Care Home: Ashdale House

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What the care home does well The standard of documentation at the home is excellent. Each resident has a comprehensive care plan in place that provides staff with detailed guidance about how they should provide support. The provision of consistent and considered support, especially in respect of managing behaviour that challenges is very effective. This is reflected in the low use of prescribed as required necessary medication and residents` ability to lead active lifestyles. Residents are fully supported with their health care needs and the home work very well with other professionals to ensure that residents receive care that is in their best interests. Residents have access to private and communal spaces that meet their needs. They are supported to personalise their bedrooms as much or as little as they wish. One resident has their bedroom set up as an art studio and they are able to express themselves through the the use of art. Residents are supported by a large team of skilled and committed staff who know and understand their daily needs and who respect their privacy and dignity at all times. Staff fully recognise the responsibility of their roles and are accountable for their actions. There is a genuine commitment to training with staff undertaking both mandatory and specialist courses to enable them to do their job well. The Registered Manager is a skilled and professional practitioner who provides leadership and stability at Ashdale House. What has improved since the last inspection? The home have complied with the requirements made at the last inspection and as such have implemented a more formal system of quality monitoring which includes greater opportunities for various stakeholders to provide their feedback on how the home is running. All staff now have contracts of employment and are clear of their roles and responsibilities. The Registered Manager has confirmed that temperature control valves have been fitted to all hot water outlets used by residents and thus prevent the risk of scalding. In addition to meeting previous requirements, the home has also identified its own areas of improvement and as such has now employed a full time handy person to ensure that the ongoing maintenance of this large and busy home is maintained. Staffing levels have also been increased to reflect the changing needs of the people who live at Ashdale House and to ensure that people receive the appropriate levels of support. The planning and support afforded to the admission of a new resident has been excellent and the home have effectively balanced the meeting of individual needs and the collective needs of people living together as a group. What the care home could do better: Ashdale House is very effectively meeting the support needs of nine people with autismand challenging behaviour living together. The difficulty with large group living for people with complex needs is that there must always be a compromise between truly person centred care and equal opportunities for everyone. As such whilst residents are able to choose their community based activities, the length of time afforded to each activity is dictated by the need to return vehicles and drivers to the home to facilitate the next person who is scheduled to go out. The high staffing levels, with some residents being funded for 2:1 support means that there are always at least ten staff in the home during the day. This makes Ashdale House a very busy place to live. It was observed that due to the challenging needs of the people living at the home, a lot of emphasis is placed on managing behaviours. Whilst effective in this area, the home is reminded to ensure that equal focus is also placed on developing independence and thus ensuring that staff do not become risk averse. There is a visible management structure at the home and whilst being very effective at getting things done to a very high standard, the home is asked to consider whether the strong sense of hierarchy allows people at all levels to confidently challenge each other and ensure the culture is truly open. The identified health and safety risks associated with unrestricted windows and unsecured radiator guards must be addressed to ensure people`s safety and security are maintained. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ashdale House 14 Silverdale Road Eastbourne East Sussex BN20 7AU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lucy Green     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Ashdale House 14 Silverdale Road Eastbourne East Sussex BN20 7AU 01323728000 01323649539 ashdalehouseLD@aol.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Alliance Home Care (Learning Disabilities) Ltd care home 10 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 10 The maximum number of service users to be accommodated is 10. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Ashdale House is a large detached property situated a short walk from Eastbourne seafront and the towns shopping centre. Accommodation is on four floors, including a small self-contained flat and nine single bedrooms. There is a walled, rear garden for residents use. The home provides residential care for up to ten adults with a learning disability, who may also have challenging needs and autistic spectrum disorders. Further information about the services provided at the home, including the range of Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home fees can be found in the homes Statement of Purpose and Service User Guide. Copies of both these documents can be obtained directly from the Provider. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at Ashdale House are referred to as residents. This report reflects a key inspection based on the collation of information received since the last inspection, a review of the homes Annual Quality Assurance Assessment (AQAA) and an unannounced site visit conducted by two Inspectors. