Care Home: Ashwood House (Leyton)

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What the care home does well The record keeping in the home is of particularly high standard and this helps the staff, managers and other health professionals monitor people`s wellbeing. The home works positively with external professionals to make sure that the people living in the home get good support to achieve their goals. The home is good at providing the people living there with choice and, involving them in their care and individual development and the general running of the home. The environment is of a particularly high standard, well planned and well equipped with good quality furnishings. The environment is designed to promote the independence and safety of people living there. The home has good support and strategic measures in place to minimise the risk of people being repeatedly admitted into hospital. The home provides activities that residents plan and join in with. The management team invest in staff training and development to make sure that people living in the home are given good support in achieving their individual goals. The policies and procedures are of a very high standard and there are very good systems to monitor the quality of the service. What has improved since the last inspection? At the last inspection, the areas for improvement included improving staff`s knowledge of handling diabetic emergencies, introducing a system to reduce overstocked medication, making sure that references obtained for staff are held on their file. A recommendation was made about finding ways to increase the availability of same gender care. At this inspection all of these areas had been addressed. The management team were concentrating on further improving people`s care plans and training had recently been provided to staff to help them with this. The new draft care plans that we saw were of a very high standard. What the care home could do better: No requirements are made as a result of this inspection and this is an indication that the management team are proactive in identifying areas for improvement and making sure that these are addressed. Recommendations are made about keeping separate written contract with 1 resident (to supplement the contracts, care plans and risk assessments that are already in place) where there are specific interventions or restrictions placed upon them, adding a standing items to the staff meeting and staff supervision agenda to further encourage staff to discuss concerns about practice within the home or the welfare of the people living there, and seeking support for 1 person from a continence advisor. Looking at the financial appointeeship for 1 person at their next review and providing training about the Mental Capacity Act for more of the team. CARE HOME ADULTS 18-65 Ashwood House (Leyton) 18-20 Church Road Leyton London E10 5JP Lead Inspector Caroline Mitchell Unannounced Inspection 2 , 3 and 4 September 2008 10:00 nd rd th Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood House (Leyton) Address 18-20 Church Road Leyton London E10 5JP 020 8924 8388 020 8252 8156 ykilroy@ashwoodhouse.org Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashwood House Ltd Lisa Jane Willsher Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2007 Brief Description of the Service: Ashwood House is a care home providing personal care and accommodation for 17 residents who are younger adults (18-65), all of whom have a mental illness. The home provides a home to both men and women. It is a privately owned and managed facility and accepts residents on the basis that they meet the home’s criteria for admission. The home is located in Leyton and offers easy access to shops and a wide range of social and recreational facilities. It was registered in October 2006 and is a fully refurbished home that is set over 3 floors. The home is designed to 8 residents on the ground and 1st floors with 1 resident having the benefit of a flat on the 2nd floor. The vision is to accommodate more dependent individuals on the ground floor with the less dependent on the 1st floor, while the flat is to be used for assessing people’s abilities for independent living. The accommodation is spacious and purpose built and meets all current building regulations. Each bedroom has en-suite facilities and adequate space for a computer, entertainment systems and other personal effects. Each of the lower floors has a separate dining and living room, a secondary lounge, communal bathrooms and toilets, smoking rooms, visitors‘ and, laundry rooms. There is also a laundry room, an activity room, a communal computer room and a multi-faith room. There is also a communal garden to the rear that is set out with flowerbeds and shrubs with a small area for therapeutic gardening. A lift is also available. The aim of the home is to provide a wide range of interventions and approaches in supporting individuals with mental health problems. Skilled staff are on hand to provide 24-hour care. There is a post of activity coordinator. Opportunities are provided to engage people living in the home in their care and to plan their future. The fees range from £600.00 to £800.00 per week and do not include personal clothing, toiletries and specialist therapies, which are variably priced. A statement of purpose and service user guide is available to all people living in the home. