Care Home: Eight Ash Court

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What the care home does well This was a positive inspection, Eight Ash Court provides a service to a range of people, some with high and complex needs. The manager and staff work hard to get to know the person, rather then their disability, and try to provide a service that is very much geared towards individual need; every effort is made to make a safe, person centred environment. The service appears well resourced with a good skill mix of staff that have had appropriate training and supervision. Staff appeared sensitive and supportive and able to work with people with varying levels of physical and learning disability. The training needs of the staff team are being proactively identified and addressed; the NVQ assessment for staff members is being given a higher profile, in order to ensure that a minimum ratio of 80% of care staff have completed an NVQ or equivalent qualification. The accommodation in terms of size, facilities, furniture and fittings and decoration is of a high standard. Service users are able to appropriately personalise their own room. Overall, the physical environment is very homely and comfortable, and a high level of cleanliness was evident. What has improved since the last inspection? Daily notes seen have greater clarity, although this is a continuous area of development. The provision of activities within the home appears to be high with positive feedback being provided in the surveys that were completed by service users. A new kitchen has been installed in bungalow two. All staff are have now undertaken POVA training (safeguarding) Quality assurance questionnaires have been made more user friendly. What the care home could do better: The inspection indicates that the service is well run, with motivated and trained staff, who relate well to the service users. Care and staff management systems including health and safety are being implemented to good effect. The management team continue to identify improvements needed within the service and respond accordingly. By adopting this approach any further shortfalls will be identified and acted on. CARE HOME ADULTS 18-65 Eight Ash Court Halstead Road Eight Ash Green Colchester Essex CO6 3QJ Lead Inspector June Humphreys Unannounced Inspection 19th November 2007 11:00 Eight Ash Court DS0000017809.V351512.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 Eight Ash Court DS0000017809.V351512.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. Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eight Ash Court Address Halstead Road Eight Ash Green Colchester Essex CO6 3QJ 01206 710366 01206 710366 eightashcourt@btinternet.com 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) Mr Pelandapatirage Gemunu Susantha Dias Mrs T Cheung, Mr W K Cheung Mrs Jacqueline Kennedy Care Home 12 Category(ies) of Learning disability (12), Physical disability (3) registration, with number of places Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 12 persons) Two named persons, under the age of 65 years, who require care by reason of a learning disability, who also have a physical disability, who have resided in the home since April 2002 One male person, under the age of 65 years, who requires care by reason of a learning disability, who also has a physical disability, whose name was made known to the Commission in June 2003 The total number of service users accommodated in the home must not exceed 12 persons 28th November 2006 3. 4. Date of last inspection Brief Description of the Service: Eight Ash Court is a care home providing personal care and accommodation for twelve individuals, with learning disabilities, of whom three named individuals have physical disabilities. The home is located in Eight Ash Green, within a walking distance from local amenities. All of the home’s rooms are single, none have en-suite facilities. Each of the two units have separate kitchen, laundry and communal areas. The care home was registered prior to the commencement of the Care Standards Act 2000 and the requirements of the National Minimum Standards. The service ‘pre-existed’ and therefore the standards associated with the premises comply on this basis only. Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspections main finding is that all of the key Standards assessed on this occasion are either met or, in a number of cases, exceeded. Consistent with the last inspection report dated 28.11.06, evidence shows that the quality of care offered at Eight Ash court has been consistently maintained to a good/high standard. Information gathered from service users, staff members, relatives, and records confirm the core values are well understood by the staff team. The staff members appear to have a good knowledge of service users identified needs, and how to support them. There has been no further admission to this service since 2003. The service has been rated as excellent at this inspection. What the service does well: This was a positive inspection, Eight Ash Court provides a service to a range of people, some with high and complex needs. The manager and staff work hard to get to know the person, rather then their disability, and try to provide a service that is very much geared towards individual need; every effort is made to make a safe, person centred environment. The service appears well resourced with a good skill mix of staff that have had appropriate training and supervision. Staff appeared sensitive and supportive and able to work with people with varying levels of physical and learning disability. The training needs of the staff team are being proactively identified and addressed; the NVQ assessment for staff members is being given a higher profile, in order to ensure that a minimum ratio of 80 of care staff have completed an NVQ or equivalent qualification. The accommodation in terms of size, facilities, furniture and fittings and decoration is of a high standard. Service users are able to appropriately personalise their own room. Overall, the physical environment is very homely and comfortable, and a high level of cleanliness was evident. Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Eight Ash Court DS0000017809.V351512.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 Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment procedure is in place, and service users can expect to work with staff to ensure that the placement is appropriate. EVIDENCE: The home has a Statement of Purpose available upon request. A Service Users Guide, which is individual to each person, has been produced in an ‘easy read’ and symbol format for service users. There is also a video guide, which provides further information about living at ‘Ash court.’ The manager of the home is responsible for completing the initial assessment, and examines whether the prospective service users needs can be met, but also that the prospective service user will fit in with the people currently living in the home. No service users have been admitted to the home since 2003, and suitability would take priority over the need for full occupancy. Eight Ash Court DS0000017809.V351512.