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was completed by the Registered Manager and returned when we asked for it. Care Homes for Adults (18-65 years) Page 6 of 32 The site visit was carried out over seven hours between the times of 9:35am and 5pm on Tuesday 2nd June 2009. We had a look around the home and examined some care, medication and staffing records. We observed the interaction between staff and residents throughout the day. During the visit we met and spoke with all of the nine people currently living at the home. Time was also spent individually with the Registered Manager and Deputy Manager and two senior carers and two support workers were met with in private. Prior to the inspection, the Inspectors also viewed the collation of stakeholder feedback gathered by the home as part of their own quality monitoring systems. What the care home does well: What has improved since the last inspection? What they could do better: Ashdale House is very effectively meeting the support needs of nine people with autism Care Homes for Adults (18-65 years) Page 8 of 32 and challenging behaviour living together. The difficulty with large group living for people with complex needs is that there must always be a compromise between truly person centred care and equal opportunities for everyone. As such whilst residents are able to choose their community based activities, the length of time afforded to each activity is dictated by the need to return vehicles and drivers to the home to facilitate the next person who is scheduled to go out. The high staffing levels, with some residents being funded for 2:1 support means that there are always at least ten staff in the home during the day. This makes Ashdale House a very busy place to live. It was observed that due to the challenging needs of the people living at the home, a lot of emphasis is placed on managing behaviours. Whilst effective in this area, the home is reminded to ensure that equal focus is also placed on developing independence and thus ensuring that staff do not become risk averse. There is a visible management structure at the home and whilst being very effective at getting things done to a very high standard, the home is asked to consider whether the strong sense of hierarchy allows people at all levels to confidently challenge each other and ensure the culture is truly open. The identified health and safety risks associated with unrestricted windows and unsecured radiator guards must be addressed to ensure peoples safety and security are maintained. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents benefit from an admission process that ensures their individual needs and aspirations are comprehensively assessed prior to moving into the home. Evidence: There has only been one new admission to Ashdale House since the last inspection in 2006. The Inspectors viewed the assessment information for this individual which provided evidence that a thorough assessment process had been undertaken prior to them coming to live at the home. Documentation showed that information had been gathered from a variety of sources and that multi agency working had begun prior to admission. A referral under the Deprivation of Liberty Safeguards was made prior to placement at the home, although the proposed care plan was assessed by the Supervisory Body as not amounting to deprivation. The transition for this person was planned and tailored to the needs of this individual. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: There was evidence that the resident had had the opportunity to visit the home prior to admission and had been supported to personalise their new bedroom. Staff and management also visited the resident at their previous placement on several occasions to assess them in their own environment and obtain a thorough handover from the people who used to support them. A service user guide had been personalised to the individual through the use of pictures and photographs and the Registered Manager confirmed that this was made available to the person before they moved to Ashdale House. There was evidence of a settling in period, with regular formal and informal reviews having taken place. The Inspector was able to establish from the documentation in place and discussion with all relevant parties that the information gathered at the assessment stage is used to inform a comprehensive care plan which evidences that the home can fully meet this individuals needs and aspirations. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The high standard of care planning provides staff with comprehensive information about how to support them and keep them safe. Evidence: Through discussion with staff and observation of their practices, it was demonstrated that they have positive relationships with the people they support and a good understanding of their support needs. A review of the care plans in place for three residents revealed that staff understanding and practices are a reflection of the high standard of care planning at Ashdale House. The care plans viewed comprehensively outline the care needs of the individual and it is possible to audit and track every step of the process. Due to the complex needs and behaviours of the people living at Ashdale House the care plans contain a lot of information about how to manage and support behaviour Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: that challenges. Whilst goal setting and monitoring are fundamental principles in the way care plans are constructed, it was observed that emphasis in these areas are very focused on behavioural management. The outcome of this is clearly good, as reflected in the relatively low level of incidents and minimal use of prescribed as required necessary (prn) medication. The home is however reminded to look holistically at the person and support individuals to set and work towards other short and long term goals that also develop their skills and independence. As such, it was highlighted through discussion with staff that success is sometimes gauged by the absence of negative behaviour as opposed to maximum independence. An example of this is that a wardrobe for one person was found locked. The Deputy Manager informed the Inspectors that this was due to a behaviour that had been identified several years previously. The locking of the wardrobe has seen a decline in this behaviour, but now several years on this practice has not been reviewed as to whether it is still necessary. Given that other furniture in this bedroom was not found to be locked it is possible that this restriction is no longer required. There was documentary evidence that care plans are regularly reviewed. The information viewed was found to be detailed, focused and adopt a multi disciplinary approach. A range of detailed risk assessments are in place for each of the residents whose care was tracked. Risk assessments are clearly linked to care plans and ensure that the necessary controls are in place to keep people safe. Through discussion with staff, observation of their practices and a review of the documentation in place, it was identified that the focus of support is heavily on safety and minimising behaviours. Whilst these are important factors, the home should also consider their role as facilitators in supporting people to maximise their choices and independence and as such taking appropriate risks are sometimes necessary to secure these outcomes. In conclusion, the standard of documentation