Care Home: Ashfield House

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What the care home does well Ashfield House offers homely, residential support to service users with complex needs who are unable to live independently in the community. They are provided with opportunity to develop life skills, taking ownership of their own single bedrooms, involving in shopping, simple domestic activities and choosing the interests they wish to pursue. The service users express satisfaction with living at Ashfield House, and confirm they are able to contribute their views about what happens there. They are supported by a personal plan of care with goals that they own. They are encouraged all the time to make choices about things that matter to them. All eight surveys said they can choose morning, afternoon, evenings and weekends what they want to do. Choice was also evident with their meal times and whether they wished to go out. A resident told us `the manager and staff are good to me.` The home scored nearly 100 % positive response to the staff and manager always treating them well, and similarly for staff and the manager always listening and acting on what they say. One said `happy at Ashfield House; another said `I like Ashfield House.` A good level of training is provided for staff and an open ethos exists in terms of communicating concerns. What has improved since the last inspection? The one requirement made in the last inspection report related to the development of person centred care plans. We noted that the home has admitted four people since the last inspection and has a comprehensive pre-admission procedure. Care plans are now person centred, largely written in the first person, pictorial where appropriate and owned by the service users. Other improvements stated by the home is the fitting of a hand rail at the front door, redecoration of the activities room and the adaptation of rooms on the ground floor into a small self contained flat for one resident. The latter has had a knock on effect with the loss of one lounge for use by all the service users. What the care home could do better: We drew to the manager`s attention the poor quality of some of the easy chairs in the television lounge and the limited space available here if each resident, supported by staff wished to use this room. We observed that parts of the home required better cleaning and some parts were in need of redecoration and re-grouting of tiles. The Service User Guide should be further developed with information about the provider and the structure of the Company, and it should incorporate views of the residents from the home`s internal quality assurance. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ashfield House 105 Ashley Road Ashley New Milton Hampshire BH25 5BL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joyce Bingham     Date: 1 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 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 30 Information about the care home Name of care home: Address: Ashfield House 105 Ashley Road Ashley New Milton Hampshire BH25 5BL 01425619256 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): bellhousehome@tiscali.co.uk Ashfield Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 9 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 9 The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category 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 Ashfield House is a care home providing personal care and accommodation for service users with a learning disability who may also present challenging behaviours. It is owned by Ashfield Care Homes Ltd, a subsidiary of Allied Care Ltd, which has a number of other registered properties in the area. The home is located on the outskirts of the town of New Milton. The home comprises a detached, double fronted property with car parking for 4 vehicles to the front of the building and a well-maintained and accessible garden to the Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home rear. All bedrooms are occupied on a single basis, and seven of these have an en-suite facility. There is a lounge with a television easily accessible to service users, and a separate dining room. The home also has another room that is available for use by service users for recreational activities. The fees range from #800 to #2041 per week. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the service users living at Ashfield House experience good quality outcomes. The purpose of the inspection was to find out how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These include the Annual Quality Assurance Assessment (AQAA) completed by the home, and surveyed comments from all eight residents and seven staff. Care professionals did not respond to the request for comments on this occasion. An unannounced visit to the home took place on 12 May 2009 and lasted nearly nine hours. During this time we were able to walk around part of the premises, including two bedrooms, bathrooms and toilets, the television lounge, dining room, activity room Care Homes for Adults (18-65 years) Page 6 of 30 and kitchen. We had private discussions with the registered manager, two other staff, and contact with nearly all the residents. We spoke specifically with three service users, supported by the staff. We were kindly invited to have lunch at the home. We appreciated the hospitality offered. We sampled staff and service user records, and policies and procedures that relate to the running of the home. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Care Quality Commission (CQC). What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 30 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential service users are supported and protected by individual needs assessment. Their choice and wishes in the matter are tested by opportunity to visit before admission and decide if they like the home. Evidence: The homes AQAA informed us of the process of their pre-admission assessment which includes obtaining as much information as possible from the current placement and giving opportunity to visit the home and have overnight stays. The existing service users are also consulted. Professionals in the field are consulted. The family of any new person is also afforded the opportunity to visit, according to individual service users wishes. We inspected four files of people admitted since the last inspection. The previous inspection acknowledged that the home admitted people with very complex needs and looked for assurance that the referrals would be fully explored with the specialist health care team before taking a decision to admit, in order to