Care Home: Ashbridge Lodge

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What the care home does well The registered manager and her staff are working hard to meet the needs of people living in the home with detailed and up to date assessment information and care plans assisting in this process. Qualification and training opportunities for staff also contribute the provision of sensitive care. The home provides a comfortable and homely environment and all of the residents, who have lived at the home for a number of years, were seen to interact positively with staff throughout the inspection. A social care professional told us "the manager is good at communicating with social services and will follow suggestions made". What has improved since the last inspection? At the last key inspection fifteen requirements were made and we were pleased to see that these had all been complied with. The requirements were in the following areas: to provide clearer information for prospective residents in the service user guide and statement of purpose; to improve documentation to assist the home undertake assessments for prospective new residents; to personalise care plans further to better reflect how people`s needs will be addressed on a more individual basis; to improve the home`s risk assessment process to better protect residents; to encourage more activities in the community; to improve the variety of meals available; to ensure prompt referrals are always made to healthcare professionals; to review medication procedures; to make sure documentation states people can contact the Commission regarding complaints at any time; to make sure sharp objects were always locked away when not in use; to improve the home`s staff recruitment practice; to maximise staff safety when they work on their own at night; to make sure that all staff have regular supervision; to consult more widely about the quality of care the home provides and to improve the system for looking after residents money. Four good practice recommendations were also made at the last inspection and these were being acted on. These were to make some documentation more accessible to residents; providing additional staff training; to try to obtain more independent advocacy for residents and to improve the detail in the registered provider`s monitoring visits to the home. What the care home could do better: At this inspection one requirement is made to maximise protection for people by improving infection control procedures with regard to laundry undertaken in the home. Three good practice recommendations are also made to: involve the community dietician for further advice on healthy meals that residents will enjoy; seek advice from the Environmental Health service regarding infection control and to consider increasing the management capacity in the home. CARE HOME ADULTS 18-65 Ashbridge Lodge 5 Ashbridge Road Leytonstone London E11 1NH Lead Inspector Peter Illes Unannounced Inspection 2nd July 2008 09:30a Ashbridge Lodge DS0000007276.V366723.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 Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbridge Lodge Address 5 Ashbridge Road Leytonstone London E11 1NH 020 8989 7767 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) ashbridge@talktalk.net Mr Siddicq Yadallee Millicent Marjorie Tracey-Adejimola Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can provide care for one named service user with a mental health needs. 19th November 2007 Date of last inspection Brief Description of the Service: Ashbridge Lodge is a privately operated care home, registered to provide personal care and support to five younger adults who have a learning disability. The home is a converted terrace house with accommodation provided on two floors. The ground floor contains an entrance hall, two bedrooms, lounge, kitchen, dining room and a pleasant rear garden. The first floor contains three further bedrooms. A staircase leads to the first floor that contains a further three bedrooms and the office. There is no lift and residents who have some mobility needs are accommodated on the ground floor. Three of the residents’ bedrooms have en-suite facilities and the other two have wash hand basins. The home also has separate toilet and shower facilities on each floor. The home is situated close to local amenities; a post office and local shop are a road away. Other facilities, which include places of worship, public transport, leisure centre, public library, shopping centre and restaurants, are all within walking distance. A stated aim of the home is to provide a safe, structured and caring environment that is free from any prejudice and which offers (our residents) the opportunity to be listened to and to express their wishes, needs and feelings. At the time of this inspection, the weekly fee was from £575 to £850 per week. Information about the service, including inspection reports, is available on request from the registered manager at the home. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection took approximately seven hours with the registered manager being available throughout. Five people were living in the home and there were no vacancies. All the residents have lived at the home for a number of years and no new admissions have been made since that time. The inspection was undertaken by the lead inspector although terms such as “we”, “our” and “us” are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The inspection activity included: meeting all five of the people living in the home and speaking to two independently, communication was limited because of some of the people’s communication needs; detailed discussion with the registered manager; independent discussion with two care staff; independent discussion by telephone with a social care professional from L.B. of Newham and a social care professional from L.B. of Tower Hamlets. Further information was obtained from surveys received from residents, staff and relatives; a current Annual Quality Assurance Assessment (AQAA) submitted by the home, a tour of the premises and documentation kept at the home. What the service does well: The registered manager and her staff are working hard to meet the needs of people living in the home with detailed and up to date assessment information and care plans assisting in this process. Qualification and training opportunities for staff also contribute the provision of sensitive care. The home provides a comfortable and homely environment and all of the residents, who have lived at the home for a number of years, were seen to interact positively with staff throughout the inspection. A social care professional told us “the manager is good at communicating with social services and will follow suggestions made”. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. 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. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 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 Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Up to date information is available to prospective residents and other interested people to make an informed choice about living in the home. People’s needs and preferences are regularly reviewed once they are living in the home to assist staff be aware of and act on any changes in these. EVIDENCE: At the last inspection a requirement was made that the home’s Statement of Purpose and Service User Guide was updated to provide the correct information on the service. This was because the home’s admission procedure was not detailed in the Statement of Purpose and the complaints procedure was not clear enough in the Service User guide. Both of these documents have now been updated as was required and clear information is now available about what services the home can and cannot offer. A good practice recommendation had also been made at the last inspection that documents are provided in formats suitable to the communication needs of residents living at the home. The registered manager told us that this was being acted upon with the Statement of Purpose now being available on tape and that work was Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 9 progressing on reviewing other documentation in the home to make it more accessible. No new residents have been admitted to the home for a number of years and at the last inspection we judged that the home had a robust admission procedure. This included that prospective residents would be able to visit the home as many times as they like, have an opportunity to stay overnight and that relatives and family would also be invited to visit the home. However, a requirement was made at that time that the home develops a new preadmission assessment form to further assist staff in determining if the home could meet the needs of any prospective new resident in the future. This requirement had been complied with and a detailed pre-admission assessment form was seen that would further assist the home in assessing the needs of any new referrals. The new form provided clear headings including relating to people’s needs and preferences regarding culture, religion and sexual identity. We were pleased to be told by the registered manager that she had downloaded from the Commission’s website, “CSCI Professional” our latest equality, diversity and human rights prompts. The registered manager went on to say that the home would refer to these when reviewing documentation and practice in the home in the future. The files of three of the five residents were inspected on this occasion and each showed clear evidence that the needs of the residents were being reviewed on a regular basis. This included annual reviews by placing authorities and by the home undertaking in-house reassessments of need on a regular basis. Key workers also undertake one to one meetings to discuss people’s progress with them and this information contributes to the reviews of the person’s care plan. It was noted in the records of key worker sessions sampled that the residents’ preferences are discussed as well as their assessed needs and this included preferences about their culture and religion. Two social care professionals from different placing authorities were spoken to independently by telephone. They both stated they were satisfied with the care and support the home provided to their respective residents. One stated that they had recently reviewed their resident and went on to say that the staff were always polite and courteous when they had contact with the home. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is working hard to meaningfully identify people’s needs and preferences, which are recorded in their care plans to assist staff in meeting these. People are supported to maximise their independence by making as many decisions as possible for themselves. People are also supported and guided to take appropriate risks in their daily lives to assist them to safely achieve their aspirations. EVIDENCE: At the last inspection a requirement had been made that care plans were developed and reviewed with involvement of the resident and their relatives and representatives; and include sufficient detail to meet the needs of residents. It was noted at the time for example that care plans did not state whether a resident required the assistance of one or two carers when undertaking specified tasks. At this inspection the care plans for three of the Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 11 residents were inspected and showed that the home was working hard to comply with this requirement. We saw that an additional section had been added to care plans to further clarify each person’s likes and dislikes and also their preferred daily routine. The plans now also recorded the level of assistance a resident needed when being supported in identified areas and how many staff were needed to do this. The plans seen were clear and detailed and included guidance for staff on how to support people regarding their culture, religion and sexual identity. Evidence was also seen that the home involves residents as far as possible in the review of their care plans and that the home had written to relatives to invite them to attend identified reviews for their resident. Residents are encouraged to make as many decisions for themselves as they can and this was evidenced in documentation inspected. For example care plans record where a person is able to choose their clothes for the day and if they could dress themselves. The home also holds monthly residents meetings. The minutes of these were sampled and showed that residents were encouraged to express their views in areas such as meals, outings and holidays. At the last inspection it was noted that the North East London Advocacy service, (NELA), represented and worked with two residents at the home. The three other residents did not have access to an advocate and, to facilitate all residents having representation a good practice recommendation was made that all residents had an advocate. The registered manager stated that the two residents still received support from NELA although it was proving difficult to access independent advocates for the three residents that had moved to the home from other local authority areas. She went on to say that she had written to the three peoples’ placing authority’s to seek their assistance with this although reported that progress was slow. Copies of letters to those placing authorities were sampled to evidence the action