in care plans is excellent. The information is however vast and the process of reviewing and updating information is undertaken by the management team and senior staff. As such, there is a risk that care plans are seen as management tools, rather than working documents for all. Similarly, whilst there are systems in place to keep permanent staff up to date with changes, through the process of attending detailed handover sessions each day, a temporary staff member would struggle to extract the salient information. The home is therefore asked to consider the accessibility of information available. Care Homes for Adults (18-65 years) Page 14 of 32 Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to lead healthy and active lives. Residents benefit from a range of nutritious and well balanced meals. Evidence: Ashdale House is a busy home, with each resident having the opportunity to go out and engage in appropriate activities. At the time of the inspection, residents were found to be attending college courses, going out for lunch, walks and trips shopping. There was documentary evidence that each resident has an activity timetable that enables them to access a range of social and educational activities that are meaningful to them. The senior in charge of each shift has an overall activity plan for the day which ensures that people undertake the activities they are scheduled to do. Some residents have pictorial activity charts that are displayed in communal areas Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: which enables them to visualise their plans on a day by day basis. The Inspectors tracked the care and lifestyles of three residents and through the interviewing of staff, review of records and observation and interaction with residents it was evident that people do have the opportunity to participate in activities they enjoy and that are meaningful to them. Due to the needs of the people accommodated at Ashdale House, routine and structure is important and the service manages both of these areas exceptionally well. The fact that there are nine people living at the home, each with their own set of complex needs and expectations, does however mean there is little room for change and flexibility on a day to day basis. It was highlighted for example on one persons activity timetable that they have a scheduled half hour period to go to a pub. The length of the activity is based on the need to share the vehicle with other residents, but thirty minutes for this activity means that both location of the pub and length of time spent there is set by factors other than personal choice. The home has the difficult job of off setting the right to person centred living against the needs of the larger group. The ratio of care staff and drivers and vehicles also feature heavily in this equation. The home manages the lifestyles of people living in a large group with only two vehicles very well, but the outcomes for individuals cannot be excellent when their own needs and choices have to be considered in the context of what the other eight people they live with are scheduled to do. The home has a positive approach to enabling residents to maintain contact and relationships with relatives. There was evidence in the care plans that the home supports residents to meet with and receive visits from their families and do their best to involve relatives in life at Ashdale House. The Registered Manager and all staff spoken with confirmed that the home understands the importance of good relationships with other stakeholders. Resident reviews include the opportunity for residents relatives/representatives to attend if the resident wishes. Meals at Ashdale House are prepared according to a rotating menu. The menu is drawn up by staff and is reflective of specialist diets and individual likes and dislikes. The menu displayed showed that it had been recently updated and included a range of varied and well balanced meals. One of the Inspectors joined some of the residents in the dining room for their lunchtime meal, there was evidence of staff offering choice and support in an appropriate and dignified way. One of the residents told the Inspectors that they had thoroughly enjoyed the lunch and that the food was always good. Care Homes for Adults (18-65 years) Page 17 of 32 Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the skill, knowledge and expertise of those who support them and benefit from the provision of personal and health care support that reflects their wishes and best interests. Medication is now managed well at Ashdale House. Evidence: The residents at Ashdale House are dependent on staff to support them with their complex range of personal and health care needs. Care plans provide detailed guidance for staff as to how support should be delivered and the Inspectors observed care to be provided in a discreet, dignified and respectful way. Each resident has a fully endorsed health action plan in line with the Valuing People recommendations. There is documentary evidence of a multi disciplinary approach to health support and the support plans in place evidence working relationships with doctors, challenging needs service, learning disability team and speech and language therapist. The work the home has recently undertaken to support one resident with a complex Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: health issue is an excellent example of their joint working with other professionals and representatives. The outcome of this work has enabled this individual to receive treatment through the best interests process and highlights how personal support is provided in a holistic and proactive way. A staff member confirmed that there are policies and procedures in place for all aspects of dealing with medications. No resident is currently self medicating. The home needs to ensure that documentation is in place to identify why the home controls medication and assess if with training and support, some residents may be able to achieve independence or at least be involved in some aspects of their medicines ie: applying creams. All staff who administers medicines has received appropriate training. Medication Administration Records (MAR) charts viewed identified that medicines are signed for at the time of administration. There were good practices noted to be in place when observing staff administering the lunchtime medication. There are monitoring systems in place that assist staff and management to ensure residents safety. The home has notified us of medication errors and identified that appropriate action was taken to ensure safety measures were put in place. Whilst there was clear guidance in place for some as needed (PRN) medicines, the home should take action to ensure easy and accessible guidance for staff is provided for all PRN medicines. An example is where cream is to be applied, when and signs and symptoms (why) to look for to suggest it may be needed. The home assured us this will be addressed. On discussion with a senior staff member, it was noted that there are clear procedures in place for dealing with medicines if residents go on holidays or out on day activities etc. These procedures ensure that residents receive medicines they require and a clear audit trail is maintained. The Registered Manager confirmed that there is a suitable controlled drugs cupboard at the home the complies with current legislation. There were no controlled drugs being stored at the home at the time of this site visit. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the systems in place to safeguard them and ensure their views are heard. Evidence: The home has a complaints procedure in place, which provides a pictorial version for residents, although due to the complex needs of the residents they would require support to make a complaint. A complaints book is in place and an examination of this provided evidence that the home takes complaints seriously and all recorded complaints had been fully investigated and outcomes recorded. Positive interaction was observed between residents and staff during the inspection. Residents and their representatives are encouraged through a variety of ways to express their views about the service. Ashdale House has a clearly defined management structure and conversations with staff identified very hierarchal arrangements. Following the inspection, this was raised with the Registered Manager and it was agreed that there was an ongoing need to try and open up the culture at Ashdale House to ensure all levels of staff feel confident and able to professionally challenge and accept constructive criticism. The home has a number of systems in place to protect residents from abuse. New staff are employed subject to the necessary checks being undertaken. There are systems Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: for supporting residents with their finances which include monies being checked and signed for. Staff have demonstrated that they are aware of their responsibilities in respect of safeguarding vulnerable adults and are proactive in protecting the people they support. All staff have completed relevant training in this area. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite necessary and ongoing maintenance, residents benefit from an environment that meets their diverse and complex needs. Evidence: The Inspectors undertook a partial tour of the home during the course of the visit and three residents took part in showing their bedrooms. Accommodation is provided across four floors and at the current time level access is not available and as such people must be independently mobile to access all areas. Eight single bedrooms and the self contained flat were viewed. There was evidence that residents, where they are able, are supported to decorate and furnish their bedrooms in a way that reflects their individual interests and choices. Some residents have recently swapped bedrooms and as such were in the process of redecoration. The Inspectors were particularly impressed with the way one persons bedroom has been decorated in graffiti paint, to enable this individual to express themselves through art and as such draw on the walls and floor as they choose. It was also identified that two bedrooms were very basic with limited furniture and no soft furnishings. The Deputy Manager stated that this was due to behaviour Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: management strategies and the Registered Manager confirmed that for one of these individuals, a lot of work has been undertaken to support them to have a wardrobe in their room. Risk assessments and guidelines in these individuals care plans supported these assertions. Each bedroom door is self locking and as such residents have to ask staff to open their rooms. Whilst it was evident throughout the inspection that residents have the capacity to make this request and that staff respond quickly, it is still viewed as a restriction on their environment and as such through the care planning process, other options should be explored. Similarly, as identified in the Individual Needs & Choices section of this report, staff must ensure that they do not become risk adverse and as such should try to promote independence and explore things that may have failed in the past. For example, one persons wardrobe was found to be locked. The explanation given was that this individual had in the past, damaged their clothing. It was however, observed that this persons chest of drawers was not locked. The Inspectors therefore suggested that the home should consider whether this restriction to the wardrobe is therefore still necessary. The provision of communal space includes a lounge, dining room, kitchen and sensory room. There was evidence that the lounge and kitchen had been decorated and furnished to a good standard. Further work is however necessary to achieve the same feel in the dining room and sensory room. A secure and accessible garden is situated to the rear of the home and this outside space was observed being enjoyed at the time of the visit. The two communal bathrooms are in need of further refurbishment and it was evident that such work has already commenced. One en suite toilet on the fourth floor is also highlighted for complete redecoration. A test of hot water in this room also indicated that there was a plumbing problem as no hot water was available from the washbasin. A requirement has been made for these maintenance works to be completed in a timely way. A call alarm system is available throughout the home and due to the complex needs of the people accommodated at the home, staff carry pendant alarms. This system was seen to be effectively used throughout the inspection. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the support of a committed and competent team of staff and are afforded protection by the recruitment procedures in place. Staff have both the skills and support to enable them to perform their roles effectively. Evidence: Due to the complex needs of the people living at Ashdale House and the number of residents requiring additional staff support, minimum staffing levels require nine care staff across the day and three waking staff at night. The rotas viewed were reflective of this and in addition, a senior carer is always on shift during the day. The Registered Manager works in a supernumerary capacity. Staffing levels are further increased when some residents access the community. This number of people on duty at any one time, makes Ashdale House a busy house. It was highlighted in the Annual Quality Assurance Assessment that the majority of staff employed at Ashdale House are from overseas. As all of the residents are British, with English as their first language, this was raised with the Registered Manager, who confirmed that all staff are able to understand and speak English well. She stated that support with written documents is provided as necessary. At the time of the inspection, the atmosphere was observed to be friendly and relaxed and the positive Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: relationships between staff and residents were obvious. It was evident that the staff on duty were able to effectively communicate with those residents who express themselves in non verbal ways. Discussion with the Registered Manager, Deputy Manager, Senior Carer and two support workers identified that the residents needs are currently being met by the staffing levels. As detailed in the Lifestyle section of this report, the collective needs of residents, including the shared access to vehicles and staff who can drive has an impact on outcomes. As such, even those residents who have 2:1 funding do not have unrestricted access to external activities. Due to the size of the home and needs of the residents, it was observed that the home places great importance on the sharing of information. As such, in addition to the communication book, it was observed during the inspection that a comprehensive handover session is held at the time of shift changeover. Formal staff meetings and supervision sessions are also held. Discussion with the Registered Manager and examination of two staff files identified that staff training is ongoing. There was documentary evidence that new staff members were in the process of completing an induction programme in line with Skills for Care. Staff files also provided evidence of a robust system of recruitment being in place: with all the correct documentation and checks being in situ. The training matrix and staff interviews provided evidence that staff have access to a raft of mandatory and specialist training including; fire safety, safeguarding, autism awareness, Makaton and conflict management. In information submitted by the Registered Manager prior to the inspection, it was stated that only three of the fourteen staff members currently have NVQ Level 2 or above in Care. The Inspectors are aware that as the majority of the staff team are from overseas, they have completed higher level training in their own countries. The home must evidence that such training is equivalent to NVQ status. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the home being run by an experienced and committed management team who ensure that the home is run efficiently. Evidence: The Registered Manager is a skilled and experienced practitioner who has worked at Ashdale House for almost seven years. The Registered Manager is supported by a Deputy Manager, a team of senior staff and an administrative assistant. The outcome is a highly efficient and competent management team. The standard of record keeping at the home is excellent, with regular auditing of the extensive documentation in place. The service has demonstrated an ability to learn from its own experiences and as such, there are lots of cross checking that pieces of work have been completed appropriately. Since the Deprivation of Liberty Safeguards came into force on 01 April 2009, the home have demonstrated their understanding and compliance through the submission Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: of two urgent authorisations and one standard authorisation. Following assessment by the Supervisory Body, it was confirmed that the home is not currently depriving anyone of their liberty. The home has a system of quality monitoring in place with line management conducting regular visits in accordance with Regulation 26. There is also evidence that annual satisfaction surveys are sent out to stakeholders. Due to the hierarchal culture of the staff team and the complex needs of the resident, it is recommended that the home continue to explore ways of ensuring feedback mechanisms are sufficiently robust. The home has various systems in place to ensure the health and safety of the home are maintained. The Registered Manager confirmed in the AQAA that the appropriate health and safety checks are regularly conducted and as such these records were not examined on this occasion. During a tour of the home, it was identified that three windows above ground floor level were not restricted and as such posed risks in respect of both health and safety and security. These were discussed with the Registered Manager and Deputy Manager who both stated that they were aware of the risk and that the maintenance person was in the process of sourcing appropriate restrictors. It was also noted that several radiator guards were not fitted to the wall and these also need to be secured. A requirement has been made that both these matters are swiftly addressed. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Regulation 15(1): The 01/09/2009 Registered Person must further develop care plans to ensure that service users are fully consulted and supported to identify and work towards aspirations and goals that maximise choice, control and independence. To ensure that individual plans are accessible and meaningful to service users and reflective of personal goals and self development. 2 42 13 Regulation 13(4)(a)&(c): 01/07/2009 The Registered Person must take appropriate action to ensure the risks identified in respect of unrestricted windows and unsecured radiator guards are so far as possible eliminated. To ensure that the safety and security of service users is maintained. Care Homes for Adults (18-65 years) Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 It is recommended that the Registered Person consult with service users and staff to ensure that key information about daily support needs is available in an accessible format which new and temporary staff would be able to follow easily. The Registered Person should consider whether there is any way the restriction on activities placed by the number of vehicles and drivers available could be reduced to enable service users greater freedom of choice when accessing the community. It is recommended that the Registered Person consult with service users and other relevant stakeholders through the care planning process to further involve service users in the management of their medication and develop greater independence in this area. 2 14 3 20 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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