Care Home: Ashleigh House [Taunton]

Similar services:

• 2 Perhaver Park
• The Vicarage
• 7 Hyde Road
• St George`s
• 5 Seafield Road
• Radfords
• Trevaylor Manor

What the care home does well Ashleigh House is a suitable house for the people who live there. The staff are generally knowledgeable about people`s needs and aspirations and try to meet needs in an empathetic manner. There are a good range of good community and in house leisure activities on offer to people. The comment cards that were returned from people living at the service were satisfied with the care and support received. What has improved since the last inspection? At the last inspection five requirements and one recommendation were made to the home. Requirements related to safe medication management, retaining evidence of safe staff recruitment checks, risk assessing challenging behaviour, risk assessing activities and reviewing the routine use of key pads to restrict access to parts of the home. These requirements have been met. A recommendation was made that contracts be issued to people living at the home. These have been issued to parents, as contracts are not produced in easy to read formats. What the care home could do better: Medication systems are now more robust but some information needs writing on the daily medicines sheet to make the medicines administration system safer. A number of recommendations are made to the service. Staff would benefit from more training in communicating with people who have either difficulty with talking or understanding. More staff need to undertake NVQ training in care qualifications. Staff need to have training in supporting people who may not always be able to give their consent to doing things or having things done to them. Some records in the home would be easier understood by people living there if they were written in easy to read formats. Some parts of the home could be made more homely. Some health monitoring needs to be explained in care plans. Complaints procedures need to be changed to say that other people can be contacted at any time if a person feels unhappy about things at the home. There is good information kept in the home about staff recruitment but the manager should write down when there has been a discussion about gaps in people`s employment history when they apply to work at the home. CARE HOME ADULTS 18-65 Ashleigh House 20 Chip Lane Taunton Somerset TA1 1BZ Lead Inspector Judith McGregor-Harper Unannounced Inspection 18th January 2008 10:30 Ashleigh House DS0000059617.V357377.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 Ashleigh House DS0000059617.V357377.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. Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashleigh House Address 20 Chip Lane Taunton Somerset TA1 1BZ 01823 350813 01823 257914 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) Voyage Ltd Miss Julie Pamela Lawrence Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) 2. Physical disability (Code PD) The maximum number of service users who can be accommodated is 8. Date of last inspection 30th April 2007 Brief Description of the Service: Ashleigh House is registered as a care home to provide personal care (PC) to eight people with a Learning Disability (LD) and Physical Disability (PD). The home is located within walking distance of Taunton town centre, as there is a lane that runs by the home providing a short cut into the town. This lane is suitable for using during daylight hours. The home also has its own wheelchair friendly transport. Ashleigh House has eight single bedrooms and all bedrooms have full en-suite facilities. Two bedrooms are located on the ground floor. There is a large lounge, conservatory, dining room and kitchen. The home has a passenger lift to the first floor. The home is furnished and decorated to a reasonable standard. The current scale of charges for the home is approximately £950 - £1,600 per week. Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means that people who use this service experience good quality outcomes. This inspection took place over one day in January 2008. The inspection was announced as we asked permission from the manager to use in the inspection the services of an expert by experience. An ‘expert by experience’ is a person who because of their shared experience of using services, and/or ways of communicating visits a service with a inspector to help them get a picture of what it is like to live in or use the service. The expert by experience provided some verbal feedback on the day of inspection and written feedback following the visit. Information received from the ‘expert by experience’ has been included in this report within the section relating to Lifestyle and Staffing. Eight people were living at the home on the day of the inspection. There are currently no vacancies at the home. Four men and four women between the ages of 19 - 45 years live at the home. There has been one admission since the last inspection in 2007. We were able to see and observe staff interactions most people. Some people were out at day centres/ activity sessions. We spoke with four staff on duty. No relatives were visiting the home at the time of the inspection. The manager Miss. Lawrence was on duty and available during the inspection process. We would like to thank the duty staff for their time and hospitality shown to us during our visit. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. Records examined during the inspection were three care and support plans, written risk assessments, staff recruitment and supervision records, medication administration records and maintenance records. After the inspection, at our request the home provided and forwarded copies of the staff training matrix, activity timetable for individuals living at the home, revised Statement of Purpose and Service User’s Guide, Regulation 26 reports of monitoring visits by the provider and contact addresses of community health and social care professionals linked to the service, so that surveys could be sent to them. We received survey responses from two people living at the home completed with help of staff working at the home, and surveys from three staff members and six relatives of people living at the home. Their comments have been made anonymous and included in the body of the report. The service was also requested to complete an Annual Quality Assurance Assessment (AQAA) and Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 6 submitted this to the Commission but this was not received back by the given due date at the time of writing this report. What the service does well: What has improved since the last inspection? What they could do better: Medication systems are now more robust but some information needs writing on the daily medicines sheet to make the medicines administration system safer. A number of recommendations are made to the service. Staff would benefit from more training in communicating with people who have either difficulty with talking or understanding. More staff need to undertake NVQ training in care qualifications. Staff need to have training in supporting people who may not always be able to give their consent to doing things or having things done to them. Some records in the home would be easier understood by people living there if they were written in easy to read formats. Some parts of the home could be made more homely. Some health monitoring needs to be explained in care plans. Complaints procedures need to be changed to say that other people can be contacted at any time if a person feels unhappy about things at the home. There is good information kept in the home about staff recruitment but the manager should write down when there has been a discussion about gaps in people’s employment history when they apply to work at the home. Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 7 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. Ashleigh House DS0000059617.V357377.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 Ashleigh House DS0000059617.V357377.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, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is written information about the home and a summary is available in an easy to read format for people to clearly understand what the home is like. A comprehensive assessment of need is completed prior to people moving into ensure the home will be able to fully meet their needs. Contracts are given to people’s families but this information is not available in easy to read or pictorial form for people who live at the home. EVIDENCE: The home sent us the most recently updated copies of their Statement of Purpose and Service User’s Guide, which give information about the home, the staff and how people will be treated if they move in. Only the Service user’s Guide is available in an east to read format with pictorial aids. We looked at the care plan for the person who moved in last. There were detailed assessments of care and emotional/behavioural support needs that the person had been getting and still needed. Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 10 The person visited the home over several days to find out if they liked the home. Other people in the home’s needs were considered and how any new admission would affect the group living. The two surveys responses from people living at the home did not express any opinion to how they thought the move into the home was for them. Ashleigh House DS0000059617.V357377.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have a written plan of care that is drawn up by consulting professional care staff. A person’s health and social care needs are reviewed often and then the care plan is changed. This is to make sure that people know about how much someone help and support someone is needing. People’s activities are risk assessed by staff; there is little evidence of consultation with people living at the home during risk assessments. EVIDENCE: Three care plans inspected included a photograph of the person and gave information regarding care needs, daily routines and preferences. The care plans also include records of visits to health care professionals, contact with families, activities undertaken and any accidents and incidents reported. There is evidence in the care plans of monthly reviews by staff and family input. Systems are in place to monitor development and changes. Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 12 The home is in the process of starting to change the care planning format. The aim is to develop care plans in more accessible formats; this will help people to be more involved in the care planning process. Risk assessments were seen written in relation to individual’s behaviours, such as pinching or slapping. Since the last inspection there has been work to ensure that there is a plan is place to deal with such anti-social behaviours. Survey returns from two people living at the service reported that they always make decisions about what they do each day and that staff always listen and act on what they say. In one person’s room was a colour chart display that the person would indicate a daily preference for choosing items of clothes to wear. This is a simple and effective devise in enabling a person to demonstrate choice and inclusiveness in daily activities. The service has accessed advocacy services under the Somerset Independent Mental Capacity Advocacy scheme to help support people to make important decisions. There is a photo board is the home hallway displaying staff photos of who is working that day. There is also a board displayed in the dining room displaying pictorial signs, photography and symbols listing the activities planned for that day. One person uses a communication board. This person continues to use a communication passport, which enables the person to tell staff what they want to do or talk about. One survey response from a relative said that in their view the staff approach to their relative’s communication needs was inconsistently applied due to not all staff possessing specialist knowledge of communication aids. Ashleigh House DS0000059617.V357377.