Care Home: Ashgold House

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What the care home does well The team are longstanding and stable. The registered manager of the home has left but the home is well run by the new manager. The residents are well looked after and the home makes sure that all their health care needs are seen to. The home provides activities and tries to get residents out and about as much as possible. At times this is restricted because there are not enough staff available. The care staff on duty talked and interacted with the residents in a respectful and caring way. The residents are encouraged and supported to do as much as possible for themselves. There are good care and behaviour support plans in place. Mandatory Training is up to date and on going and all staff receive formal support and guidance to carry out their jobs effectively. Recruitment practises are robust and protect the residents. Any complaints or concerns are taken seriously and acted on. Ashgold House is homely, comfortable and clean and a safe place to live. The home is looking at ways and areas it can improve the service. What has improved since the last inspection? Each resident now has a clear contract in place, which explains what he or she is paying for from the service. The organisation has introduced a person centred assessment tool, which they plan to complete with each individual to review needs and identify aspirations and personal goals. The hallway and landing carpet has been replaced. 50% of the staff team have now achieved their NVQ level 2 or above. What the care home could do better: At the 3 previous inspections it has been a requirement for the service to increase the number of staff it has on per shift to enable the residents to have a fulfilling lifestyle. Allocated staffing hours per week have reduced. It was apparent on the day of the visit and from looking at records that at times there are not enough staff on duty to enable residents to do activities and get out and about. The new manager needs to apply for to be registered with the CSCI and complete the necessary training. All the financial records of the residents need to be kept at the home and there needs to be clear financial audit trails available. The residents care files and daily information needs to be streamlined so that plans can be used as a daily working tool by the residents and staff.Specialist training needs to be further developed and the competencies of staff need to be checked regularly. CARE HOME ADULTS 18-65 Ashgold House Church Whitfield Road Whitfield Dover Kent CT16 3HZ Lead Inspector Mary Cochrane Key Unannounced Inspection 13th November 2007 10:00 Ashgold House DS0000031343.V353148.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 Ashgold House DS0000031343.V353148.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. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashgold House Address Church Whitfield Road Whitfield Dover Kent CT16 3HZ 01304 823966 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) Ashgold House Limited Vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2006 Brief Description of the Service: Ashgold House is a residential home providing care, support and accommodation for 5 residents with learning disabilities, some of whom also have health conditions and sensory impairment. The building is a detached chalet style bungalow, situated on a small country road, in the quiet Hamlet of Church Whitfield. It is about 1 mile away from Whitfield village, which offers limited amenities, and 3 miles from the nearest town of Dover. Residents are transported from the home in a ‘people carrier’ so they are able to under take activities, visits and other pursuits. All people who live at the home have their own bedroom. The sleeping accommodation is arranged over two floors. The communal living space consists of a dining room, lounge and conservatory. There is also a quiet room on the first floor, There is a garden to the rear and side of the building and this is well kept, easily accessible, and safe for those who wish to use it. The current fees for the service at the time of the visit range from £971.99 to £1426.14 per week. Information on the Home’s services and the CSCI reports for prospective residents will be detailed in the Statement of Purpose and Service User Guide. The e-mail address of the home is ashgoldhouse@tiscali.co.uk Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over one day. The site visit forms part of the key inspection. The inspection involved looking at and analysing information and documentation received about the home since the last inspection. The home was unable to return an annual quality assurance assessment form prior to inspection, so feedback has not been sought from other stakeholders Information from the previous inspection was also referred to. The site visit involved spending time talking to residents and staff. Staff interactions with residents, care interventions and activities were observed. Time was spent with the manager looking at individual support plans and risk assessments were discussed. Selected policies, medication charts, training matrix and training programmes and financial arrangements were looked at. A partial tour of the premises was also undertaken. The purpose of the visit was to look at and assess the progress made achieving outstanding requirements and recommendations within previously agreed timescales and to find out if the home was developing ways to improve the service. The home has demonstrated a commitment to make the necessary improvements although a few shortfalls in meeting all the national minimum standards have been identified. What the service does well: The team are longstanding and stable. The registered manager of the home has left but the home is well run by the new manager. The residents are well looked after and the home makes sure that all their health care needs