make sure support Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: mechanisms are in place. We confirmed that thorough assessments had been conducted. There was ample recorded information about the range of each persons needs. But we noted that reference to consultation with the community team had not yet been incorporated into the homes admission procedure and recommended again that this should be a step in the procedure and be seen to be so. The Service User Guide and Statement of Purpose were seen. The Guide was not completely up-to-date lacking details of the Company (providers) and organisational structure of the home, as required in the legislation. The admissions procedure should include the step of referral to the local community team and other professionals as this is an accepted part of the process. The Manager agreed to update both items. The confidential surveys returned by service users confirmed that each person had sufficient information about the home to decide if it was the right place for them. We asked some of the people how they like living at Ashfield House and were responded to with smiles and OKs. One said happy at Ashfield House; another said I like Ashfield House. Care Homes for Adults (18-65 years) Page 12 of 30 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. Service users are supported by staff following personalised plans of care. These contain detailed risk assessments of aspects of living that enable people to live as independently as possible. They are enabled to make some decisions about their lives with assistance from family and staff. Evidence: At the last inspection a requirement was made for the home to develop more person centred care plans. The AQAA told us that all person centred plans, support plans and risk assessments are reviewed regularly with the involvement of the service users, key workers and the manager. We examined three care plans in detail and found them to be comprehensive, written in the first person and individualised. Ample information and guidance was available for staff to follow including detailed triggers, signs of unhappiness, aids to distractions and specific strategy for certain behaviours. Graphics, simple printed English and visual aids were used. Securicare plans were available for physical interventions when necessary and these were reviewed annually. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Historically there are a number of gaps where reviews of care plans have not been completed or recorded. Currently reviews were found to be up-to-date. We saw evidence of adjustments to the environment resulting from individual assessments, e.g. provision of an easy access ensuite shower, planned alterations to the dining room exit on to the patio area. We saw evidence of risk assessments relating to peoples specific needs and the support measures the home had put in place to ensure independence was maximised within safe limits. We saw that staff support service users by holding and making available when requested their personal monies and supporting them in various degrees in budget management and planning what to spend. The confidential survey returns from the service users indicated that they are all enabled to do what they want at all times of the day. The same question framed differently demonstrated that of the eight responses, two felt they always decided what they wanted to do, four felt they usually did, and two felt they sometimes did. Although three from the local care team were invited to return surveys, no comments were returned. We observed that staff interactions with service users prompted them in a supportive way about what to wear, and gave them choice of going out and type of activity. Care Homes for Adults (18-65 years) Page 14 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Ashfield House are provided with opportunities for recreation, and are supported by families and friends. People benefit from quality home-made meals every day that are tailored to suit the residents. They are varied, nicely presented, usually accompanied with home made puddings. Evidence: The homes AQAA told us that all the service users are supported to make full use of the services, facilities and activities in the local community, including shopping, library, market, college courses, and local clubs. The home has its own transport and the majority of the staff can drive. Two service users attend work experience on a weekly basis and one service user has a regular part time job. They are supported to places of worship when requested. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: We spoke with one person who showed us their self contained flatlet, including bedsitting room, dining room/kitchen and ensuite bathroom. We were told that he is happy at Ashfield House and would not want to change anything. Another said they liked being there and the staff were good to them. They also showed us their bedroom that had been fitted with an easy access shower to meet their needs. Files contained a weekly activities plan including walking, cooking, going out in the car, attending the Gateway club, Brockenhurst college, seeing families and going to the pub. There was an example of one person who was enjoying some employment in a local shop. We discreetly observed the serving of lunch and noted that people enjoyed the meal. Separate tables were used in the main dining room and the activities room was also used for two residents supported by a member of staff. The lunch was Moroccan lamb couscous, home made with mixed spices, followed by home made pineapple and cherry sponge and custard. The experienced chef was enjoying cooking at the home and provides a varied and balanced menu. The manager confirmed that service users are encouraged to take part in the planning and preparation of meals as they choose. We noted that one resident who was at college all day had a meal reserved for him on his return. However, he chose something else and his request was readily met with. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users physical and emotional needs are supported by good understanding of their needs and written strategies for specific aspects of care. They are protected by good systems of medicine administration. Evidence: The AQAA told us that people are supported to register with a GP and dentist of their choice, and the home has regular links as needed with other support such as opticians, podiatrists, psychiatrists, occupational therapists, physiotherapists, dietitians, continence advisers, psychologists, and community nurses. All service users are supported to have annual health checks, biannual eye tests and regular visits to the dentist and podiatrist. We saw in the files there was evidence of contact with professional services. Visual timetables were seen for those who needed prompts with graphics to help them understand what was planned for them. We noted that an internet medical print out had been put in one file to instruct staff on the implications of a recent diagnosis. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Detailed strategies were available for named individuals who had identified dietary needs. People could choose the key worker they wished to support them. We saw the medicine cupboard, which is secure and kept within a secure room, and checked on the drug administration processes and records. They were found to be upto-date and in order. Triggers for administration of medicine as and when needed were recorded and available. The manager told us that she conducts regular medication checks and an audit is carried out by the Companys own Quality Assurance Manager. We discussed the provision of personal care and how this was followed with two of the staff. The principles of dignity and respect are followed. Cross gender care is discussed and residents wishes in this respect are heeded. We saw that special arrangements were needed and put in place to ensure female staff were available at night. We noted that the home had been supporting one service user to a very high level with repeated (emergency) admission to hospital, when on-going staff support was necessary. On the day of the inspection one of the home staff had visited the service user and spent time with them at the hospital. Care Homes for Adults (18-65 years) Page 18 of 30 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. People living at Ashfield House feel their views are welcomed and heeded. They are protected by reporting measures and prompt action that may arise to avoid abuse, neglect or self harm. Evidence: The home has communicated any incidents/events to the Care Quality Commission regularly and has co-operated with safeguarding issues that have arisen. No formal complaints have been made to the regulatory body. The Manager told us that the complaints log held at the home had been archived six months previously so it was not possible to trace back comments/concerns further than that. We told the manager that the infrequent number of complaints did not make this archiving reasonable and that the log should be kept available for inspection for everything occurring between inspections. The home has a complaints procedure that has been developed in a format that helps people raise any concerns they have. It lacks clarity about the stages a complaint can pass through, with timescales for dealing with each stage. The manager agreed to adjust this. The AQAA told us that all service users are informed of the complaints procedure which has been given to them in pictorial format, and is displayed on the notice board in the hall. They have had the procedure explained to them and each has Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: said they understand it (where capacity is sufficient). They are given opportunity and encouragement to voice any complaint in the weekly meetings. The confidential survey returns told us that the residents all knew who to speak with if they were unhappy, and all except one knew how to make a formal complaint. The staff we spoke with during the day expressed good values in relation to identifying, confronting and reporting any potential abuse, and were familiar with the process of whistle blowing. Examples were given where poor practice had been challenged. The staff expressed confidence in the Managers dealing with referrals to her around these issues. We were told the detail of one former staff members POVA (protection of vulnerable adults) referral. Care Homes for Adults (18-65 years) Page 20 of 30 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. The residents live in a homely, comfortable house, in a domestic setting with no stigmatising signposting. Ashfield House is generally well maintained but lacks adequate lounge seating and would benefit from extra cleaning in bathrooms and toilets. Evidence: We were able to meet with most of the residents in the lounge, and were invited by two residents to see their bedrooms. One has been provided with a self contained flat, with an internal door linking to the home, and their own front door. It has a lounge/bedroom, kitchen/dining room and separate bathroom. It was designed for their comfort based on their choice, with posters and articles around the rooms that they had selected. They expressed appreciation of the space and independence it offered, although this was not fully operational as supported living. Another resident showed me their bedroom with en suite bathroom that had recently been fitted with an adapted shower to enable easy access. Each room was supplied with comfortable furniture that added to the homely feel of the house. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: We saw the small front lounge, large rear dining room and separate activity room. The lounge was supplied with seating for seven people in a mix of sofas and chairs. Some of the seating was very worn, and tears in the covering were patched with tape. At one time there were six people (a mix of residents and staff) using this room, where the television was on and the main cause of attraction to this point. The space was limited as not all the residents could have been seated here with the staff they would need to have with them in support. We requested details of the day space provision from the manager and this was subsequently provided. It demonstrated that the home still provides adequate overall communal space according to the National Minimum Standards. However a number of the residents present with challenging behaviour at times, and it is recognised that physical alternatives for removing people and reducing/descaling incidents is important. A number of the staff expressed some concern at the loss of an alternative quiet area within reach of the main lounge. We recommended that this room adjustment should be kept regularly under review. Positive views were expressed about the possibility of creating somewhere in the home a sensory room that would benefit all the residents. We understood that in the past a sensory room had been provided in nearby premises. This building had also undergone some changes, so the sensory facility had regrettably been lost to Ashfield House. We were told that the Company have put arrangements in place to alter the stepped area leading from the dining room to the rear patio as this has been