Inspection on 20/12/06 for Ascot House

This inspection was carried out on 20th December 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ascot House 28/06/10

Ascot House 19/05/08

Ascot House 12/11/07

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 20 December 2006 & 23rd January 2007 th 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.V304918.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.V304918.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 (This if for the RI) 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 Mrs Tanya Jane Dixon Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Ascot House DS0000000391.V304918.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 9th May 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. 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 is also available. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days, the 20th December 2006 and 23rd January 2007. Staff were observed caring for residents in the lounge and during lunch time. A number if bedrooms, communal lounges, laundry and kitchen areas were inspected. Records examined included, three care plans, staff records and the records for complaints as well as the health and safety, accident and maintenance records. Three visitors were spoken to during the inspection. There were no service user satisfaction surveys received but comments from residents and visitors are contained in the report. This inspection found that most requirements have been met since the last inspection and a number of areas have improved. What the service does well: What has improved since the last inspection? A number of areas in the home have been redecorated and the programme of furniture replacement continues. Areas of concern identified by the infection control audit have been addressed or are in the process of being addressed. Preventative care plans are in place when people are identified as at risk of developing pressure sores. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 6 The external appearance of the home has improved. 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. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. The home does not provide intermediate care so standard 6 was not assessed. This judgement has been made using available evidence including a visit to this service. All service users are assessed before they move into the home to make sure the home is a suitable place to care for them. EVIDENCE: All residents are assessed before they are admitted to the home. This is carried out by the manager who visits them in hospital or at home. Copies of the pre admission assessment are kept in the residents file. The records of three residents were read and all contained assessment information recording their needs. This assessment includes information about how much help they require with personal care, medical needs, any problems they may have such Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 9 as being prone to falls and risks to their safety. Contact details of family and friends and other professionals involved in their care are also recorded. The home also receives a comprehensive assessment of needs from the care manager before admission. Ascot House DS0000000391.V304918.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 adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are written into individual care plans and these needs are usually met. Procedures for dealing with medicines are satisfactory, which means that residents are protected. Residents are usually treated with respect and their right to privacy upheld. Procedures are in place for staff to follow in the event of the death of a resident. EVIDENCE: Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 11 Care plans for three residents were read. These record areas of care and attention required by the resident and describe how staff should carry this out. They include physical and psychological care plans. Care records are generally good. A range of assessments are carried out. These include moving and handling assessments, nutritional needs, skin care, mouth care and mental health assessments. These are reviewed on an ongoing basis so that any changes to care required can be recorded. Risks are also identified using specialist assessment tools, such as falls risk, smoking, and bed rail entrapment. The risk of developing pressure sores (bed sores) is monitored, and people felt to be at high risk of developing a sore have a preventative care plan in place. This was a requirement from the last inspection and has been met. One care plan had not been updated following a visit by an Occupational Therapist where additional advice had been given. Nurses must ensure new information is added to care plans to keep them up to date. Care plans are reviewed monthly and those inspected were up to date. Residents sometimes require admission to hospital from the home. A transfer form is sent to the hospital with the resident. This contains all contact details, allergies, communication needs, aids and adaptations used, safety issues, and information about their routine including usual sleep pattern. This is good practice. Time was spent in the lounge observing staff care for residents, and speaking to residents and visitors. Staff are generally very caring in their manner, and have good relationships with residents. One resident had a minor nosebleed and this was dealt with well by staff, who explained what was happening. They provided reassurance and offered them the opportunity to wash and change. Visitors spoken to spoke very highly of the staff in the home saying that the care