Care Home: Ashurst House

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What the care home does well The home is well run. The registered manager gives support, direction and guidance to the service users and the staff group. She makes sure that the aims and objectives of the home are met and that the service users receive the care they need. People told us, "You can go to the manager at any time. She listens". Staff said "The manager is very supportive. The home has improved since she started working here". Ashurst House provides the necessary information for prospective service users and their families/representatives to help them make an informed decision as to whether or not the home is a suitable place for them to live in. Information is written in pictures and symbols which makes it more understandable for people who use the service. Each service user has a person centred plan. This gives the staff all the information they require to support and care for the service users in a way that suits them best. The plans and risk assessments allows them to live a fulfilling life while keeping them as safe as possible. People living at the home said that their views are listened to and acted on. They are involved in the day to day running of the home. One person said "I help cook the meals and do my own washing every week." The goals and aspirations of the people who live at the home have been identified and are being developed. Everyone has an activities programme and the majority of people are doing what they want. A service user said "The staff support me to go out. They help me organise the things that I want to do". The service users we spoke to said they enjoy what they do. They told us and indicated that they are happy living at the home. The staff we spoke to have a knowledge and understanding of the service users. The care staff on duty talked and interacted with people in a respectful and caring way. The service users are encouraged and supported to do as much as possible for themselves and make independent choices and decisions. The routines of the home are flexible in order to support the individual and diverse needs of the people living in the home. The home does meet the physical and healthcare needs of the people who live there. There is input from the local specialist teams and people see their doctor when they need to. Each of the service users has their own rooms, which are personalised and reflect their individual tastes and choices. What has improved since the last inspection? The new registered manager of the home follows the policies and procedures in safe guarding adults to make sure the people living at the home are protected and kept as safe as possible. She makes sure that complaints are taken seriously, addressed and acted on to protect the service users and improve Ashurst House. The service needs has now made sure that people are as safe as possible. The new manager has registered with the commission and has the skills, knowledge and experience to run the service in the best interest of the people who live there. People who are less able are now doing more activities and experiencing more fulfilling life. Tools are being developed to help them communicate better. What the care home could do better: We made no requirements in this report because we are confident that the registered manager will address the shortfalls. She had already taken action by the time we finished the inspection. People`s medication needs to kept safe and secure at all times. All staff need up to date specialist training to make sure that they have the knowledge skills and competencies to meet the individual needs of the people who live at Ashurst House. People need to be informed about the results of the quality assurance surveys so they can see the strengths and weaknesses of the service and know how it is going to develop and improve. All staff need to have regular supervision so they have the support and guidance to look after people in the way that suits them best. Key inspection report Care homes for adults (18-65 years) Name: Address: Ashurst House 9 Briton Road Faversham Kent ME13 8QH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mary Cochrane     Date: 0 2 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Ashurst House 9 Briton Road Faversham Kent ME13 8QH 01795590022 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ashhursthouse@tiscali.co.uk Ashurst House Ltd Name of registered manager (if applicable) Mrs Patricia Susan Jeanette Ross Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category 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 category: Learning disability - LD Date of last inspection Brief description of the care home Ashurst house is a large detached property in a residential road of Faversham. The property has been converted for its present use. The home is owned and run by the company Allied Care Ltd who are based in Surrey. They are registered to provide personal care and support for up to eight adults aged 18-65 years who have a learning disability. There are currently six service users living at the home. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 8 0 4 1 1 2 0 0 8 Brief description of the care home Accommodation is set over two floors. Stairs access the first floor. All rooms are for single occupancy and have en suite toilet facilities. Some rooms have en suite bathrooms and showers. All bedrooms are fitted with locks and have a television aerial point. There is a large lounge, separate dining room and kitchen. There is a second small kitchenette on the first floor. and a small garden to the rear of the property. There is limited parking to the side of the property. The home is within walking distance of the railway station and bus stops. Local shops and facilities can be easily accessed. A copy of the statement of purpose and service user guide is kept in the hallway of the home. All service users have an individual copy of the service user guide. A copy of the most recent CQC report is available. Weekly fees are £798. 76p to £1,316.14p Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The visit to the service was an unannounced Key Inspection which took place over one day. The inspection started at 09:45 a.m and finished at 3:00 p.m. The registered manager was available during this time. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. We spoke to three service users and two staff members during the visit. They told us things about the home and the support and care they receive and give. General observations were made on how people are supported. We had a look around the communal areas and some bedrooms. We looked at the documentation kept by the home. We saw and discussed service users individual support plans and their risk assessments. We looked at medication procedures and records. We also looked at staff Care Homes for Adults (18-65 years) Page 6 of 32 files and training records. We saw how the service recruits their staff and the homes quality assurance systems. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. The AQAA contained the information we needed to assist in making judgements about the service. Unfortunately people did not receive surveys so we were unable to use these in our inspection process. We did speak to service users and staff on the day of the visit. We tried to contact professionals who have contact with the service by phone but we where unable to speak to them. We took into account the things that have happened in the service; these are called notifications and are a legal requirement. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: The home is well run. The registered manager gives support, direction and guidance to the service users and the staff group. She makes sure that the aims and objectives of the home are met and that the service users receive the care they need. People told us, You can go to the manager at any time. She listens. Staff said The manager is very supportive. The home has improved since she started working here. Ashurst House provides the necessary information for prospective service users and their families/representatives to help them make an informed decision as to whether or not the home is a suitable place for them to live in. Information is written in pictures and symbols which makes it more understandable for people who use the service. Each service user has a person centred plan. This gives the staff all the information they require to support and care for the service users in a way that suits them best. The plans and risk assessments allows them to live a fulfilling life while keeping them as safe as possible. People living at the home said that their views are listened to and acted on. They are involved in the day to day running of the home. One person said I help cook the meals and do my own washing every week. The goals and aspirations of the people who live at the home have been identified and are being developed. Everyone has an activities programme and the majority of people are doing what they want. A service user said The staff support me to go out. They help me organise the things that I want to do. The service users we spoke to said they enjoy what they do. They told us and indicated that they are happy living at the home. The staff we spoke to have a knowledge and understanding of the service users. The care staff on duty talked and interacted with people in a respectful and caring way. The service users are encouraged and supported to do as much as possible for themselves and make independent choices and decisions. The routines of the home are flexible in order to support the individual and diverse needs of the people living in the home. The home does meet the physical and healthcare needs of the people who live there. There is input from the local specialist teams and people see their doctor when they need to. Each of the service users has their own rooms, which are personalised and reflect their individual tastes and choices. Care Homes for Adults (18-65 years) Page 8 of 32 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is produced in different formats so people have the information they need to make a decision about the home. People know that their needs and future goals will be assessed to make sure the home can support them properly. They know what they are paying for and their places at the home are protected. Evidence: People are given the information given they need about the home to help them make a decision about moving in. It tells them about the home, the staff and what support and care they can expect. There is information on how to make a complaint and also about the terms and conditions of residency. The service users guide is easy to read and is pictorial, which makes it easier for people to understand. Each person at the home has a copy of the service users guide. One person has been admitted to Ashurst House since our last key inspection. We looked at the homes assessments procedures to see how they make a decision about Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: whether the home will be able to look after the person in the way that suits them best. We saw that a detailed assessment had been done by the social services care manager and then another assessment had been done by home. The assessment looks at the persons life and family history, physical and mental health, personal care and social needs. It also looks at cultural and religious needs. There was also discussions with the district nurses and doctor to make sure all the persons health needs could be met at the home with the support from the local professionals. People are invited to come and test drive the home before they make a decision about moving in. All this is done is done so that people can be confident that moving into Ashurst House is the right thing for them. Each person has a contract with the company and this is reviewed every year. It includes information on the fees that are charged by the company. It also states who pays the fees and when. The contracts include information on any additional charges made by the company stipulating the amount and the reason why. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have individual care and support plans that identify their changing support needs and personal goals. They are able to make decisions with assistance and they are supported to take risks as part of an independent life style. Evidence: All of the people living at the home have a support /care plan. We looked closely at three of the plans and at specific details in another plan. They covered all aspects of health and social care, medical needs, specialised needs, behaviour management, and nutritional information they are easy to understand, follow and cross reference. They have references to equality and diversity issues. Each person has a key worker. The home is working towards making all the plans more person centred. The next step is to develop the plans into a format that contains pictures and symbols as well as written text. This will make them more personalised, meaningful and easy for the service users to be involved in and use on a daily basis. We saw that people can access their care plans when they want to. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: The plans explain how to support and care for the person in the way they preferred. Likes and dislikes are included and there was information in place about how people prefer to communicate and how staff can support them to do this. The service users told us that they decide how they are cared for and what support they need from the staff. The service users are involved in planning their own lives and take control. Risk assessments are recorded in each support plan. They are used to promote independence and not restrict people. Restrictions are only placed on people when absolutely necessary and this done following a discussion and agreement of the service user. Staff help people to take reasonable risks. Work has been done to ensure that all individual risks have been identified and that procedures are in place to minimise them. Staff did report there is a consistent approach when dealing with behaviours. The staff we spoke to were able to explain about risks and how to minimise them. When new risks are identified they are documented in the individuals care plan. People could be more involved