Care Home: Ashlong House

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What the care home does well The home is able to demonstrate that it is assessing and meeting the needs of service users living at the home. Prospective service users, their relatives and friends are able to visit and to assess the quality, facilities and suitability of the home. The health and social care needs of service users are being well met. Service users are living in a safe, well-maintained environment, with access to safe, pleasant and comfortable facilities. Service users presented as being well settled and very happy in their environment, and very satisfied with the staff, their care support and the communal and personal facilities provided. Hannah Lane is managing the home in an open, professional and very competent manner. What has improved since the last inspection? The following progress has been made since the last full key standards inspection carried out in June 2006. Service users now receive their own copy of the Service User Guide. This includes a copy of the complaints procedure and process, a copy of their latest care plan and any relevant risk assessments. A signed and dated copy of their contract with the home is included. A ragged carpet in one of the residents bedrooms has been replaced. With regard to care planning referring agencies are now being kept within the care planning loop for their service users and copies of "in house" reviews are routinely sent to the referring agency concerned with the resident. The quality assurance process has been uprated and the questionnaires for the service users has been revised together with the input of a service user living in the home. Other sources of feedback have been gained and an analysis of the feedback received from questionnaires and other feedback sources has been carried out and now informs the home`s annual development plan. What the care home could do better: This is a very positive inspection report and it will be important in the future to maintain the high standards that have now been achieved. CARE HOME ADULTS 18-65 Ashlong House Ashlong House 141 Longfellow Road Worcester Park Surrey KT4 8BA Lead Inspector David Halliwell Key Unannounced Inspection 3rd December 2007 09:30 Ashlong House DS0000048490.V355465.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 Ashlong House DS0000048490.V355465.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. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashlong House Address Ashlong House 141 Longfellow Road Worcester Park Surrey KT4 8BA 020 8330 2708 01483 740 569 hanlane860682560@aol.com 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) Throwleigh Lodge Hannah Suzie Lane Care Home 15 Category(ies) of Learning disability (15), Physical disability (10) registration, with number of places Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service user in bedroom 3 must be able to manage in the bedroom without the aid of a wheelchair. The service user who was named to the CSCI on 4th April 2005 is the only service user who may occupy Bedroom 2 if they require the use of a wheelchair whilst in the bedroom. 7th June 2006 Date of last inspection Brief Description of the Service: The home comprises of a detached house and a bungalow, both situated in a cul-de-sac off a quiet street in Worcester Park. Ashlong House is registered to support 10 people with learning disabilities and 5 with physical disabilities. The home has been prepared so that the bedrooms, bathrooms and communal spaces can meet the needs of this service user group. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit of the services at Ashlong. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with 3 staff and the Manager and 4 of the service users who are residents at Ashlong. Since the last full inspection the acting Manager (as was) has now registered with the Commission for Social Care Inspection and is the Registered Manager. No requirements have been made as a result of this inspection and no recommendations; reflecting an extremely positive inspection and a good deal of very positive progress that has been made by the Manager and her staff team since the last inspection. The Inspector was very impressed by the commitment and enthusiasm of the Manager and of the staff group and of the quality of the services being provided at Ashlong. The Inspector found the residents and staff most helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. What the service does well: The home is able to demonstrate that it is assessing and meeting the needs of service users living at the home. Prospective service users, their relatives and friends are able to visit and to assess the quality, facilities and suitability of the home. The health and social care needs of service users are being well met. Service users are living in a safe, well-maintained environment, with access to safe, pleasant and comfortable facilities. Service users presented as being well settled and very happy in their environment, and very satisfied with the staff, their care support and the communal and personal facilities provided. Hannah Lane is managing the home in an open, professional and very competent manner. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 6 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. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 7 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 Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 8 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): Standards 2, 4, & 5 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Prospective service users may be fully assured that their needs are assessed and that their individual aspirations and wishes will be taken into account in the assessment process. They may also be assured that they will be offered an opportunity to visit and to “test drive” the home. Each service user has an individual written contract and is provided with a copy. EVIDENCE: Standard 2 – The Manager informed the Inspector that since the last inspection 5 new residents have been admitted to the new unit called Ashlong Cottage. No new residents have been admitted to Ashlong House. The Inspector reviewed the files of the new residents and found that all had received a full and comprehensive pre-admission needs assessment that was carried out with skill and sensitivity by Ashlong staff to the needs of the people concerned. The Manager also told the Inspector that staff ensure a needs assessment and care plan is obtained from the referring authorities for each new