Care Home: Ashpark House

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What the care home does well The initial assessment documents contain a good detail of information about the person and what the service will need to consider when supporting them. People`s health and wellbeing is supported by the service and they have access to community and specialist health advice. The manager has a good focus on the rights of people living at the home and advocates on their behalf. What has improved since the last inspection? The care planning information has improved and now provides greater detail about the individual and how staff should support their needs. Activities are more individualised and give people opportunity to express themselves. Most people living at the service have been able to take a holiday supported by staff in the last 12 months. These breaks have been successful and more opportunities are being considered. The staff team have stabilised and people living at the home have been able to build relationships with the team. CARE HOME ADULTS 18-65 Ashpark House Peldon Road Abberton Colchester Essex CO5 7PB Lead Inspector Sara Naylor-Wild Unannounced Inspection 31st July 2008 10:30 Ashpark House DS0000017754.V370093.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 Ashpark House DS0000017754.V370093.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. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashpark House Address Peldon Road Abberton Colchester Essex CO5 7PB 01206 735567 01206 735567 ashparkhouse@aol.com www.alliedcare.co.uk Ashpark House Limited 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) Mrs Lynette Carter Care Home 11 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (1) of places Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 11 persons) One named person, over the age of 65 years, who requires care by reason of a learning disability, whose name was provided to the National Care Standards Commission in October 2003 The total number of service users accommodated in the home must not exceed 11 persons 27th July 2007 3. Date of last inspection Brief Description of the Service: Ashpark House is a detached house with large, enclosed grounds, in the north Essex village of Abberton, south of Colchester. Its a rural, village location and was originally bought as a vacant property. It has been decorated throughout in a style appropriate for the type of residents it is intended for. Ashpark House is registered for 11 residents with learning disabilities. It is divided into two distinct units, one upstairs and one downstairs. All rooms are single occupancy, seven are ensuite and all have good views over the grounds of the home. The home has a large garden to the rear of the home. Fees currently range from £1000.00 to £1800.00 depending on needs/staffing requirements. Additional costs are made for toiletries, hairdressing, chiropody and some activities. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was carried out on the 31st July and 7th August. As part of the inspection we checked information received by Commission for Social Care Inspection (CSCI) since the last inspection on 22nd July 2007, looking at records and documents at the care home and talking to the manager, Ms Lynette Carter, care staff and the people living at the home. In addition the Annual Quality Assurance Assessment (AQAA) completed in May 2008 was considered as part of the inspection process and a tour of the premises was completed at the visit to the care home. The service sent us their Annual Quality Assurance Assessment (AQAA) when we asked for it. This contained information about what they felt they did well. Although this information was brief and did not always tell us how the service was seeking to improve the outcomes for people living at the service, beyond their present provision. The manager assisted the inspector at the site visit. Feedback on findings was given during the visit with the opportunity for discussion or clarification. We would like to thank the manager, the staff team, and people living at the service and their relatives for their help throughout the inspection process. What the service does well: The initial assessment documents contain a good detail of information about the person and what the service will need to consider when supporting them. People’s health and wellbeing is supported by the service and they have access to community and specialist health advice. The manager has a good focus on the rights of people living at the home and advocates on their behalf. Ashpark House DS0000017754.V370093.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. Ashpark House DS0000017754.V370093.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 Ashpark House DS0000017754.V370093.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): 1, 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are considering moving to the home can be assured that the service will understand them and how best to support their needs before agreeing to their admission. EVIDENCE: There had not been any new admissions to the home since the last inspection; although the service was operating with one vacancy and initial enquiries had been made about a person moving into the home. The documents relating to the last person admitted to the home were considered again at this inspection. The documents contained a full briefing of the person’s current needs at the time of their assessment and how they will need to be supported by the service. The manager undertakes these assessments and where possible may also take another member of the staff team with her. Transition periods are encouraged to help residents settle in well and to ensure that the home will be able to meet their needs. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 9 The information gathered at the assessment is translated into the beginning of the care plan and examples seen stated ‘wash – I need assistance in washing especially with my back and legs’ and ‘make a light meal – I can assist with making a light meal but I require full supervision from staff’. The assessment covers a full range of needs and gives a clear indication of where the person will need support. From the assessment the team should be able to assess whether they would be able to meet the residents needs. The statement of purpose and service user’s guide had been reviewed in 2007. There had not been any changes made to the way the service operates, therefore the content of these documents continues to deliver the information in a satisfactory format that is appropriate for the resident group in relation to their abilities. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the service can be assured that staff will understand how best to support them to ensure their needs are met and this is documented to ensure consistency in the quality of their approach. EVIDENCE: Care plans for three people living at the home were considered at this inspection. The manager had reviewed these since the last inspection and a considerable improvement in the information they contained was found at this visit. The care plans follow on from the information set out in the individual’s initial assessment and provide greater detail of how the person would need support. The descriptions are completed in short sentences to identify the ability and support required in a positive manner that emphasis how the person should be supported to make choices and remain independent. In some areas these are very specific instructions. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 11 The files contain monitoring records of people’s health and well being such as weight and behaviour. This supports the staff in tracking changes that may be affecting the person. The next portion of the document contains goal-setting plans that are intended to promote the person’s independence and future planning. These are reviewed and updated at regular intervals. There are risk assessments on each person’s file that gives an individual detailed assessment of the risk. The format asks a series of questions of the person compiling the assessment to ensure that there are full considerations of proportionate action taken in response to the risk. It also includes details of who is responsible for monitoring the risks and how this information is communicated to others with review dates set for all documents. There were also accompanying infringement of rights forms completed where appropriate. The manager discussed the recent workshop training that they had attended in relation to The Deprivation of Liberty Assessments that form part of the Mental Capacity Act 2005. These assessments are required from April 2009, and will provide a formal framework for the imposition of support where a person lacks the capacity to agree. This was discussed with the manager who demonstrated a good insight into the way people’s rights should be protected. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from a range of opportunities for occupation and activity. These are supported by their care plans and known to staff. EVIDENCE: There are weekly activity sheets posted on notice boards around the home that give details of the range of events and who will be participating in these. The sessions include activities such as short walks visits to shops, pubs and bus rides. There are also individual’s personal activity records that indicate what each person prefers to do and on what days these things could be attempted. The actual activity that each person had engaged in was also recorded. These were supported by each person’s activities plan within their care planning documentation. This lists individual activities on each page and indicates their frequency, location, transport arrangements and how staff should support the aims of the activity. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 13 On the day of the inspection one person was registering with the community college for pottery and music and other residents had gone out on the mini bus to appointments and carry out chores for the home. The service has resumed holidays for people living at the home with several short holidays taking place in the last year. Typically these had been breaks of between 4 and 5 days for small groups of people to Great Yarmouth or more local seaside towns. These had been very successful and people told us about their holiday and how much they had enjoyed this opportunity. The care plans detailed peoples’ contact with family and friends and how the service supports this contact. There is an open visiting policy and some of the residents do have regular contact with family members. Some residents maintain contact with homes they have lived in previously and meet up with residents from other homes. Families and friends are actively invited to events at the home. The menus for the service were planned on a 6-week cycle. Residents have a variety of meals and where possible are involved in the shopping. Due to some behavioural challenges, access to some foods has to be limited. The details of this were included in their care plan and gave an indication of how staff should approach this area of their support and their intake monitored. During the inspection there was evidence of a varied approach to the protection of peoples’ rights to be treated with dignity and respect. There were examples witnessed by us of where staff members did not conduct themselves in a way that upheld these rights. In one example a staff member described to the inspector the behaviour of a person living at the home and how this was managed by the service in front of the individual and within earshot of other people living at the home. However discussions with the manager and other team members as well as observation of their interaction with people living at the service demonstrated that overall the ethos of the service positively upholds people’s rights. However the manager was made aware of the examples observed on the first day of this inspection. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home can be confident that their health needs will be supported and they will have access to healthcare advice as appropriate. EVIDENCE: The records held in care plans and daily logs demonstrated a proactive approach to peoples’ health care needs. There are a wide range of health professionals consultation as appropriate to each person, including Consultants in Learning Disability, physiotherapists, local district nursing services, dental services, opticians and continence advice. Where possible people attend appointments at the surgeries or clinic they are receiving treatment for. On the day of the inspection a person was visiting their dentist and further appointments were made. The service uses a monitored dosage system for the management of people’s medication. The systems were well managed and records were accurately maintained. People received regular medication reviews from either their doctor or Consultant. Significantly individual records demonstrated a review of medication to enable the reduction of medication where possible. The service Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 15 has separate controlled drugs storage and maintains a controlled drugs book that is signed by two staff on dispensing. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at the home can be confident that their concerns will be listened to and acted upon. They can be assured that staff understand how to protect them from abuse. EVIDENCE: The service has a complaints policy that reflects the expectations of the Care Homes Regulations 2001. They maintain a complaints log to record all concerns and complaints received by the service. This held records of five complaints received in the past 12 months, and these related to issues with noise raised by neighbours to the home, complaints made by people who lived at the home about staff and other people resident at the home. The record stated the nature of the complaint and the steps taken by the service to address this. The service has a satisfactory safeguarding policy. There had been one safeguarding referral relating to the behaviour of a staff member, made since the last inspection and the CSCI had been notified as part of the home’s procedures. The matter had been referred to the local authority safeguarding body. The management of the home have responded properly to these matters and residents obviously feel confident to raise concerns/complaints with the manager. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 17 All staff had received safeguarding training in the last 12 months, and from discussions with staff during the inspection it was evident that they fully understood the home’s policy and procedures and the responsibilities they held in upholding this. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at the home enjoy an environment that is homely and meets their needs. EVIDENCE: A tour of the building demonstrated a homely environment where people were able to exercise their personal preferences in décor and adornment of their rooms. Communal areas were furnished in a domestic way, and had pictures and ornaments appropriate to the group of people living at the home. The corridors were in the process of redecoration with panelling being added as a decorative touch. Specialist equipment is available throughout the home and includes hoists, padding and handrails. Specialist wheelchairs are also in use. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 19 The home has a large garden to the rear, which consists mainly of lawn with some shrubs to the edges. There was a large patio area with seating and a basketball hoop. Maintenance certificates for the fixtures and equipment in the home were inspected at random and found to be in order. These included safety certificates for electrical, gas systems and the fire safety system. There were also maintenance checks for equipment such as hoists. Regular fire drills and visual checks on equipment were carried out and recorded. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the service can be assured that the staff team are provided with sufficient training and support to enable them to meet peoples assessed needs. EVIDENCE: Staffing levels remained the same as found at previous inspections with 5/6 staff working on each shift during the day and the manager’s office hours are additional to this. The deputy manager has office time to help ensure that care records are up to date. At night 2 awake night staff are on duty. Staffing levels tend to be 5 on each shift during the day at weekends. New staff had been appointed since the last inspection and records relating to their recruitment were considered. There were completed application forms, two references and checks made against Criminal Records Bureau (CRB) and the department of Health’s Protection of Adults (POVA) Lists. Staff spoken with confirmed that the service had required them to submit information such as the CRB and proof of their identity prior to being offered a post. Overseas staff had evidence of Home Office work permits for students on file. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 21 The organisation has an annual training programme in place that provides for aspects of health and safety, safeguarding, risk assessment and behaviour management. The manager maintains a staff training folder with each staff member having a section headed by a matrix of the training they hold and where this is required for renewal. All staff hold a recognised qualification such as National Vocational Qualification (NVQ) level 2 as a minimum standard, with a number holding NVQ levels 3 or 4. There was evidence that the individual staff have been provided with training that meets their needs or the development of their role, so for example NVQ level 2 Team Leader courses had been attended by staff new to the senior role. Staff spoken with felt that they were given appropriate levels of training and this had supported them in their development. They were able to relate how the information provided by training in confrontation management had helped them when working with people living at the home. The staff receive line management supervision, although this has not been consistently carried out. The manager acknowledged that this was an area in need of development, and hoped that with the involvement of the senior support staff in supervision a more consistent approach would be achieved. All the staff spoken with had received supervision and felt this supported their role. They also stated that the manager was always available and particularly easy to approach for advice and support. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home can be assured that a competent manager who listens to their views and takes action leads the home. EVIDENCE: The manager has been in post for two years and had been registered with the CSCI since the last inspection. She has several years experience in the care sector and had worked in the home prior to taking up the manager’s post. During the inspection visits the manager was able to demonstrate a close rapport with people who live at the service, and from discussions about issues affecting the service demonstrated a commitment to advocating the rights of people living there. Staff spoken with clearly saw the manager as someone who was supportive and approachable. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 23 However there remains some shortfalls in the records relating to supervision of staff, and in particular ensuring that the ethos of the service is maintained by all the staff working there. The organisation carries out an annual quality assurance system with questionnaires being provided to those people living at the home who are able to participate as well as relatives in regular contact with the service. The outcomes were audited and an action plan created to address the issues raised. The manager and the organisation should consider how the views of people who are unable to participate in formal questionnaire process could be incorporated into the quality assurance model in use. There were policies relating to health and safety in place and risk assessment was completed for issues such as fire safety and COSHH. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 25 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. 1. Refer to Standard YA39 Good Practice Recommendations The quality monitoring system should be developed further to ensure that the views of people who cannot participate in questionnaires are included in the consultation. Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Ashpark House DS0000017754.V370093.R01.S.doc Version 5.2 Page 27 - 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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