. Several of the medication administration records were looked at for people and although there were no gaps in recording, not all entries were clearly recorded. For example, staff use different codes for refused or not required, this made it difficult to follow an audit trail for the medication being received to either being administered or returned to the Pharmacy. One person had missed their Respiredol for one day as the medication was late coming in. The manager explained that, “the order had been placed early enough, but the pharmacy was late in sending the medication”. A bottle of Procyclidine liquid did not Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 19 have a date of opening on, this needs to be done to ensure that staff know exactly when the medication was opened as some medication has a shorter shelf life. The manager confirmed during the visit that she undertakes the monitoring of the medication on a regular basis, but that this will be increased. She also said, “I have called an urgent team meeting to discuss the recording with the staff and I have also contacted the Pharmacist who is coming on the 25.9.08 to undertake an audit of the medication”. The home currently does not have any controlled drugs. It was explained to the manager that a controlled drugs cabinet and controlled drugs registered would be required if a person required controlled drugs. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service are informed about the complaints procedure and are able to express their concerns in an open culture. Training for safeguarding adults is offered to all staff. EVIDENCE: The home has a complaints procedure in place and people who live in the home are given a copy of the service user guide, which details how to make a complaint and who to, the Commission for Social Care Inspection address and telephone number are also included. There have been two complaints since the last inspection and from looking at written evidence it would appear that the management has dealt these with, although there was no evidence that the outcome of the complaint is relayed to the complainant in writing. Surveys received from people living in the home included; “no complaints at all”, “no Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 21 concerns”, “I know how to make a complaint and I have got a complaints form in my room”. The home has a multi-agency safeguarding adults policy and procedure. From speaking to the manager it was clear that all staff have either undertaken or are booked onto training for safeguarding adults, written documentation was seen confirming this. Since the last inspection there has been one safeguarding referral made to the local care management team. This has been investigated and the outcome was that the allegation was unfounded and there is to be no further action taken. Although the home offers moving and handling training to it’s staff, this is not as regular as it should be and there is no-one working in the home that has undertaken the assessors’ course that would ensure people have their mobility assessed fully. The home employs staff when the appropriate vetting has taken place; therefore people living in the home receive support from a staff team who are suitable. The home maintains records for the personal finances of people living in the home. Several records were checked and found to be accurate and up to date. From speaking to people it was clear that they have access to their own finances and personal belongings. Where there are restrictions for people these have been agreed within a multi-disciplinary and risk assessments state the potential risk and how this is to be managed. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26 & 30 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a safe, clean and well-maintained home that meets all of their needs. However, not all staff have undertaken training for infection control, this would ensure that infection was managed and the risk to people living in the home reduced. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 23 EVIDENCE: A tour of the building was undertaken and overall the standard of accommodation, equipment and furnishings as stated in the last inspection, is of a good standard. The home was clean and hygienic and there no malodour was detected. Disinfectant gel is situated in the main entrance area and staff carry one with them. It was confirmed from speaking to the manager and looking at written records that only three staff have received training in relation to infection control and this was in 2005. As part of the inspection process an Expert by Experience assisted with the inspection, part of their role was to look at the environment and speak to people about what it’s like to live at Ash Lodge. Some comments and observation will be included within this section of the report. The Expert by Experience commented; “the majority of clients I spoke to enjoyed living at Ash Lodge and had their own rooms”. It was commented that one person has to use a shower situated in another person’s room due to poor mobility preventing them for accessing the first floor communal bathroom. Upon further investigation and from speaking to the both people concerned it was identified that both parties were in agreement to this and it had been recorded in the care file. The manager is aware that is anyone has physical needs that the home cannot meet then this will have to be addressed through the care management process of re-assessment of need. A survey received from a relative stated; “Ash Lodge maintains a clean and tidy environment for service users”. Surveys received from people living in the home confirmed that the environment is kept clean and tidy, “always clean”, “the room is kept nice and clean”. The bedrooms were found to be homely and people had their own personal belongings in them. From speaking to several people who live in the home it was confirmed that they are happy with their room. Some comments included; “I like my room, I have a telly and a music centre”, “it’s lovely”, “I’ve had a new carpet and it’s been decorated”, “I have my photos in here”. There is a written plan of what maintenance work is required for the year and the manager said she prioritises what is most urgent. She also said, “the provider is very good, I ask for extra resources and usually it is agreed”. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live in the home are cared for by staff in sufficient numbers to meet basic need, however it is recommended that the staffing levels be reviewed to ensure that those with more diverse needs receive the same support as those who are more able. Staff are properly recruited, this ensures that overall they receive a satisfactory service. However, training in relation to maintaining health and safety and supervision is undertaken, but it is not always up to date or as regular as it should be and this means safety may be compromised. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 25 EVIDENCE: During the site visit three staff files were looked at, all of the files contained personal details including identification of the person, two references and an up to date Criminal Records Bureau check. Evidence was seen to confirm that the home is following the recruitment procedure and gaining the appropriate checks and references prior to employing a person. This ensures that people living in the home receive support from staff that has been properly vetted. Two staff members were spoken about their roles and responsibilities and they were able to describe the needs of people living in the home and what was in their care plan. Staff are aware of the main aims of the home and clearly described the values stating, “we encourage people to be independent and make decisions for themselves”, “the service users come first”, “the home is very friendly and homely”. Throughout the visit staff were observed interacting with people and this was carried out in a caring, yet professional manner and it was clear that staff have developed good relationships with people. Some comments received from surveys included; “always given in house training and go on all the relevant courses”, “promotes independence, treats every client as an individual with individual needs”, “we always welcome clients suggestions”. The home offers induction training to all new employees and this is in two parts. An in-house induction programme that is assessed by the deputy or manager. The manager confirmed that in addition to that staff undertake the common induction standards. 85 of care staff has now achieved NVQ level 2 and the remaining two staff members are currently undertaking the training. There has been no change to the staffing numbers since the previous inspection and the home continues to have a team of thirteen care workers; in addition there is a deputy manager and the manager. The total amount of care hours currently is 348 per week; in addition there are sixteen domestic hours and twenty for catering. The Residential Forum recommends that the minimum number of care hours for the number of people currently living in the home is 398. From speaking to several people who live in the home and two staff members it was clear that the current staffing numbers were sufficient to meet their basic needs. The Expert by Experience reported that one person was most disappointed that a carer who used to take them out had left their employment at the home and since that time the trips out had stopped. It would appear that the level of activity within the home depends upon the good will of staff that often undertakes activities and outings with people in their Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 26 own time. It is recommended that the staffing levels be reviewed to ensure that all of the people living in the home have their needs met. The training records were looked at and it was apparent that some areas of training that require development in particular specific training for challenging or difficult to manage behaviour. From looking at the staff training records it was clear that mandatory training is offered, but this is not always kept up to date, these included infection control, food hygiene, first aid and moving and handling. It was confirmed by looking at three staff files that supervision is offered, but this is not always on a regular basis. Two staff members were also spoken to and comments included, “I haven’t had supervision since March, but I can go to the manager at any time”, “I can go to the manager at any time, this is both informal and formal”, “Mandy is always available and her office is always open”. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 28 37, 38, 39 & 42 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live in a home which is well managed with their views being taken into account, however staff need to have all required training to help them keep people safe and look after them well. EVIDENCE: During the visit the manager was spoken to with regard to her role and responsibilities. She confirmed that NVQ Level 4 Registered Manager’s Award was nearly completed and has two more units to complete. She said, “I am going to have it completed by November 08”. The manager understood the needs of the people living at Ash Lodge. The management style is open and both staff and people living in the home commented about how ‘good’ the manager is and some comments included; “she is very good and I can see Mandy at anytime”, “the manager is lovely”. From observation it was evident that the manager promotes the rights, independence and equality of those living in the home. The registered provider undertakes unannounced visits to the home under Regulation 26 of the Care Homes Regulations 2001, however written evidence suggests that these are not done on a monthly basis. The manager did