that the home was taking. We spent some time chatting to residents during the inspection and observing the interaction between themselves and staff. This interaction was seen to be sensitive and it was noted that staff had significant knowledge of each individuals’ needs and preferences. Staff were also seen to be able to communicate with residents in an appropriately respectful and meaningful way, including with those people whose speech was limited. The home looks after the residents’ personal allowances, the money is then given to them when required and as agreed on an individual basis in their care plans. At the last inspection a requirement was made that the recordings of expenditure were checked to ensure they were correct, all incomings and outgoings of money were recorded straight away and that each residents’ monies was looked after individually. This requirement was being complied with. We sampled individual personal allowance sheets for residents, which were clear and logically set out. Residents’ cash is now kept in individual envelopes that are securely stored. The cash for one resident was checked and accurately reflected the amount shown on that person’s personal allowance record. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 12 At the last inspection a requirement was made that risk assessments were completed to ensure the protection of people who use the service. This was because it was judged at that time that the guidance for staff in an identified risk assessment for one resident needed to be more detailed. At this inspection the risk assessment for the identified individual was inspected and judged to be satisfactory. This now includes the level of staff support that is needed to minimise the identified risk in differing circumstances e.g. within the home and within the community. A range of satisfactory risk assessments was also seen on the other residents’ files that were inspected. It was noted in the risk assessments seen that some residents could be potentially vulnerable to exploitation in the wider community and satisfactory guidance was included for staff on how to minimise the identified risks. All the risk assessments seen included some evidence that the resident and had been included in the process of agreeing it. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are being actively encouraged and supported to take part in a range of activities including within the wider community. They also enjoy contact with family and friends to the extent that they wish. People are supported to be as independent as possible and are being encouraged to enjoy healthy and nutritious meals of their choice although may benefit from further professional advice in this area. EVIDENCE: All residents have a programme of external day activities. The ethnic origin of two residents is Afro-Caribbean and they both attend a local centre for AfroCaribbean people two days a week, they also attend another local day service, Ellingham Employment Services, two days a week. Two other residents attend Ellingham Employment Services four days a week and the fifth resident Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 14 currently works at a local garden centre one day a week. Residents spoken to stated that they enjoyed their day activities. At the last inspection a requirement was made that residents were actively involved and encouraged to participate in community activities of their choice to ensure social inclusion. This was because it was judged that residents were spending a lot of time watching television and not having the opportunity to undertake recreational and leisure activities of an evening or weekend. At this inspection it we judged that the home was working hard to comply with this requirement. On the day of the inspection, a Wednesday, none of the residents had a planned day activity and in the morning staff were observed actively negotiating with residents where they would like to go for the day. The provider organisation’s mini bus was available and the choice ended up between going bowling and going to the cinema. It was noted that some residents had to be encouraged by staff to participate, as some were initially stating that their preference was to stay home and watch television. In the end all residents went out and went bowling. On their return residents were keen to tell us that they enjoyed the bowling and the outing. The activities log showed that residents were being encouraged and supported to undertake other activities in the community. Examples of this were that one resident was now supported to go swimming at the weekend and that staff supported residents to attend church when they wished to go. The registered manager stated that additional staff were rota’d to work when residents had planned recreational activities if necessary. The staff rota sampled and staff spoken to confirmed this. The home has a range of indoor games and other resources that were seen; one resident when asked what they liked doing best stated, “I like doing (jig saw) puzzles”. It was noted that the home had a cat that residents looked after with the assistance of staff. The home also offers residents an annual holiday and both residents and staff told us about a holiday to a holiday camp that all were looking forward to later in July. Photographs were also seen of residents and staff enjoying themselves on last years holiday and of various parties and celebrations held during the past year. The Annual Quality Assurance Assessment (AQAA) stated that residents are registered to vote and confirmation of this was seen on people’s files. The registered manager stated that some residents did vote at the last election and were supported by their advocate or staff in understanding the process. People living at the home originate from different ethnic communities and their needs and preferences, including in such areas as food, personal care and places of worship, were sought from the person and recorded. Key worker records sampled showed that people’s preferences regarding their sexual identity, religion and culture were discussed with the person and respected by the home. People living at the home are able to develop and maintain family relationships. Some residents visited their family’s home while others had Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 15 family members visit them at their home. This was confirmed in surveys returned to us by two relatives prior to this inspection. At the last inspection a requirement was made that the service must provide food, which is varied, and a choice of meals to meet the preferred dietary needs of residents and ensures their rights to choice and autonomy are promoted. This was because it was judged there was not