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 5 Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The inspection was unannounced. It was carried out over 3 days on 2nd 3rd and 4th September 2008. Throughout the course of the visit the registered provider and the deputy manager were present. The registered manager no longer works in the home and the current arrangement involves the Director managing the home with the daily support of the deputy manager. During the inspection we spoke to all of the people living in the home, most in private, and all at some length. Most were very pleased with the service that the home provides. We looked at medication practice, activities, menus, policies and procedures, all records required by regulation, residents’ assessments and plans, and the environment. Discussions were held with several staff, (both in groups and in private). Of the 5 members of staff we talked to, 2 staff did point out some areas for improvement. The majority of these areas could be better discussed as part of the regular staff meetings, in-house training sessions, daily handovers and staff supervision, provided as forums for staff. The home had returned the Annual Quality Assurance Assessment (AQAA) and this was used as part of the inspection. The AQAA is a self-assessment completed by the home, which focuses on how well outcomes are being met for people living there. It was of a particularly high standard and gave us lots of information about what the home does well, what has improved in the last 12 moths and what other areas of improvement the management team intend to concentrate on in the coming months. It also gave us some numerical information about the service. We also looked at the action that had been taken by the home to address the requirements from the last inspection. Shortly before the inspection, an anonymous person brought a number of concerns about practice in the home and the management of the home, to the attention of the Commission. 2 of these issues were referred to the local authority under safeguarding procedures. They were not upheld. No evidence was found to show that there was any cause for concern about the service offered to people living in the home or the management of the home. What the service does well: The record keeping in the home is of particularly high standard and this helps the staff, managers and other health professionals monitor people’s wellbeing. The home works positively with external professionals to make sure that the people living in the home get good support to achieve their goals. The home is good at providing the people living there with choice and, involving them in their care and individual development and the general running of the home. The environment is of a particularly high standard, well planned and well equipped with good quality furnishings. The environment is designed to Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 7 promote the independence and safety of people living there. The home has good support and strategic measures in place to minimise the risk of people being repeatedly admitted into hospital. The home provides activities that residents plan and join in with. The management team invest in staff training and development to make sure that people living in the home are given good support in achieving their individual goals. The policies and procedures are of a very high standard and there are very good systems to monitor the quality of the service. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are confident that the care home can support them. This is because there is a very thorough, 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, have lots of visits to 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. EVIDENCE: People living in the home have access to information about the home because there is a clear statement of purpose and a service user guide. There was evidence in people’s written records that they had been given a copy of the guide. The people who we spoke to, who live in the home, told us that the guide gave them useful information about the home. We looked at the statement of purpose and the guide and they were of a high standard, very clear and comprehensive and tell people about the specialist services that are provided at Ashwood House. Both documents were in formats that were suited Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 10 to the communication needs of the resident group and the Director told us that the documents could be made available in alternative formats and languages, if required. He added that he is looking at doing further improvement so that these documents can be assessed for the “Crystal Mark”. The statement of purpose tells people about the way the home approaches equality. We looked at the written records about how 2 people had been admitted to the home. These were of a high standard and very detailed. There was evidence that information was gathered from referring agencies before people were admitted. People had been involved in their assessments and the input of relatives was also key to the overall process. People’s plans were developed from these assessments, which outlined the actions required to achieve each of their objectives. As part of delivering a safe service, risk assessments were linked to the plans to make sure that people’s independence was promoted without compromising their safety. People are given the chance to really find out if the home suits them by having lots of planned visits. The Director said he was keen to stay within the eligibility criteria, and not to admit people whose needs wouldn’t be met. The people who live in the home told us they are asked their views about new admissions. The written records of the 2 people we looked at showed that they had lots of visits and overnight stays before deciding to live there. They met the other people living there and the staff team, and experience what it like to live in the home. Copies of contracts were on file for each person. In each case the person had signed their contract. The contracts included detailed information about fees and the rights and responsibilities of people living in the home and, of the registered provider. The contracts we saw were in a format that the people living in the home could understand. In the AQAA the Director told us that the preliminary and secondary assessments are carried out by managers from the home, and people have day visits, overnight stays and a probationary period. Assessments are only made after the following information has been received: a referral form, current risk assessments, brief history, list of current medication, current care plan. People living in the home are initially assessed in their existing environment and a number of assessments may be carried out as required to make sure there is consistency. He said that when people visit, a staff member is allocated to assist the person’s needs. We found that all of the written records supported what the Director had told us. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs and goals are met. The home has a very good 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 are good at promoting people’s 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 good, clear policies and procedures that staff follow. EVIDENCE: We saw from people’s records that they had been invited to sign an agreement about confidentiality and sharing of information. This was about whom the home can share their information with. There were also clear guidelines for Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 12 staff about confidentiality. The residents we spoke to were aware that they can see their records and said that staff in the home had told them about their right to confidentiality. We looked at 4 people’s written records, including their care plans. It was clear that people were properly involved in planning their care. The people we spoke to about their care plans were keen to become as independent as possible as they had the goal to move on to more independent living. The records showed that key workers work closely with them in setting up and reviewing their individual plan. People had regular 1-1 meetings with their key workers, to talk about at their wellbeing and progress. The plans we saw had been reviewed regularly and updated as they settled in the home. There was also evidence that most people were having regular reviews with social workers or care coordinators and 1 person was waiting to be allocated a new care-coordinator. The plans were very individual, including people’s specific needs and were linked to the assessments carried out with them when they moved in. The Director told us that staff have had some in-house training recently because the management team were focussing on improving the plans further. We saw the draft of 1 of the plans that was being reviewed and were impressed by how positively and sensitively it was being written. The staff we spoke to had a good knowledge of people’s needs and goals. Some said that the training they had recently was helpful in their task of helping the people that live in the home to develop their plans. In terms of equality and diversity, 1 person said that they did not want information about a particular aspect of their life to be included in their plan and this had been respected. However, it was clear that the team remain aware of and sensitive to the person’s needs in this area. All but 1 person said they knew about their individual plan and, were aware of the other professionals involved in their care. We looked at the records of the person who said they didn’t know what was in their plan and found that they had signed it. Key workers write a monthly report about people’s progress and their plans are reviewed quarterly. Plans were also in place to help people to budget their money. There was also an activity chart, which showed what activities people had chosen to be involved in. This information is looked at as part of people’s reviews. People also had ‘approach plans’. These identified the signs of any mental health relapse for that person and included agreed actions to reduce the levels of distress to people, if they become unwell. 1 person suffers from anxiety and we noted that very good day-to-day records were kept about his welfare and the anxieties that he expressed. There was information on advocacy services displayed so that people could use the service if they wish to. Most people had the support of their relatives and in many respects, were able to talk about their needs and advocate for themselves. 2 people were managing their own money. Some people choose Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 13 to use the security storage in the home for keeping things like benefit books. Support was available to help people to manage and safeguard their finances, and guidance for staff makes sure that they are encouraged to be as independent as possible. We looked at the records of 1 person’s day-to-day spending and clear, accurate records were in place. 1 person, for whom the local authority acts as appointee, told us that they were not happy about this restriction being placed upon them. We looked at the written records for this person and found that the decisions around this arrangement had been made as part of a multi-disciplinary approach and included the consultant psychiatrist and care co-ordinator, as, when their mental health was not stable, the resident was particularly vulnerable in this area. The risk assessment, assessment information from other professionals, and the care plan for this person clearly showed why and how these decisions had been made. It was also clear that the degree to which this person was willing to cooperated with this arrangement was related to the state of their mental health. As this person is due for a placement review a recommendation is made about this issue being discussed as part of their next review. There was lots of evidence that people were encouraged to be involved in things like menu planning, choosing and planning activities and outings and the how often they had their meetings. Copies of the policies and procedures were kept in the main lounge so they and their visitors could read them. Although 1 person told us that the policies were reasonably easy to understand, the Director said that is his aim to improve the further, so that they are clearer for people. Quality assurance systems, such as surveys, were carried out, and people were consulted as part of their meetings about various matters in home. 1 person told us that they had been asked about what equipment they would like in the activity room. The Director told us he is encouraging people to form a residents’ committee and 1 person living in the home sat in on the recent care planning workshop. The risk assessments that we saw were of a good standard and there was evidence that they helped to promote peoples’ safety and independence. They were linked to people’s plans and generally kept up to date. Clear actions were recorded to keep risks to a minimum. Some of the people living in the home told us that the house rules were not unreasonable and 1 person told us about the ways the staff were helping them to think about living in the “real world” when they become more independent. In the AQAA the Director told us that people are given lots of opportunity to be involved in decisions about how the home is run and gave the example of the smoker’s room being run by people living in the home. He added that key worker sessions and monthly reports have been improved. We found plenty of evidence to support what the Director had told us. He said that an area that could be improved is helping the people living in the home to understand the risk assessments and risk management strategies better. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 in the area of their personal, family and sexual relationships. People are encouraged to be 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. EVIDENCE: Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 15 There were rotas for tasks like food shopping and keeping the house clean. People in the home agree these between themselves. They do their washing and ironing and keep their rooms clean. The emphasis was on supporting people to develop practical life skills. Some need more support and encouragement, but everyone has the opportunity to contribute and learn. 1 person told us that they had swapped their shopping for cleaning with another person, as that is what they felt comfortable with. People are encouraged to identify and develop their goals and they get support in budgeting. Most of the people we spoke to told us that this was helping to develop their confidence and skills for moving on to a more independent setting. Specialist therapeutic techniques such as cognitive behavioural therapy, reflexology and homeopathy are made available from external sources. The home encourages people to use art, craft, exercise, relaxation exercises and music to maintain their wellbeing. People have the opportunity to pursue their spirituality or beliefs and 1 person told us about the importance of religion in their life. Another told us that they go to church on Sunday. There was a communal computer in the activities room and people have access to the Internet. The library on the first floor is developing well. Most of the people we spoke to went out regularly. Staff continue to help them to find and use community resources, based on their interests. On the various days of inspection, people were coming and going to various activities, and doing various tasks in the community, such as the library, appointments and shopping. People use the local banks and post office. 1 person does regular voluntary work and another does sports therapy. Another has qualifications in electronics and told us that he was considering what other courses to do at college. There is a post for an activity co-ordinator to provide leisure and development opportunities for people. There are group activities like discussions and art sessions, and these continue to develop as people move in and settle in the home. 1 person living in the home consults the others and organises outings, such as trips to parks, the cinema, and exhibitions and staff work flexibly to support these. Staff also accompany people when they go on holiday and several people said they were looking forward to a holiday that was coming up very soon. There was a range of recreational activities available in the home, such as sky television, board games and video games. The people that we spoke to were very pleased with the range of activities available. There was a thriving vegetable garden and 1 person was very involved with this. Another is keen on model making and showed us the models they had made. During the time we were in the home we saw 2 people dancing to an Afro-Caribbean music video in the lounge, and heard different cultural music coming from people’s bedrooms. There was evidence that the staff team support people living in the home to maintain relationships with relatives and friends. 1 person told us that they visit their relatives regularly and looks forward to this. Another person told us their family visit regularly and often stay for lunch. Arrangements were in place for people living in the home to meet with visitors in private and people Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 16 said that they choose their friends. There was also evidence that people are given good support around their sexuality and sexual health. It was clear that people’s rights were respected and their responsibilities were detailed in their plans and contracts. Menus were in place, and people living in the home told us that they are involved in choosing them. They reflected the cultural and the diverse needs of the resident group. As there were 2 people living in the home who are diabetic, there were diabetic alternatives. People said they were involved in preparing meals and told us that there was a good supply of food in the home. They said the go out to buy things like bread, milk and fresh fruit and vegetables each day. In the AQAA the Director told us that the home promotes, supports and educates people to develop their independent living skills through various activities and healthy living. Staff encourage and support people to find employment, both paid and voluntary, and encourage people to actively further their education and training. Information is displayed about local activities and day centres and people are encouraged to participate. People are invited to celebrate birthdays, cultural events and organise parties at Ashwood House, where family and friends are invited and catered for. People are encouraged to become actively involved with planning for their own dietary needs and invited to use the services of a nutritionalist. The home discourages people from eating processed, pre-packed foods and fried foods and discourages people from consuming take-away foods where possible. The home doesn’t buy high fat or high salt products and encourages the people living in the home to buy fresh fruit and vegetables daily. We found lots of evidence to support what the Director told us. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are quite independent, and where personal support from staff is needed, it is given 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. EVIDENCE: We saw very clear and thorough health care records for 3 people. These showed that people had input from community psychiatric nurses and psychiatrists, they were registered with a GP and there were arrangements in place for them to see other health professionals such as the dentist, chiropodist and the optician. There were records of hospital appointments and medical reviews for other specialist health care needs, and it was clear that the home supports people to participate in their healthcare. People can also see health care professionals in private, in the home. Their plans contained details of their emotional healthcare needs and good arrangements were in place for monitoring people’s mental health. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 18 At the last inspection the registered persons were required to make suitable arrangements to make sure that staff have a sound understanding in managing diabetic emergencies. The staff records that we saw showed that most staff had been provided with training about diabetes, and it is on the training schedule for new staff. We looked at 1 person’s records to see how they were being supported to manage their diabetes. Their needs around this were clearly recorded in their care plan and risk assessment, and identified as needing intervention by other professionals, as part of their admission. They had signed their plan. It was clear that it was a challenge for the staff team to keep them eating a suitable diet, that was not harmful and they told us they had a sweet tooth. A recommendation is made about this. We also noted that this person’s needs have changed since they moved in to the home, and they were having a number of health care and medication reviews as a result. Staff had been given some guidance about how to support the person during this period. The person was becoming less steady on their feet and had had some falls. During the inspection it was recommended that the registered person seek support from an occupational therapist about lifting and moving them and supporting their mobility. The Director was very responsive and acted upon this before this report was produced. It is also recommended that this person be provided with support from a continence advisor, as this seemed to be an emerging need from our discussions with staff. We spoke about personal support with 3 of the people. They all said they were happy with the way in which staff provided personal support to them. This is co-ordinated through the key-worker system. People have their individual style of dress, which reflected their choice, culture and personality. Staff were sensitive when making interventions to support people with these choices. People’s cultural needs were included in their plans. A good medication policy was in place to include guidance on promoting people’s independence with their medication. Records showed that people were being provided with support with their medication to varying degrees, according to their needs. We saw a senior staff member carrying out a medication audit. They told us that was done monthly, as part of the quality assurance system. There were good records of medication coming in and going out of the home and 2 staff sign the administration record when medication is administered. The home is now using the Boots ‘monitored dosage system’. The records we saw showed that staff had training before they administered medication and we also saw evidence that there was a very thorough assessment of their competence before they were given the task. At the last inspection the registered persons were required to keep smaller stocks of medication. At this inspection we found that this had been addressed. In the AQAA the Director told us that where staff intervene, it is done in a sensitive, understanding non-intrusive way. People are encouraged to administer and control their own medication within a managed framework. Staff and managers attend people’s CPA meetings to make sure that needs are Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 19 recognised and assessed appropriately. All people living in the home have the option of choosing their own GP and dentist. Again, there was lots of evidence to support what the Director told us. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: As mentioned in the summary of this report, an anonymous person brought a number of concerns about the practice in the home and the management of the home, to the attention of the Commission, just prior to this inspection. 2 of these issues were referred to the local authority under safeguarding procedures. They were not upheld. We looked at the areas of concern that had been raised with us as part of assessing the key standards and throughout the 3 days of the inspection no evidence was found to show that there should be any cause for concern about the service offered to residents or the management of the home. There was lots of evidence that the management team were open, co-operative and reasonable in their approach, with a strong commitment to providing a service of a high standard that is very person centred. A clear complaints procedure is in place and all of the people living in the home were aware of this. Everyone told us they felt able to raise issues of concern, should they feel the need to. They also showed an understanding of their right to complain. The complaints procedure is displayed around the home and is in the statement of purpose and the service user guide. People told us they would talk to the deputy manager, or the Director or talk about in 1-1 Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 21 meetings with their key worker. 