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): 6,7,9 and10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users have a detailed care plan. The home has effective systems in place to ensure that care plans are reviewed and updated monthly. Service users can expect to be supported to learn, develop, and take part in activities, which they choose and enjoy. EVIDENCE: Detailed care plans involving service users, relatives and other health & social care professionals are in place. Four care plans were looked at as part of the inspection and were found to have clear, and up to date information. Good descriptions as to individual care needs were recorded along with suggested or proven methods of communication, i.e. key words or phases used by individuals, as many of the service users have limited communication skills. The manager said that the key worker system had been further developed enabling relatives of service users to talk directly to key workers rather then through the manager. One relative who was spoken to said “‘ they look after Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 10 (the service user) well. (The service user) is happy here, and able to join in, and do the things they like. Staff follow the care plan, talk to me regularly, and provide me with up to date information.” Several service users who have limited contact from relatives now have advocates working with them to ensure that their needs are fully met. Risk assessments are completed involving individual service users where possible. Helpful suggestions as to how certain known difficult situations might be handled to minimise risk were recorded. Risks are regularly reviewed, and the home support service users in taking risks as part of an independent life style. All information within the home is handled with care and respect. All personal notes and files detailing information on the service user are stored safely. The records of the service users’ meetings were looked at as part of the inspection. There was good evidence to suggest that staff make every effort to involve service users in decisions concerning the running of home. Eight Ash Court DS0000017809.V351512.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): 12,13,15,16 and17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The quality of this outcome area is excellent with service users accessing a range of activities both inside and outside the home to suit individual needs. Service users are involved in selecting the food they wish to eat; and staff support by providing information relating to varied, healthy eating. EVIDENCE: The provision of activities within the home is high with positive feedback being provided from the surveys that were completed by service users. Care plans clearly identify each person’s weekly planned activities, and are updated regularly to take account of any changing needs or personal choices. Each service user attends the local day centre for four, two-hour sessions per week. These are to take part in specific chosen activities. On the day of this inspection several service users had been out in the homes mini bus to Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 12 purchase plants from a local garden centre. Evening activities have been increased since the last inspection to include trips to the theatre, local pub and restaurants. All the service users have been on a holiday of their choice this year, and several were keen to tell me about their experiences. The inspectors observed that routines in the home are flexible, and varied according to individual choices, and needs. Relatives and visitors are encouraged to visit, and there are no-restrictions. Records indicated that visitors were regular and that good communication has been maintained between the home and families. Service users decide the menu in advance; this is usually completed as part of the ‘residents meetings’. Changes are made regularly to ensure a wide range of different foods is offered. Staff at the home usually undertake the cooking of the main meal due to the high needs of many of the service users, however service users do get involved in making snacks and drinks wherever possible. Staff have food hygiene training, and keep appropriate records to demonstrate that the food is stored and cooked in a safe and hygienic way. Menus are in the process of being changed to include symbols and pictures of food, which the Manager hopes, will enable greater choice. Eight Ash Court DS0000017809.V351512.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): 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. Service users are able to receive personal support in the way they prefer and health care needs are recorded within their care plans. Policies and procedures are in place to ensure that medication is administered safely. EVIDENCE: Care plans appeared in place for each service user; four excellent examples were looked as part of the inspection. The examples viewed contained detailed information of each individual’ persons needs; including agreed strategies for dealing with particular issues such as behaviour management, mobility, personal care, food likes and dislikes, activities etc. The care plans were accessible and very informative, providing information for staff to work with. Information is regularly updated by staff, and altered if necessary to reflect changing needs. A range of symbols are used in the home to help service users with little or no verbal communication to express opinions. These are included in the plan. Care plans were seen to be regularly reviewed involving the service user where- ever possible. Following a visit to the GP, dentist, Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 14 Chiropodist or other health professional, the information is recorded on their files, with details of any further treatment/appointments required. The support worker on duty had a clear understanding of the aims of the home and their responsibilities in supporting service users to act independently within a risk assessment framework. Staff were observed as having good relationships with the residents and were familiar with their individual needs as specified in the care plan. A sample of the medication administration systems was examined as part of the inspection. The administration and recording of the three samples checked was very good. No gaps were found on the administration sheets, and the correct amount of medication in stock was exactly as recorded. The manager regularly audits the medication. In one of the houses an eye ointment was found to be stored in the homes fridge in the kitchen. The manager subsequently confirmed that a separate small fridge was on order for the storage of such items. This will be located in the medication room. Eight Ash Court DS0000017809.V351512.