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a busy programme of activities and leisure pursuits both in and outside of the home for people living there. People living at the service tend to mix with staff. This means that there is not a lot of peer interaction at the home and people are more likely to build relationships with staff. Family contact is encouraged and some people have maintained very close family links using opportunities to go back to the family home each week. EVIDENCE: The ‘expert by experience’ focussed upon the activities and choices available to people at the home. Their assessment of the service found: ‘Verbal communication is limited for all people who live at the home. Some people communicate by using Somerset Total Communication or Makaton with Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 14 those staff that have attended this training. Peoples’ likes and dislikes, where expressed are recorded in care plans. For day-to-day decision making families are included. Peer advocacy is not used but staff on duty were open to this suggestion by the expert by experience. During the inspection people indicated choice by signing or pushing away what is not wanted. This means that people have the ability to exert some control in decision making to simple questions. One person gave the thumbs up sign when asked if they enjoyed living at the home. People have been offered holidays. Holidays tend to be local and holidays are only not taken if there is either a good medical or psychological reason to not go. This is recorded in the care plan and is discussed and agreed with a person’s care manager. The range of current activities undertaken by people in the home include horse riding, trampoline sessions, swimming, walks and drives in the mini-bus, art and music groups, sensory light room therapy, college (classes in computers, art, sign language and symbols), theatre trips, day centre access, pub lunches and toning tables. The home has a good size garden which is presently under utilised and potentially would offer rewarding opportunities for people to be more involved with growing produce or gardening than is the present case. During the inspection people were coming and going from the house for different activities. At other times people were observed walking about the home. In the house a conservatory is converted to a Snoozelen room and light area. The home has a modern kitchen and plentiful supplies of food including fresh produce. The menu board is in an accessible format and people are invited to go with staff to buy food for weekly groceries.’ Choice of meals is influenced by people’s recorded likes and dislikes. In the two survey responses from people living at the service both people said that they could do what they wanted during the day, evenings and weekends. Ashleigh House DS0000059617.V357377.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, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health care is closely monitored although the reason for some routine monitoring is not given. People use professional health care services in the town whenever they need to do so in order to keep them healthy. Medicines are given safely to people but some record keeping for medicines needs to be clearer so that staff always know how much medicines can be safely given. EVIDENCE: The home has aids and equipment to help people’s mobility. Four people currently use wheelchairs when out of the home on trips. Four care plans inspected to look at health care needs showed that people have regular health care checks from the GP and community nurse. They also see other professionals including a psychiatrist, psychologist and physiotherapist if needed. The two survey responses received from people living at the home said that the staff treat them well. Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 16 The health care needs in care sampled contained records of the visits made to the GP, dentist, chiropodist, optician, speech and language therapist, physiotherapist and consultant psychiatrist. People are routinely weighed at the home as part of health care monitoring. Healthcare needs need to be monitored in order to recognise potential problems and identify complications so that procedures in place to address them. In three health care plans where weights were recorded this was linked neither to Body Mass Index calculation nor nutritional assessment. This means there was no rationale for why people are weighed, how to interpret the measurement or what this means or what should be done about it. One other person in the home is weighed regularly due to being very thin. This person does have a plan to manage their weight and their plan and is good practice. Everyone should have a rationale recorded for being weighed linked to a nutritional assessment plan in order for staff to make sense of the measurement results. At present nobody living at the home is able to retain or administer their own medication. The reasons for this are documented in the individuals file. The home’s processes for the handling and recording medicines were checked. There was good record keeping for medicines that are not regularly taken and a reason for why the medicine might be needed by a person written on the medicine chart as a guide for staff. Medicines that can be bought without a GP saying so were also safely managed and the home had written to each person’s GP asking what medicines a person might safely take with medicines that the GP has prescribed. There were written guidelines for some specialist medicines to be given in emergency situations. Staff had recorded on bottles or tubes of liquids and creams when they had been opened and must not be used after to ensure that people do not have medicine that is out of date and unsafe. The medicine sheet did not have what the maximum safe dose of Paracetamol must be in a 24 hour period. Two liquid medicines written on the medicine chart did not have the strength of the dose on it. The fridge where medicines that need to be kept cold in it was too cold and had regularly been running too cold. The home needs to change the guidance for staff on the correct temperature that cold medicines need to be stored at. The guide in the home was for that of a domestic fridge and not for medicines. The home is using independent advocacy services support some people living there when taking a team approach to important health decisions that will affect their life. Everyone at the home has his or her own en-suite facilities to receive personal care in privacy. Ashleigh House DS0000059617.V357377.