Care Home: Ashview House

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What the care home does well The home gives people good information that is written in a way that people can understand.Pre-admission assessment People will have their needs assessed before they move in to ensure that the home can meet them.The care plans are person centered and detailed and they give staff clear information on the support that people need.People living in the home are helped to take part in activities such as attending college, visiting relatives, shopping and eating out. What has improved since the last inspection? The daily records are now more detailed and they show what people have done throughout the day and how staff has helped them to do it.DAILY RECORDSStaff now sign and date all open bottles and packets of medication and all handwritten entries on the medication records are signed by two staff. What the care home could do better: The staff duty rota must show who is in charge of the home, who is working or not working and what their job is and it must show all changes such as when staff come to work in an emergency.The home`s complaints paperwork must include the role and contact details of the CQC.COMPLAINTS POLICY Any gaps in the medication records must be identified and investigated as soon as possible after they occur.If a medication temperature log/manager weekly check is kept or carried out it should be done and recorded as required. MEDICATION RECORDS Key inspection report Care homes for adults (18-65 years) Name: Address: Ashview House Riverview High Road Vange Basildon Essex SS16 4TR The quality rating for this care home is: one star adequate 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: Pauline Marshall Date: 0 8 1 2 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 38 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 38 Information about the care home Name of care home: Address: Ashview House Riverview High Road Vange Basildon Essex SS16 4TR 01268583043 01268583675 ashview@caretech-uk.com www.caretech-uk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashview House Limited care home 13 Number of places (if applicable): Under 65 Over 65 13 13 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 13 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Physical disability - Code PD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Ashview House provides a home for up to thirteen people up to age 65 who have a learning disability with or without a physical disability. The home is a two storey detached house in a cul-desac, in a residential area and is close to the local shops. Each person has their own bedroom this means that nobody has to share a room and there is plenty of other space for people to use. Care Homes for Adults (18-65 years) Page 5 of 38 There is parking to the front and to the side of the building, and there is a garden that people can use. ON THE MINI BUS The home has two mini-buses that take people to their activities and to college; One of the people living in the home has their own mini-bus. The last key inspection took place on 12th December 2007. The manager gives people Care Homes for Adults (18-65 years) Page 6 of 38 that want to move to Ashview House a copy of the Statement of Purpose and Service User Guide. The cost of living at Ashview House is between £768.75 and £1993.95 each week and some people are asked to pay a contribution of up to £62.50 per week towards this. People also have to pay for their toiletries, hairdressing, trips out such as bowling, the cinema, the pub and meals out and towards their annual holidays. Care Homes for Adults (18-65 years) Page 7 of 38 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: one star adequate 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 Care Homes for Adults (18-65 years) Page 8 of 38 How we did our inspection: This is what the inspector did when they were at the care home We visited the home and looked at some of the files belonging to the people living in the home and to some of the homes staff. We also looked at the policies that explain how the home does things. We looked around the home and spoke to the staff, the support manager and the deputy manager. We read the information (AQAA) sent to us by the manager. The AQAA is a form required by law for the manager or provider to carry out a self-assessment of how well the outcomes of people using their services are being met. Care Homes for Adults (18-65 years) Page 9 of 38 The manager is not working in the AQAA home at present due to personal circumstances, but he did complete the homes AQAA. We have received information for this inspection from the person who is currently managing the home (support manager) and from the area manager. We have used these names to describe who said or did what in this report. We sent surveys to six of the people that live at Ashview House, to four professional people that visit the home and to six of the homes staff, to see what they think about it. We received five completed surveys from people that use the service and one completed survey from a professional and five completed surveys from staff that work in the home. We have added their Care Homes for Adults (18-65 years) Page 10 of 38 comments to this report. What the care home does well The home gives people good information that is written in a way that people can understand. Pre-admission assessment People will have their needs assessed before they move in to ensure that the home can meet them. Care Homes for Adults (18-65 years) Page 11 of 38 The care plans are person centered and detailed and they give staff clear information on the support that people need. People living in the home are helped to take part in activities such as attending college, visiting relatives, shopping and eating out. What has got better from the last inspection The daily records are now more detailed and they show