Care Home: Ashingham House

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ashingham House London Road Temple Ewell Dover Kent CT16 3DJ     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: Mary Cochrane     Date: 0 6 0 4 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 36 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 36 Information about the care home Name of care home: Address: Ashingham House London Road Temple Ewell Dover Kent CT16 3DJ 01304826842 01304828982 ashinghamhouse@tiscalli.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashingham House Ltd Name of registered manager (if applicable) Mrs Catherine Logan Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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 Ashingham House is a large detached property standing in its own grounds between the villages of Temple Ewell and Lydden, close to the port town of Dover. The home is registered to provide 24-hour care and support for up to 10 people with learning disabilities . The home presently has 8 service users, all of which have their own individual bedrooms. Care Homes for Adults (18-65 years) Page 4 of 36 care home 10 Over 65 0 10 Brief description of the care home The accommodation is arranged over two floors and the communal facilities are on the ground floor. There are 2 bedrooms on the first floor and the remaining are on the second floor. The staff sleep-in room is located on the 1st floor. There are 2 bathrooms and 2 separate toilets within the building. The large garden is laid to lawn with shrub and planted areas. There is plenty of private space in the garden for the service users to enjoy outside activities in the better weather. The home has its own transport. The Allied Care Company who has several other homes in the area owns Ashingham House. The current fees for the service range from £1,200 to £2,200 per week. Information on the home for prospective service users is detailed in the Statement of Purpose and Service User Guide. A copy of the CQC report is kept at the home and is available on request. Care Homes for Adults (18-65 years) Page 5 of 36 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 people who use this service experience good quality outcomes. The last inspection on this service was completed on 7th November 2007. The visit to the service was an unannounced Key Inspection which took place over one day. This means we visited the home without telling anyone we were coming so that we could get an idea of what the usual day is like for people living in the home. We were in the home for just over 6 hours. We spent some time with one of the team leaders during the first half of the visit. We were introduced to the people living in the Care Homes for Adults (18-65 years) Page 6 of 36 home and the staff. We walked round parts of the home and had a look around. We talked to some of the staff and service users. The registered manager was available from late morning to the end of the visit. The people living at the home and the staff on duty were helpful and co-operative. General observations were made during the day of how people are supported. We observed how staff supported service users during social activities and when offering care. We looked at and discussed service users individual support plans and their risk assessments and saw some polices. We also looked at staff training records and the homes quality assurance. We saw part of the lunchtime medication round. An annual service quality assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We also took into account the things that have happened in the service, these are called notifications and are a legal requirement. What the care home does well: What has improved since the last inspection? Staffing numbers have improved at the home and the registered manager is recruiting 2 more staff. She also plans to use the staffing hours in a more creative way to benefit the people who live at the home. Care Homes for Adults (18-65 years) Page 8 of 36 The home now has a deputy manager who is supernumerary 2 days a week to give managerial support. The service has streamlined their documentation and how they keep the service users plans and daily records. This could be further developed and improved. Quality assurance systems are being further developed to make sure the people living at the home and stakeholders have a say in how the service can improve. The staff now make sure that all safety checks are carried out accurately and that procedures are adhered to. The registered manager does make sure that the staff have the competencies and skills to undertake delegated tasks and that there are monitoring systems in place to make sure that staff do what they are supposed to. 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. 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 Care Homes for Adults (18-65 years) Page 9 of 36 7535. Care Homes for Adults (18-65 years) Page 10 of 36 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 11 of 36 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. The Statement of Purpose and Service Users Guide provide sufficient information for service users and their family/advocates to make informed decisions about the homes ability to meet their needs. Service users know that the home will assess their needs and aspirations. Service users do know what services they are paying for at the home. Evidence: The home has a statement of purpose, which includes a philosophy of care. There is a Service Users Guide, which is well written and informative. It contains all the relevant information about the home and how care will be delivered. The guide has been developed into a format which is suitable for the service users. It contains pictures and symbols and are easy to follow and understand. The service users do not have easy access to the guide so do not have the information to tell them what the home has to offer. The manager said that this issue would be addressed. Care Homes for Adults (18-65 years) Page 12 of 36 Evidence: One new person has come to live at the home since we last visited. We tracked how this was procedure was carried out. Before coming to live at Ashingham House the prospective service user was visited in their previous home by the manager and area manager of Ashingham House. A thorough and comprehensive assessment was completed which looked at all the aspects of support and care the person would need. The assessment we saw contained detailed information needed to assist in making a decision as to whether or not the home would be able to look after the person. All areas of support, care and intervention are looked at. The assessments contained the information that was needed to start developing a care plan. After the person had been living