are seen to. The home provides activities and tries to get residents out and about as much as possible. At times this is restricted because there are not enough staff available. The care staff on duty talked and interacted with the residents in a respectful and caring way. The residents are encouraged and supported to do as much as Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 6 possible for themselves. There are good care and behaviour support plans in place. Mandatory Training is up to date and on going and all staff receive formal support and guidance to carry out their jobs effectively. Recruitment practises are robust and protect the residents. Any complaints or concerns are taken seriously and acted on. Ashgold House is homely, comfortable and clean and a safe place to live. The home is looking at ways and areas it can improve the service. What has improved since the last inspection? What they could do better: At the 3 previous inspections it has been a requirement for the service to increase the number of staff it has on per shift to enable the residents to have a fulfilling lifestyle. Allocated staffing hours per week have reduced. It was apparent on the day of the visit and from looking at records that at times there are not enough staff on duty to enable residents to do activities and get out and about. The new manager needs to apply for to be registered with the CSCI and complete the necessary training. All the financial records of the residents need to be kept at the home and there needs to be clear financial audit trails available. The residents care files and daily information needs to be streamlined so that plans can be used as a daily working tool by the residents and staff. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 7 Specialist training needs to be further developed and the competencies of staff need to be checked regularly. 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. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 8 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 Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 9 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 and 5 People who use the service experience good outcomes in this area. Prospective residents have access to adequate information about the home and there are assessments tools in place to assess any prospective new residents. Resident’s places at the home are protected and they know what they are paying for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has reviewed and updated its Statement of Purpose and Service User Guide. These documents have information about the facilities and services the home has to offer. The Service Users Guide is well written and informative. It includes how to make a complaint, terms and conditions, rights, fees and extras. The guide has been transferred into a format that is more understandable for the people who use the service. The manager has developed a pictorial guide and there is an audiotape. There have been no new admissions to the home since the last inspection. For the people who are already living at the home a person centred format tool is going to be used to assess their needs and aspirations. The manager will make Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 10 sure that this information is transferred into the residents individual care plans. This will ensure that all needs and aspirations of the present residents have been identified and met. The work is on going. The service has all the necessary tools in place to undertake a good assessment if the need arises. The manager said that only someone with the necessary skills and knowledge will undertake the assessment All the residents now have contracts and terms and conditions of residency on file. There is information about the fees charged what they cover when they must be paid and by whom. This requirement has now been met Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 11 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 and 9 People who use the service experience good outcomes in this area. All the people at the home can be sure their personal goals will be planned for and supported. Residents are supported to take reasonable risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the people at the home have a care plan. 3 plans were looked at in detail during the visit. They have all the necessary information on the action that is required to ensure that individual needs are met. The plans are person centred and contain information on likes and dislikes, how to manage challenging behaviours and the reasons that infringements are in place. There are also plans on, eating and drinking needs, personal hygiene care, medical and specialist needs, and individual management. The home arranges 6 monthly Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 12 reviews for all the residents but for some residents the care management teams will only attend annually. The home then carries out an in-house review. Some parts of the plans are written in a format, which is more understandable to the residents. The plans are well organised and can be crossed referenced with other documentation. They do contain a great deal of information and are a cumbersome document to use on a daily basis. Staff said that they do not use them as a daily working tool and tend to just use write in the daily records which are kept on a separate file. A lot of the information about the residents is duplicated and repeated. The files and plans now need to be streamlined. The home has just started to transfer care-planning information into a more person centred format called ‘My Personal Lifestyle Action Plan’. When this is completed they need to remove the redundant information from the files. The manager is aware of this. Risk assessments are recorded in resident’s plans and are reviewed before activities including community access. They are used to promote independence and not restrict people. Staff enable residents to take reasonable risks. Work has been done to ensure that all individual risks have been identified and that procedures are in place to minimise them. There are risk assessments to cover the residents as individuals, their activities and their environment (on and off site), to maximise their capacity to be independent. The staff spoken to were able to explain about risks and how to minimise them. The residents were observed being supported in their daily routines, and observed interactions between staff and the residents were appropriately familiar and respectful during this visit. There was evidence available to show how people choose their meals, how they choose what they want to do and where they want to go. Ashgold House DS0000031343.V353148.