1 person said “I’d talk to my care coordinator, or talk about it in my CPA meeting, but I’ve got no complaints”. We saw the minutes of the residents meetings and people are also encouraged to talk about the quality of the service. No complaints had been recorded since the last inspection. However, the home keeps a clear and thorough record of any minor concerns raised by residents and this showed that these are taken seriously and resolved as quickly as possible. The Director told us that, during the inspection, 1 person had raised some concerns about the way 2 staff and 1 other person living in the home had behaved towards them, and the Director said that an investigation would be undertaken about this. Staff have had various training about safeguarding adults from abuse, both inhouse and externally. A good, clear policy is in place at the home and this includes clear guidance on ‘whistle-blowing’. As part of their induction, staff are taken through the safeguarding adults guidelines and a copy of the Local Authority Safeguarding Adults protocol is kept in the home. The Director understands the procedures for safeguarding adults and used it appropriately on 1 occasion, about an issue concerning the previous manager. The management team alerted the necessary professionals, attended meetings and provided information to external agencies as part of this process. This previous referral was managed well by the home. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. The staff that we spoke to showed a sound awareness of their responsibilities and of these reporting procedures. Although, during the inspection 2 staff told us about issues that would have been more appropriately discussed with the management and staff team, as part of the ongoing development of good practice in the home. It was clear from talking to these, and other staff, that there was no reason that prevented them from talking openly and there were plenty of forums for staff to share ideas and concerns. We noted that there is already a standing item on ‘whistle-blowing’ on the agenda for the staff meeting. However, it is also recommended that concerns about practice in the home and about the welfare of the people living in the home also be added to this agenda, and to the agenda for staff supervision. Some staff also had training in dealing with challenging behaviour and a policy on dealing with aggression was in place. All of the people we spoke to who lived in the home said that they felt very safe in the home. The Director and 2 senior staff members had done training about the Mental Capacity Act 2005. A recommendation is made for more of the team to have this training. In the AQAA the Director told us that staff are trained to look for changes in people’s behaviour and signs of possible abuse. People’s family and friends and other appropriate people are encouraged to keep in contact them. Staff receive training in principles of care, role of the care worker, raising concerns and whistle blowing regularly. We have sourced and implemented additional Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 22 training for staff on safeguarding. The records we saw and the people we talked to confirmed what the Director told us. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This is an exceptionally well designed home. It is safe and very well maintained, homely, clean, comfortable, very pleasant and hygienic. People stay in a home that has lots of 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. EVIDENCE: The home is relatively newly adapted and registered and has been very well and thoughtfully designed for people with mental health needs. It was very clean and people living in the home were involved in keeping it nice. The equipment, furnishings, and fittings were of a very good quality. A lot of thought has gone into the safety and security of people living in the home and there are security cameras on exit doors and the side gate entrance and, clearly marked safety signs. The environment was homely, spacious, Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 24 stimulating, airy and bright and the people living there all said they were pleased with it. Although the home was not fully occupied, there was lots of evidence to show that people living there felt that it was their home. 1 person told us about some of the photos that were displayed. The people living in the home were particularly pleased with their bedrooms. These exceeded the national minimum requirements for space and they all have en-suite shower facilities. The fittings and furnishings in the bedrooms were of a high standard and people had been encouraged to personalise their rooms as much as possible. Some people showed us their bedrooms and there seemed to be no limit to the creativity in individualising them. They also had Internet access, 4 double sockets, and Sky TV connection. 1 person said, “I love my room.” In addition to the en-suite facilities, there are also toilets and bathrooms on the ground and first floors. 1 person told us they liked this because they sometimes like to relax in the bath. The home is also designed in a way that allows further adaptations to be made if people have specialist needs, such as physical disabilities and there are disabled toilets on the ground and first floors with sensor lighting. There is a passenger lift with disabled access between all floors. There is a range of communal spaces on the ground and first floors. There are dining and communal lounges, visitors’ rooms, laundry and kitchen facilities and smoking rooms. To add to this there is a computer, activity and multifaith room in the home. Staff have adequate office facilities and facilities for storing their personal belongings. There is a pleasant, large rear garden. There are also laundry facilities and additional storage space in the basement. It was clear that the home provided various spaces for a range of activities, as well as peace and quiet for people. The laundry facilities were designed to promote people’s independence and to encourage them to develop their skills in this area. An infection control policy is in place and people living in the home and staff are encouraged to work within this. The laundry equipment is designed to cater for soiled linen and appropriate arrangements were in place for maintaining them. The layout of the home is such that foul linen is kept away from food preparation and so the risk of the spread of infection is minimised. In the AQAA the Director told us that the communal rooms also exceed all standards for communal areas. The home meets all current Disability Discrimination Act requirements, with disability adaptations throughout the building. All residents have keys to their rooms, unless restricted by the assessment process. Directors, managers and staff do checks regularly to monitor the quality of the environment and the health and safety. There is a maintenance schedule to log any areas of concern and to monitor progress. There is an annual re-decoration schedule. There is an assessment process, Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 25 which evaluates security risks and identifies any security needs. Water temperatures are regulated at each appliance and regular checks are conducted as part of health and safety monitoring. Additional cleaning hours are provided to assist the staff and the people living in the home according to people’s needs. Again, we were pleased to find lots of evidence to support what the Director told us. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35, 36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent, qualified staff on duty at all times and there are usually high numbers of staff on duty. They have confidence in the staff at the home because very good 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. EVIDENCE: We spoke to 5 staff in private and some others as they were doing their work, and in groups at handover. The staff we spoke to were aware of the aims and philosophy of the home understood their role in delivering the service. They also had a good understanding of the peoples’ needs. There was evidence that they worked well with the people living in the home, enabling them to meet their personal goals. Staff had been through the General Social Care Council’s code of conduct as part of their induction. We had time to observe the practice of some staff over the 3 days of the inspection and they were positively engaging and interacting with people living in the home. On an occasion when 1 person living in the home became anxious, the staff’s interventions were Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 27 timely and sensitive. During the inspection the Director was made aware of the allegation that a staff member had accepted a gift from a person living in the home and began the process of investigating this. The records that the home keeps about staff training showed that 1 staff member had training and achieved a National Vocational Qualification (NVQ) at level 2 in care. 4 staff had achieved NVQ up to level 3, while 2 staff were undertaking NVQ 3. 2 other senior staff were undertaking NVQ level 4 training. We met the external NVQ assessor from Waltham Forest College and she was very complimentary about the support the management team were giving to staff around their NVQ training. We looked at the rota for a period of several weeks and it was clear that staff cover was well planned to provide adequate numbers of staff to meet the needs of people living in the home. The rotas showed that it was planned to provide a minimum of 3 staff in the morning, and there were often 3 in the afternoon and evening. Flexibility was built into the planning to fit in with resident’s appointments and other commitments. However, we were told by 1 staff member about an incident, at the end of August, when a staff member cancelled a shift and this was not covered, leaving a senior staff member on their own, from 2.30 pm, with young volunteer. The Director was asked to undertaking an investigation of why senior members of staff had not taken action to cover the cancelled shift. When the home first opened there was a staff member sleeping-in at night. At the time of this inspection waking night staff had just been provided. The night staff had worked in the home during the daytime, for a good period of time, (1 for 6 months and 1 for about a year) before changing to the night shift. They had been provided with specific training before this change in their role. This increase in staff cover was in response to 1 person’s changing needs. This person told us that they were particularly pleased that there was now a staff member awake and available during the night. There was also a clear management on-call system for staff, so that they were able to contact members of the management team on a 24-hour basis, if they needed support or in an emergency. The registered provider was very clear about his plans to review the staffing levels as people move into the home or as people’s needs change. The cultural and ethnic mix of the residents is reflected to a good extent in the staff team, so people get support from staff from similar ethnic and cultural backgrounds. At the last inspection it was recommended that a more flexible and diverse staff team be developed, in relation to same gender care. At this inspection we found that the staff team now provide a good mix of male and female staff. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 28 The home uses Peninsular, an organisation providing external consultancy, to support them with human resource issues. The staffing recruitment is ongoing and there was evidence that it has been improved as the service has developed. Staff are now short listed from their written applications, attend a 1st stage interview, and if successful, are asked to attend a 2nd stage interview. People living in the home have recently been more involved in staff recruitment. Staff are subject to a probationary period. We looked at the recruitment records for 2 staff and all the necessary checks had been done before they started work. The home uses Peninsular, an organisation providing external consultancy, to support them with human resource issues. At the last inspection the registered persons were required to maintain robust recruitment practices with regard to references. At this inspection we found that this requirement had been met. A training and development plan is in place for the staff. This covers key aspects of induction training as well as training that is specific to the needs of the people living in the home. It shows what training staff have had since working in the home and highlights training needs. There is a training budget and staff discuss their training and development needs through the supervision and appraisal system that is in place. There have been regular team meetings since the home opened. Handovers take place daily and formal supervision is carried out for all levels of staff. The staff who we spoke to told us that the found supervision to be supportive and useful. 