what people have done throughout the day and how staff has helped them to do it. DAILY RECORDS Care Homes for Adults (18-65 years) Page 12 of 38 Staff now sign and date all open bottles and packets of medication and all handwritten entries on the medication records are signed by two staff. What the care home could do better The staff duty rota must show who is in charge of the home, who is working or not working and what their job is and it must show all changes such as when staff come to work in an emergency. Care Homes for Adults (18-65 years) Page 13 of 38 The homes complaints paperwork must include the role and contact details of the CQC. COMPLAINTS POLICY Any gaps in the medication records must be identified and investigated as soon as possible after they occur. If a medication temperature log/manager weekly check is kept or carried out it should be done and recorded as required. MEDICATION RECORDS Care Homes for Adults (18-65 years) Page 14 of 38 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Pauline Marshall 03000 61 61 61 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 set out 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 15 of 38 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 16 of 38 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. People know that their needs can be met within the home. Evidence: There has been a change of ownership since the last inspection took place and Ashview House is now owned by Caretech Community Service Ltd who purchased the home on 20/03/08. The Statement of Purpose was last reviewed in October 2008 and it provides information about the company and the other areas that it serves. The Statement of Purpose was informative and included information on room sizes, support plans, activities and how the home would meet peoples cultural and spiritual needs. The support manager provided us with a copy of the organisations Service User Guide, which is adapted by each individual home to show people what the home does and does not provide. It was presented in an easy read format supported by pictures to suit the needs of the people using the service. The information in the copy supplied for this inspection did not provide people with a summary of the complaints procedure as required in the Regulations and it was not dated. We looked at a copy of a Service User Guide on the care file of a person living in the home and it incorporated the persons contract, describing the fees and charges and it explained exactly what the home was Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: offering to the person and included a summary of the homes complaints procedure. We looked at four care files and they all contained a copy of the individuals preadmission assessment and these showed that other professionals, family and the individual themselves had been involved in the assessment process. There has been one admission to the home since the last inspection and the pre-admission assessment showed that the person had been fully involved and it looked at all areas of need including social, emotional, health and personal care. The assessment included a detailed account of the persons life before they moved into the home and it showed their personal likes and dislikes as well as their preferences. People spoken with said and indicated that they were happy living at Ashview House. Care Homes for Adults (18-65 years) Page 18 of 38 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. People receive appropriate individualised care based on their identified needs. Evidence: We looked at four care files and each of them contained a my plan for a range of activities such as personal hygiene, continence, communication skills, clothing, mobility, nutrition, behaviour, medication, social and leisure activities, spiritual and cultural needs, family and friends and goals and aspirations. The my plans that we looked at were person centered and written in plain English. The support manager said that the my plans are in the process of being updated and she showed us one that had been completed; this included pictorial and easy read information. There were photographs of the persons family and friends and of some of the activities that they had undertaken such as holidays and outings. Two of the my plans that we looked at had been regularly reviewed. In addition to the my plan there was a document entitled What I must do/hope to do on each of the care files that we looked at; this document showed the goals and aspirations of people for the following month. Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: The daily notes are recorded in My daily records and this document is person centered and looks at things I would like and have to do today and things I want to do (my time) and who can help me. There is provision to record how the person felt, what and how much they ate and if they attended any appointments throughout the day. The my night record documents what has happened during the night (i.e. time retired and support needed, and how the person felt overnight and what happened in the morning (i.e. time got up, support needed and food and drink taken). There is also provision on the my daily record sheets to record any accident/incident or behavioural occurrences. Staff spoken with said that the document ensured that the person using the service was fully involved in writing up their notes and one person spoken with said that they write up their own notes, which were detailed and informative. We looked at the notes of the last three meetings that were held for the people living in the home and these showed that people participated in decision making and that they discussed their holidays, the food that they wanted to eat and the activities that they wanted to do. We spoke to some of the people living in the home and one person said I choose what to eat and I tell the staff what I want to do. There were risk