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 and 17 People who use the service experience good outcomes in this area. People living at the home are able to maintain and develop an appropriate and fulfilling life-style inside in the home However the lack of sufficient staff prevents them from fully participating in events outside of the home. The residents are offered involvement and choice in a varied and healthy diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Abilities, activities and personal preferences are identified in the residents care plan and each person has an activities programme tailored to meet their individual needs and preferences. Activities are subject to day-to-day review pending on the needs of the resident on the day. Residents are encouraged to take part in educational courses and they are also encouraged to develop and pursue their own hobbies. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 14 Residents said that they have enough to do in the house but some said that they would like to go out more. At the last inspection a requirement was made to increase the staffing levels so as to allow residents more community access with the support that they need. (Staffing numbers will be discussed later in the report) Apparently staffing hours did increase for a while but have now reduced again. There is usually a shortage of staff in the evenings and at weekends and this restricts the residents from going out. There has also been some difficulty in making sure a driver is available. The service needs to make sure that they have enough staff on duty to allow residents to go out if they want to. Residents were able to show pieces of artwork and certificates they have achieved. Residents said they enjoy going into the town and the shops. One resident said he would like to go swimming, as he had not been for a long time. During the visit 2 residents asked to go out but were unable to do so because of staffing numbers and no driver for the homes transport. All the residents had a holiday this year. The residents have the freedom to access all communal areas of the home. They can choose when to be in the privacy of their own rooms or in the communal areas. One person has a key to his own room. The other residents do not. The reasons for this are documented. The residents have regular contact and with their families and are actively encouraged to write letters, send cards and make phone calls home. There is evidence in place, which supports this. Family and friends are welcome at Ashgold House. Members of staff were observed demonstrating good body language and communication skills when interacting with residents. They talked and interacted in a positive way and involved and included residents in conversations. The home provides a healthy, nutritious and varied diet. The staff team do all the cooking at the home. Which also has an impact on the number staff available to the residents. Residents said that they can choose what they want to eat. A record is kept of all food eaten. Residents said they liked the food. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 15 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 and 20. People who use the service experience good outcomes in this area. Personal care needs are recorded and supported enabling people to be as independent as possible. Health needs are met. Medication practice is safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care needs are recorded in individual plans with an emphasis on maximising and maintaining independence. Residents said they get the help they need with personal care. Staff said that residents are encouraged and supported to as much as possible for themselves. The home operates a key worker system. Personal care, life skills and dignity are promoted. Personal care is delivered in a way that is flexible reliable and person centred. The staff were seen to respect the privacy and dignity of the residents allowing them control over their own life. The residents are encouraged to choose their own clothes and are supported to shop. There is a Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 16 flexible approach to daily living activities e.g. getting up, bed, bath and mealtimes A record of health needs and appointments is kept. The service makes sure that the residents have access to all the healthcare facilities and routine checks and monitoring are carried out at the necessary intervals. Resident’s health care needs are closely monitored and they are promptly referred to professionals when necessary. A member of staff accompanies residents when they are attending appointments. The people who are not already involved with the local specialist team have recently been referred. Medication is reviewed regularly. Staff have received the training to give medication safely. The senior staff where able to explain about medication practice. Medication is stored appropriately with records of receipt and administration kept. The manager has developed thorough and robust guidance about ‘when required medication’. The manager does need to ensure that all hand written entries on prescription are signed and dated. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 17 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 and 23. People who use the service experience good outcomes in this area. The home has a satisfactory complaints system and residents are protected from harm and abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints to the home since the last inspection. Residents are encouraged to air their views and said ‘ they feel listened to’. The manager arranges one –to one sessions so any concerns can aired, discussed and acted on. There is complaint procedure available to each resident and it is written in a picture format that the residents understand. The home understands the procedures for safe guarding adults and staff have received training in safe guarding adults. A lot of the resident’s financial information is still kept at head office. Gradually this is being sent to the home and there was some information available to demonstrate that the resident’s finances are managed appropriately and safe guarded. The manager has been actively contacting local banks and building societies to open personal individual accounts for each resident but has come across obstacles while doing this. At the present time not all the residents have Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 18 their own bankbooks. The manager hopes this issue will be resolved shortly. The home has received bank details for each of the residents and has also received quarterly bank statements. There are also invoices to the funding authorities. The home has developed a safe system for managing resident’s personal monies, which protects them from abuse. The home provides a safe place for the storage of monies and valuables. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 19 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 and 30 People who use the service experience good outcomes in this area. Residents live in a safe, clean home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the visit most of the home was seen. The home is homely, inviting and clean. Residents said they enjoy taking part in the housework. They said get help from the staff to keep their rooms clean and tidy. The furniture is domestic in style, and comfortable. Homely touches include a residents’ artwork. The manager said the residents are involved in choosing the ornaments, arrangements and paintings around the home. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 20 Two residents bedrooms were seen, which are personalised and individual. They said that they liked their rooms and enjoyed spending time there. The home is now maintained to good standard and environmental work continues. The recommendation made at the last visit to replace the carpet on in the hallway and stairs has been completed. The manager has plans to build raised planting areas in the garden so residents can grow plants and flowers. The home is clean and hygienic. Effective infection control policies and procedures are in place. The kitchen is clean and foods are appropriately stored. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 21 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 and 36 People who use the service experience adequate outcomes in this area. The staff have a good understanding of the residents and positive relationships have been formed. The staff group within the home is stable. Sufficient numbers of staff are not always available to assist residents. Checking staff competencies and more specialist training will improve the care and support offered to the residents. Recruitment practises protect the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff reported they have developed good relationships with the residents and are able to anticipate and meet the individual needs of the client group. The residents responded positively to staff and they reported that they like the staff. The staff said there is a strong staff team and they all get on well together. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 22 It was observed the staff are accessible and approachable to the residents and exhibited good listening and communication skills. The people using the service are generally satisfied with the care they receive but there was evidence to show that at times there are not enough staff on duty to meet all their needs. Since the last inspection the number of staff working at the home has increased but the allocated staffing hours has reduced from 410 hours per week to 375 hours per week. The manager reported that for a time following the last inspection staffing hours were increased but these have now been reduced. The numbers of staff on duty are not enough to meet the high needs of the people living at the home, particularly in enabling them to go out into the local community. The manager is trying to be creative in how she uses the staffing hours. One resident has 1 to 1 throughout the day another is funded to have 1 to 1 for six hours a day. Three of the residents can only go out if they have 2 staff members. There is normally 3 or 4 members of staff per shift and they also have to undertake kitchen duties. The staffing numbers speak for themselves. Residents are not able to do what they want and staff reported that they are not able to provide the activities and community presence they would like because there is not enough staff available per shift. Staff reported that outings in the evening and weekends are not so frequent as there are not enough staff available. This was discussed with the manager, area manager. They will be looking at ways of addressing the issue. The company provides an on-going training programme. Training opportunities for staff have improved greatly and the training programme is being further developed and expanded to include subjects like equality and diversity and managing risk. New