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): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured that their welfare will be promoted by the safeguarding procedures and training within the home. EVIDENCE: A suitable complaint procedure written in ‘easy read’ format and symbols was displayed on the notice board in the entrance hall to the home. The interaction between service users and staff during the visit was observed to be positive, and encouraging. Due to the level of disability of some of the service users, the manager advised that a number of systems are in place to ensure that any concerns or complaints would be acted on. This includes a key worker allocated to each individual, involvement of outside advocates when necessary, and an ‘open door’ policy for friends and relatives. This was confirmed by one person who was spoken to who said” I visit regularly and I would approach the Manager who I am pleased to say would deal with it!” As per the previous inspection the Manager confirmed that no complaints had been investigated by the home during the period since the previous inspection. CSCI have not received any complaints, concerns or allegations about this service during the same period. All staff are have now undertaken POVA training (safeguarding). Eight Ash Court DS0000017809.V351512.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): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is maintained in a homely and comfortable manner, taking account of service users’ privacy and comfort. EVIDENCE: The home comprise of two bungalows. Both properties are spacious, and provide ample space for service users to be involved in different activities. All bedrooms are for single accommodation, and were clean. They contained service users personal furniture and belongings. One bungalow accommodates a higher proportion of people who have a profound physical disability and the environment reflected this. Various items of moving and handling equipment were available. Equipment is serviced at least on a yearly basis and this was verified as part of the inspection. There were no obvious health and safety hazards noted in either dwelling. Access to the building is adequate for wheelchair use. Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff are confident in caring for the people living at the home and safeguarding their welfare, because they are well trained, supervised and feel supported by the management structure within the home. The outcomes for service users are very positive. EVIDENCE: The service has maintained a stable core group of staff, several of whom have worked at the home for a number of years. The experience and expertise of staff ensure that service users with high support needs are understood, and that there preferences are known, and acted on. There were three care staff members on duty in each house (a ratio of 1 staff member to two service users) allowing staff time to spend with service users doing the things they may wish to do. The rotas reflected that these levels are maintained. The manager is aware of the importance of only appointing suitably qualified or experienced staff. The home has robust policies and procedures for recruitment Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 18 of staff, employees do not start work until POVA First and CRB checks have been received, and two supporting references. Two staff files were sampled as part of the inspection and were found to be very well organised and comprehensive. As previously evidenced at the last two inspections the home has a very good commitment to training and development of carers. The records seen indicated that carers have been involved in both national Vocational Training (NVQ) and the Learning Disability Award Framework (LDAF) training and induction approach. The manager was very enthusiastic about training, and encouraged and supported staff to progress with further training and skills development. The service demonstrated that the margin of qualified staff with N.V.Q qualifications was above 50 with staff members each having an up to date training and development profile. This included a set action plan for the year ahead. All statutory training had been undertaken and staff regularly attended refresher courses. Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is run efficiently and consistency and stability of care promoted. EVIDENCE: The standard of care offered within the home is very good; both in the delivery of care, and the recording of information. As previously stated care plans and overall written information exceeds the National minimum standards. The Home benefits from having a well establish experienced manager who is able to encourage and develop the staff team within the home. Over several inspections Mrs Kennedy has demonstrated her knowledge and commitment to providing a service, which exceeds the minimum requirements, and is managed for the benefit of the service users. Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 20 Supervision records showed that a system of all staff receiving one to one sessions was in place. The frequency between meetings was variable upon need. Four surveys were completed by staff, and all expressed how ‘open and positive’ the manager was; all feeling able to speak to her if there were any concerns. One person said, “Communication and support is good, and this includes handovers at every shift change, and regular staff meetings.” A range of records was sampled, as part of the inspection. All appeared wellmaintained and included health and safety practices in the home, regular tests of fire alarms and equipment, electrical and equipment maintenance. COSHH products are kept in a cupboard, which has a lock on it. Staff ensures products are put away when not in use. Policies, procedures and protocols were in place at the home to protect the financial interests of service users. Many of the service users finances are not solely managed within the home i.e. relatives are involved in the process. However recording is good with two service users finances being examined and found to be accurate. The company carries out a Quality Service Review, which seeks the views of service users and other interested parties regularly, following which a report is produced. A regular newsletter is produced and sent to relatives and all interested stakeholders. Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 21 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 X 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 4 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 3 LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 3 X Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 22 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. Refer to Standard Good Practice Recommendations Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Eight Ash Court DS0000017809.V351512.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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