assessments on all of the care files that we looked at and these included clear plans on how the risks were to be managed. We viewed risk assessments and management plans for a range of identified risks that included, accessing the community, using the bathroom, using the laundry, using cleaning equipment, medication, pain/illness, finances, the use of wheelchair lap belts and not responding to the fire alarm. All of the risk assessments viewed were person centered and showed the date and signature of the staff member reviewing the documents. Care Homes for Adults (18-65 years) Page 20 of 38 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. People are well supported to live a lifestyle that meets their identified needs and preferences. Evidence: The manager said in his AQAA a number of people living in the home are enrolled on college courses. We looked at four care files and three of them showed that people regularly attend college courses, and the subjects included communication, arts and craft and sports. People living in the home said when spoken with that they had attended a PAT dog session and one person said that they had been out to a local night club. The manager said in his AQAA one person goes out independently and visits local amenities and the care file showed that this person had made a trip to London and taken many photographs with their new digital camera. People using the service are encouraged to maintain relationships with their families and friends; one person was going out in their mini-bus with their relatives on the day of our visit. The care files showed that people maintained regular contact with their families and Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: friends and people spoken with confirmed this. Care staff was seen to be supporting people in the home in a sensitive manner and took their time explaining their requests when people did not respond in an appropriate way. People using the service appeared to be involved in the daily routines of the home and the records showed that people had dusted their room and helped prepare their lunch. People spoken with described their visits to a local pub where they had a meal and chatted with each other and the staff. People living in the home go shopping with staff every Monday at a local supermarket and they said when spoken with that they choose their meals for the following week each Sunday and that they pick the meals that they like to eat. To assist people with communication difficulties in choosing their meals, pictures of plated dinners and desserts are used when planning the weekly menu and at times when people may have forgotten their choice. The support manager said that a healthier way of cooking meals such as cooking them in the oven or grill as an alternative to frying had been implemented recently and one person said when spoken with this is good for me, much healthier. Care Homes for Adults (18-65 years) Page 22 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care in a way that suits them and their health care needs will be fully met, but they may not always receive their medication safely. Evidence: We spoke to people living in the home about how their personal care was delivered and three people spoken with all said that their support was provided in private and that staff helped them with their personal choices such as with choosing appropriate clothing. The daily records showed that people using the service had been encouraged to wear clothing that was appropriate for the weather or for the planned activity. All of the care plans that we looked at were written in a person centered way and they showed that people using the service attended their healthcare appointments whenever necessary. The manager said in his AQAA we have referred all of the people living at Ashview House to the occupational therapist for a full functional assessment. There was evidence to show that as a result of her assessments earlier in the year, the occupational therapist had recommended that some equipment be purchased such as a rotunda stand, a sling and some grab rails. One health professional said in their survey staff are willing to raise concerns and discuss issues with our service but the home does not always respond to our recommendations quickly. The support manager said that although there had been delays due to the funding of the items, they have now all been purchased and Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: are in use. Each person has a Health Action Plan but some of the information in the plans was out of date; the support manager said that these were in the process of being reviewed and updated to reflect peoples changing healthcare needs. The home has a clear medication policy and procedure and the training matrix showed that all staff who administers medication has had recent medication training. There was evidence on the staff files that we looked at to show that they had completed a medication assessment, which was due to be reviewed after a six month period. Medication is stored in locked cabinets in each persons bedroom and the medication administration sheets (MARS) are kept in a medication folder in a locked medication trolley. The home uses a monitored dosage system for most of its medication, however, some medication cannot be provided in this way so there is a range of medication in packets and bottles. Due to a high level of medication errors earlier in the year the manager, the support manager and operation support has put in place a range of audits to ensure that any errors are picked up and rectified as soon as possible after they occur. These included recording the storage temperatures of the medication, a tablet count and completion of a none blister pack medication issue sheet for all medication in packets and bottles (bottled medication is counted with the use of a triangle), the staff members confirmation of