provided is very good. Before lunch, a number of residents were helped into wheelchairs using a hoist. This can be a frightening experience for some people. It was noticed that apart from a brief explanation “you are going up” staff do not always provide adequate reassurance or explanation of what they are doing. Some residents appeared visibly anxious whilst being raised, and on two occasions staff did not provide eye contact and were chatting to one another. The anxiety is added to by the fact that for someone with a short- term memory problem, they may not recall ever being hoisted before. Staff must therefore make sure that they give an adequate explanation, pay close attention to the resident and provide reassurance throughout the process. One resident was fast asleep when it was time for lunch. The member of staff approached them gently and allowed them time to wake up before returning and attempting to help them through to the dining room. This is good practice. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 12 Staff have a good rapport with residents and visitors and demonstrate a good use of appropriate humour. In general communication with residents is good but staff must remember not to speak about residents in front of them. For example, one member of staff who was with a resident said “did I tell you what he did yesterday?” Training in person centred care would help staff to recognise why this is not appropriate. Medication procedures have improved in the home. One care plan read regarding medication states that there is strictly no crushing tablets or disguising medicine. The treatment room is clean and tidy and well organised. The medicine fridge contained antibiotics that were in current use and the date of opening written on them. The fridge temperature is checked daily and the medicine trolley is also tidy. The medicine records of three residents were examined and are fully completed with no unexplained gaps. Procedures for the disposal of medicines and sharps have been reinforced to all nurses. New spillage kits (to deal with body fluids spillage) and a suitable solution to use in the event of a diarrhoea and vomiting outbreak have been provided since the last inspection. These were requirements from the Infection Control Audit. There was also a requirement that medicine pots must not be washed and then left upturned on the radiator. Pots are now washed and put away. A poster is displayed on the treatment room wall advising staff what to do if they receive a needle-stick injury. Residents are clean and tidy in appearance and staff help residents to change clothing if required throughout the day. This has improved since the last inspection. Staff respect the privacy of residents most of the time, and are discreet when, for example, asking if someone would like to use the toilet. One member of staff was trimming fingernails in the lounge, and this should be done in private along with other personal care tasks. Another lady was given a foot massage, which was a therapeutic activity but should have been done in the privacy of her room, or another quiet area in the home, not in the main lounge. Guidance is in place for caring for a resident who is dying, and how to care for them following death. The policy states that “ All service users should be able to die in comfort and peace with dignity and free from pain”. It provides further guidance to staff about who to contact when someone dies and also the procedure to follow in the event of a sudden death. There are instructions about how to care for someone who has died. It is recommended that some training is provided to complement the written procedure for less experienced staff. It was confirmed that when someone is dying, the home will care for them as long as possible if it is their wish to remain at the home. Additional staff are provided at this time to enable staff to sit with the person and comfort relatives. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 13 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): 12,13,14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home tries to meet the social, cultural, recreational and religious needs of residents. Residents may maintain contact with friends and relatives and their local community if they wish. There is a varied diet and the standard of dining facilities is adequate. EVIDENCE: On both days of the inspection, some residents were involved in activities in the home. This included more able people who were, for example, playing cards or knitting. People with limited abilities were also receiving one to one attention from staff appropriate to their needs such as a foot massage. The activity programme has improved but needs to be further developed to ensure Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 14 all residents receive adequate social stimulation. The activity co-ordinator post is currently vacant. Visitors spoken to said they feel welcome in the home and one said of the staff, “nothing is a bother to them”. Dolls used previously for doll therapy were all out of view of residents and were not in use on the first day of the inspection. They were also dirty. These had been cleaned and replaced around the home on the second day and some residents were enjoying interacting with them. Biography information is available for many residents detailing their past life history and likes and dislikes. These vary in detail and one file checked contained no biography information. Families are encouraged to complete these and where there is no family staff should try to complete as much information as possible. Social care plans are in place. Again, these