identified as a hazard for one of the older residents. A ramp with handrails is planned. A handrail has already been fitted at the front door. The rear garden is well maintained and attractively laid out with shrubs and plants, a table and seating and a shelter at the bottom of the garden for use as a smoking area. We found the home to be generally clean and free from poor odour. We were told the cleaner had been off sick for two days but we drew to the managers attention that a number of the toilets in the house had staining build up from a long period of time and were poorly cleaned. The wash hand basin surrounds and some shower tiles were discoloured and in need of re-grouting. The manager said this was in process of receiving attention. Fire checks, gas checks, legionella and electrical testing were up-to-date and certificated. We saw the recent report from the Environmental Health officer and confirmed the requirements had been completed by the home. The staff commented that the home was a positive place to work but the view was expressed that the service users would benefit from the provision of more spacious Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: vehicles. This was taken up with the manager who also confirmed that due care is needed with the current vehicles in use. Care Homes for Adults (18-65 years) Page 23 of 30 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. People living at Ashfield House are supported by competent and qualified staff, who have been recruited through robust employment practices. They are well supported and supervised. Evidence: The homes AQAA told us that it has a well trained staff team to support the service users. All recruitment checks are conducted and new staff are given a six-month probation period for induction and training involving acquiring an understanding of the company policies and procedures. All staff files contained re-employment checks and records that all have regular supervisions. Of the thirteen carers three have obtained National Vocational Qualification (NVQ) Level 2; one has NVQ Level 3; another is starting Level 2 and three are starting Level 3. A further staff member is starting Level 3 in Management. As fifty percent of the staff team should be qualified to level 2, this is slightly below what is expected by the Standards. Confidential surveys were returned by seven staff. All were very positive about working at Ashfield House. They each confirmed they were given up-to-date information in order to fulfil their roles. They all confirmed that the recruitment practices the home follows were thorough. Two said the induction covered everything Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: they needed to know and five said most things were covered. Each one confirmed the training they are given is relevant, up-to-date, helps them understand the needs of the service users and provides them with knowledge about health care and medication. They all knew what to do if someone had concerns they wished to express. In response to the question about sufficient staff to meet the needs of the service users five felt they always had sufficient staff and three said usually. All felt the way the home communicated information was working well. Four staff felt they had sufficient experience and knowledge to always meet the people needs, and three felt they did usually. Apart from the points detailed in the report already staff said, the home was effective at understanding the individual needs of the service users, making their lives run as smoothly as possible and residents have a really good standard of living. It also assists residents in accessing the community and ensures the needs, medically, nutritionally and financially are met. We spoke privately with three staff members. Without exception they were happy to be working at Ashield House and enjoyed being part of the team. They felt they were engaged in something very worthwhile and assured us that ideas, suggestions were welcomed by local management. Three surveys suggested possible improvements for the home. these included: -provide a multi-sensory room for the service users to relax in, and -provide more spacious vehicles for service users to join in activities. Service users views about the support they receive from the staff were also very positive. A resident told us the manager and staff are good to me. The home scored nearly 100 positive response to the staff always treating them well, and similarly for staff always listening and acting on what they say. Care Homes for Adults (18-65 years) Page 25 of 30 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. The residents benefit from a generally well run home where their views are heeded and their welfare is promoted. Evidence: The manager has been registered at Ashfield House for several years. She is experienced in the field of learning disability and and is qualified to NVQ Level 4 and the Registered Managers Award. We confirmed from records and during discussion that the manager updates on all mandatory core training with the staff. The AQAA told us that in addition over the past year she has attended training in safer food, better business, new health and safety requirements and in the Mental Capacity Act. A resident told us the manager and staff are good to me. The home scored nearly 100 positive response to the staff and manager always treating them well, and similarly for staff and the manager always listening and acting on what they say. We observed the interaction between some residents and the manager. It was Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: affirming and respectful. We observed the interaction between the manager and some staff and that was equally supportive and warm. We learned that the Companys Quality Assurance Manager audits the homes policies and procedures and ensures a regular quality monitoring of the service takes place. We advised that the outcomes for service users of the internal quality assurance should be incorporated in summary form into the Service User Guide. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 22 16 The provider must provide quality lounge furniture in sufficient numbers to be suitable for the number and needs of the service users and supporting carers. 28/08/2009 2 23 23 The provider must arrange for thorough and regular cleaning of toilets and attend to discoloured, tiled areas in bathrooms to ensure all parts of the home are kept clean and reasonably decorated. 31/07/2009 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 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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