in recording about what they do during the day. At the moment staff come to the office to write daily records and the service users are not involved. The manager told us she would review this practise. People are encouraged and supported to make their own decisions and choices. This was evidenced in the daily record reports. We observed that staff listened to what the service users had to say and acted on this. There was evidence available to show how people choose their meals, how they choose what they want to do and where they want to go. A service user told I can do what I want. The staff help me. We spoke to care workers and they were able to explain about the support and care they give to people and how they do this in a way that best suits that person. We saw evidence that they did this according to the individuals care plan. Reviews are held at regular intervals with relatives and care management. Personal goals and aspirations are identified and plans are developed with the service user to achieve them. One person told us that she was getting support to move take a trip to Europe. Other plans showed that people are having more control over their monies and medication. People have the opportunity to access advocacy services if they want to. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are encouraged and supported to take part in appropriate activities. They are part of the local community. Service users are supported to maintain family contact and assisted to exercise choice over their lives. Evidence: We saw that peoples hobbies and things that they like to do are identified in their care plans. Each person has an individual activities plan in place which is tailored to meet individual needs. There is also a generic programme that people can join in with if they want to. Three of the activities plans were looked at and cross-referenced with the daily records. The home now keeps a daily activities log for each person. This Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: means it is easy to see what people have done and whether or not they had a good time. The records showed that people had participated in the activities that were planned for them. In most cases the staff had recorded whether or not the person enjoyed what they were doing or not. We saw that staff actively encourage and support service users to participate in activities. Some service users attend sessions at a day centre. We saw that other people have employment with a local business. One person does voluntary work in a charity shop. There are also visits to the local stables where people are involved in looking after the horses. We saw that staff supported and encouraged service users to do things in the house if they did not go out. In house activities are being developed by the new registered manager. A singer had recently visited the home and people said that they really enjoyed this and were looking forward to him coming back again. The registered manager has made sure the lifes of people that re not so physically able has been enhanced and developed. We saw that people are going out more and doing the things that they like and enjoy. Communication aids are used so they choose what they want to do. Service users told us they enjoyed doing things inside and out-side the home. The service users are also part of the local community and visit the village pubs and other local facilities. People are also supported by staff to attend religious services of their choice. The registered manager told us she is continually looking at ways to improve and develop the activities and leisure pursuits for the service users. The service users are encouraged and supported to maintain contact with their family and friends. People go on home visits and holidays are arranged with service users. One person told us he was planning to go Spain after Christmas and another person was about to go to France to visit family. The service users are involved in the daily routines of the home and are encouraged and supported to take care of their own rooms and do laundry. Those who want to have a key to their own room and the majority also have a key to the front door. People have the freedom to come and go. People can choose when to be in the privacy Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: of their own rooms or in the communal areas. Members of staff were observed demonstrating good body language and communication skills when interacting with the service users. They were seen to talk and interact in a positive way. They involved and included service users in conversations. Service users told us that they get on well with the care staff. If there are any problems the manager sorts them out. Care staff cook the main meals at the home. Service users are involved planning what they eat and preparing their own meals. Service users said that they enjoyed their mealtimes and the food is good. They said that they had meals out regularly. There is a small kitchenette on the first floor of the house to allow more independence for people to get drinks and prepare small snacks. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have support they need to take more control of their health. People have the support they need regarding their personal care. The majority of medication policies and procedures have been adhered to. People receive their medication on time and safely. Evidence: During the visit we saw and were able to evidence that personal care is delivered in a way that is flexible, reliable and person centred. We saw that life skills and dignity are promoted. The staff were seen to respect the privacy and dignity of the service users allowing them control over their own life. Each person living at the home has a key worker. This promotes sensitive and individual support to the service users. We saw that individual plans clearly record how the service users like to have their personal needs met. They focus on what people can do for themselves and detail exactly how staff will give the support needed while allowing the service users to be as independent as possible. Staff have got to know each person well and have found out how they like to be supported with their personal care. Routines have been Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: established and guidelines have been written for the staff so that everyone is doing the same thing. There is a flexible approach to daily living activities e.g. getting up, going out, bed, bath and mealtimes. People choose their own clothes and are supported to shop. Staff were seen to approach service users in a caring and supportive manner. Service users health is closely monitored and if any problems arise they are dealt with promptly and appropriately. The service makes sure that people have access to all the healthcare facilities. We saw that routine checks and monitoring are carried out at the necessary intervals. People are promptly referred to specialists when the need arises. We saw that people had contact with the speech and language therapist, physiotherapist , psychologist, the local learning disability team. Some of the people have complex health needs. The service was able to evidence