say that the registered provider is available over the phone and does pop in on a regular basis. The management style within the home is open and honest. People living in the home were spoken to about the management and this confirmed that the manager is approachable and reasonable. Some comments included; “Mandy is lovely, I can go to her at any time”, “all of the staff including the manager are great”. The home has a quality assurance system that seeks the views of the people living in the home. Surveys are sent to a variety of people included people living in the home, relatives, and friends, other professionals such as GPs, community psychiatric nurses and social care workers involved with the care. The manager confirmed that following the collation of the surveys; a report is produced and shared with the people living in the home. However, this is not shared with other stakeholders including CSCI. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 29 Equality and diversity is promoted by staff, from speaking to people who live in the home it was confirmed that staff respect and promote dietary requests or needs. Some of the staff have attended training in relation to equality and diversity, mental health awareness and managing challenging behaviour. The home has safe working practices in place and from looking at written evidence it was confirmed that the majority of staff have undertaken training in relation to health and safety, first aid, fire safety, safeguarding training and medication. However, there continue to be staff that either have not undertaken or updated some aspects of the mandatory training, these include moving and handling, food hygiene and infection control. None of the staff are trained to assess the moving and handling needs of people living in the home. All staff must undertake this to maintain the health and safety of the people living in the home. The home has a fire risk assessment, this has been updated since the last inspection. Fire safety training is offered to all staff on a regular basis and the home is adhering to the new smoking regulations. Equality and diversity is promoted within the home. People living in the home have a range of diverse needs including mental health issues, depression, schizophrenia, anxiety disorders, alcohol and drug related issues. The home employs both male and female workers of varying age and experience giving breadth to the staff group as a whole. Some staff have undertaken training in relation to meeting more diverse needs of people and these include; mental health awareness, violence and aggression or managing difficult behaviour, the Mental Capacity Act. The maintenance of the building and equipment were up to date and certificates were seen confirming this. Ash Lodge Residential Home DS0000065410.V370136.R01.S.doc Version 5.2 Page 30 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 4 39 2 40 X 41 X 42 3 43 X 3 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ash Lodge Residential Home Score 3 3 2 x DS0000065410.V370136.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13,14 Requirement Staff must be trained to assess the moving and handling needs of people; this would ensure that a well-trained, skilled and competent staff group undertake the relevant assessment. Training in relation to maintaining health and safety is undertaken, but it is not always up to date or as regular as it should be, this included infection control, first aid, food hygiene, moving and handling, this means safety may be compromised. Timescale for action 17/03/09 2. YA35 13,18 17/03/09 3. YA37 26 The registered provider must 17/03/09 undertake unannounced monthly visits, a report prepared and kept within the home. This would ensure that clear lines of communication are established and the registered provider is involved in the management process within the home, offering support and advice when necessary. DS0000065410.V370136.R01.S.doc Version 5.2 Page 32 Ash Lodge Residential Home 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 YA9 Good Practice Recommendations Risk assessments would benefit from being more descriptive and specific, as this would ensure that people have risk managed or reduced to a minimum. Further development to the activities programme that would take into account the social/recreational needs of all people, this would ensure inclusion for those with more diverse needs. The home has a medication procedure, however the use different codes for refused or not required made it difficult to follow an audit trail for the medication being received to either being administered or returned to the Pharmacy. A review of the procedure and clear records would demonstrate that people receive the correct amount of medication as prescribed. Bottles of medication did not have a date of opening on, this should be done to ensure that staff know exactly when the medication was opened as some medication has a shorter shelf life. The staffing levels should be reviewed to ensure that those with more diverse needs receive the same support as those who are more able. Supervision should be offered to all staff a minimum of six times per year, as this would ensure that staff are competent and receive support, supervision and monitoring on a regular basis. The Registered Manager should complete the NVQ 4 Registered Manager’s Award (or equivalent qualification), as this would ensure that a qualified manager who fully understands management processes runs the home. The annual quality assurance report should be shared with other stakeholders including CSCI, as this would ensure that the home is keeping all interested parties informed about what is going on in the home. DS0000065410.V370136.R01.S.doc Version 5.2 Page 33 2. YA14 3. YA20 4. YA20 5. 6. YA33 YA36 7. YA37 8. YA39 Ash Lodge Residential Home Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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