enough choice in meals for residents at that time. Staff are working hard to comply with this requirement. The home has introduced pictorial menus and records sampled showed a choice of meal was available for all meals. Evidence was seen from minutes of residents meetings that menus were discussed and planned with residents. Two nights a week residents now have a choice of a takeaway meal and the menus seen contained dishes such as rice and peas and other ethnic choices for those that prefer them. Although none of the residents was on a special diet it was noted in documentation seen that some residents would benefit from losing weight, including on health grounds. Care plans also included exercise regimes for some to assist with this. The registered manager stated that it was sometimes difficult getting residents to be enthusiastic about strategies to assist them to lose weight and there was a perceived tension promoting healthy eating and residents preferences. A good practice recommendation is made that the home seeks the support of a community dietician to review the menus in the light of the residents’ preferences in order to further assist them enjoy healthy meals that they like. There was a satisfactory supply of food in the home, including fresh fruit and vegetables, and food was being properly stored. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs and preferences. They are also supported in meeting their physical, mental and emotional healthcare needs, including by accessing relevant health care professionals. The medication administration procedures within the home safeguard the people living there. EVIDENCE: Residents’ needs and preferences regarding their personal care are recorded in their care plans and residents spoken to stated that they were happy with the support they received with their personal care. It was noted that residents whose ethnic origin is Afro-Caribbean were having their preferences regarding their skin and hair care met by staff that understood these and that individual’s needs and preferences regarding gender sensitive care were also being respected. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 17 At the last inspection a requirement was made that proper provision to meet the healthcare needs of residents is made and that prompt referrals are made to health care professionals. This was because a situation had been identified with one resident at that time where it was judged that a referral to a healthcare professional had not been made in a timely manner. At this inspection evidence was seen that residents had access to a range of healthcare professionals and that referrals to them were being made when required. All residents are registered with a GP and evidence seen of appointments being made and kept. Satisfactory records of appointments with other health care professionals were seen on the files inspected. The records showed evidence of appointments with learning disability specialists, general hospital outpatient departments, dentist and optician. Individual files showed an overall record of each appointment attended and planned and a more detailed record of the reason for the appointment and the outcome. At the last inspection a requirement was made that medication practices are reviewed to ensure the safety of residents. This was because it was judged that the system for giving residents their medication to take to their external day services needed to be more robust. It was also noted at that time that the staff signature list for identifying which staff were authorised to administer medication had a signature missing. Evidence was seen that this requirement was being complied with. The documentation for administering medication now includes a separate record for medication being supplied for when the person attends their day services and another record for when a person spends a longer period away from the home such as overnight visits to family members or holidays. The staff signature list for administering medication was also up to date with all staff included. The home has now bought a new purpose made medication cabinet where at the last inspection medication was kept in a locked kitchen cupboard. The home has a satisfactory medication policy and guidance for staff included a “do’s and don’ts” list and guidance regarding medication that is to be administered “when required” (PRN) as opposed to at specified times. Medication and medication administration record (MAR) charts were inspected for two people living in the home. These were accurate, indicating medication was being given as prescribed and there were no mishandling or missed doses. Up to date records were seen of medication being received into the home and when medication was disposed of. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are able to express their views and concerns and have these acted on appropriately. The home’s safeguarding adults policy and procedures assist in protecting people from abuse. EVIDENCE: At the last inspection a requirement was made that the home’s complaints procedure was amended to include that the Commission can be contacted at any stage of a complaint being made and this had been complied with. An amended complaints procedure was seen at this inspection and was satisfactory. The Annual Quality Assurance Assessment (AQAA) stated that each resident has a copy of the complaint policy and procedures on tape and a copy can be found in the service users guide and a copy in the visitor’s room. The home has not recorded any formal complaints since the last inspection although has recorded four relatively minor concerns and the records of these showed that they had been dealt with satisfactorily. Residents spoken to indicated that any concerns they raised would be dealt with properly. Surveys returned to us by two relatives prior to this inspection also indicated that they knew how to make a complaint about the care provided by the home if they needed to. No complaints have been made to the Commission about the home since the last inspection. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 19 The home has a satisfactory safeguarding adults policy and also a copy of the L.B. of Waltham Forest’s safeguarding policy, the local authority for the area the home is located in. There have been no allegations or disclosures of abuse made to the home or to the Commission since the last inspection. Evidence was seen that staff had undertaken training in safeguarding adults since the last inspection and staff spoken to were able to describe what action needs to be taken should an allegation or disclosure of abuse be made to them. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is comfortable, well decorated, well maintained and that meets their current needs. People who live in the home, staff and visitors benefit from the building being kept clean and tidy although further action is needed to maximise infection control procedures. EVIDENCE: The home is a converted terrace house with accommodation provided on two floors. The ground floor contains an entrance hall, two bedrooms, lounge, kitchen, dining room and a pleasant rear garden. The first floor contains three further bedrooms. A staircase leads to the first floor that contains a further three bedrooms and the office. There is no lift and residents who have some mobility needs are accommodated on the ground floor. Three of the residents’ bedrooms have en-suite facilities and the other two have wash hand basins. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 21 The home also has separate toilet and shower facilities on each floor. The home is situated close to local amenities; a post office and local shop are a road away and other facilities, which include places of worship, public transport, leisure centre, public library, shopping centre and restaurants are all within walking distance. The furniture and fittings are domestic in nature, comfortable and meet the needs of the current residents. The Annual Quality Assurance Assessment (AQAA) submitted just prior to this inspection stated that the entire ground floor, including the bedrooms, is to be decorated within the next two months. The registered manager confirmed that this was still the plan and a written maintenance and decoration schedule for 2008 was seen as evidence of this. Residents showed us their bedrooms and were obviously proud of them. One bedroom seen had been decorated and furnished in pink, the resident’s choice. Another resident was keen to show us their new bed that they had been involved in choosing. Bedrooms seen had been personalised with photos and ornaments and contained electrical equipment such as a television and music player if that was the person’s choice. It was noted that keys were available for bedroom doors if the person chose to use them. At the last inspection a requirement was made that all parts of the home to which residents have access to are so far as reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated. This was because on that occasion a packet of razor blades had been found in an unlocked bathroom cabinet and the shed in the garden that contained sharp gardening tools was not locked. During a tour of the home at this inspection no unacceptable hazards regarding sharp objects were identified. The home had also undertaken a range of environmental risk assessments and those sampled were up to date and clear. The home was clean and free from unpleasant smells. The home has a domestic style washing machine that is situated in the kitchen and has a 95° wash cycle, which was in keeping with the non-institutional nature of a small home. However, one resident has become occasionally incontinent of urine and we were concerned that potentially soiled laundry was being bought into the kitchen and could pose a health and safety risk. The registered manager stated that the difficulty only occurred occasionally and that it was important to the person concerned that they could do their own laundry in the home. A range of possible alternatives was discussed regarding this. However, a requirement is made that laundry that is soiled through incontinence must not be bought into the kitchen in order to maximise infection control procedures in the home. A good practice recommendation is also made that the Environmental Health service should be consulted to advise the home on possible options for maximising opportunities for residents to be as independent as possible in undertaking their own laundry while ensuring that robust infection control procedures are in operation in the home at all times. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A qualified and competent staff team, in sufficient numbers, support people living in the home. The home’s recruitment policy assists in protecting people living in the home. People are supported by staff who have access to a range of appropriate training. Staff also receive formal supervision to assist in further meeting the needs of people living in the home and in their own personal development. EVIDENCE: Staff at the home currently consists of the registered manager and eight care staff. The registered manager stated that all eight care staff had completed the national vocational qualification (NVQ) in care at either level 2 or level 3 although two were waiting on their certificates to be issued. Evidence seen in staff documentation sampled and through independent discussion with care workers supported this. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 23 The staff rota was seen, was up to date and accurately reflected the staff on duty on the day. Two care workers cover the early shift, two care workers the late shift and one waking care worker covers the night shift. The registered manager works at the home full time and her hours are in addition to the staff rota. The registered manager stated that staff hours had been increased since the last inspection to allow more staff to be on duty to support residents undertake more activities in the community. The staff rota showed three care staff working on identified shifts to evidence this and staff spoken to independently also confirmed this. At the last inspection a requirement was made that appropriate risk assessments were put in place for staff to identify the level of risks they may be exposed to when working alone at night and that staffing levels are reviewed to ensure members of staff are protected at all times. This requirement had been complied with and a “lone working” risk assessment was seen to evidence this. At the last inspection a requirement had been made that the protection of residents and staff is maximised by the service completing robust recruitment checks before a potential staff member is employed. This was because at that time one staff member’s application form did not show a full employment history. In addition two identified references received by the home did not include a company stamp and that the home had not sought further confirmation, to ensure they were provided by the people the applicant had named on their application form. Evidence was seen that this requirement was being complied with. The registered manager showed us the action she had taken with regard to the employment history and references identified at the last inspection to ensure these were now satisfactory. One new member of staff had been employed since the last inspection and their staff file was inspected. This included: a completed application form; a