Inspection on 12/11/07 for Ascot House

This inspection was carried out on 12th November 2007.

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 20/12/06

Ascot House 09/05/06

Ascot House 12/07/05

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 Tyne & Wear NE4 9BQ Lead Inspector Aileen Beatty Key Unannounced Inspection 09:30 12th and 26th November 2007 X10015.doc Version 1.40 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 Ascot House DS0000000391.V353267.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 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 DS0000000391.V353267.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ascot House Address 28 - 36 Wingrove Road Fenham Newcastle Upon Tyne Tyne & Wear NE4 9BQ 0191 272 1020 0191 2725171 a.marsden@caringhomes.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) Ascot House Care Home Limited Position Vacant Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One resident is under pensionable age, within the DE category. Date of last inspection 20th December 2006 Brief Description of the Service: Ascot House is a 35 place care home with nursing providing care for older people with dementia. 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 on four floors, the basement being staff and office accommodation and the upper three floors being residents accommodation. Some bedrooms have en-suite facilities. There are a number of lounges and dining rooms on the ground floor. The current fees are between £365 and £400. A service user guide and statement of purpose for the home is available. A brochure and inspection reports are available. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out by Regulation Manager Gill Best and Aileen Beatty Regulation Inspector. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 12th and a second visit took place on the 26th November 2007 During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building/parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit We told the manager and provider what we found. The overall standard of care in the home has deteriorated since the last inspection. There has been no permanent manager in the home for a long period. What the service does well: Comments from residents and relatives include: “The nurses are all nice to me” “you get good dinners here, I am happy with everything” “my relative has improved physically since moving to the home. The staff are lovely and do everything they can”. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 6 There is a low turnover of staff in the home meaning that residents are cared for by a stable staff team. Some care plans are up to date and evaluated regularly, meaning staff have current information to enable them to care for residents effectively. Most bedrooms are nicely personalised and homely. What has improved since the last inspection? What they could do better: The standard of some care plans is poor and lacking sufficient detail to help staff care effectively for residents. Some staff demonstrate poor practice in their interactions with residents, which could damage their self-esteem or emotional well being. The standard of food and general standards at mealtimes is poor which could mean that residents become nutritionally compromised or do not enjoy this important part of the day. There is inadequate attention in the building design and layout to help people with dementia to find their way around the home or maintain some independence. Residents are not always protected by the homes medication procedures, as they are not always followed. Hygiene procedures are not always followed meaning infection control is poor. Quality monitoring is inadequate, as it has failed to pick up a number of issues. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 7 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. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre admission assessment information is not always sufficiently detailed. EVIDENCE: The care records of four residents were checked. These contained varying degrees of information gathered before admission. There was no comprehensive assessment information available for one resident, and the pre admission assessment of another was very brief. Two residents had sufficient information to demonstrate that the home could make an accurate assessment about whether they could meet their needs. Intermediate care is not provided in the home so standard 6 was not assessed. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning is generally satisfactory but there are some examples of poor practice. Health needs of residents are generally well met. Residents are not always treated with respect or have their dignity maintained. EVIDENCE: The care records of four residents were read. These varied in the degree of detail and standard, depending who had written them. The peripatetic manager had already identified some poor care plans and was addressing these with the staff concerned. Since the last inspection, it has been reported in the self-assessment provided by the home, that nurses have received updated dementia care training. One care plan was very detailed and asks the reader to consider the feelings of residents, e.g. are they demonstrating a need for warmth, love or security. Other care plans demonstrate a poor understanding of different types of dementia. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 11 Residents have access to healthcare professionals such as district nurses and GP. Residents appear generally well cared for and wearing clean and comfortable clothing. Medication procedures are not always followed. The medication administration records for some residents were checked, and there were numerous gaps with no explanation as to why the medicine had not been given. Antibiotics were left out on the windowsill in the treatment room, instead of being disposed of correctly. There are regular checks carried out in the treatment room, including checks of the fridge, room temperature, and equipment. Records show, for example, that nurses have checked the suction machine every week. This check is designed to ensure the machine is ready to use in an emergency. It was, however, covered in thick dust and the electrical test on the plug was out of date. A similar lethargic approach to following procedures is evident in a number of areas in the home and is