1 staff member said that the deputy manager was “excellent” at listening. Some talked about having had appraisals. All staff had been made aware of the grievance and disciplinary procedures and there were protocols for managing physical aggression towards staff. In the AQAA the Director told us that there is a staff handbook, which clearly outlines responsibilities and roles and management structure. The home exceeds the current guidelines on staffing numbers. The home recruits staff based on Peninsula (Human Resource) guidelines and continually monitor equal opportunities information. No staff are employed without POVA and CRB checks. Managers have an informal, open door policy and this helps to monitor staff and performance. The management team pride themselves in the fact that they have never had the need to use agency staff. All staff personnel files audited annually as part of the quality assurance system in the home. The records we saw confirmed what the Director told us. He added that he intends to look into the use of e-learning for staff. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41, 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is run and managed very well and 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 very well. People get the right support from the care home because the Director and deputy manager run 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. EVIDENCE: Because the previous registered manager was no longer working in the home the Director was working in the home on a daily basis. The deputy manager Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 30 was supporting him in running the home. The Director has achieved NVQ level 4 in care with the registered managers’ award (RMA) award and the deputy manager was undertaking this training. The deputy manager proved herself to be particularly well organised during the inspection and was able to lay her hands on any written evidence that we asked to see very quickly. It was clear that they work closely to develop the service and to make sure that it is carried on in line with regulation. 3 staff said they were more than happy with the direction and support given by the deputy manager and felt that she was very approachable. 1 staff said that they felt “respected and motivated”. Others said that they were encouraged to contribute to the development of the service. The Director intends to appoint a manager, now that the issues with the previous manager are resolved. Quality assurance systems were in place to make sure that the views of people living in the home are gathered and the development plan for the home was very clear and current and influenced by feed back from the people living there. People’s quarterly reviews were being carried out as well as regular reviews with social workers. Regular monthly provider reports are also being carried out. There were good arrangements in place to monitor the quality of the home and this included gathering the views of other professional and the relatives of the people living there. The home has an updated set of policies and procedures that are in line with current thinking and practice. They are of a particularly high standard. The way staff work to these policies is monitored through supervision, appraisal and team meetings. People living in the home also have access to these policies so that they are aware of what to expect. The record keeping in the home was also of a particularly high standard. The home uses Peninsula to advise on and externally monitor health and safety in the home. There was a comprehensive set of health and safety policies, as well as arrangements to monitor their compliance. It was good to see that people living in the home were encouraged to contribute towards recycling waste in the home. Risk assessments for safe working practice topics were in place and staff had the benefit of health and safety training. During discussion the Director told us that the home also plans to offer the people living in the home training in health and safety and basic food hygiene. The Director has demonstrated the ability to plan and develop the service. In the AQAA he told us that the management team oversees the daily records. The people living in the home have access to their records upon request and are made aware that personal information may be shared with professionals in order to maintain their wellbeing. Again, there was plenty of evidence to support this. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 X 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 4 27 4 28 4 29 4 30 4 STAFFING Standard No Score 31 3 32 3 33 X 34 4 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 4 3 X LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 4 4 4 4 X Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 32 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations It is recommended that the arrangements around 1 person’s financial appointeeship and access to their money be discussed as part of their next multi-disciplinary review. With particular reference to their capacity and consent. It is recommended that a separate written agreement be agreed with 1 person, about staff interventions for helping them manage their diabetes. It is recommended that, if necessary, a referral be made to a continence advisor for 1 person. It is recommended that a standing item be added to the agenda for staff meetings and staff supervision, to further encourage staff to talk about any concerns they might have about the welfare of residents and the practice in the home. 2. YA19 3. 4. YA19 YA23 Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 33 5. YA23 It is recommended that training about the Mental Capacity Act be provided to more staff. Ashwood House (Leyton) DS0000068068.V370469.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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