administration of medication at the end of each medication round and a managers weekly spot check. We carried out a random check of the homes medication system and we found that there was a gap on the medication administration sheet (MARS) with no explanation as to why. We also found that the storage temperature recording sheet had not been completed for ten days in November and for two days in December; the managers’ weekly check had not been carried out since 19th October 2009. We discussed our findings with both the support manager and the deputy manager and were told that the temperatures may not have been recorded due to the person being away on holiday and the gap on the medication administration sheet (MARS) may have been due to the medication not being required. We were not given any explanation as to why the managers weekly spot check had not taken place. All other records were seen to be correct and each of the medication administration records that we looked at that were handwritten contained two staff signatures. The home uses a colour coded system on the medication administration sheets (MARS) to identify morning, afternoon, evening and night. There were protocols in place for as and when (PRN) medication to show when, how and why the medication was to be given and there were photographs of the person on each of the records that we looked at so that staff can be sure that they are administering the medication to the right person. Care Homes for Adults (18-65 years) Page 24 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that they will be protected from harm and abuse but the lack of correct information in the complaints procedure may misinform them. Evidence: The manager said in his AQAA that the complaints procedure was last reviewed in March 2009 and we were provided with a copy of this and it did not show the role or contact details of the Commission. We were shown a further copy of the complaints procedure in an easy read format and this showed the contact details of the Commission but provided people with incorrect information about our role. The manager showed in his AQAA that there had been five complaints made in the last year and that all had been resolved within twenty-eight days and the homes complaints records confirmed this, showing any required actions and the outcome of the complaints. The support manager said that the complaints and compliments folder was now in a more orderly fashion and that compliments had been received by the home. We looked at the homes compliments and one of them said thank you for the evening of the 22nd, it was very enjoyable, the food was good and the atmosphere homely and welcoming and of course, the entertainment was what I can say X factor. The manager said in his AQAA that the homes abuse procedure was last reviewed in January 2009; We were provided with a copy of the Safeguarding Vulnerable Adults policy dated 9/5/08 and this showed the actions that staff must take if they suspect any form of abuse. Staff spoken with showed a good awareness of the actions that they needed to take if they suspected any abuse. There has been four referrals made under Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: safeguarding adults in the past year and these have all been dealt with appropriately. Two of the staff files that we looked at contained certificates in training in safeguarding adults and the training matrix showed that fourteen of the homes staff had received safeguarding adults training since the last inspection. Care Homes for Adults (18-65 years) Page 26 of 38 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 live in a homely, comfortable safe environment. Evidence: We looked around the home and we found that the furniture and the flooring were in a reasonable condition but the doors downstairs were badly scuffed due to the movement of wheelchairs. There are two floors with five bedrooms downstairs and eight bedrooms upstairs; two bedrooms are currently not in use. Each floor has its own kitchen and dining area and a small office where files are stored. Each of the bedrooms are personalised and comfortable; people that need it have adjustable beds that can be lowered and raised when required. There are ample additional toilet facilities and there is a shower room and bathroom on the 1st floor for people to use. We spoke to several of the people living in the home and they all said or indicated that they were happy with their bedrooms. One person spoken with said they were very happy and that they had their own computer, music and television in their room so were able to choose whether or not they wanted to go to the lounge to spend their time with others. The homes lift had been broken down for some time and was in the process of being repaired on the day of the inspection. One of the people living in the home said I have not been out for a while as the lift has not worked for ages and we have to wait for the lift engineer to move it. The support manager confirmed that the lift had been broken down for about a month and that the engineers had been waiting for parts and she said Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: that the engineer lives five minutes from Ashview House and that he has on occasions manually operated the lift so that people can get downstairs. The support manager also said that some people had been on holiday whilst the lift was out of action and that other people had spent two weeks in Caretechs other home in Kent. At the time of writing this report the support manager confirmed that the lift has been repaired and is now fully operational. The home employs its own maintenance man who works for forty hours a week but uses ten of them for driving duties. The maintenance records showed that small tasks such as repairing toilet flushing systems, blocked sinks and changing light bulbs are carried out by the maintenance man; he also carries out redecoration