vary in detail. The home maintains links with the community by inviting entertainment into the home and going on trips and outings. A number of photographs are displayed of recent trips. It is recommended that staff do not wear uniforms when going out into the community with residents. School children continue to visit the home at certain times of the year, which residents enjoy. On the first day of the inspection, the kitchen was inspected. It was generally satisfactorily clean and tidy although some files used by the chef were very dirty, and were replaced the same day. The chef has a good knowledge of special diets required by residents and likes and dislikes. Food is also supplemented for people at risk of losing weight, for example, carnation milk may be added to porridge and butter to potatoes. There were supplies of food available, but a delivery was due the next day so understandably these supplies were low. There was adequate food available, and the meal provided was that shown on the menu. Menus have been amended slightly due to seasonal variations (for example more hearty soups are provided during the winter months than the summer). On the first day of the inspection, it was found that despite previous requirements crockery remained mismatching. There were also a selection of unattractive plastic beakers for resident’s soft drinks, and white mugs were badly discoloured and stained. The beakers have been replaced by glasses and new plates have been provided. Mugs have been cleaned. On the second day of the inspection, the lunch- time was observed. New fabric napkins have been provided. Staff setting the table had wrapped up the cutlery for each person inside the napkin and this was confusing for some residents. It is recommended that this is not done to allow residents to be as independent as possible in locating and using their own knife and fork. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 15 Residents were offered a choice of lunch, a spam fritter or braised steak. For those with communication problems staff showed them two plates to select from. This is good practice. A choice of drink was also offered. Staff helping people to eat their meals did this at a relaxed and unhurried pace. Staff explained what they were doing when offering residents aprons to wear to protect their clothing. One member of staff described all the items on the plate of a resident and asked if they would like help to cut it up. The inspector ate a meal of braised steak, which was tasty and well presented. The fork provided was quite bent, and it was noticed that some of the other cutlery is misshapen. The knife was also very small and difficult to use. The overall standard of care provided during the lunch- time period was good in both dining rooms, and has improved since the last inspection. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. There is a satisfactory complaints procedure in place. Residents are protected from abuse by the homes procedures and staff training. EVIDENCE: There have been no complaints recorded since the last inspection. A complaints procedure is displayed and includes details of how to contact The Commission for Social Care Inspection to express any concerns. The complaints procedure mentions a suggestion box that is no longer in use. This could be removed from the policy if it is not the intention to replace the suggestion box. Relatives meetings are held three monthly but these are not well attended. There is an annual satisfaction survey sent out by the home and feedback from these is generally good. There have been no safeguarding adults concerns since the last inspection. Staff have received Protection of Vulnerable Adults training. A new training Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 17 manager has come into post and all training is being evaluated and a new programme developed. The recruitment procedure in the home includes criminal records checks. No staff are allowed to work unsupervised in the home until a full CRB (criminal records bureau) check has been received. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. The environment is generally safe and well maintained. Most areas of the home are clean pleasant and hygienic which means that the residents live in a satisfactory environment. EVIDENCE: A number of areas have improved in the environment since the last inspection. The main lounge is in the process of being redecorated. Some new chairs have been bought which improves the overall appearance of the lounge. New curtains have been provided. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 19 Some flooring has been replaced but flooring in some bathrooms and the lounge area still needs to be replaced. There are some new dining chairs and others have been ordered but have not yet arrived. Occasional tables that were damaged in the lounge have been replaced with hospital style over bed tables. These are not appropriate for the lounge as they are not domestic in style and should be replaced with lounge furniture. New beds are being provided in some rooms. Pull cords were tied out of reach during the first day of the inspection. Most of these were untied or were being replaced due to being grubby or damaged on the second day of the inspection. Bedroom areas are nicely personalised with photographs and personal effects. It was noticed that alarm pull cords were wrapped around the light at the head of some beds in big loops of flex. This was felt to be potentially hazardous and a risk assessment has been carried out to assess whether some residents are actually able to use the bell. If not, these are placed behind the