at Ashingham House for a while the assessment repeated. This gave a good picture of how the person had settled at the home and what areas of support and care needed to be reviewed and updated in the care plan. All the service users 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. The contracts have now been developed into an easy read format but did not contain the information about fees. Care Homes for Adults (18-65 years) Page 13 of 36 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. People at the home can be sure most needs are planned for but not all plans have been updated when support needs have changed. For some not all goals and aspirations have been identified and worked towards. People are supported to take reasonable risks Evidence: All the people living at the home have a support/care plan. We looked at 3 of these in detail. The plans contained information on how the service users are best supported and cared for. They also contain why some people are not allowed to do certain things. There are also plans on, eating and drinking needs, personal hygiene care, medical and specialist needs, and individual management. The home arranges 6 monthly reviews for all the service users but sometimes care managers will only attend annually. If this is the case the service carries out carries out an in-house review. We did find that some peoples support needs had changed but their plans had not been Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: updated to show what changes had taken place. The manager and staff were able to tell us verbally how they would best support the person but it was not documented. Since the last visit the amount of paper work and duplication has reduced so support plans are more manageable and easier to use. Care plans include risk assessments that give staff clear guidelines for how to support people and minimise risk. Staff use the risk assessments to help people do things and they are not used as restriction. Staff told us that there is a consistent approach when dealing with behaviours and incidences. The staff we spoke to were able to explain about risks and how to minimise them. The company does recognise the rights of the service users to take control of their lives and make their own decisions and choices. Through observation and talking to staff and service users we saw that some people were able to make choices about what they did in some aspects of their lives. For some people goals and aspirations have been identified and they are working towards achieving these. For others these had not been clearly identified. We were told that some people have attained goals but these have not been seen as achievements and documented and evidenced. 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. Daily records are person centred and contain relevant information about what people have done during the day. It was possible to cross reference information to show that care plans and risk assessments are being used to provide the necessary care and input on a daily basis. Care Homes for Adults (18-65 years) Page 15 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Since the last inspection there has been deterioration in meeting the first standard in this section. Some people are limited in what they do throughout the day. They need better arrangements to enable them to participate in fulfilling activities. Family links are encouraged and maintained wherever possible. The home provides a choice of healthy, nutritious meals. Evidence: At the time of our visit to the home we saw that not all the service users had an activities programme. Some people had programmes but these were out of date. Activities were planned using the homes daily diary and not all people were included in this on a daily basis. This means that some people are doing things on an adhoc basis with no pre-planning. Sometimes activities take place and sometimes they dont. Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: Sometimes there is no direction in place to inform staff what they are supposed to be doing that would be meaningful and beneficial to all the service users. We saw from a persons initial assessment that they enjoyed listening to music but when we looked at daily records there was no indication that they had done this. There was no recorded explanation as to why the activities did not occur and what alternative was offered instead. We did see that people go out for drives in the company car, which they do enjoy but this is limiting activity. The home does need to make sure that the people who are not so able also have the opportunities to develop a life style that suits their capabilities and preferences. We saw that the home now have more staff and more of them are able to drive the company vehicle. The home do have an outside cabin which was developed originally for activities but this is not being effectively used. The staff told us they go and bring the games from the activities room into the house. The home have also developed a sensory room for service users to use. Staff told us that people did use and enjoy it, but in the daily records we looked at we saw no evidence of this. The manager told us she would address this issue. A requirement will be made in the report with regards activities for service users. Service users access the local facilities and are part of the local community. Some people go to social clubs and discos. Personal friendships within and out-side the home are supported. People are encouraged to maintain family links. Some of the service users go home for periods of time. Family and visitors are welcome within the home at all reasonable times and no restrictions are imposed. Anyone who wants to can have an annual holiday. One service user told us that he enjoys swimming and going to the discos. Another told us they liked listening to music. People are encouraged and supported in doing their washing and keeping their rooms clean and tidy. We saw that the majority of care staff had good body language and communication skills. They were seen to talk and interact in a positive way; they involved and included service users in conversations. Most of the staff on duty at the time of the visit were respectful and caring. We did observe that some staff did not interact or try and involve or engage service users and were undertaking a policing role. This was pointed out to the registered manager of the home and she did address the situation immediately. One service user indicated that the staff are good and that they got on well. Service users can choose when they want to be in company or when they want to be in the privacy of their own room. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: The home provides a healthy, nutritious and varied diet. Three meals are provided daily. Meal times are flexible and menus are organized over a four weekly period. Drinks and snacks are available throughout the day. The home employs a full time cook. He works Monday to Friday. At weekends an extra member of the care staff team is brought in to do the cooking. Service users are supported to choose the food they want to eat. There is a daily pictorial menu as well as a written one. A record is kept of the food that people eat. People told us that they liked the food. Staff did tell that on occasions service users do help prepare meals but we saw no evidence of this on the day of the visit or in the documentation kept by the home. Care Homes for Adults (18-65 years) Page 18 of 36 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. People know that they will have the support they need to stay healthy. People have the support they need regarding their personal care. Medication practice is safe protecting the people who live in the home. Evidence: We saw that some people did have support plans in place around their daily routines with regards to getting up and going to bed and personal hygiene. They explained the particular way that people like to have things done. Staff have got to know each person well and have found out how they like to be supported with their personal care. Routines have been established for them and guidelines have been written for the staff so that everyone is doing the same thing. We saw that care staff gave the people the support and assistance that they need while allowing them to do a much as possible for themselves. Each person living at the home has a key worker. At the time of the visit the home were using 2 different health support plans for the Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: service users. The mmanager needs to decide which one they are going to use as this is confusing and could lead to health issues being over looked. The health records gave details of recent appointments and recommendations from health care specialists. Where people have specific medical needs there are written guidelines on how to support them. We looked at some of the detailed support and records for supporting epilepsy. The staff describe how the condition affects an individual and describe seizures when they occur. We did find that 2 of the health care plans had not been updated. This meant that monitoring a persons conditions could not easily trailed to make sure that the treatment they had been prescribed was effective or if further medical intervention was needed. The manager told us this would be addressed. We looked for guidelines that should be in place for when service users presented with behaviours that might cause a risk to themselves or others. We found that people had good guidelines in place that gave staff step by step guidance about what they had to do. Each service user is registered with a local doctor and any area of concern related to health is referred to them. There is contact with specialist services when needed. Medication is stored safely at the home, The staff who administer medication have received the necessary training and their competencies are checked. A sample of prescription sheets were seen. All prescriptions sheets had been signed to indicate that service users had received their medication on time. Thorough policies and procedures are in place. The recording of receipt, administration and disposal of drugs is sufficient to allow an audit trail. Some of the people living at the home are prescribed medication (this includes analgesia, topical creams, eye drops) on a when required basis. There are clear guidelines for giving medication and medication is given to people in a way that is individualised and best meets their needs. This makes sure that the medication is administered consistently and the effects monitored. We did find that on one occasion a service user had been given when required medications for behaviours over a few days. There was no information available about the events and behaviours to explain and trail why the service users had been given this medication. The manager did tell us she had been contacted to discuss the issue at the time. On other occasions there was good documentation in place. The people living at the home receive their medication as prescribed by their doctors. We saw that some handwritten prescription sheets had not been signed. It is important that handwritten entries are double - checked to make sure they are Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: correct. Care Homes for Adults (18-65 years) Page 21 of 36 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. The home has a satisfactory complaints system and residents are protected from harm and abuse Evidence: There have been no complaints from the people living in the home. We saw that the complaints system is not easily useable by all the service users. This means if there is a problem people may not be able to effectivelylet the staff know. There was no evidence that coomunicatio in this area was being supported. Some people are reliant on staff to interpret their needs by recognising behaviour and facial expressions. It is good that staff have got to know each person well and can do this, but further support would enable them to express their needs independently. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Timescales are adhered to. There have been 2 safeguarding vulnerable adults alert raised since the last inspection. This means that the complaint was looked at by the local social services safe guarding adults team. This was dealt with through safe guarding procedures and the alerts have been closed. The service has been active in dealing with the alert. The details of the action. Information on how this was handled can be obtained from the registered manager. Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: The majority of staff have received training in safe guarding vulnerable adults and for those who havent (who are the new staff) training has been booked. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The service has the information from head office to demonstrate that the service users finances are managed appropriately and safe guarded. The registered manager has been actively trying with local banks and building societies to open personal individual accounts for each person but has come across obstacles while doing this. At the present time the service users still do not have their own bankbooks. The home has received bank details for each of the service users and has also received quarterly bank statements. There are also invoices to the funding authorities. The registered manager is able to audit trail monies. The home has developed systems of managing personal monies, which protects them from abuse. The home provides a safe place for the storage of monies and valuables. Care Homes for Adults (18-65 years) Page 23 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are not well maintained and do not provide a pleasant and homely environment for people to live in. Evidence: We looked around different areas of the home. We looked at all the communal areas and some of the service users bedrooms. We found that the premises do not generally provide a homely conducive environment for people to live in. Since the last visit to the home in November 2007 there has been little done to improve the environment. When we looked at the maintenance plan for this year we saw the same things as had been identified last year. Timescales had not been met and maintenance issues have been carried forward. The home has had a leak in the roof which has been repaired but this has caused damaged to areas of the house. There was evidence of damage to walls internally from the leak. This includes damage to the plaster in bedrooms, dining room and bathrooms. We looked at 4 bedrooms. 2 of the bedrooms had been decorated and were personalised to reflect the individuals personalities and tastes. The other 2 rooms Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: were poorly decorated and maintained. One of the rooms had water marks down the wall and there were no covering to the windows. The room was in need of redecoration and refurbishment. The second room we saw had plaster coming of the wall. It was bare and dull. It had not been personalised and was not a pleasant or inviting place. The furniture was of poor quality, old and in consultation with the service user may need replacing. Incontinence pads were being stored on top of a cupboard. We were told that these did not belong to the person in whose room they were being stored. There where make shift curtains on the window. The flooring in areas of the home is cracked and in need of replacing. This was especially apparent in the area between the kitchen and dining room, the staff room and the dining area. Other areas of the home especially the bathrooms and toilets had flooring that was old, stained and past its best. The baths and toilets were also old and in need of up-grading. Skirting boards and walls in corridors are in need of redecoration and painting. Carpets on some of the landings are worn. Furniture and fittings in many areas of the home are old and past there best and although they are functional they are not conducive to a homely environment and need replacing. One of the fridges in the kitchen was leaking and agreement had been obtained from headoffice to get this replaced. The furniture in the lounge area was a collection of worn out settees and chairs. The manager did tell us these are due for replacement. A lot of these issues have been identified in the monthly visits by the area manager, dring documented, monthly visits on behalf of the responsible individual for the company, but work has not been completed. The gardens around the home are well maintained. They provide space for people to sit and relax or do out door activities. At the time of the visit the homes cleaner was not available. Cleaning duties were being done by care staff. We were told that a dedicated person is allocated house keeping duties on the duty rota. On the day of the inspection there were areas of the home that did need to be cleaned. The manager did address this. We did notice an unpleasant odour in one of the bedrooms. The laundry room was orderly. Service users are encouraged to assist with their own laundry. Any soiled laundry is transported safely and washed in red bags according to the homes procedures. Any clinical waste is disposed of appropriately. Staff were aware of infection control procedures. Some staff have not received infection control training but this has been planned. Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: Requirements and recommendations will be made because of the shortfalls in these standards. Failure to comply with the requirements may lead to enforcement action. Care Homes for Adults (18-65 years) Page 26 of 36 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. Most staff have a good understanding of the people living at the home but some do not. Positive relationships have been formed. On-going training is in place to make sure the staff have the competencies and skills to meet all the needs of the residents. Recruitment practices protect the service users. Evidence: The home have had a lot of staff changes in recent months. There are 18 care staff employed and 6 of these are new. Service users have had to get used of a lot of new faces. Some staff are working through their induction and others are in the process of doing the necessary training. When we spoke to the staff they told us that they have developed good relationships and with the service users. They said that they know the service users well and they are able to anticipate and meet the individual needs of the client group. The service users did respond positively to staff and they told us that they like the staff. The registered manager told us that are going to appoint 2 more care staff members and she is just going through applications. It was observed that the majority of staff are accessible and approachable to the service users and exhibited good listening and communication skills. However as Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: previously mentioned we did see evidence of staff not interacting or communicating with a service user for a long period of time. We also saw that staff were walking around with bunches of keys hanging from their belts. This gives the impression of control and lack of autonomy for service users. We also observed a member of staff serving tea to service users from a large plastic jug with the milk already in it. This indicates institutionalised practices. The registered manager did address these issues immediately and told us that these were not normal practices at the home. She told these issues will also addressed at individual supervisions and in staff meetings. Staff reported that they feel confident in the registered manager. They said that she would listen and act on any issues that are highlighted. There are 5 staff working on each shift with a flexi-person working to cover trips out or other duties. Staff did tell us that sometimes they need more staff on duty. They said that it is especially busy in the mornings when they are supporting people to get ready for the day. The manager is looking at more creative ways of using the staffing hours available so service users have staff readily available when they need them. Ashingham House has a thorough recruitment process to