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home takes reasonable steps to ensure the safety of the people living there through its policies and guidelines. EVIDENCE: Both surveys completed from people living at the home said that they knew who to speak to if they were unhappy. Neither person indicated an opinion if they knew how to make a complaint. Four out of six relative surveys said that they knew how to raise a complaint about the home. The home has a complaint procedure that is included in the Statement of Purpose. Included are timescale of how the Company will respond and by what timescale to a complaint if raised. The policy says that statutory agencies such as the Commission may be contacted after the complaint has been investigated if a person is still dissatisfied. This should be amended to say that people have the right to contact outside agencies such as the Commission at any stage of the complaints procedure. The manager reported that the home has received one complaint since the last inspection, which is currently under investigation by a senior manager responsible for overseeing quality in the home. There is a summary of the complaints procedure in an accessible format on the communication board in the home. The home has guidelines and procedures for reporting suspected abuse. Staff recruitment files inspected showed that the necessary checks on people’s Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 18 background character had been carried out to ensure that staff employed do not pose a risk to the safety of people. The manager reported that staff training on the protection of vulnerable adults is completed at induction and refresher updates are completed via the home’s training laptop that is available in the home. Staff survey responses regarding in-house training was positive. Ashleigh House DS0000059617.V357377.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, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and reasonably decorated in most areas. People do not have freedom to move unrestricted around the home, as there are a lot of keypads on doors in the home. The home has recorded the reasons why this is necessary to stop people from hurting themselves. EVIDENCE: We inspected the home’s environment. It was clean and comfortable. People’s rooms seen were personalised to reflect their own tastes and preferences. The home has bedrooms on the ground and upper floors. There are stairs or a lift to the first floor. Ashleigh House is a large late Georgian house with large sized rooms. There is a spacious lounge with lean to style conservatory. The conservatory provides extra communal space and is also used as a sensory room. Leading from the main hallway is a dining room. The dining room has been identified by the company as in need of redecoration this year. Some of Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 20 the paintwork is also tired and damaged in the lounge and ground floor corridors. Two survey responses from people living at the home reported that the home is ‘always’ fresh and clean. The kitchen is modern and has a small dining table and few chairs. This provides alternative dining area or space for cookery sessions. The kitchen was clean and hygienic. Near the kitchen is a good-sized laundry room, which has an industrial washing machine and a tumble drier. Staff said that people living at the home get involved in doing their own laundry. Next to the laundry room is a small utility area, which provides an area for the storage for medicines. The utility area was well lit and contained a small handwashing sink. There were supplies of liquid soap and paper hand towels in the home by sinks for staff to suitably wash their hands. To the side of the house, there is a large private garden that is not overlooked. The outdoor space is plentiful for outdoor activities. All bedrooms have en-suite facilities. It was noted that all rooms are assessed via a key pad locked door system. Since the last inspection rationales for this in terms of restricting people’s freedom to freely move about the home in terms of safety have been written. Around the home are a number of posters intended for staff information or for general information about hazards, such as for hand washing in the visitor’s toilet. This has the effect of the home feeling more like a place of work then a residence for the people living there. Unless required by law it is recommended that the manager review information posted in the home intended for staff to read in order to enhance the homeliness of the building. Ashleigh House DS0000059617.V357377.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, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a suitable number of staff on duty rosters to support people’s needs. There is a staff training programme and some staff still need specialist training in communicating with people and supporting people to make decisions for themselves. The home employs staff in a way that does not put people at risk but the manager should write down when there a problems in staff employment records to show that this has been noticed and talked about. EVIDENCE: Rosters for staffing over two weeks were seen. Staffing level appeared suitable to meet people’s assessed needs. Daily staffing levels at the home were reported by the managers as six to seven staff in the morning and four to five staff in the afternoon to met the care needs of the eight people living there. At night there are two waking staff on duty. The manager reported one full-time staffing vacancy at the home. Applicants have been interviewed. The homes own staff team is covering the shift hours. Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 22 Three files were inspected of staff employed since the last inspection. The manager has a clear system for organising staff recruitment records and keeps copies of recruitment records that get sent to the company central recruitment office. For one person the manager had not yet written down a record of talking about gaps in the employment history of a person employed. She must do this to show that the recruitment process was robust. The manager plans to send staff on training in the Mental Capacity Act, which came into force last year. This needs to happen so that people’s right in exercising choice can be protected. When the expert by experience talked with staff it was evident that some staff still require training in communicating with people who may have limited verbal responses or cognitive impairment. Not all the staff at the home have had specialist training in communication in order to help support people to make decisions about their care. The manager reported that less than 50 of staff currently hold a minimum qualification of NVQ level 2. The three staff surveys received were positive regarding training given to them at the home. All said that they had received an induction and that this either covered what they needed to know their job well – ‘mostly’ for one staff member and ‘very well’ for two staff members. Four out of six survey responses from relatives reported that they believed the staff at the home are well trained. Where two people expressed reservations this was explained either as being because of recent staff changes or in one person’s opinion some staff did not want to attend more training. Ashleigh House DS0000059617.V357377.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, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management of the home is stable. Quality assurance processes are in place and are carried out to make improvements to the service. Health and safety arrangements are put into action to ensure that people living at the home, staff and visitors are safe. EVIDENCE: The manager is Julie Lawrence. She does not currently hold the Registered Manager’s Award but is studying toward the company’s management development programme. Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 24 The home uses formal quality assurance processes. A senior manager from the company inspects the home monthly and writes a report of their findings. There is also an annual service review that highlights action the home needs to plan to improve the service over a year plan. In survey responses from relatives three people said that the staff ‘always’ keep them up to date with any changes in their relative’s needs. Two people said that this ‘usually’ happens and one person said this ‘sometimes’ happens’. The home uses health and safety audits. Fire safety records were examined. Fire equipment had been serviced and tested as required. The electrical hardwiring certificate, portable appliances and landlord gas safety certificates have been appropriately maintained. Staff have received fire safety training three monthly. The manager was in the process of completing risk assessments for the kitchen. All hazardous substances had been stored securely and were not accessible to people living at the home. The manager reported that the staff roster is planned to ensure that on every shift there is a person holding a current first aid certificate. The manager confirmed that first aid in choking is included in staff first aid training as there are people who live at the home who need help when eating and drinking and are also at risk of choking during mealtimes. The home has been completing the required alert forms to send to the Commission if someone is injured at the home or goes into hospital. Ashleigh House DS0000059617.V357377.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 3 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 3 X 3 X X 3 X Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13 (2) Requirement The maximum dose of Paracetamol that can be taken in a 24 hour period must be recorded on the Medication Administration Record. The strength and dose of a medication must be recorded on the Medication Administration Record. Timescale for action 01/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA5 YA6 YA19 Good Practice Recommendations It is recommended that the provider consider producing service user contracts in easy to read formats. It is recommended that individual care plans be produced in easy to read formats. Appropriate plans should be developed to identify where people are at risk of weight loss/ gain. Nutritional plans DS0000059617.V357377.R01.S.doc Version 5.2 Page 27 Ashleigh House should support the routine recording of a person’s weight. 4 YA20 It is recommended that the cold medicines recording sheet be amended to state that the recommended temperature range be between plus 2 and plus 8 degrees Celsius and that instructions are provided for staff on how and whom to report temperature variations outside of this range. The complaints policy and Statement of Purpose should be amended to state that the Commission may be contacted at any stage of the complaint’s process. It is recommended that information for staff posted in communal areas be reviewed with regard to enhancing the homely appearance of the building. It is recommended that the dining room be redecorated to upgrade the paintwork that is damaged or worn. It is recommended that work continue to ensure that a minimum of 50 of care staff achieve a minimum qualification of NVQ level 2 in care. It is recommended that staff receive additional training in communicating with service users with limited verbal responses. The manager should record explanations of gaps of employment given by staff applicants. It is recommended that staff receive training in the Mental Capacity Act 2005. 5 YA22 6 YA24 7 8 YA24 YA32 9 YA32 10 11 YA34 YA35 Ashleigh House DS0000059617.V357377.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Ashleigh House DS0000059617.V357377.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!