of the home and has recently decorated both kitchens, the downstairs lounge and the 1st floor hallway and the sensory area. Larger repair works such as major building work and lift repairs are reported to the estates manager who makes arrangements for contractors to carry out the work. The home was clean, fresh and hygienic on the day of our visit. Care Homes for Adults (18-65 years) Page 28 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a competent, well-trained staff but the shortfalls in the recruitment process and the lack of staff supervision may put people at risk. Evidence: The manager said in his AQAA that five of the twenty one permanent staff have an NVQ 2 or above in care and the training matrix confirmed this. We looked at four staff files and we saw a certificate for an NVQ level 3 on one of them; the other three staff files that we looked at were of more recently employed staff and there was no evidence to show that any of the three staff had completed an NVQ. The National Minimum Standards for Care Homes for Adults recommends that 50 of all care home staff should have an NVQ; the home has not reached this target. The support manager prepares a week to view duty roster from the monthly duty roster. The monthly duty roster is sent to Caretechs head office and any changes to the planned duty roster are made on the homes week to view version. We looked at the weekly staff duty rosters over a four week period and they showed that there had been one senior or one team leader together with a minimum of five support workers throughout the day and three support workers and one sleep in worker throughout the night. The support manager said that staffing had been increased since November 2008 to seven staff throughout the day, which includes at least one senior or team leader and this was confirmed in the duty rosters that we looked at. The support manager, the deputy Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: manager and the cleaner work in addition to the support staff. The week to view duty roster did not show the hours worked by the support manager and her deputy and it did not always show the designation of staff and who was in charge of the shift. The week to view duty roster had been amended to show most of the changes that had been made throughout the four week period, however, one member of staff (who was on call) worked on the 6/12/09 due to short notice staff sickness and they were not shown as having worked on the week to view duty roster. All staff working in the home must be shown on the staff duty roster. We looked at four staff files and they each contained a variety of documents including copies of their application forms, interview notes and training records. One of the application forms made reference to an attached curriculum Vitae (CV); it was not attached and could not be found in the staffs file. There was no evidence of staffs’ fitness on any of the staff files that we looked at. Three of the staff files that we looked at did not contain copies of the staff members’ references or their criminal records bureau checks (CRB); each of these files contained a pro-forma document that was ticked and signed by Caretechs Human Resources department to confirm that the documents had been seen. The support manager said that Caretech have an agreement with the Commission to keep staff files in the head office in Kent and we have received a copy of the agreement to confirm this. Each of the four staff files that we looked at contained copies of staffs training certificates and these included training in health and safety, safeguarding adults, moving and handling, food hygiene, medication, epilepsy, administration of Buccal Midazolam, autism, dementia, oral health care, first aid, healthier food and special diets, challenging behaviour and diabetes awareness. Three of the staff files that we looked at were for new staff that had been employed for less than three months so they were still in their induction period. We looked at one induction workbook and the support manager said that the other staff were still working through them and staff spoken with confirmed this. The support manager said that after an initial two week induction period all staff are booked to attend training in safeguarding and the training matrix confirmed that safeguarding training had last taken place on 4/12/2009 and that new staff had attended. There was supervision notes on one of the staff files that we looked at; these were for the established member of staff. There was no supervision notes on the other three staff files that we looked at; these staff had been employed for three, nine, and thirteen weeks so we would expect that two of the staff would have received their first supervision by the date of our visit. The manager has prepared a supervision matrix and this confirmed that the three new staff had not yet been scheduled to have supervision. The staff that we spoke to said that they felt supported by the support manager and one staff member said in their survey the support manager always gives me enough support and I have the experience and knowledge to meet needs of the people that I am caring for. Another staff member said in their survey I feel that we are a good team, we all work well to Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: provide support care and encouragement to our service users and our home manager is supportive to staff and I can speak openly on any issues with them. Care Homes for Adults (18-65 years) Page 31 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people live in a well run home that is run in their best interests, the frequent changes to the management team and the shortfalls in the homes quality assurance system and the lack of a basic safety check could put people at risk. Evidence: The homes manager is not currently working at the home due to personal circumstances and there is no planned date