make sure the people applying for the job are who they say they are and will work in the right manner. The manager asks for identification like a passport and 2 references from people who know the person including their previous employer. They request a Criminal records bureau (CRB) check and protection of vulnerable adults list (POVA) check to make sure they have not done anything in the past that will indicate that they are unsuitable or cannot be trusted. Staff work for a trial period of time in the home while everyone gets to know each other and the member of staff decides whether this is the right job for them. We looked at three staff files and saw that all these checks had been carried out. New staff have induction training prior to working in the home so that they know what is expected of them. This is tailored to the needs of the service and is designed with reference to National Vocational Qualification (NVQ) training. We were told that 50 of staff have completed their NVQ level 2 or above. We saw some of the induction training in the files and also spoke to new staff during the visit. The home has a training matrix. The company provides an on-going training programme. Training opportunities for staff have improved greatly and the training programme continues to be developed and expanded to include subjects like equality and diversity, managing risk and equality and diversity. 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. Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: The service told us that regular staff meetings are held, evidence of this was seen during the inspection. There is an open door policy, issues are usually discussed as they occur. All staff have regular supervisions and appraisals booked in advance. The manager akes sure staff have the right support to help service users live fulfilling and active lives. This is done by a system of staff competency checks, that are carried out regularily. If the manager identifies any competencies issues , support and/or training is provided. Care Homes for Adults (18-65 years) Page 29 of 36 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 manager is qualified and has relevant experience to run the home. She is aware of the areas that need improvement and has plans to do this. The home has a consistent record of meeting relevant health and safety requirements. Evidence: The home now has a registered manager, Mrs Cathy Logan was registered with commission following an interview 2 days before the inspection visit. She has several years experience as a deputy manager at the home. The interview she had with the commission showed she has the skills and experience to run the home. The registered manager has a clear understanding of the key principles and focus of the service. She is aware of the shortfalls within the home and has the vision and plans on how these will be addressed. She is working continuously to improve the service and provide an increase quality of life for the service users. She understands the importance of person centred care and actively promotes and leads the staff team. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: The AQAA told us that the home has now a deputy manager who works 2 days a week in a supernumerary capacity assisting the manager with managerial duties. The Company has a quality assurance programme in place, the Area Manager carries out Regulation 26 visits and the Quality Assurance Manager visits the home at regular intervals with questionnaires for staff and service users. Regular audits are done to ensure that standards are maintained and with the aim to identify shortfalls. The results of these questionnaires had not been collated so that the strengths and weaknesses of the service could be identified. The results of the survey had not been published and made available to the service users. Effective quality assurance and monitoring systems measure the success of the home in achieving its main aims and objectives. The AQAA told us all of the necessary Health and Safety checks have been carried out in the home. The random checks that we did confirmed this. Environmental and personal risk assessments are in place. All fire assessments and checks are done at the required intervals. Water temperatures are taken and comply with regulations. The home tells about any event or incident that may affect the well being of the people who live at the home. Care Homes for Adults (18-65 years) Page 31 of 36 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 32 of 36 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 12 15 Each person living at the home needs to have an activities programme tailored for their individual needs and preferences. To ensure that each of the people who use the service are offered the opportunity to engage in a range of activities that are likely to engage their interests and suit their preferences and abilities. To help people live a fulfilling and meaningful life. 30/06/2009 2 23 16 To provide a bedroom that is 31/07/2009 well maintained and adequately furnished including curtains and flooring. To make sure each service user has a bedroom that is well maintained and individualised to reflect their personalities and preferences. Care Homes for Adults (18-65 years) Page 33 of 36 3 23 23 The providers must ensure 30/05/2009 that the premises are well maintained. This means that sufficient maintenance hours must be provided for the ongoing general upkeep of the home; and a clearly documented maintenance plan must be put into place with time scales that are adhered to. This refers to repairs for walls, skirting boards, plaster damage. new flooring to badly damaged and worn areas. Tomake sure that peple live in a environment that is well maintained, homely and pleasant plac eto live. 4 32 18 Staff respect the service users and have attitudes and characteristics that are important to them. To make that all people are treated equally, fairly and with respect and dignity. 30/04/2009 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 1 2 3 6 16 20 All plans need to be up to date and all peoples goals and aspirations need to be identified and worked to wards. All staff need to be able to communicate effectively with service users. The service needs to make sure that an accurate account of events is documented when people receive when required medication for behaviours or any other reason. Page 34 of 36 Care Homes for Adults (18-65 years) Hand written prescriptions need to be signed by 2 people. 4 5 23 23 Bathrooms need upgrading and redecorating All areas of the home need to kept clean and free from any odours. Care Homes for Adults (18-65 years) Page 35 of 36 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. 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