staff receive an induction programme. All staff have now completed mandatory training and this is updated at the necessary intervals. Some staff have received specialist training and this is on going. The management of the home now needs to make sure that staff competencies are checked at regular intervals. The home employs 10 staff of varying skill. To date 6 members of staff have completed their NVQ level 2 or above and 2 are working towards the qualification. The home have now met this standard. The home does have a thorough recruitment practises. The sample of files looked at contain all the necessary information to ensure that the residents are protected and safe guarded by the companies recruitment procedures. There was evidence to show that the home does have staff meetings. All staff receive regular supervision and staff said they find this helpful. Notes are taken of meetings and sessions. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. People who use the service experience good outcomes in this area. To show the home is well managed the manager needs to complete her training and register with the CSCI. The homes quality monitoring systems allow residents and their representatives the opportunity for their views to help improve the service. residents health, safety and welfare is promoted and protected by the homes policies, procedures, and training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the registered manager has left. There is now a new manager in post who has worked at Ashgold House for many years. She has several years experience in working with people with a learning disability. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 24 She has recently completed her level NVQ4 and has started the Registered Managers Award, which she will complete in June ’08. She is committed to improving the standard of care for the residents. There is a strong ethos of being open and transparent in all areas of running the home. The manager is able to communicate a clear sense of direction and leadership, which the staff and the residents responded to. She has regular support and supervision from the company’s area manager. It was evident that the registered manager possesses a good understanding of the needs of people living at Ashgold House. Staff spoken to commented on her positive management style and stated that she is approachable and valued within the team. Residents said they got on well with the manager and liked her. One resident said ‘she takes me out ‘ The manager now needs to apply for registration with the CSCI. The company has a dedicated person to undertake effective quality assurance and quality monitoring systems. The aim is to look at managerial effectiveness, improve paper work and highlight any deficits so they can be addressed. The out-come is to ensure all homes within the company are working to the same remit and working to met the minimum standards. Due to unforeseen circumstances the quality assurance visits have not happened recently. The manager continues to develop and use in-house audits to ensure that the home is meeting its aims and objectives and to identify any shortfalls in practises of the service. The home has some quality assurance and monitoring tools in place. Residents and relatives are given questionnaires on a regular basis where they are asked for their views on the home and the service they receive. There was evidenced to show the outcomes of the surveys. The home does needs to show that views have been acted on. The health, safety and welfare of residents and staff are protected by the homes procedures. Policies are in place to strengthen safe practices. The manager told us that all the relevant checks and inspection of equipment and systems have been undertaken. An accident book is maintained. Fire checks are being done and the home has a fire risk assessment Water temperatures are undertaken on a weekly basis. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 25 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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 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 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 3 X X 3 X Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 YA13 Regulation 16(2)(m) Requirement The home needs to provide sufficient staff to meet the needs of the service users and to enable them to engage in local, social and community activities. (Outstanding requirement from the previous 3 inspections Timescale of the 30/10/06 not met) The home must provide an effective staff team with sufficient numbers and complementary skills to support service users’ assessed needs at all times, including enabling them to engage in social and community activities. Staff numbers/hours need to be based on the individual needs of the residents. (Out-standing requirement from the previous 3 inspections Timescale of the 30/06/06 not met) Timescale for action 31/01/08 2. YA33 18(1)(a) 31/01/08 Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 27 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 2 3. 4 5 Refer to Standard YA20 YA23 YA33 YA35 YA37 Good Practice Recommendations The service needs to ensure that all hand written prescriptions on the drug sheet are signed and dated by 2 people. All residents need to have their own individual bankbooks and there needs to be clear financial audit trails in place for each person. The service needs to make sure that staff have the competency to undertake the task they have been asked to do. Staff need to continue to have more specialist training to assist them in meeting all the needs of the people they care for. The manager needs to complete the necessary qualifications and register with the CSCI. Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Ashgold House DS0000031343.V353148.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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