health questionnaire; proof of identity with a photograph and evidence that the person was entitled to work in the UK; two written references that had been verified and evidence that the person had an enhanced criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check that had been applied for by the home and had been received before the person started work. Evidence was seen that new staff receive a satisfactory induction when first employed and that the home provides ongoing training and refresher training for all staff. At the last inspection a good practice recommendation was made that the registered provider considers providing further training to staff in understanding and managing challenging behaviour, person centred care and mental health to provide them with the skills and information to meet the needs of residents. This was in the process of being acted on. Evidence was seen that the home has provided the following training for staff since the last inspection: food hygiene; safe administration of medication; health and safety; fire safety; basic first aid; safeguarding adults and managing challenging behaviour/ aggression. Staff spoken to independently confirmed the training that they had undertaken. The registered manager has also prepared an Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 24 information folder for staff on the practical implementation of the Mental Capacity Act 2005. At the last inspection a requirement was made that all staff must be supervised at least six times a year, ensuring staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. Evidence was seen on staff files sampled that this requirement was being complied with. A list of planned supervision dates was also seen in the registered manager’s office and staff spoken to stated that they found their supervision sessions helpful. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from effective management at the home although they may benefit further from additional management resources. The views of residents and other interested parties are sought regarding the quality of life experienced in the home and to help this to keep on improving. Health and safety procedures assist in protecting people living at the home, staff and visitors. EVIDENCE: The registered manager has been in her post for nearly two years and has a number of years care and management experience previous to that. She has completed her national vocational qualification (NVQ) level 4 in health and Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 26 social care and is currently undertaking her registered managers award (RMA). It was clear from the inspection activity and evidenced throughout this report that the registered manager has worked hard to comply with the requirements and recommendations made at the last inspection. Feedback from residents’ staff and social care professionals was positive about the registered manager and the home. One social care professional stated “the manager is good at communicating with social services and will follow suggestions made”. We noted that the home does not have a deputy manager or designated senior care worker to assist the registered manager. When asked about management arrangements when the registered manager was on leave she stated that the registered provider was involved in the home on a practical basis and covered essential management tasks. Given the management workload at the home a good practice recommendation is made that the registered provider considers appointing a deputy manager or nominated member of care staff at the home to deputise for the registered manager to undertake appropriate delegated management tasks. At the last inspection a requirement was made that the results of quality assurance surveys are communicated to residents and their families and that stakeholders must also be included in the process. This requirement was being complied with. Evidence was seen that the home had sent out quality assurance satisfaction questionnaires in February 2008 to residents, relatives, and health and social care professionals. We noted however that feedback from health and social care professionals from the questionnaires had been limited. The registered manager had collated responses from the feedback into an Improvement Plan, dated 22/04/08, and this was available to those interested and was available for inspection at the home. The home also holds monthly residents meetings and regular key worker meetings with residents to further assist meaningful involvement and communication with them about the running of the home. The registered provider undertakes regular monitoring visits to the home. At the last inspection a good practice recommendation was made that reports of the provider visits gave more details on the findings of the visit and the views of residents obtained during the visit. Reports of recent visits were sampled and judged to be adequate, the registered manager confirmed that these reports were now in a clearer revised format than at the last inspection. At this inspection a range of satisfactory health and safety documentation was seen. This included: a gas safety certificate, electrical installation certificate and portable appliance test. The home’s fire log was inspected and showed that the fire fighting equipment had been serviced, regular safety checks on fire alarms were being carried and that fire drills were being undertaken every three months. We also saw evidence that the fire officer had visited the home on 09/05/08 and a letter confirming that the fire officer judged the fire precaution arrangements at the home to be satisfactory at the time. Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 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 3 27 3 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA30 Regulation 13(3) Requirement The registered persons must ensure that that laundry that is soiled through incontinence must not be bought into the kitchen in order to maximise infection control procedures in the home. Timescale for action 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations The home should seek the support of a community dietician to review the menus in the light of the residents’ preferences in order to further assist them enjoy healthy meals that they like. The home should consult with the Environmental Health service to advise on possible options for maximising opportunities for residents to be as independent as possible in undertaking their own laundry while ensuring that robust infection control procedures are in operation in the home at all times. 2. YA30 Ashbridge Lodge DS0000007276.V366723.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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