headboard of the bed and it is written into the care plan the reason for this. This was due to a fear that a resident may become entangled in the cords as they were previously stored. Bathroom areas have been decorated to make them look more homely. Not all toilets have toilet roll holders (including en suite) and one toilet seat was loose. One shelf in an en suite bathroom is bare wood and requires painting. The wooden gate at the bottom of the stairs on the ground floor is to be replaced by a proper door. This will improve the appearance of this area of the home and will be more domestic in style. The appearance of the hairdressing room has improved but it requires further attention. The floor is badly marked. This is the only area used in the basement by residents. The remainder of the basement is used for offices and staff room and storage. Staff currently smoke in the staff room, although this will change when new legislation is introduced later this year. In the meantime it is recommended that a risk assessment is carried out to assess how safe this practice is given the location of the staff room and surrounding combustible material. There were some issues concerning noise in the home. On the first day of the inspection, a Christmas tree next to the front door had lights that played continuous tinkly tunes. This was very distracting and could cause agitation to some residents. One the second day of the inspection, a door guard (used to keep a fire door open) beeped all day. Staff said that this was because the battery needed to be replaced and the handyman would do that. Staff are not aware of how to do this and appear unaware of the potential disturbance of residents. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 20 The communal areas of the home and most bedrooms are clean and tidy. There was no odour present during the inspection. Some areas of the home are not adequately clean such as some windowsills and finger- plates on some doors. Some chairs and the carpet in the dining room were dirty. All areas of the home must be kept satisfactorily clean. Requirements set at the last inspection resulting from the infection control audit were checked. Most areas have been addressed including: 1.New policies and procedures and products are available to deal with body fluid spillages and outbreaks of sickness and diarrhoea. 2.The manager now audits the home environment weekly and soiled and difficult to clean furniture has been removed and replaced (the replacement of some furniture remains ongoing). Heavily soiled carpets have been replaced and a carpet cleaning and renewal schedule is now in place. 3. A pillow washing and mattress inspection programme have been introduced and both washing machines and tumble dryer are in working order. 4. Hand washing techniques have improved and training given to staff. 5. Procedures for handling sharps (such as needles) have been updated and training provided. 6. Waste disposal procedures have been improved. As previously mentioned, the dolls used for doll therapy were dirty. When receiving training in doll therapy it is emphasised that these dolls must remain clean and clothing washed regularly to prevent cross infection. Staff must continue to remember to do this although they had been cleaned on the second day of the inspection. Mobile equipment such as zimmer (walking) frames and hoists have been added to the wheelchair cleaning schedule. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient suitably trained staff on duty which means that residents needs are able to be met. Residents are in safe hands and are protected by the recruitment practices in the home. Staff receive regular training which means they have the knowledge and skills they need. EVIDENCE: There were sufficient staff on duty on both days of the inspection. A new regional manager is in post and was visiting the home on the first day of the inspection. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 22 A requirement was set at the last inspection to monitor dependency levels in the home and to adjust staff accordingly. It was reported that this has been done and that no adjustments to staffing levels are currently necessary. Bank staff are used to cover sickness and vacancies although there is not a high turnover of staff in the home. Staff records were checked and contain all of the required information including two references and criminal records checks. The manager reported that an inspection from the Social Services contracts department found records to be in order. Staff receive regular training. A new training manager for the company is in post and new guidelines about training have been issued to the homes. This details the type of induction staff must receive depending on their qualification and experience. A monthly training report must now be sent to head office and the new manager will notify homes of any changes affecting training legislation. The training manager is visiting the home in February 2007 and a full audit of training will be carried out at the next inspection. The manager confirmed that statutory training in moving and handling and fire safety are up to date. There is evidence that some staff have carried out this training. Staff have not received training in person centred care. The care provided by staff is generally good but there are occasions when this could be improved. There is a tendency to lead people around by the hand, and sometimes while walking quite quickly ahead of the person. This immediately suggests an inequality in the relationship as it gives the appearance of an adult leading a child, not an adult supporting another