unsatisfactory. During the inspection, staff were observed caring for residents. All staff appear to genuinely care about residents and there were some examples of good interactions. Some staff, however, demonstrate some poor practices, which compromise the dignity of residents and gives the impression that they are not familiar with up to date best practice. For example, staff said in a loud voice that a resident was “wet” in the middle of the lounge, instead of being discreet and doing their utmost to preserve the dignity of the person. At other times there was evidence of labelling, a well recognised form of poor practice, such as referring to people as “feeders”. At lunchtime there was use of the word “bib” to describe clothing protectors, which could embarrass some residents. The home provides nursing care and there are times when it is the wish of family members that residents remain in the home for as long as possible, including at the time of their death. There are notifications sent to The Commission for Social Care Inspection when someone dies, including details of the cause of death, who was present at death and whether it was expected or unexpected. Details of whether the coroner is involved are also supplied. There is little done, however, to record what the person wants to happen in the event of their death. The section in assessments relating to wishes in the event of the death of a resident is often left blank. This may be due to people feeling uncomfortable about approaching relatives about this and it is acknowledged that it may not be most appropriate to discuss this upon admission. It should be possible to complete this information once a relationship has been formed with the family. Many older people have already considered what they would like to happen in the event of their death, or have religious considerations. Some residents may have spoken about their wishes before becoming ill and it is important that the home is aware of these wishes if possible. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a satisfactory range of activities available to residents. The quality of food, service and equipment at mealtimes is very poor. EVIDENCE: An activities coordinator has been employed and the range of activities available has improved although this continues to be developed. Some activities were being carried out during the inspection such as puzzles. Sensory equipment has been provided and this creates an area of interest in the main reception, although this equipment may be moved and used in different locations. Social care plans vary in detail, but there are good examples of information that has been gathered about residents past interests and history. Visitors are welcome to visit at any reasonable time of day. There was some evidence of choices being offered at mealtimes, but there was no choice of drink, with juice being the only option. There is a general lack of evidence that staff include residents with examples of “doing to” people, as Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 13 opposed to “doing with”. For example, staff were observed helping a resident into a wheelchair and began moving their legs without explaining what they were doing or where they were going. Both inspectors ate lunch with residents, in two dining rooms. Tables were set with cups (with no saucers) and knives, forks and napkins. Staff no longer wrap cutlery up in napkins, as this was confusing to residents. There are some nice pictures on the dining room wall with food and drink, a helpful aid to reminding residents that it is a dining room. Staff sat down to help residents with meals and provided a satisfactory level of support. As mentioned previously, some staff asked residents if they could put their “bib” on, compromising their dignity. Juice was poured into cups, as the glasses used for juice were reported to be broken. Staff were trying a new routine and appeared to be finding it quite stressful. It is acknowledged that the inspection could have added to staffs’ anxiety, and there was also a delivery during lunch, which was disruptive for staff. The standard of meals was very poor on the day of the inspection. The chicken curry on the menu was lamb curry and was not an enjoyable meal. The pie and chips was also poor, with very stodgy pastry and over cooked chips. The meat in the pie was okay. Both inspectors complained about the standard of the meal and inspected the kitchen. The chef has left and the kitchen assistant is currently cooking the food. The home hopes to appoint a new chef soon. It was apparent that the new arrangements are not working well, with basic safety and hygiene checks not being carried out. The gas ring on the cooker was left on and unattended, and the cupboard for storing hazardous chemicals was left open. The fat in the fryer had not been changed when due, and the fryer itself and other equipment in the kitchen was dirty. Mugs and teapots were badly stained. The food available for cooking was checked. The kitchen assistant confirmed that she was not fully aware of the procedures for ordering supplies, which is why lamb was used in the curry, as there was no chicken ordered. She also complained about the heavy workload due to the dishwasher being broken. The dishwasher was replaced and was in use on the second day of the inspection. There were few fresh foods available, and the majority of ingredients were frozen and “smart price” value brands. On the second day of the inspection, the new manager and regional manager had devised a kitchen strategy to deal with these issues, and the kitchen was tidier. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are adequate complaints and protection procedures in place. EVIDENCE: There are written procedures for dealing with a complaint although no complaints have been recorded since the last inspection. The self- assessment information supplied to the Commission for Social Care Inspection by the home states that there has been a reduction in the number of complaints. The company now provides training in customer care and all staff would benefit from this. Some staff have received training in safeguarding adults but a number of people have received no training or require refresher training. The new manager is liaising with the training manager for caring Homes and plans to arrange this as soon as possible. The induction programme now includes an introduction to adult protection issues to help staff be alert to potential safeguarding issues. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some areas of the home are satisfactorily safe, well maintained and clean. EVIDENCE: Some areas of the home have been redecorated and the self- assessment states that there are plans in place for ongoing planned decoration. The home is generally tidy. The storage in the basement of the home has been tidied and reorganised. Some new furniture has been provided making some areas of the home more homely and comfortable. The outside of the building has improved and is much tidier. A number of bedrooms are nicely personalised and residents are encouraged to bring in their own belongings if they wish. Some bedroom furniture is badly Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 16 damaged and care should be taken when giving new residents mirrored wardrobes as they can upset some people with dementia. The home would benefit from more signage to help residents find their way around. It would be particularly useful to have signs in the main lounge, showing the way to the nearest toilets for example. Some other rooms have signs including bathrooms and showers but these vary in style. Some toilets say WC, and others have picture and word signage. Bathrooms and toilets are generally cold and clinical in appearance despite some painting to brighten them. Again, the standard varies. Some very threadbare, faded towels were found to be in use. Pull cords in some bathrooms are very dirty, and emergency call pull cords are sometimes too high. Similarly, bedding is often mismatching and staff don’t always close the poppers at the bottom of duvet covers so they can slide out. This gives a generally poor, unkempt appearance. The dining area has improved. Laminate floor is in place to enable thorough cleaning. Pictures of food on the walls are attractive and functional in making the purpose of the room more easily identifiable. The lift broke down on the first day of the inspection, and this is quite a regular occurrence. The engineer explained that the lift is very old, and the car is two welded together. There have been some electronic parts upgraded, but there are numerous other parts that are now obsolete so new parts must be adapted to fit. This is a major inconvenience to staff. The clocks in almost every bedroom were at the wrong time. This is very confusing for people with dementia who struggle to understand what time of day it is anyway. In one identified bedroom, the carpet is lifting near to the en suite doorway, and the net curtain is torn. There is water damage to the ceiling in another room and the toilet seat was broken in another. Staff must ensure that damaged items are reported so that they can be replaced or repaired promptly. Some areas of the home are not satisfactorily clean. Some toilets were found to be dirty and a commode in one room had been emptied but not washed, leaving urine residue. In several rooms there were creams such as “Sudocrem” with no name or belonging to another resident. Some “Anusol” haemorrhoid cream was left lying with the administration adaptor still in situ and covered in cream. Canestan cream with no lid or name was found in another room. These kinds of habits were identified at the infection control audit in 2006 so staff should be aware of acceptable hygiene practices. Hygiene and general cleanliness had improved in the home but has deteriorated again. As previously mentioned, the kitchen was not satisfactorily clean on the first day of the inspection. There were some improvements by the second visit but the Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 17 floor remained quite grubby under benches. The new manager has identified this, and she is already working with the kitchen staff to improve this. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 18 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are generally sufficient numbers of staff, but they are not all sufficiently skilled. EVIDENCE: Staffing levels have stabilised in the home therefore fewer shifts are required to be covered by agency staff. Where regular bank staff are used, they are familiar with the home, which leads to better continuity of care for residents. Recruitment procedures were checked and the files of three new staff were read. All contained the required information such as references and criminal records and health checks. Some concerns about the recruitment process were discussed with the regional manager and new manager and they confirmed that these have been addressed. Ascot House is a care home with nursing. Qualified staff are employed (Registered Mental Nurses). Qualified staff do not always demonstrate best practice, or appear to be up to date with what actually is current best practice in dementia care. A requirement was set at the last inspection that all staff must receive training in challenging behaviour and dementia care. There is little evidence of any change in practices or that the training has been Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 19 delivered. It is not recorded on the training matrix supplied by the home. Most staff are very caring but some have developed very institutionalised practices that undermine the good practice that is present. Some staff have NVQ level 2 and above. The new manager and the company training manager have carried out a review of all training. Some urgent statutory training has been arranged including “Fire Marshall” training. A number of staff require safeguarding adults and first aid training. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 20 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,15 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users have not benefited from a strong ethos, leadership or management approach since the last inspection. Health safety and welfare of service users are not always adequately promoted or protected. EVIDENCE: There has been no permanent home manager for over a year and this has had a detrimental effect on the home. There has been ongoing support from the Regional Manager and peripatetic managers. Some improvements have been made in the past year such as environmental, but standards in other areas have deteriorated. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 21 On the second day of the inspection, a new manager was in post and was given feedback about the first day of the inspection. The regional manager was also present and both are keen to work closely together to bring about the necessary improvements in the home. The new manager has yet to go through the “fit person” process with the Commission for Social Care Inspection. This is when managers go through a series of checks and an interview with inspectors to determine that they are fit to manage a home. The new manager demonstrated a good understanding of the issues presented and described good ideas about how she plans to address these. This includes prioritising areas for more urgent attention, and the development of longer term plans. Concerns about medication, hygiene and care practices have been raised at previous inspections, and action taken by the home has brought improvement in some instances. There has been difficulty evident in sustaining these improvements and the lack of a manager is part of the cause. Qualified staff working in the home on a permanent basis must also take some responsibility for ensuring that standards do not slide when they are not being directly supervised. The morale and motivation of some staff appears low and has been identified as a concern by the new manager who is keen to support staff in making the necessary improvements. A random check of residents’ funds found that the balances were correct, and all transactions are recorded with receipts provided. The procedure has not changed since the last inspection. There were some safety concerns identified during the inspection. As previously mentioned, health and safety procedures in the kitchen were not followed and hazardous substances were left in an open unlocked cupboard. Some small electrical equipment has not been tested for over a year. The sluice upstairs was unlocked, and the bedpan machine has not had an electrical test for over a year. In the corridor towards the kitchen, the laminate is lifting at the edges where strips were placed to solve the same problem. This is a potential tripping hazard. Routine safety checks of water temperatures and fire safety equipment is carried out. Records are available for inspection. Ascot House DS0000000391.V353267.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 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 (1) Timescale for action All care plan information must be 20/01/08 sufficiently detailed and kept up to date to ensure that all staff know how to care for residents. OUTSTANDING since 09/05/06 Staff must receive training in person centred dementia care to enable them to care better for people with dementia. OUTSTANDING since 09/05/08 Medication must be administered and stored in line with the home’s policies and procedures, to ensure residents are protected. Staff must preserve the dignity of residents at all times. Care assessments must include details of how residents wish to be cared for at the time of their death. Meals served must be of a high standard. Staff must receive training in customer care to ensure that the quality of service at mealtimes is improved. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 24 Requirement 2. OP8 13 (5) 20/02/08 3. OP9 13 (2) 20/01/08 4. 5. OP10 OP11 12 (4) (a) 14 (1) (a) 20/01/08 20/02/08 6. OP15 16 (2) (g) 20/02/08 Glasses must be provided for cold drinks. Implement the kitchen strategy and advise CSCI of outcome to ensure standards are raised. Ensure all staff receive training in protection of vulnerable adults and provided details of attendance with dates. The design and layout of the home must meet good practice requirements in dementia care including improving signage to help people to be more independent. Clocks must be kept at the correct time to avoid confusion. Provide details of redecoration plans, to ensure progress continues in this area. Lifting carpet and linoleum must be repaired so that it does not present a tripping hazard. Damaged bedroom furniture must be replaced, as it is unsightly. Review the safety of the lift and determine whether any work can be carried out to prevent further frequent break- downs. Bedding and towels must be of a good quality. Threadbare towels must be removed and replaced. 9. OP26 23 (2) (d) All areas of the home and equipment must remain clean and tidy. OUTSTANDING since 09/05/06 Creams and lotions must be Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 25 7. OP18 18 (1) (c) (i) 23 (2b) 20/02/08 8. OP19 23/03/08 20/01/08 named and be stored in line with the homes procedures to prevent infection. 10. OP28 18 (1) Ensure all staff are trained and competent to do their jobs and that over 50 of care staff have NVQ level 2 in care, or above. Confirm all statutory training has been brought up to date including dates. The manager must submit an application to the registration team at CSCI within 3 months. Quality monitoring systems must be reviewed to ensure that areas of concern are identified quickly and dealt with effectively without allowing standards to deteriorate. OUTSTANDING since 09/05/06 Cupboards with hazardous items must remain locked when not in use. Electrical tests on small appliances must be brought up to date. Confirm that safety training has been brought up to date including fire marshal and first aid. 20/04/08 11. 12. 13. OP30 OP31 OP33 18 (1) (c) 9 (1) 24 (1) (a) 20/02/08 20/05/08 20/02/08 14.. OP38 13 (4) (a) 20/01/08 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 OP15 Good Practice Recommendations It is recommended that table menus are made available for residents including alternative choices, in a one day format with suitable size font. DS0000000391.V353267.R01.S.doc Version 5.2 Page 26 Ascot House 2. 3. 4. 5. OP26 OP30 OP26 OP26 Heavily patterned wallpaper is replaced by plain when redecorating as it can cause perceptual difficulties to people with dementia. Nurses meet regularly to discuss “prep” requirements and share ideas about remaining up to date. Plastic pull cord covers are provided that can be easily cleaned and prevent the cords becoming discoloured, dirty and harbouring germs. Pictures are placed lower on the walls to enable residents to see them more easily, particularly wheelchair users. Ascot House DS0000000391.V353267.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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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