resident. Evidence Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 9 of this was seen by the Inspector on the resident’s files and the combined information from both sources form a comprehensive information base for each resident from which accurate and relevant care plans can be drawn up. The Manager explained to the Inspector that the needs assessment process is about ensuring that staff can meet the identified needs of the prospective resident in that they have the appropriate skills, training and knowledge to enable them to do so. Before agreeing admission to Ashlong the Manager allocates a key worker to each resident who will work with them on developing the home’s care plan and in making sure it meets their identified needs. The residents concerned were involved in the assessment process as much as is possible, given their level of disability. Where appropriate, families or advocates spoke for residents and together this provided them with the opportunity to express their wishes and preferences and to comment on their identified needs. Information about the family and close relationship needs of the residents had been included in the assessment and care planning processes. When the Inspector spoke with one of the residents it was clear from what she told the Inspector that she had been and is still fully involved in the process and that she is very satisfied with the outcomes of her care package at Ashlong as a result. Standard 4 – The Manager told the Inspector that all prospective residents are encouraged to make a preliminary visit to Ashlong in order to familiarise themselves with the home and to provide them hopefully with enough information from which they may decide to go to live there. Following this visit prospective residents are offered a trial period over which they can better decide if Ashlong is right for them. Families and friends are said to be encouraged to visit the home over this period. At the end of the trial period there is a meeting with the prospective resident and their clinical team which has referred them and the staff at Ashlong and a decision is then made as to whether the placement will proceed or an alternative resource found. Residents confirmed to the Inspector the process above and said that they had found it very useful in helping them to decide whether they wanted to live at Ashlong or not. They decided they did wish to and remain happy with this decision. Standard 5 – Each resident’s file inspected contained a written contract which specified all the terms and conditions as set out under Standard 5 of the National Minimum Standards. Where possible residents had also signed in their agreement and they have a copy of the contract on their own handbook that is kept in the resident’s own bedrooms. A requirement made at the last full inspection has now been met. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 10 The Manager is reminded that these contracts will need to be renewed each year. Ashlong House DS0000048490.V355465.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): Standards 6, 7, & 9 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents may be assured that their assessed and changing needs and personal goals will be reflected in their care plans. They may also be assured that they will be able to make decisions about their daily lives and be enabled to take risks as part of developing a more independent lifestyle with support, as they need it. EVIDENCE: Standard 6 - 4 residents files were inspected and all had a Life Style Plan, this plan is very comprehensive and includes detailed information on the service user’s health, social and domestic activities and communication needs. The plan is person centred and completed by the service user with help from an allocated key-worker. Plans examined included photographs of residents involved in domestic, therapeutic and social activities. The plan also includes information under the headings “The support I need to meet my needs and reach my goals” and “My daily living activities”. For a new resident the plans Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 12 are reviewed initially on a three-month basis and subsequently then on a six monthly basis. All service users have had their plans reviewed. At the last inspection it was recommended that in order to ensure that referring agencies are kept within the care planning loop for their residents, copies of “in house” reviews be sent to the referring agency concerned for the resident. The Manager told the Inspector that this has since been done for every review. Referring agencies are also always invited to the reviews. Standard 7 - The home offers service users and their relative’s questionnaires in order to seek their views of the service that the home provides. Information from these questionnaires is used as part of the homes Quality Monitoring System so that the service offered to the service users can be improved. At the last inspection it was recommended that the Manager analyses feedback received from questionnaires and other feedback sources and where trends or themes emerge they are inputted in the home’s annual improvement plan as priorities for service improvements. The Manager told the Inspector that this is now in place and the Inspector was given a copy of the development plan that clearly shows how the feedback information has been used. A previous good practice recommendation has now been met. Residents meetings have now been re-instated and are a regular feature in this home. The Manager informed the Inspector that since the last inspection when these meetings were not happening, residents had since decided they wished to continue to have them as their view was that it could better meet their needs for improved communication within the home. Interviews with residents confirmed this view. At the last inspection the Inspector recommended that staff record in the daily record sheets all important decisions and discussions had with resident as this would better protect residents and staff from misrepresentation at a later stage. The Manager told the Inspector that since the last inspection this has been done and that problems identified that lead to this recommendation has been mostly resolved. A previous recommendation has therefore been met. Standard 9 - All residents have had risk assessments carried out for both inside the home and for activities outside the home. These assessments are reviewed on a regular basis and are referred to in the residents care plans. All staff have signed these care plans. Inspection of the review reports showed that the changing needs of residents had been identified and that appropriately revised care plan objectives had been drawn up together with the resident where-ever possible. Key workers were seen to actively provide 1:1 support; to revise the care plans as necessary and to keep the residents informed. Formal 6 months reviews are planned and held with the clinical teams and the residents. Ashlong House DS0000048490.V355465.