for his return so the home is being managed in the meantime by a support manager and her deputy. The support manager was not able to say how long she expected to be working at Ashview House but did say that she would be there for as long as it takes. The support manager is the registered manager of another regulated service owned by Caretech; she has twenty-eight years experience in care and holds a diploma in management and a BA Honors in education and training. The support manager has recently updated her practice by training in safeguarding, the Mental Capacity Act, the Deprivation of Liberties, moving and handling, fire management, epilepsy and medication administration. The support manager said that the quality department of Caretech visits the home on a six monthly basis and carries out an audit that includes surveys of interested people such Care Homes for Adults (18-65 years) Page 32 of 38 Evidence: as the people living in the home, their relatives and involved professionals such as GPs, nurses and social workers. The last survey took place in 2008 and a copy of the report was not available in the home but was later sent to us by the area manager. The report prepared as a result of the survey included information from all of the services owned by Caretech and it was not possible to determine how much of the report was relevant to Ashview House. The area manager was not able to tell us this but did say that Ashview House was due to undertake their own survey in early 2010 and he provided us with copies of the survey materials that were to be used, which includes questionnaires in an easy read pictorial format. The area manager carries out regular monthly visits and prepares a report identifying any necessary actions as a result of the visit. There were copies of these reports kept in the office and these showed that actions identified at the previous visit had been carried out. The manager returned his completed annual quality assurance assessment (AQAA) by the required date and it included all of the information that we asked for with the exception of the date of the last electrical installation test. As the AQAA did not show the date of the homes last electrical installation test so we asked to see the test certificate and this was not available for inspection. As a result of this inspection an electrical safety test was carried out on 16/12/09 and the support manager has confirmed that the homes electrical system has been declared satisfactory. There was a range of policies and procedures for health and safety including moving and handling, infection control, food hygiene and first aid. Staffs spoken with were fully aware of the content of the homes safety procedures and were observed using safe working practices. We looked at the homes gas safety certificate, which was in date and showed that the system was satisfactory. The last fire officers’ visit took place on 24th August 2009 and his report showed that at the time of his visit the homes fire safety was of a satisfactory standard. There were two issues brought to the homes attention by the fire officer and the support manager said that both issues had been actioned. Care Homes for Adults (18-65 years) Page 33 of 38 Are there any outstanding requirements from the last inspection? Yes  No  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 1 34 19 Ensure that robust 12/12/2007 recruitment procedures are adopted so as to ensure that residents are kept safe. Previous timescale of 14.8.06 and 14.4.07 partially met. Care Homes for Adults (18-65 years) Page 34 of 38 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 Description 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 Description Timescale for action 1 20 13 The manager must make 31/01/2010 sure that there are safe systems in place for the recording, handling and administration of medication. To ensure the safety of the people using the service. 2 22 22 The manager must ensure that all copies of the homes complaints procedure show the correct role and contact details of the Commission. 31/01/2010 To ensure that people using the service know that the home is regulated and how to contact us. 3 33 19 The manager must ensure that the duty roster shows the full name, designation and who is in charge of the home for all staff that are working in the home. 31/01/2010 Care Homes for Adults (18-65 years) Page 35 of 38 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 Description Timescale for action To ensure that people using the service are fully protected. 4 34 19 31/01/2010 The manager must ensure that that they hold full and satisfactory information on all of the homes workers and this is to include evidence of their fitness to work in the home. To ensure that people using the service are fully protected. 5 36 18 The manager must ensure that all staff receives appropriate supervision. 31/01/2010 To ensure that staff are fully supported to carry out their work. 6 42 13 The manager must make sure that all parts of the home are safe. This refers to the need to ensure that all safety certificates are in place and up to date. 10/01/2010 To ensure the safety of people using the service. Care Homes for Adults (18-65 years) Page 36 of 38 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 1 1 It is recommended that all copies of the homes information paperwork contains the same details to ensure that people get correct up to date information about the service. It is recommended that the people living in the home sign and date their care plan documentation wherever possible when reviewing, it to ensure that the people using the service are fully involved in their plans. It is recommended that the home carries out its own quality assurance surveys to ensure that the views of the people using the service are sought. 2 6 3 39 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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