Inspection on 12/07/05 for Ascot House

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ascot House 28/06/10

Ascot House 19/05/08

Ascot House 12/11/07

Ascot House 20/12/06

Ascot House 09/05/06

Ascot House 18/05/05

Ascot House 27/09/04

Ascot House 01/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ascot House 28 - 36 Wingrove Road Fenham Newcastle upon Tyne NE4 9BQ Lead Inspector Aileen Beatty Announced 12 July 2005 09:30 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 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 Older People. 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. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ascot House Address 28 - 36 Wingrove Road Fenham Newcastle upon Tyne NE4 9BQ 0191 272 1020 0191 272 5171 N/A Ascot House Care Home Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Tanya Jane Dixon CRH 35 Category(ies) of DE(E) - Dementia over 65 (35) registration, with number of places Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Two residents are under pensionable age, within the DE category. Date of last inspection 18/05/05 Brief Description of the Service: Ascot House is a 35 place care home with nursing providing care for older people enduring mental health problems. Care in the home is provided by Registered Mental Nurses supported by care staff. the home is owned and managed by Caring Homes Ltd a national provider of care to vulnerable client groups. The home is situated in Wingrove Road in the west of the city of Newcastle Upon Tyne close to local shops and good public transport links. The building is comprised of four floors the basement being staff and office accommodation and the upper three floors being residents accommodation. There are a number of lounges and dining rooms on the ground floor. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. What the service does well: What has improved since the last inspection? What they could do better: The environment in the home is not of a satisfactory standard. It is in need of redecoration and refurbishment, and a number of items of furniture must be replaced. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 6 There are a number of health, safety and hygiene concerns. These concerns are listed in the report. There are some gaps in medication records and medication is not always stored correctly. The privacy and dignity of residents is compromised by some practices in the home. 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. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 and 5. Service user needs are assessed prior to admission. Service users and their representatives know that their needs will be met. They are able to visit to assess the quality of the service offered before deciding to live in the home. EVIDENCE: All service user records examined contain detailed assessment information that was obtained by the home before admission. A Statement of Purpose and Service User Guide are provided to prospective residents and their families to provide information about the type of care and services offered. Pre admission visits are arranged before admission to enable residents and their families the opportunity to assess the quality of service offered. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10. Standard 11 was not assessed but it was noted that there remains an outstanding recommendation relating to specific information required when caring for residents who are dying and have different religious or cultural needs. The overall standard of care is satisfactory. Care plans are generally of a good standard and residents are well cared for. Medication procedures must be improved as a matter of urgency. Service users are treated with dignity and respect but privacy is sometimes compromised. EVIDENCE: Care plans for 4 residents were examined. They were up to date and are reviewed regularly. The overall standard of care plans is good. The home completes assessments on each resident relating to activities of daily living, continence, moving and handling, pressure sore risk, behaviour, mental state, general and specific risk assessments. The files examined show that these assessments are completed on a regular basis. At the last inspection it appeared that theses assessments are not always used in a preventative way. At this inspection it was noted that pressure area rating scales were used Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 10 to prompt a pressure sore prevention care plan. Staff now have full instructions about how to use the Braden scale. Residents and relatives spoken to said that the standard of care is good. Some relatives expressed a concern that communication can be poor at times, but that staff try to address any concerns raised. Residents appear clean and well cared for. Fingernails are noticeably short and clean and staff carry manicure kits which is good practice. Medication administration and storage is poor. At the last inspection, various unexplained gaps were noted in medication records. Medication was stored in the trolley that should have been refrigerated. At this inspection, medication records still have unexplained gaps, which is unacceptable. Items were still being stored in the trolley that should be in the fridge, and a controlled drug, Temazepam was found stored in the trolley instead of the controlled drug cupboard. These matters were brought to the immediate attention of the manager who agreed to urgently address them. It was recommended at the last inspection that the suction machine be replaced. It was noted that it has since been assembled ready for use in an emergency. Staff are respectful in their manner towards residents. At this inspection it was noted that staff continue to display private information about residents. Handovers between shifts also continue to take place in public. It was agreed that this should immediately cease. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. Service users currently have access to activities to support their social and recreational requirements. Contact with friends family and the local community is supported. A wholesome and appealing diet is provided. EVIDENCE: There is currently no activity coordinator in post. A list of activities was displayed on the notice board, and there are a number of small and larger lounge areas in the home for people who wish to watch TV or sit quietly etc. A pleasant garden area is available. Entertainment has been organised by the home such as “stars in their eyes” evenings and pie and pea suppers. Takeaways are sometimes ordered. Staff relate well to residents and communicate effectively with those who find it difficult. A “biography” completed by relatives is in use and contains a lot of useful and interesting information about the past lives of residents. This can be used to formulate personalised social care plans. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 12 Visitors may be received at any reasonable time of the day. The kitchen was inspected. It was clean and well organised. The drinks vending machine has been removed which will prevent any unauthorised staff wandering through the kitchen. The health and safety executive visited and complimented the chef regarding his moving and handling assessments. Smaller oil drums are ordered for staff to move more easily. Tablecloths remain very creased and untidy. The chef asked whether it was possible to change menus depending on the weather. It was agreed that menus could change according to the weather, and that this would be good practice. Service users must be consulted however. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. There are satisfactory complaints procedure. Adult protection procedures are in place, but not always followed. EVIDENCE: The home has a satisfactory complaints procedure. This is publicly displayed in the home. There is a Protection Of Vulnerable Adults and Whistle Blowing procedure in place. Staff receive regular POVA training. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26. Service users live in a generally safe environment, with some maintainence problems. The home is generally clean and hygienic. EVIDENCE: The overall impression is that the home is in need of major refurbishment and investment. Many items of furniture are badly marked or worn and mismatching. A tour of the premises took place commencing in the basement. The stairwell leading to the basement is quite unpleasant with a strong smell of cat urine. The flooring in the basement corridor is patchy and uneven and must be improved for safety and hygiene reasons. There remains a strong smell of cat urine. The basement contains office and administration areas and staff rooms and storage. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 15 The staff room is a smoking room and is functional yet not a particularly pleasant room. There are sofas, which must be checked to ensure they comply with fire regulations. Consideration must be given to providing non smoking staff facilities. The ground floor contains lounges and dining areas. The “parlour” is a very nicely decorated room. Some mismatching furniture has been removed from this room, since the last inspection making it much more homely and less cluttered in appearance. The toilet areas have been brightened up with tile transfers. A colourful mural has been painted on the wall outside the bathroom and toilet. It is reported that residents appear to be very pleased with this. It is an outstanding recommendation that bathrooms or toilet areas should have net curtain or blind. This should be considered for a number of bedrooms that are overlooked. Some signage is required on toilet doors. The “nurses station” area is untidy and furniture is mismatching. The desk is damaged and an appropriate office chair is not provided. Staff handovers occur in this open space, which is poor practice as confidentiality is breached as anyone can overhear. Records, discussions and notices about care should be inaccessible to residents and visitors. (See standard 10) Dining areas are tidy and table centrepieces have been ordered. A number of chairs in the small lounge must be replaced as they are marked. The bedroom furniture belonging to the home is old and damaged and all needs to be replaced. The radiator cover in an identified bathroom is broken and must be replaced. There is condensation between the panes of Velux windows, which must be repaired or replaced. The carpet on the first floor corridor near the lift is marked and threadbare and must be replaced. The wooden frames around windows in some rooms are rotting and have been identified as a risk by the maintenance man. These were being repaired during the inspection. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30. There are sufficiently trained and experienced staff on duty in the home. There are satisfactory recruitment procedures in place. Staff receive regular training and support to do their job. EVIDENCE: Staff records were examined and found to contain the required recruitment information. References and criminal records checks are in place. The staff rota identifies adequate staff on duty at the time of the inspection. A training plan is in place. Staff attend regular statutory training. The home continues training staff in NVQ. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36 and 38. The home is run in the best interests of service users. Staff are not supervised regularly at formal sessions. There are some hygiene and safety requirements. EVIDENCE: The manager is experienced in caring for older people and encourages high standard of care. Residents are consulted and relatives are kept informed by regular newsletters. There are currently no residents with a formal advocate. Staff supervision is not always up to date. An inspection was carried out by Richard Bishop from the Health and Safety Executive. He identified the following concerns. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 18 1. The lift has no sensors. Richard Bishop (RB) recommends having a guard fitted. 2. Cot sides – risk assessment in place but out of date and not taking into account change of mattress, which changes measurements of potential entrapment point. Staff have no training re cot sides. They are not routinely inspected or maintained. 3. Window restrictor identified as inadequate on top floor. All must be checked and changed to ensure robust mechanism in place. 4. Hot water – noted some thermometers broken. These need removed and replaced. 5. COSHH – RB very concerned about paint stripper used by handyman containing dichloromethane. No COSHH assessment done - should not be used in care home environment. No COSHH risk assessments for hydrogen peroxide used in washing machines. 6. Manual handling – only 1 hoist – RB recommends 2 as one may be on the wrong floor, the lift may be out of order, the hoist will invariably be required by more than one person. 7 people currently use hoist. Slings are not routinely examined e.g. 6 monthly. 7. Recommends the manager complete health and safety training. The following safety or hygiene issues were identified during the inspection. 8. The strip must be secured to the join in flooring outside kitchen. 9. Pull cords must be skirting board height. 10. Towels must be removed from bathrooms. 11. Sluices must be locked. The manager has not had any formal Health and safety training. This must be arranged. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 1 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x 2 x 1 Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 20 yes 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. 1. Standard 7 Regulation 12 (4) Timescale for action Personal information must not be Immediate publicly displayed. Staff handover must not take place in public. OUTSTANDING Medication must be administered Immediate and stored correctly in line with NMC guidelines. OUTSTANDING Tablecloths must be ironed Immediate before use. OUTSTANDING Areas identified during the 1/11/05 inspection must be redecorated. OUTSTANDING REQUIREMENT from previous 3 inspections. Velux windows affected by 1/10/05 condensation must be repaired or replaced. OUTSTANDING REQUIREMENT from previous 3 inspections. Overlooked bedrooms must be Immediate offered nets. OUTSTANDING All old and marked bedroom 1/10/05 furniture owned by the home must be replaced. Chairs and bed tables identified during the inspection must also be replaced. The first floor carpet is frayed and threadbare in places and must be replaced. OUTSTANDING An action plan must be provided 12/09/05 in relation to each area identified Version 1.30 Page 21 Requirement 2. 3. 4. 9 15 19 13 (2) 16 23 (2b) 5. 19 23 (2b) 6. 7. 10 19 12 (4a) 23 (2b) 8. 38 Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc below. Those asterixed require immediate attention. 1.The lift has no sensors. HSE recommends having a guard fitted. 2.*Cot sides – risk assessment in place but out of date and not taking into account change of mattress, which changes measurements of potential entrapment point. Staff have no training re cot sides. They are not routinely inspected or maintained. 3.*Window restrictor identified as inadequate on top floor. All must be checked and changed to ensure robust mechanism in place. 4.*Hot water – noted some thermometers broken. These need removed and replaced. 5.*COSHH – HSE very concerned about paint stripper used by handyman containing dichloromethane. No COSHH assessment done - should not be used in care home environment. No COSHH risk assessments for hydrogen peroxide used in washing machines. 6.Manual handling – only 1 hoist HSE recommends 2 as one may be on the wrong floor, the lift may be out of order, the hoist will invariably be required by more than one person. 7 people currently use hoist. Slings are not routinely examined e.g. 6 monthly. 7.Recommends the manager complete health and safety training. The following safety or hygiene issues were identified during the inspection. Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 22 8. *The strip must be secured to the join in flooring outside kitchen. 9. *Pull cords must be skirting board height. 10. *Towels must be removed from bathrooms. 11. *Sluices must be locked. The manager has not had any formal Health and safety training. This must be arranged. 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 Good Practice Recommendations Ascot House B53-B03 S391 Ascot House V227476 120705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 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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