adult. Staff should be discouraged from doing this except where the resident volunteers their hand. For moving and handling purposes it may be more difficult to support someone who becomes suddenly unsteady and falls over (possibly backwards) while walking ahead of them holding their hand. There were two occasions where staff did not respond appropriately to challenging behaviour. The first was in the lounge when a person being hoisted nipped the member of staff. The response from the staff member was inappropriate and demonstrated a lack of training in dealing with this type of behaviour. In the dining room a resident was banging loudly on the table and appearing agitated and was completely ignored by staff. The challenging behaviour team at Newcastle General Hospital may be a useful resource for training and advice. Over 50 of staff have NVQ level 2 or above. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 23 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): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home management has not changed since the last inspection. The home is generally run in the best interests of residents. Resident’s financial interests are safeguarded by procedures in place in the home. The health safety and welfare of service users and staff are not always adequately promoted and protected. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 24 EVIDENCE: There has been no change to the manager or deputy since the last inspection. The manager is a first level nurse with over two years management experience. It was reported that the Deputy has requested management training and that this will be planned during the forthcoming training review. A number of new policies and procedures were introduced to the home following the last inspection and infection control audit. The manager has delivered a number of training sessions to accompany these changes leading to an improvement in these areas. Systems have been introduced to audit various areas of the home including a weekly environment audit. During this inspection it was found that not all areas are satisfactory so there appears to be some failure in the audit process. This should be reviewed to ensure that cleanliness and safety in the home are adequately maintained at all times. Annual quality assurance surveys are sent to relatives and responses are usually satisfactory. The Regional manager visits the home monthly and sends a report to CSCI detailing their findings (Regulation 26). These reports demonstrate continuous internal monitoring by the company. Procedures for the safekeeping of resident’s money are satisfactory. The balances of the accounts two residents were checked and found to be correct. Every transaction is signed by two people. The regional manager and home manager check balances on a monthly basis. All transactions are recorded and receipts are available for items purchased. Regular safety checks are carried out including window restrictors and water temperatures. Staff receive regular fire safety training and equipment is checked regularly. Small electrical appliances are tested regularly, as is larger equipment such as hoists. The cupboard used by maintenance staff was open on the first day of the inspection. A set of ladders were also lying in the basement corridor causing a potential tripping hazard and obscuring a fire route. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 25 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 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 26 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. 2. 3. 4. 5. 6. Standard OP7 OP8 OP10 OP12 OP15 OP19 Regulation 15 (1) 13 (5) 12 (4) (a) 16 (2) (m) 16 (2) (g) 23 (2b) Timescale for action All care plan information must be 23/03/07 kept up to date. Staff must provide adequate 23/03/07 reassurance to residents requiring the use of a hoist. Personal care tasks and intimate 23/01/07 activities must take place in private. The activity programme must be 23/03/07 further developed to meet the needs of all residents. New cutlery must be provided. 23/03/07 Confirm plans for 23/03/07 completion of redecoration and flooring renewal. Replace occasional tables in lounge with those domestic in style. Identified toilet seat must be fixed. Identified shelf in en suite must be painted. Confirm plans for the replacement of the gate at the bottom of the stairs. Staff must receive guidance about the effects of distracting noises in an environment for people DS0000000391.V304918.R01.S.doc Version 5.2 Page 27 Requirement Ascot House with dementia. 7. OP26 23 (2) (d) All areas of the home and equipment must remain clean and tidy. Training in dementia care and managing challenging behaviour must be provided. Cupboards with hazardous items must remain locked when not in use. Ladders must not be stored in corridors. 23/03/07 8. 9. OP30 OP38 18 (1) (c) 13 (4) (a) 23/04/07 23/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP11 OP12 OP15 OP38 Good Practice Recommendations It is recommended that training in care of residents that are dying is introduced. It is recommended that uniforms are not worn by staff accompanying residents on outings. It is recommended that cutlery is not wrapped up in napkins. It is recommended that a risk assessment is carried out regarding smoking in the staff room. Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 28 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. Extracts may not be used or reproduced without the express permission of CSCI Ascot House DS0000000391.V304918.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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