that these are well managed. There is information in the plans, which highlights early warning signs of identified health needs, this means staff can take immediate and appropriate action. A member of staff accompany people when they are attending appointments. A report is maintained by the home to evidence dental, chiropody, G.P. and other health care appointments. There was a lot evidence to show that staff are pro active in seeking specialist support when it is needed and do everything possible to make sure the complex needs of the people are met. Any changes in health care is updated in the persons care plan as soon as possible. This makes sure all health needs are identified, met, monitored and reviewed at the required intervals. The home is working towards all the service users who are able having control over their medication. Medication systems are easy to use and service users have the support of the staff. Each person has individual cupboards in their rooms where they keep their own medication. The team leaders on duty has keys to the cabinets. We did find that one cabinet was left open. We were told that this was because the district nurse needs to get medication when she visits. This is not safe practise. The registered manager said she would address this issue immediately and different procedures would be put in place. We looked at the prescription sheets. All prescriptions sheets had been signed to indicate that service users have received their medication on time and safely. The staff Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: who administer medication have received the necessary training and their competencies are checked. The recording of receipt, administration and disposal of drugs is sufficient to allow an audit trail. The people living at the home receive their medication as prescribed by their doctors. Some of the people living at the home are prescribed medication (this includes analgesia, topical creams, eye drops) on a when required basis. There are clear guidelines for giving medication. This makes sure that the medication is administered consistently and the effects monitored. The registered manager is looking at ways to make sure people have their medication when they leave the home for activities or days out. She is continuing to explore the safest options for this. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People now know their complaints will be taken seriously and acted on. People now know they will be protected from harm and abuse. Evidence: The home encourages and support people to express their views and concerns. There have been twelve complaints made to the home since the last inspection. The majority of these were related to the previous safe guarding alerts. Following the last inspection it was brought to our attention that complaints made by service users were not being addressed according to the companys policies and procedures. The new registered manager now ensures that all complaints are dealt with appropriately. Everyone has access to a copy of the complaints procedure which is written in a picture and symbol format. This means that it is more understandable for the people who use the service. If people have a concern or complaint they are able to effectively let the staff know. One service user told us if they are worried about anything they would speak to the manager. At the time of the visit we saw that a complaint made by a service user was dealt with immediately by the registered manager and an outcome was reached which the service user was happy with. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: There are also regular service users meetings where people can express their concerns and how they want things to be done in the home. All complaints are logged and there is evidence in place to show that the complaints have been investigated and outcomes have been reached. Since our last key unannounced inspection there have been two safe guarding vulnerable adults alert raised at the home. This means that a complaint, concern or allegation is being looked at by the local social services safe guarding adults team. The safe guarding concerns were identified by the area manager and she was proactive in making sure all the procedures were precisely followed. The necessary action was taken to protect the people living at the home. Meetings have been held in conjunction with the management of the home. One of the safe guarding alerts have been concluded and closed. The other one is being further investigated but is now being done without the need to further involve the service. The majority of staff have received training in safe guarding vulnerable adults and for those who havent (who are mainly the new staff) training is being booked. The registered manager told us that retraining is being planned for care staff who had received their training prior to the alerts. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The service has records to demonstrate that the service users finances are managed appropriately and safe guarded. The registered manager is able to audit and trail monies. The home is developing systems of supporting people to have more independence to look after their personal monies. This system further protects them from the risk of financial abuse. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a safe and comfortable environment with adequate personal and communal space to meet their needs. Evidence: We looked around the home. We saw that the home is maintained to a good standard. The lounge and dining room are comfortable and provided an environment for people to relax in. The kitchen was clean and service user can help themselves to drinks and snacks. A room upstairs has been converted into a kitchenette so that people who want to move towards more independent living can develop more skills and become more autonomous. The bedrooms that we saw are individual and reflected the personalities of the people who live at the home. All the bedrooms have an en-suite toilet and three bedrooms have an en-suite bathroom or shower. One person had recently had a new shower, a new mattress, and new wheelchair. There is ramp access to the front and back of the house the home and rails around the house to aid mobility. This means that all service users can access all the communal Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: areas of the home without any restrictions. The home is a clean and pleasant place to live. The Aqaa told us there is a cleaning schedule for all areas of the house which is checked and signed. There is separate the laundry area and service users are supported and encouraged to do their own washing. Soiled laundry is transported and washed according to the homes infection control policies and procedures. The majority of staff have received training in infection control. The registered manager told us training will be planned for those who have not received it yet. These are mainly the new staff. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to support the people living at the home. Staff have not had all the specialist training they need to make sure they have the competencies and skills to support people. People are protected by the homes recruitment processes. Evidence: There have been a lot of staff changes at the home since the last inspection. Service users have had to get used of a lot of new faces. When we spoke to the service users and staff they told us that they have developed good relationships. The staff said they are getting to know the service users and they are able to anticipate and meet the individual needs of the client group. The service users did respond positively and openly to staff and they told us that they like the staff. It was evidenced that the staff on duty put the needs of the service users first. Some staff have worked at the home for a reasonable length of time and have a good knowledge and understanding of the service users. The home has an NVQ programme. They have yet to reach the 50 target of staff Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: with NVQ level 2 or above but they are working towards it. We did see that not all the team leaders had achieved a minimum of an NVQ level 2 in care. The manager told us this had been identified as a shortfall and will be addressed. The home has an induction programme which is linked to skill for care. The two newest members of staff are in the in the process of undertaking this programme. The registered manager had audited the staff training records. She had identified that some of the existing staff members had not completed parts of the induction programme. They were asked to complete it and have now done so. We looked at the training matrix. Most of the staff except the new starters had nearly completed the required mandatory training and it was up to date. We did find that two people had not received infection control training. The manager was able to show a planned training programme which identified the short falls in training. We did see that there are significant gaps in specialist training. This means that people may not be receiving the support and care they need as staff may not have the necessary knowledge and skills about peoples specific conditions. Staff have regular meetings to discuss any issues that have been identified. They look at what is working well at the home and what needs to be improved. At the beginning of every shift there is plan in place to tell staff what they have to do for the day. This means that responsibilities are delegated to each member of staff so that people get the support and care that they need. We looked at three staff files and saw that safety checks had been carried out. Ashurst House has a thorough recruitment process to make sure the people applying for the job are who they say they are and will work in the right manner. The manager asks for identification like a passport and two references from people who know the person including their previous employer. They request a Criminal records bureau(CRB) check and protection of vulnerable adults list (POVA) check to make sure they have not done anything in the past that will indicate that they are unsuitable or cannot be trusted. Staff work for a trial period of time in the home while everyone gets to know each other and the member of staff decides whether this is the right job for them. A supervision and appraisal programme is in place and staff confirmed they are receiving supervision and we saw evidence of this. However we did see that staff will not receive a minimum of 6 supervisions within this year. This means that they may not be receiving adequate support to do their jobs effectively and safely. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the qualifications and experience to run the home efficiently and safely. There are quality assurance systems in place to improve the service for auditing and recording purposes. People know their health and safety will be protected. Evidence: Since the last visit to the home a new manager has been appointed. She registered with the commission in June of this year. The interview she had with the commission showed she has the skills and experience to run the home. She had been acting manager at the Ashurst House for several months prior to her registration. She has previous experience as a home manager. The service have now also appointed a deputy manager who has the skills and knowledge to support the manager in the day to day running of the home. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: The registered manager has a clear understanding of the key principles and focus of the service. She is aware of the shortfalls within the home and has the vision and plans on how these will be addressed. She is working to improve the service and the quality of life of the service users. She understands the importance of person centred care and actively promotes and leads the staff team. This means that the service users will live in a home that is effectively managed on a day to day basis and they will receive the support that they need. The registered manager has received Mental Capacity Act training and Deprivation of Liberties training. There will now be a roll-out programme to the rest of the staff team. We observed at the visit that the service users have a positive and relaxed relationship with the manager. Staff told us that the manager is approachable and understanding. They said that they could speak to her about any concerns they might have. Service users and staff told that the home has improved since she came to post. Although we have identified some shortfalls that need to be addressed we are confident that the appropriate action will be taken by the registered manager and the organisation to resolve these issues. The manager has already taken steps to do this. We received an AQAA from the home when we asked for it. The information in it was sufficient to assist us with parts of the inspection process. It contained detailed information and examples about the home and how people are supported. It could have given more information on what they do well and how they plan to improve in the future. The AQAA told us that all of the necessary Health and Safety checks have been carried out in the home. The random checks that we did confirmed this. The Company has a quality assurance programme in place, the Area Manager carries out Regulation 26 visits and the Quality Assurance Manager visits the home at regular intervals with questionnaires for staff and service users. Regular audits are done to make sure that standards are maintained and with the aim to identify shortfalls. The results of the questionnaires have been collated so that the strengths and weaknesses of the service have been identified. The results of the surveys had not been published and made available to the service users and other people who have an interest in the service. Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: Environmental and personal risk assessments are in place. All fire assessments and checks are done at the required intervals. Water temperatures are taken and comply with regulations. The registered manager keeps us up to date about things we need to know about the service users and the home. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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