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): Standards 12, 13, 15, 16 & 17. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that they will be able to take part in appropriate activities, some of which will be based in the local community. That they will be supported to maintain appropriate personal relationships with family and friends; and that their rights will be respected and their responsibilities recognised in helping them to construct an appropriate programme of activities in their daily lives. EVIDENCE: Standard 12 - The Manager told the Inspector that in order to ensure that each resident is involved in daily activities appropriate to their abilities, needs and wishes, the staff at Ashlong maintain daily activities sheets. These record the activities of each resident and link the activities with their care plan objectives and what they say they want to do. Inspection of 4 of the resident’s files show that the resident’s care plan objectives do identify activities that are appropriate to the resident’s age, ability and cultural needs. Residents Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 14 interviewed by the Inspector said that they participate in the activities they wish to do. Residents told the Inspector that if they wanted to do an activity, staff would support them to do so. The actual range and scope of activities undertaken by the service users however is limited by the extent of the resident’s own ability and their wishes at the time. The Manager told the Inspector that as a part of trying to maintain continuity for the residents in their daily lives where ever possible previous interests, pastimes, hobbies and relationship are encouraged and are built into the daily activities plan for residents. Residents who spoke to the Inspector said that they do much more at Ashlong than they had done at previous homes they had lived in. As a part of the care plan review it was evident that significant relationship links for the residents are recorded in the care plans and that the importance for the residents of these links is not underestimated. Information about local activities was seen on the notice boards within the home and staff who were interviewed by the Inspector said how they will support residents, in their capacity as care support workers, to take as much of an active role in the community as is appropriate for residents. Residents are supported and enabled to take part in appropriate activities and they are able to express their wishes and be listened to and responded to with active and appropriate support. Standard 13 - Interviews with residents and staff identified that some residents are involved in local activities such as swimming, bowling, going to the cinema and to the pub, all of which assists service users in developing their social interactions and in their integration into the community. The Manager informed the Inspector that all residents are registered to vote in elections and are supported by staff to do so if the residents wish to. Residents confirmed with the Inspector that they are supported and enabled to vote. The Inspector saw information made available within the home about local activities for residents to take up if they wish. The service at Ashlong actively encourages residents to develop and maintain social, emotional and independent living skills where ever possible. Staff were seen by the Inspector to be actively supporting residents to make informed choices about the things they want to do. The Manager told the Inspector that relations with the local neighbours are good with no problems arising up to this point in time for the home or for the neighbours. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 15 Residents do seem to be engaged as much as is possible with their local community. Standard 15 - Some Service Users can and often do make full use of local public transport facilities in order to get out and about and to see friends and family. Interviews with 4 of the residents confirmed that where possible they do maintain regular contact with members of their families and either go out to visit their relatives or receive them at Ashlong. Residents told the Inspector that they are enjoying the opportunities that they experience at Ashlong. Staff interviewed by the Inspector said that they encourage these visits and are sometimes involved in helping their resident’s sort out difficulties that they experience their relationships with their relatives as this often has a direct bearing on the mental well being of the resident. Visitors to the home are encouraged and use the visitor’s book to sign in. The Inspector saw information made available within the home about local activities for residents to take up if they wish. Standard 16 – Policies seen by the Inspector to be established within the unit ensure that service users rights to privacy, respect and dignity are respected. Residents who were interviewed also confirmed that they felt staff respected these rights. Residents said that their mail is unopened, staff uses their preferred form of address and staff do knock on their doors before entering. The Inspector observed staff to be interacting with residents in a friendly and respectful manner. A recommendation made at the last inspection for a discussion with all staff about the home’s policy on service user’s privacy has now been met. The Manager informed the Inspector that all staff have seen, read and had a chance to discuss the unit’s policy. Other staff interviewed by the Inspector confirmed this. Interviews both with staff and residents confirmed that residents participate where appropriate in household chores as a part of the rehabilitative process and this participation was seen to be supported in residents care plans. Following recent legislation on smoking, smokers now have to use a covered area outside the house and there are appropriate policies regarding drug and alcohol taking on the premises. Standard 17 - With regards to meals and meal times there is a planned and varied menu which residents told the Inspector they thoroughly enjoyed. Where possible residents take an active part in planning and cooking their own Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 16 meals and they are supported by staff to do so. Specific needs are catered for and alternative choices are provided. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 17 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): Standards 18, 19, & 20 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Standard 18 - Residents who were interviewed at this inspection confirmed with the Inspector that they receive their care in the way they prefer. They said that, as far as they are able to, they decide themselves about their daily routines and this was backed up by care staff who were also interviewed by the Inspector. Staff ensure that care support at Ashlong is person led, flexible, consistent and is able to meet the changing needs of the residents. It was confirmed by the staff and the residents that they are able to choose when they get up, when they go to bed, when they have a bath, what they Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 18 wear and what they will do during the day. A member of staff interviewed explained how when drawing up the weekly activities chart, which is based on the care plan, they always sit down with the resident and go through the programme in order to gain the residents approval and to understand their choices. Standard 19 - The Manager told the Inspector the residents are registered with dentists, opticians, chiropodists and community nurses in order to maintain their all round good health. Residents interviewed were able to confirm this. Information in their case files also evidences it by the recording of their contact with these services. It was confirmed that annual healthcare checks are routinely carried out by GPs. Standard 20 – The home’s policies and procedures manual contains appropriate policies for the control of medication. The Inspector reviewed the records for the administration of medication to residents (MAR sheets) and these were seen to be appropriately completed and in line with the home’s policies and procedures. Photographs of the residents were attached to the MAR sheets, which helps to ensure that staff administer medications to the right resident. The Manager showed the Inspector guidance that is provided for staff about PRN medications that is used for one of the residents. This states when PRN medication should be used and the potential side effects for the individual resident. The resident’s GP was involved in this process and the information was placed together with a medication profile for each resident. The Inspector did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate. Although controlled drugs are not currently in use within the home, appropriate provision for being able to do so will be required in the future i.e. there will need to be a lockable metal cupboard within the existing metal cabinet. There is also a refrigerated cupboard for those drugs requiring cool conditions. Training is provided for staff in medication and the Manager informed the Inspector that this is mandatory training for all staff. The staff interviewed said they had both received this training. At present some residents are unable to administer their own medication. The home actively supports service users who wish to self medicate. All the residents’ files inspected contained appointment information for dentists, opticians, chiropodists, weight charts and individual homely remedies. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 19 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): Standards 22, & 23 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self-harm. EVIDENCE: Standard 22 - The 4 residents who spoke to the Inspector all individually confirmed that they feel their views are listened to and acted upon. They said that if they had a complaint they know the procedure to be followed and would do so if they needed to. Staff interviewed confirmed with the Inspector that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The homes’ complaints policy was inspected and was seen to be satisfactory. The Inspector asked the Manager to see the home’s complaints record. 4 complaints had been registered in the record book since the last inspection and all had been resolved to the satisfaction of those people who had complained. Standard 23 - The home has an adult protection policy and the Manager informed the Inspector that the whole staff group had received training in the last year. The allegation of abuse record was seen by the Inspector, one allegation had been made since the last inspection by a resident about a member of the staff Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 20 group. This was confirmed by the Manager to the Inspector. The allegation was appropriately followed up according to the unit’s procedures and the matter was referred to all the appropriate authorities in the correct way. As a part of this inspection the Inspector spoke to the resident concerned who confirmed that they were satisfied with the manner in which the allegation had been dealt with by the Manager and that the issue has been resolved. The policies and procedures manual for the home include a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and staff are asked to sign to say that they have read and understood the policies and procedures. A review of staffing records held on staff files by the Inspector confirmed that all staff had signed such an agreement. The Manager informed the Inspector that training in these areas is offered to staff. The home does look after resident’s money and the Inspector reviewed the financial records for these transactions which were in order. All transactions are dated and signed for by both staff and residents to confirm satisfaction by all parties. No anomalies were found by the Inspector. An inventory is maintained and kept up to date by key workers for all residents belongings which are kept in their bedrooms. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 21 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): Standards 24 & 30 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users at Ashlong are able to live in a homely, comfortable and safe environment. The home is also clean and hygienic and well looked after by staff. EVIDENCE: Standard 24 - The home supports service users with learning disabilities and physical disabilities. The home was assessed by an occupational therapist and the home has been built around the service users assessed needs. Most of the residents have en-suite facilities with either a bath or a shower as they have requested. Shower heads are set at assessed levels so that service users can use them. Service users with mobility problems have the use of hand rails and hoists. The kitchen work surfaces have been lowered and doors widened to aid service users who use wheelchairs. Some service users who have ceribal palsey have electronic door locks on their bedroom doors. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 22 A tour of the home together with the Manager was undertaken as a part of the inspection and the home was seen to be clean and tidy in all areas. The general condition of the home and the facilities is good; communal areas and bedrooms are kept clean and odour-free. The staff provide a ‘homely’ touch through supplementary decoration and ornaments / flower decorations and pictures hanging on all the walls. The Manager has ensured that the physical environment of the home provides for the individual requirements of the residents. Also the communal living areas were found to be appropriate by the Inspector for the needs of the residents at the time of the inspection. Four of the residents who spoke to the Inspector over the course of this inspection said that they see Ashlong as their home and that they find it a nice place and are happy living there. The home is designed to provide small group living and people who live here can enjoy independence in a non-institutional environment. There is space within the home that may be used to entertain guests or for residents to sit quietly in. The Manager showed the Inspector the fire records for the home. An assessment carried out in the last week did not identify any problems or any actions that were required. Records were also shown to the Inspector by the Manager for other safety checks that have been carried out over the last year and that are part of a regular process of checks carried out to help ensure the safety of the residents. This includes weekly hot water checks of all the hot water outlets and checks of the temperatures of the home’s fridge and freezers. The Manager advised the Inspector that a handyman is employed to carry out routine maintenance around the home and that a programme of repairs is kept. Standard 30 – The Manager showed the Inspector the home’s infection control procedure, which seems comprehensive and to be effective in practice. At the time of this inspection the home was clean and hygienic. Staff interviewed confirmed that they are issued with appropriate clothing and equipment for them to carry out their work appropriately The laundry facilities in the home are appropriate for the residents who are living in the home. The Inspector was informed by the Manager that laundry is not taken through any areas where food is being prepared. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 23 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): Standards 32, 34, 35 & 36 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users benefit from the clarity of staffing roles and responsibilities and they can be assured that they are supported by competent, appropriately trained, qualified and supervised staff. The homes recruitment policy and procedures helps protect the residents. EVIDENCE: Standard 32 – The Inspector saw care staff working at Ashlong to be approachable for the residents and in taking time to deal with there questions appropriately and patiently. The Manager told the Inspector that the training programme for staff is comprehensive and covers all the essential training required by the staff to do their jobs well and efficiently. The provision of funding for training is also said to be good and the Manager told the Inspector that if a training need is identified then a training course is provided. The Manager informed the Inspector that all the care staff have now either achieved their NVQ level 2 Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 24 awards or are currently enrolled on a course and are due to complete their NVQ level 2 training. Records were seen by the Inspector that confirmed this. The Inspector gained the impression over the course of this inspection that all the staff are committed to ensuring that their skills and knowledge is continually being developed by appropriate levels of training so that they can best meet the needs of the residents. Training records were examined by the Inspector and evidence was seen of staff having completing the following training courses: • 1st aid • Fire marshal training • Manual handling • Basic food hygiene • Challenging behaviour • SOVA • Health & safety • Safe handling of medications • Autism /Aspergers • Bereavement • Infection control • Securicare • Risk assessment • Epilepsy • Sexuality A very useful training matrix has been developed by the Manager that provides an excellent tool for management and staff to see at glance what training has been received and by which staff. Where the gaps are and therefore what training needs exist for each member of the staff team. Standard 34 - The Manager told the Inspector that the home does have a recruitment policy and procedure and that all staffing posts are filled by application and interview. Evidence of these processes being used was seen by the Inspector on the staffing files. Review of 4 of the staffing files evidenced that suitable application forms are completed, that 2 references are obtained including one from the last employer. All staff files reviewed by the Inspector evidenced that proper CRB checks have been carried out for staff employed within this unit. Equally that all other documentary evidence required (under Standard 34) to be gathered for staff was seen to be held on the staff files reviewed. The result of this is that there is at Ashlong a staff team that has a balance of the skills, knowledge and experience to meet the needs of the residents. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 25 Staff interviewed confirmed that all have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home. Standard 35 – As already indicated earlier in this report the Manager said that there is an overall training and development plan for the home. The Manager informed the Inspector that a structured induction programme is offered to new staff and documentary evidence of this was seen by the Inspector and supported in interview with staff. It includes: • Understanding the principles of care • The agency and the worker role • Maintaining safety • Effective communication • Recognising abuse • Worker development Evidence was seen on the staffing files inspected that all those new members of staff had completed this comprehensive induction training and had signed to say so. The Home’s management prioritise training and facilitate staff members to undertake training beyond the basic requirements. Training certificates were seen by the Inspector confirming that staff had attended the stated courses. Standard 36 – The Manager told the Inspector that there is a properly structured staff supervision policy and procedure. Records were inspected and both the policy and the supervision tools comprehensively cover the areas that are required in order to implement an effective supervision process. Inspection of the supervision records that are held on staffing files showed that staff have received regular and formal supervision. Areas of discussion include: • Resident’s issues • The key working process • Monthly reports on progress made by key workers with care plans • Daily activities and outings for residents • Employment and training needs • Holidays and leave • Work performance issues. A useful supervision schedule and planner has been devised and this schedules over the course of the year every supervision session for each member of staff. This is a considerable asset and management monitoring tool. This means that all the key and important areas for the review and monitoring of the work being done in the home to meet the needs of both the residents and the staff groups should now be properly met. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 26 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): Standards 37, 39 & 42 were inspected at this inspection. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be confident that they benefit from a well run home. The quality assurance system helps to ensure that their views underpin monitoring and review of the homes developments. Service users may also be confident that their rights and best interests are safeguarded by the home’s record keeping policies and procedures. EVIDENCE: Standard 37 - The Home’s Manager has now achieved an NVQ level 4 in management. She has acted as Manager in the home for over a year and has Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 27 gained considerable experience from this and when speaking with the Inspector demonstrated extensive knowledge about the residents and the services being offered to them. From the very positive interactions the Manager has with residents and staff, she is clearly well thought of and liked by both groups of people. Interviews conducted by the Inspector with both staff and service users provided very positive feedback demonstrating the committed, sensitive and thoughtful approach the Manager has and all of this means that the service users and staff benefit from a well lead and well run home. Monthly Regulation 26 visit reports have been sent to the Commission for Social Care Inspection as required. Standard 39 - The Manager explained to the Inspector the quality assurance processes being used within the home to ensure that resident’s views underpin all self-monitoring review and development by the home. The Manager said that there is an annual management audit undertaken that reviews all health and safety issues, statutory and legal issues, the effective implementation of the homes policies and procedures, the environment and the building, staff and employment issues and training issues. A service user questionnaire was used in August 2007 to gain feedback from the residents and other questionnaires have also been devised to get feedback on issues to do with quality, from friends, families and visiting professionals. Quality checks are made on the recruitment procedures used to employ staff and a room-by-room risk assessment of the building is completed annually, information from which also informs the developments to be made in the home. The Inspector saw evidence of the feedback questionnaires from August and September 2007and it was very positive in its detail and in what the residents had to say in their feedback. At the last inspection it was recommended that the feedback gained from all these questionnaires be analysed and used to inform an annual development plan for this home. The Manager told the Inspector that this has since been completed and a newly developed annual development plan is now in place. The previously made recommendation has now therefore been met and with the implementation of this new quality assurance tool it should mean that there is in place a very effective method of maintaining high quality standards in the home. Standard 42 – The Inspector was shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager informed Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 28 the Inspector that all staff receive training in moving and handling, fire safety, first aid, food hygiene, and infection control. This was supported by staff interviewed that confirmed that they had received training in these areas. Up to date certificates were seen by the Inspector for: Boiler & Gas – 20.11.06 Fire alarms – 30.11.07 Fire extinguishers – 4.8.07 Portable electric appliances – 6.07 All food was seen to be stored appropriately and properly labelled with dates of opening and expiry. Records were seen by the Inspector that confirmed regular tests had been carried out for the: Fire alarm - weekly Fire extinguishers - weekly Emergency lighting – 6 monthly last on 26.9.07 Hoists – 30.8.07 Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked none were noted since the last inspection. Hot water temperatures were also checked and records indicated that they also came within the acceptable range. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. A visit by the Environmental Health Officer on Thursday 2nd November 2007 resulting in 9 recommendations being made to improve practices to do with the handling of food and food hygiene. The Manager informed the Inspector that all 9 areas have since been addressed and the evidence that this has been done was shown to the Inspector. This means that the health and safety of the residents to do with food can be more assured. Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 29 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 X 2 4 3 X 4 3 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 X 4 X X 4 X Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 30 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 Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Ashlong House DS0000048490.V355465.R01.S.doc Version 5.2 Page 32 - 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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