Care Home: Ashwood Place

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What the care home does well The residents have limited communication skills but members of staff interacted well with them using the individual`s preferred mode of communication. They appeared well cared for. The people who use the service benefit from premises that are well maintained and have a homely and comfortable atmosphere. There is a rolling maintenance programme to ensure that the home remains comfortable. What has improved since the last inspection? The management has complied with all the Statutory Requirements from the last inspection which will improve outcomes for the people who use the service. What the care home could do better: The Medication Administration Record charts examined contained handwritten notes that were not signed and dated. There were also some repeat prescriptions for large quantities of paracetamol tablets that may not be needed. Since the inspection, the manager has given her assurance that all repeat prescriptions will be reviewed as soon as possible and that all handwritten notes will be signed and dated accordingly. CARE HOME ADULTS 18-65 Ashwood Place Off Sunnyside Road Hitchin Hertfordshire SG4 9JG Lead Inspector Yoke-Lan Jackson Unannounced Inspection 4th January 2008 11.00a Ashwood Place DS0000019274.V357256.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 Place DS0000019274.V357256.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 Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood Place Address Off Sunnyside Road Hitchin Hertfordshire SG4 9JG 01462 435135 01462 435235 mandidean@lycos.co.uk www.caretech-uk.com CareTech Community Services Ltd 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) Amanda Dean Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8), Physical disability (8) of places Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd January 2007 Brief Description of the Service: Ashwood Place is a residential care home provided by CareTech Community Services Ltd. The home is registered for 8 people with learning and/or physical disabilities. It is situated in a residential area in Hitchin, a short distance away from a busy trunk road leading to the A1(M). There are parking spaces in the front of the building. The home has its own minibus service. The purpose-built bungalow has large communal areas. There are 8 bedrooms, two with ensuite bathroom facilities and 6 with toilet facilities. It is designed and equipped to meet the needs of people with profound learning and physical disabilities. To one side of the building is a small courtyard with potted plants and this area is assessable to wheelchair users. The home charges from £980.09p - £1344 per week. Information about the home and the service it offers is contained in the Statement of Purpose and Service User Guide. A copy of these and the most recent CSCI inspection report are available on request in the home. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 04/01/08. The home manager was not on duty. One of the senior support workers was present. The home has 8 residents. The inspection included a tour of the premises. Time was spent observing how the staff interacted with the residents. Staff and residents were interviewed and documents were examined. Information received by us (the Commission) since the last inspection was reviewed. This included the Annual Quality Assessment (AQAA) which providers of registered services are required to complete. The AQAA focuses on how well outcomes are being met for people using the service. What the service does well: What has improved since the last inspection? What they could do better: The Medication Administration Record charts examined contained handwritten notes that were not signed and dated. There were also some repeat prescriptions for large quantities of paracetamol tablets that may not be needed. Since the inspection, the manager has given her assurance that all repeat prescriptions will be reviewed as soon as possible and that all handwritten notes will be signed and dated accordingly. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 6 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 Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence. Prospective residents can be assured that they will have the opportunity to visit and assess the facilities and suitability of the home and a pre-admission assessment will be completed before they are admitted to ensure that the home can meet all their care needs. EVIDENCE: The provider has a revised Statement of Purpose and each resident has a Service Users’ Guide. A new resident moved into the home recently following a full assessment by the manager. Additional security and alarm systems were installed the next day on all exit doors to raise awareness so that members of staff can assist the new resident from wandering on to the streets. Appropriate risk assessments were carried out and any action taken by the staff reflects relevant specialist and clinical guidance. The staff work closely with the local Social Services Learning Disability Team to ensure that the resident’s care needs are being met. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that they will have a written care plan so that staff are able to identify goals and care needs appropriately enabling the opportunity for people to make everyday choices, respecting preferences and requests enabling them to achieve independent lifestyles. EVIDENCE: The residents appeared well cared for. The majority of the residents are nonverbal. Members of staff were observed to interact well with them using words and gestures that the residents understand. There was a good rapport between the staff and the residents. The residents have access to local independent advocacy and support schemes. Each resident has a comprehensive written care plan. There is an alternative person-centred care plan in picture format. The care plan reflects the personal objectives and care needs for the resident identified by staff during their reviews and ‘talk time’ sessions. These sessions are held monthly on a one-toone basis. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 10 A yearly assessment is carried out that involved all interested parties, including relatives and supporters, healthcare professionals, the social service and the management team. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can expect that their rights will be respected and that they will be encouraged to lead an independent lifestyle and engage in communal activities. They will be encouraged to maintain contact with their family and friends. A healthy diet is promoted. EVIDENCE: Residents are helped to participate in activities of their choice and to make use of local leisure facilities. There is a weekly planned programme of activities for each resident. The residents attend a day centre regularly and some attend five days a week. Within the home, members of staff assist each resident to take part in a variety of activities and projects. In-house entertainment includes karaoke, music and art sessions. Outdoor activities include shopping and places of interest such as theatre, farms and museums. Holidays are arranged by staff for interested residents who choose where they want to go. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 12 Family members are encouraged to contact the residents in the home. Some residents see their family members at weekends. However, some residents have no family and they consider the staff their “family”. Staff handle confidential information in accordance with the home’s policy and procedures and the Data Protection Act 1998. The home offers residents a nutritious, healthy diet and uses fresh vegetables and fruit. Each member of staff takes turns to cook the meals. On the day of the inspection, a resident was observed enjoying a hot meal. Members of staff were assisting two other residents at mealtimes. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are treated with dignity and receive personal care and support in the way they prefer and require, including a full range of healthcare facilities. They are protected by the medication policies and procedures. EVIDENCE: The residents appeared comfortable and well cared for. The members of staff were observed to be patient and gentle with them. Members of staff seemed to have a good knowledge of the residents’ conditions and their likes and dislikes, and deliver care and support accordingly. The home has the support of health care professionals such as the General Practitioner and the Community Psychiatric Team. Health and behavioural concerns are referred to them for immediate assessment. Currently the community team is supporting the home in caring for a new resident, admitted only yesterday. The resident has a tendency to wander on to the streets. For the safety of the resident, additional security alarm systems were installed to alert the staff. Risk assessments and the Protocols for a Missing Person are in place. On the day of the inspection, the new resident seemed settled. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 14 None of the service users manage their own medicines. Since the last inspection there have been no medication errors. The manager audits medication regularly and a pharmacist from Boots, who supply the home, also carries out a six-monthly audit and presents an advisory session for the staff group. Only members of staff who have had medication training are allowed to administer medication. The Medication Administration Record charts were examined and there were no gaps on the charts. However, some of the MAR charts had handwritten notes that were not signed and dated. There were some repeat prescriptions for large quantities of paracetamol tablets that may not be needed. There are no controlled drugs in use at the present time. Since the inspection, the manager has agreed to consult the General Practitioner and all repeat prescriptions will be reviewed as soon as possible. All handwritten notes will be signed and dated accordingly. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that they will be protected from harm, they will be listened to and that their legal rights will be protected. EVIDENCE: The home’s complaints procedure is made available to residents in a userfriendly format. Staff have received training in adult protection and abuse recognition and understand the significance of the home’s whistle-blowing procedure. There is a copy of the Hertfordshire Social Services Safeguarding manual in the home. Staff have a refresher session regularly to ensure that everyone is familiar with the procedure to follow. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a homely, safe and comfortable environment, with access to all the communal facilities and the specialist equipment they require to maximise their independence. EVIDENCE: The premises are well maintained and have a homely and comfortable atmosphere. There is a rolling maintenance programme. On the day of the inspection, the lounge and bedrooms appeared neat and tidy. Some bedrooms were recently redecorated to suit individual taste. There were personal items on display and pictures and posters on the walls. Some bedrooms have stimulating accessories on the walls and ceiling. The hoists and wheelchairs have been serviced. All recliners have been risk assessed. On the day of the inspection, the workman was busy fixing a security alarm system to the exit doors so that staff can be alerted in the event of an incident of wandering by one resident, who has a tendency to wander on to the streets. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 17 To ensure residents safety throughout the home doors were held open with automatic hold open door devices. One bedroom door was fitted on the day with the device. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34, 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home has an effective staff team who will support them. They can be confident that they are safeguarded by the home’s robust recruitment policy and procedures. EVIDENCE: On the day of the inspection the staffing level was adequate for the current group of clients. There were five members of staff present including the senior care worker who was managing the team. The home benefits from a stable and long-serving staff team. There has been only one new member since the last inspection. Since the home manager was not on duty it was not possible to examine the staff recruitment file. However, previous inspections indicated that all the necessary checks had been completed. The new staff member confirmed that she started working only after the necessary security checks had been completed and clearance had been confirmed. She has had a period of induction and mandatory training that included Food and Hygiene, Fire Safety, Moving and Handling and First Aid. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 19 There is a staff meeting each month as well as a meeting for the senior staff, and individual supervision takes place regularly. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, 40, 41,and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standards of administration and management of the home are well maintained and this benefits the residents. Their safety is promoted and protected by the home’s policies and procedures. EVIDENCE: The registered manager was not on duty on the day of the inspection. However, the home was running smoothly in the capable hands of a senior care worker. Team working was evident. There is a robust quality assurance system in place. There are fully documented monthly audits by a senior manager of the company and a twiceyearly audit by an independent auditor. Every aspect of the home is looked at during these audits. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 21 Residents, their relatives and others are given written questionnaires to complete yearly and their response are noted and appropriate changes made accordingly. The audit documents were readily available for inspection. Records in relation to health and safety in the home are maintained and show in particular that fire safety procedures are tested regularly. The home holds some cash for the residents. Proper accounting records were kept for each resident. The Annual Quality Assessment (AQAA) forms issued by the Commission were received on time for this inspection. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 3 3 3 x Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA20 YA20 Good Practice Recommendations It is recommended that all repeat prescription for paracetamol tablets (PRN medicine) be reviewed to avoid large quantities being stored in the home unnecessarily. It is recommended that all handwritten notes on the Medication Administration Record Chart are signed and dated by the author. Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashwood Place DS0000019274.V357256.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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