Care Home: Ashley House

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What the care home does well All of the people we spoke to or who completed questionnaires gave positive comments about the service. People who live in the home benefit through the positive and inclusive management approach to running the service. The home provides an excellent and innovative programme of social and recreational activities, is good at promoting choice and maintaining the motivation and independence of people who have dementia. Staff levels in the home are sufficient to ensure that quality time can be offered and people who use the service receive support when they need it. Staff in the home are well trained to enable them to meet the needs of people who live there and the staff recruitment procedures ensure people are protected. A health professional who visits the service told us that `Staff go out of their way to ensure that residents are supported in their choices.` Another health professional commented on the `excellent, stimulating environment, caring well trained staff with excellent management`. A relative remarked that `the staff are very kind, helpful and friendly` and `the home is beautifully kept at all times`. What has improved since the last inspection? The home has continued to develop care and activities planning to make these more person centred. The environment has also been further improved through the thoughtful use of small areas around the home. What the care home could do better: There were no areas for improvement identified through this inspection. CARE HOMES FOR OLDER PEOPLE Ashley House 56 Forest Road Bordon Hampshire GU35 0XT Lead Inspector Laurie Stride Key Unannounced Inspection 8th November 2007 10:00 X10015.doc Version 1.40 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 Ashley House DS0000067403.V349684.R02.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 Older People. 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. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashley House Address 56 Forest Road Bordon Hampshire GU35 0XT 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) 01420 489877 margaret.powell@sanctuary-housing.co.uk Sanctuary Care Limited Mrs Margaret Powell Care Home 36 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0) Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 36. Date of last inspection 14th December 2006 Brief Description of the Service: Ashley House is a care home that is registered to accommodate 34 people in the old age category. Of the 36 residents, the home can accommodate ten (10) older people with dementia, ten (10) older people with a mental disorder and five (5) older persons with a physical disability. The home is owned and managed by Sanctuary Care Ltd. The home is purpose built on two levels and is situated on the site of other assisted living accommodation. The home is subdivided into six clusters, each containing a small lounge and kitchenette area. All 36 rooms are single accommodation with en-suite facilities. There is a large communal dining area, which leads onto an attractive garden that has colourful shrubs and plants. This area provides seating for people who live in the home to enjoy the garden. The home is situated in a quiet residential area that is close to some local shops. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 5 Weekly fees range from £330 to £575. This information was obtained at the time of the inspection visit. Members of the public may wish to obtain more up-to-date information from the care home. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection visit, which lasted five hours, during which we met four of the people who use the service and also spoke with the home’s registered manager and the staff members on duty. Comments were also received through postal survey questionnaires returned by seven of the people who live in the home, a relative and another friend of two people who use the service, three external health professionals who have contact with the home, and twelve members of staff. All comments received were positive about the home, management and staff and the standard of care provided. During this visit samples of the homes records were seen and a tour of the premises was undertaken. The registered manager had also provided information about the service in the annual quality assurance assessment (AQAA). The findings of the previous inspection report of 14th December 2006 were also reviewed as part of the evidence used for this inspection report. What the service does well: All of the people we spoke to or who completed questionnaires gave positive comments about the service. People who live in the home benefit through the positive and inclusive management approach to running the service. The home provides an excellent and innovative programme of social and recreational activities, is good at promoting choice and maintaining the motivation and independence of people who have dementia. Staff levels in the home are sufficient to ensure that quality time can be offered and people who use the service receive support when they need it. Staff in the home are well trained to enable them to meet the needs of people who live there and the staff recruitment procedures ensure people are protected. A health professional who visits the service told us that ‘Staff go out of their way to ensure that residents are supported in their choices.’ Another health professional commented on the ‘excellent, stimulating environment, caring well trained staff with excellent management’. A relative remarked that ‘the staff are very kind, helpful and friendly’ and ‘the home is beautifully kept at all times’. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: 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. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 & 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home’s comprehensive assessment procedures and responsive approach ensure that those people who are admitted will have their needs met. The home does not provide intermediate care, therefore this standard is not applicable. EVIDENCE: There were no areas for improvement identified in the previous inspection report, which was the first key inspection since the home was registered under a new provider. The home’s annual quality assurance assessment (AQAA) stated that potential service users have a needs assessment undertaken prior to moving into the home, and a trial period, to confirm that the home can meet the persons needs. The AQAA also stated that information about the home is given to prospective service users and/or their representatives to enable them to make informed Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 10 choices about where they wish to live. All those admitted have a statement of terms and condition of residency in the home, this was confirmed through comments from people who use the service. We saw that the statement of purpose had been updated to reflect the increase in numbers of people the home is registered to admit. Seven people who use the service and who returned questionnaires confirmed that they received enough information about the home before they moved in, so they could decide if it was the right place for them. One said that they made a visit prior to moving in. We saw the assessment and care planning records of three people, one of who had been recently admitted to the home. The registered manager had assessed their individual needs to determine if these can be met by the service. A comprehensive pre-admission assessment procedure had been used to gather this information, which together with the relevant care managers’ and/or health professionals’ assessments, had been used to generate care plans for the individuals. The assessment process included an activity questionnaire and a section on ‘what you need to know about me’. The home has an activity coordinator, who also undertakes visits to people prior to their admission, which enables the home to get a full picture of the whole person. Detailed daily records are kept following admission and all the information is reviewed after four weeks to form the individuals’ care and support plan. Through looking at the records and speaking with the individual, we learned that a person recently admitted had been able to raise questions and concerns during the assessment process and staff had taken time to put the person’s mind at rest. The activity coordinator had explained that she would be at the home when the person arrived to meet them and help them to settle in. This was carried out and on the first day there were introductions to the home and to some of the people already living there. After lunch the activity coordinator sat with the person in their room for a chat. Subsequent records showed the person continuing to settle in and engaging in social activities. This was all confirmed by the individual, who said that the staff are kind and considerate and had helped her to feel less anxious during the move. All comments received from people who use the service, relatives and friends, staff and health professionals indicated that the home does very well at meeting the needs of people. We saw further evidence of this throughout our visit and this is reflected in the relevant sections of this report. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care services are based on individual needs and the principles of respect, dignity and privacy are put into practice. EVIDENCE: In the previous inspection report the home was commended for the comprehensive care planning system, which is still being used and developed. The format of the care plans indicated that the home takes a person centred approach to supporting people, which is also based on good practice for the care of people with dementia. The three plans we saw included details of peoples’ religious beliefs and spirituality; memory orientation and decision making capacity; comfort, attachment and anxiety factors; fulfilment of interests and hobbies – feeling busy and occupied; and well being profiles. For each person there was a detailed record of their likes and dislikes, memories and preferred routines. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 12 Social histories are collected for all individuals, detailing past history, previous hobbies and recreational past times. This is part of the homes’ holistic approach to the assessment and care planning. Full risk assessments are undertaken for health and safety and include moving and handling. Nutritional and tissue viability risk assessments are also undertaken for individuals and care plans are written if a risk has been identified. We also saw evidence that the home is providing care and support that matches the assessed needs and preferences of people who use the service. Four people who provided comments indicated that they always receive the care and medical support they need, and that staff are always available when they need them. Another three people answered ‘usually’ to the same questions. People we spoke to in the home said their health care needs were being met and were very positive in their comments about the manager and staff. Relatives/friends of people who use the service also indicated that they feel the home meets individuals’ needs. One said ‘if I feel (the person) needs more care in certain areas, I inform the relevant member of staff who does her best to provide what is needed.’ A health professional who visits the service told us that ‘the care of residents with dementia has improved considerably over the past couple of years.’ Comments from the three health professionals who returned questionnaires indicated that the home is effective at seeking advice and acting upon it to manage and improve individuals’ health care needs. All stated that staff members always respect individuals’ privacy and dignity. One said ‘the manager has put in a lot of time and training to ensure staff treat residents with respect and dignity at all times and this is evident whenever I visit.’ The home has appropriate policies and procedures in place with regard to medication. The sample of records we saw were well organised with clear, structured systems for ordering and receiving medications into the home. The return of medication to the pharmacist was well recorded and the records signed by the receiving pharmacist. The storage area for the medication is in a treatment room and holds a fridge for medication storage. We observed that daily temperatures were being recorded. The medication is dispensed as part of a Monitored Dosage System (MDS), supplied by a local pharmacist. Medication Administration Records (MAR) sheets were found to be up to date and completed correctly. The team leader responsible for the management of medication during the shift said that all new staff receive training in the system, although only senior support staff Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 13 administer the medication. Records in the home confirmed that relevant training was provided. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides an excellent and innovative programme of activities, designed so that people who use the service are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The various cultural and dietary needs of the people who use the service are well catered for. EVIDENCE: In the previous inspection report the home was commended for the activities organised for people who use the service. The home employs an activities coordinator who also works on a one-to-one basis with individuals. For example, we saw how individuals were being supported to build up life history albums, using photographs and information provided by the individuals and their families. These are then used as a basis for finding out what people are interested in and developing relevant activities. The outcome of activities and individual participation in them is comprehensively recorded and this is referred to at care and support reviews. Activities include bingo, reminiscence sessions, baking, arts and crafts and quizzes. A notice board in the home contained photographs of people taking Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 15 part in activities and socialising. A person who lives in the home told us how much they had enjoyed the recent bonfire night in the garden and holding sparklers. Another recent activity that the manager and co-ordinator said had been popular was ‘bringing Autumn outside inside’. Using materials such as leaves to stimulate people’s memories and thoughts about what Autumn meant to them, through seeing and touching and talking about the objects. The registered manager told us how one person missed being able to work on a vegetable patch and so the home had made its own vegetable patch, where with support the individual has been able to grow a selection of vegetables including runner beans which have been cooked for lunch. The home’s annual quality assurance assessment (AQAA) states that helping people to be busy and occupied is especially important for people with dementia. We met another individual who we observed assisting staff with domestic tasks and this person told us how much she enjoyed doing this and ‘did’nt want to be sitting around’. Another individual told us that her family had chosen this home because of the activities and the atmosphere. The AQAA also states that one-to-one sessions are given to people who prefer not to join group activities and who sometimes like just to chat, and importantly to be listened to. The home is involved with the local community, for example a play school and junior schools visiting and on occasions people who use the service visiting them. Outings are arranged and relatives and friends are encouraged to join in. The local Vicar visits and takes communion once a month and some people have a religious leader of their choice visit them. In recent months the local church held the morning service at Ashley House with the whole congregation attending. At the time of this visit the vicar was attending the home to give a service in the ‘bar area’ that has been created to emulate a local pub; beer taps and optics included. People who use the service are enabled to exercise choice and control over their own lives. This was observed throughout our visit, in relation to assessment, care and activities planning, food and meal times and social activity. There are three married couples living in the home. Although they have separate rooms they are given the privacy of sharing each other’s rooms. A relative we spoke to was very positive about how the home supports people to keep in touch. People who provided comment confirmed they liked the food. One said this is ‘excellent’. Another said they ‘would like smaller meals but I do enjoy them’. A relative/friend said ‘the food is very good and varied.’ There is a spacious main dining room although people can choose to eat in one of the smaller areas or in their own rooms. There is a daily menu with a choice of alternatives as well as the main meal. People we spoke to confirmed that if someone changes their mind when the meal is being served every effort is made to give them their choice. Breakfast is served between 7am and 9:30am with a choice Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 16 of cooked breakfast as well as cereal and toast. Fresh cakes are made daily for afternoon tea. Snacks are available between meals including during the night. Visitors are welcome at any time and may stay for meals if they wish. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has suitable procedures for dealing with concerns and people who use the service are protected by the home’s policies and procedures. EVIDENCE: The home’s annual quality assurance assessment (AQAA) states that Ashley House has a complaints procedure, which is sent out with every Service User Guide and there is also a Sanctuary booklet called how to complain, which gives the local address of the Commission for Social Care Inspection. All staff receive protection of vulnerable adults training and there is a policy in place. Staff are given a copy of the whistle blowing policy at induction. Seven people who use the service returned questionnaires indicating they know who to speak to if they are unhappy and how to make a complaint. All twelve of the staff members who returned questionnaires said they know what to do if a person living at the home or their representative has concerns about the home. The three health professionals who responded to the survey indicated that the home always responded appropriately if they or the person using the service raised concerns about their care. A relative of one person and the friend of another both indicated that they had never felt the need to make a complaint but knew what to do if they had concerns. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 18 The registered manager reported that the home has received no complaints and there have been no safeguarding referrals, in the time since the last inspection. The registered manager has attended a train the trainer course provided by Hampshire County Council, which qualifies her to deliver training for staff in safeguarding issues. The homes’ records indicated that staff have received the training. Staff spoken to demonstrated their understanding of the reporting procedure and further confirmed they had received the relevant training. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The attention paid to the design and layout of the environment means that people who use the service are able to live in a clean, comfortable and safe home that meets their needs. EVIDENCE: The registered manager reported that since the previous inspection the home has dedicated the first floor to people without dementia, allowing them the freedom to leave doors open and jigsaws, chessboards etc unattended. Those people living with the experience of dementia have rooms on the ground floor so they have the freedom to wander along the corridor and access the garden without disturbing those people who do not have dementia. Meals can be taken together in the dining room if wished. A relatives meeting was held to discuss these proposals, which the manager says have worked very well. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 20 An inspector from the commission’s registration team had conducted a visit on 05/07/07 and their report stated that the premises are fit for purpose and provide a suitable environment to meet the needs of two additional service users. Office areas and the medication cupboard have been re-sited elsewhere in the home. These were viewed and found to be suitable for purpose. The communal areas were well lit and all areas were furnished to a high standard. There is a large dining area, which we observed is also used for activities. In the previous inspection report the home was commended for the way the small lounge areas, which can be used to take meals, have been created and decorated to make a very homely environment. Attached to these areas is a small kitchen area that has facilities for making tea. We saw that the home has continued to make excellent and thoughtful use of the small areas located around the premises. The Dog and Trumpet pub area, already mentioned in another section, was created following a reminiscence session. We also saw a recent creation has been a ‘country kitchen’ area that includes an oven for tactile use, dining table, chairs and scales. There is a spiritual corner in the home that contains a book of remembrance with photographs of people who have passed away placed in it. The registered manager said that families, staff and residents find this experience helps with the grieving process and assures them the person has not been forgotten. The atmosphere in the home was warm and welcoming and people who use the service have plenty of space of wander and sit in different areas if they so wish. They also have access to safe and comfortable outdoor facilities in the finer weather. There is clear signage around the home making it easier for people to find their way around. All private rooms are en suite and there are five bathrooms with specialist baths or hoists. The bathrooms and toilets were clean and it was noticed that wallpaper borders had been put up in the bathrooms to make theses areas more welcoming. We saw that people who use the service are encouraged to bring in their own personal possessions to personalise their rooms. This supports people to have choice and control over their own lives and helps them to settle in. An inventory of the items brought into the home is maintained in the individual’s records. The organisation has preferred suppliers and contractors who deal with maintenance issues and also provide an out-of-hours service. The registered manager said that this arrangement worked very well. The laundry at the home is operated by dedicated laundry staff and has two industrial washing machines and a tumble drier. Staff members receive Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 21 training in infection control that is cascaded down from senior staff. Staff members complete questionnaires to test their knowledge, there is a clear laid down procedure for washing commodes and the home was clean throughout. We observed that staff members were following procedures for the prevention of infection control and hand-washing facilities were available throughout the home. People we spoke to were very satisfied with the facilities and all who returned questionnaires confirmed the home is kept fresh and clean. A health professional commented on the ‘excellent, stimulating environment.’ Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitably qualified staff are employed in sufficient numbers to ensure the individual needs of people who use the service can be met at all times. Appropriate training is provided to enable staff to develop skills that help them meet the needs of the service user group. A robust employment procedure ensures that people who use the service are protected. EVIDENCE: The homes’ rota was seen, which showed that there are usually five staff members on duty on the early shift and four staff members on the late shifts. Three staff members cover the night duty. These numbers do not include the registered manager and the activities co-ordinator. The registered manager said that if peoples’ needs increase, busier times are covered with extra staff, for example 7-10am and 5-9pm. The registered manager said that bank staff are also employed, who all work regularly ensuring continuity and all have the opportunity to undertake the training that permanent staff do. This eliminates the need to use agency staff. The catering staff consists of a Chef Manager or Second Chef with two catering assistants. The home also employs a housekeeper, a laundry assistant and three cleaners who are on duty daily. During the visit, staff were observed Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 23 spending time with individuals who use the service. We observed staff conducting a handover between the shifts and noted how thoroughly this was carried out. Care plans and daily records were referred to for each individual who lives in the home and any relevant issues were discussed and clarified. Staff spoken to demonstrated positive attitudes to their work and commitment to providing quality care to people who live in the home. A health professional who visits the service commented that ‘staff are clearly interested and motivated to work with this client group, much of which I am sure is due to the example of the manager.’ The homes annual quality assurance assessment states that all who have worked in the home in the last twelve months had satisfactory preemployment checks. We saw further evidence of this at the time of the visit through a sample of records relating to a new staff member currently being recruited and another recent recruit. The new member of staff was awaiting the outcome of Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks before starting work. We saw written requests for references, copies of the interview questions and a questionnaire designed to ensure that staff are able to record entries in care plans sufficiently well. The other member of staff had started work and we saw that all the required information, such as a completed application form with employment history, two written references, POVA and CRB checks was in place. This demonstrates that people who use the service are being protected. The registered manager reported that all staff members have had some training in dementia care and 90 of staff are undertaking a qualification in dementia care. 80 of staff members have a level 2 or 3 National Vocational Qualification (NVQ) in social care. Catering and housekeeping staff members are also taking NVQ level 2 qualifications. Records and certificates were on file to confirm this. We saw that training records are kept in files for all staff. The home has its own induction pack and also uses DVD training. The registered manager and senior staff have accomplished a train the trainer award in order to deliver the training. We saw the comprehensive dementia training packs and staff members commented on how useful they found this training. One said they thought the training being offered ‘is excellent’. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from the homes’ management, which is based on openness and respect and promotes individuals’ safety and independence. The home is able to demonstrate a sustained track record of providing a high quality service to people. EVIDENCE: The registered manager, Mrs Margaret Powell, holds the Registered Managers Award (RMA) and a Diploma in Dementia Care and also has an NVQ Assessors Award. She has also undertaken Train the Trainer courses in Dementia Care, Protecting Vulnerable Adults, Infection Control and Medication and the Mental Capacity Act. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 25 Comments received from three health professionals who have knowledge of the service were all positive. One said that the management of the home is excellent. Another confirmed this saying they thought ‘the care service at Ashley House is extremely high’ and indicated that the service had improved significantly since the registered manager had been in charge. Staff members confirmed that the management is supportive. One said ‘support is always on hand so you never feel you are out of your depth.’ Throughout the visit it was clear that the ethos and management approach of the home creates an open, positive and inclusive atmosphere. People who use the service, staff and other stakeholders gave very positive comments about the management and how the home is run. The excellent outcomes demonstrated in terms of the overall support planning and quality of life for people who live in the home are the result of a well-managed service. The home actively seeks the opinions and views of people who use the service and their relatives/friends on how the home meets it’s stated philosophy of care. This is undertaken by questionnaires and also by the manager being available and around the home to talk to people. There is also a monthly newsletter. Regular staff and service user meetings are held and relatives often attend. The manager has an ‘open door policy’ and we observed this throughout the visit. A relative commented that the registered manager ‘is available to talk to at any time. She is very caring and will listen to you.’ An area manager undertakes monthly regulation 26 visits to the home and reports were available. These showed that people who use the service were asked their views, care plans and other records were checked and any matters requiring action were recorded and followed up. The home holds small amounts of money for some individuals and records of all transactions are kept on file. Money is stored individually and records signed by two authorised signatories. We saw a sample of the records relating to one individual and this had been completed correctly and matched the balance held. The registered manager supervises the team leaders who supervise the care staff. The registered manager is supervised and supported by a regional manager. We saw records demonstrating that staff members receive regular recorded supervision and annual appraisals. The home had recently received the updated organisational policies and procedures. We saw evidence that safe working practices are promoted in the home. Fire safety records were up to date and completed correctly for all equipment, Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 26 instruction and drills. There was an updated fire risk assessment for the building, following the recent changes to the premises. Certificates were also seen for annual tests on gas boilers, PAT (electrical equipment testing) and water systems testing. All staff members undertake mandatory training in health and safety subjects, such as fire safety, moving and handling, food hygiene, first aid and infection control. Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 4 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 17 18 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 X 3 3 X 3 Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Ashley House DS0000067403.V349684.R02.S.doc Version 5.2 Page 30 - 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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