CARE HOMES FOR OLDER PEOPLE
Ascot House Ascot Avenue Sale Cheshire M33 4GT Lead Inspector
Helen Dempster Unannounced 5 September 2005 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 F55 F05 s32526 ascot house v225542 170505 Stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ascot House Address Ascot Avenue Sale Cheshire M33 4GT 0161 912 1212 0161 973 6780 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) Trafford Metropolitan Borough Council PC Care Home only 45 Category(ies) of OP Old age registration, with number DE(E) Dementia - over 65 of places MD(E) Mental Disorder - over 65 Ascot House F55 F05 s32526 ascot house v225542 170505 Stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The home provides accommodation for a maximum of 45 service users, 17 of whom require care by reason of old age (OP), 19 of whom are older people who require care by reason of dementia (DE(E)) and 9 of whom are older people who require care by reason of their mental ill health (MD(E)). Separate lounge and dining space is provided to meet the needs of the service users who require care by reason of dementia (DE(E)) and the the needs of the service users who require care by reason of their mental ill health (MD(E)). There are currently 3 additional named older service users who require care by reason of old age (OP) and 2 additional named older service users who require care by reason of dementia (DE(E)). Should any of these service users no longer require accommodation at the home, the places will revert to the catagory (MD(E)). The Statement of Purpose must be maintained in line with the requirements of Schedule 1 of Regulation 4 (1) of the Care Homes Regulations. The Statement must be kept under review and updated. Any changes to the home`s purpose must be agreed with the Commission for Social Care Inspection prior to implementation . The staffing arrangements at the home must be maintained in line with the minimum levels set out in the guidance published by the Residential Forum, `Care Staffing in Care Homes for Older People`. This must be reflected in the Statement of Purpose. The home must be managed at all times in accordance with the guidance and regulations issued in respect of older peoples` homes by the Secretary of State for Health under Sections 22 and 23 (1) of the Care Standards Act 2000. The authority must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 25 January 2005 Ascot House F55 F05 s32526 ascot house v225542 170505 Stage 0.doc Version 1.30 Page 5 Brief Description of the Service: Ascot House is a purpose built local authority residential home, which provides accommodation and personal care to 45 older people. The home is located in a residential area of Sale, Cheshire, close to public transport routes into the city centre and surrounding areas. The home is divided into 5 units, 2 of which accommodate 18 older people, 2 of which accommodate older people with dementia and 1 of which accommodates older people with mental ill health. Each of the 5 units has its own lounge/dining area and kitchen. The home is therefore able to provide a separate living area, with bedrooms located close by for service users in each unit. Accommodation is provided in 45 single rooms. Forty-three of the 45 single bedrooms are over 12 sq. meters and could therefore accommodate wheelchair users. The remaining 2 bedrooms measure in excess of 10 sq meters. Ascot House F55 F05 s32526 ascot house v225542 170505 Stage 0.doc Version 1.30 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted by 2 inspectors. It started at 1.30 pm and finished at 5.30pm on 5th September 2005. The inspectors spoke to residents, the new manager, a senior manager and staff. The term of address preferred by the users of the service was confirmed as “residents”. It was felt this best reflected the function and purpose of the service. What the service does well: What has improved since the last inspection?
In response to a requirement made at the previous inspection, staff had an individual training and development profile. There was evidence of the availability of staff training, so that staff have a minimum of 3 days training each year. Since the previous inspection, staff had good access to the “Protection of Adults from Abuse Policy” and training in its implementation. This had enhanced residents’ safety. The residents’ savings arrangements had improved including using external banking to the organisation where residents could receive interest on their savings. Ascot House F55 F05 s32526 ascot house v225542 170505 Stage 0.doc Version 1.30 Page 7 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. Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 6 Residents’ needs were not consistently assessed and documented before they were admitted to the home. EVIDENCE: The initial assessments of residents were not dated and those sampled at the time of inspection were not consistent/linked with the active care plan. For one resident, admitted from another home managed by the provider on 15 July 2005, there was no updated care plan or assessment. The care plan in place did not give the correct information, including the GP details. A requirement was made accordingly. The home does not provide intermediate care. Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 Contradictory, incomplete and inaccurate information in some care plans has the potential to put residents at risk. Some good practices in management of medication were seen but some aspects of administering medication did compromise the health of the residents. EVIDENCE: Four care plans were sampled and tracked. The care plans tracked were contradictory. One example was that of a resident for whom the care plan profile, which is used as a summary of the care plan, stated that eating was “independent”. However the care plan for this person stated that they were “at risk of choking if his food is not cut up into small pieces for him” and “high cholesterol, need for monitoring”. The dangers of having such contradictory information was discussed with the management and a requirement made accordingly concerning the need to monitor assessments and care plans for accuracy. Care plans covered issues such as mobility and pressure care. However, they did not extend to medical history and health needs that required monitoring. Some of this information could be sought from a manual handling assessment,
Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 Page 11 but to ensure that health needs are met, this information needed to be part of the care plan. A requirement was made accordingly. The 4 residents files tracked contained bathing records. In some cases, there were gaps of up to 2 weeks when a bath did not appear to be offered. The manager stated that there had been some staffing problems. For one resident where baths had been relatively infrequent, the manager stated that this person had infrequent baths because the resident is frail and sometimes it is kinder not to give a bath as the person screams and shouts when offered a bath. This information was not contained in the care plan. This needed to be addressed and a risk assessment undertaken regarding this issue. Alternative ways of providing personal care for this resident must be identified. The medication records of two lounge areas were examined. In the majority of the cases a good and accurate record was being maintained, including having additional medication care plans and guideline records for medication, which were “As and When Required”. However, the manager confirmed a staff error that occurred on 2/09/05. A further error, where the record had been signed to indicate that a drug had been administered, but it remained in the cassette was also discussed. The manager stated that it was her signature but that she had not administered the drug as she was not in the building at that time. Concerns were raised about the fact that one resident had not had any of their morning medication administered on one day. While the manager had noted this when auditing and had issued guidance to staff, there had been no action taken concerning the adverse effects to the resident of missing medication. The need for staff to immediately question whether medication has been administered when they note a gap in the medication administration record and observe and record any impact on the resident was discussed and a requirement made accordingly. The medication fridge was not locked at the time of inspection. A requirement was made accordingly. A requirement made at the previous inspection to the effect that details must be put in the service user plan about the decisions reached over residents with mental frailty not receiving their own mail had not been addressed and was therefore repeated. Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15 Residents’ friends and relatives are made welcome when visiting and focus groups are a good source of information about residents’ preferences. Residents are served a nutritious, appealing and wholesome diet. EVIDENCE: The home has an open visiting policy, although visitors are asked to avoid mealtimes. The home holds focus meetings to obtain the views of residents. The minutes of these meetings, including the most recent one held on 21/06/05, contained important information about residents’ views of entertainment and food. The detail in focus group meetings is a strength of the home and it was recommended that these meetings are held more frequently. The manager said that there had been no social trips recently, but that some were planned and an in house social evening had been held on the previous Friday. Residents said that they had enjoyed this social evening and the alcoholic drink provided. The home has a rotating menu, which offers a nutritious and varied diet to residents. At the time of inspection, the home was not documenting menu choices. Residents said that the food was good, but could not recall choices being offered. It was recommended that the home documents the choices offered.
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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 A complaints procedure was available to allow residents to raise concerns. However, staff needed training in dealing with complaints. Staff having been trained and having access to the policy and procedure for the Protection of Vulnerable Adults had the potential to enhance residents’ safety. EVIDENCE: The home had a clear complaints procedure and a record of complaints. Staff needed training in dealing with complaints and customer service and a requirement was made accordingly. The senior manager said that the organisation was planning this training. The “Protection of Adults from Abuse Policy” was readily available at the home and staff had received training in protecting adults from abuse. Ascot House F55 F05 s32526 ascot house v225542 050905 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 Overall, the home was clean, tidy and comfortable, with a good standard of furnishings and fittings. Some aspects of residents’ health and safety were being compromised by furniture layout restricting safe moving and handling and the use of bar soap and cloth towels. EVIDENCE: A partial tour of the premises was undertaken. Overall, the home was found to have a good standard of furnishings and fittings and was clean and comfortable. There was an odour coming from one bedroom where the management of continence was an issue. Most toilet areas had liquid soap and paper towels. However, others had bar soap and cloth towels. This practice should cease due to the infection risk it poses. A requirement was made accordingly. When the inspectors were talking to residents in one lounge area, moving and handling practice was observed. The layout of furniture was restricting safe moving and handling and the need to complete a risk assessment to address this was discussed. A requirement was made accordingly.
Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 Page 15 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 and 30 Adequate numbers of staff were deployed to meet residents’ needs and there was evidence of the availability of staff training. EVIDENCE: The home has 5 lounge areas. The home deployed a minimum of one carer to each lounge, with additional senior staff providing support. Residents said that the staff were very good and that they come straight away when they call them. At the time of inspection, there were 2 vacant care posts, which the manager was about to recruit to. Any shortfalls were covered by agency staff and the organisation’s domiciliary reablement team. On viewing records of training, it was noted that staff have a minimum of 3 days training per year. In response to a requirement made at the previous inspection, staff had an individual training and development profile. Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 Page 16 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) 35, 36 and 38 The review of systems for the management of residents’ finances respected their rights. Staff would benefit from regular documented supervision. The safety of residents and staff will be enhanced when the planned completion of fire safety work to the premises takes place. EVIDENCE: Since the previous inspection, a new manager had been appointed at the home. The need for an application for registration to be submitted was discussed. In response to a requirement made at the previous inspection, systems for the management of residents’ finances had been reviewed, including using banking external to the organisation. This enabled residents to get interest on their savings. Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 Page 17 The staff records examined demonstrated that staff were not having regular supervision. As a result of this, a requirement made at the previous inspection about this was repeated. All fire safety checks were up to date and the maintenance of fire records had improved since the previous inspection. A requirement made at the previous inspection concerning fire safety in the building had not been fully actioned and was therefore repeated. However, the senior manager was able to report positive progress in addressing the fire precautions within the premises. Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 Page 18 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x 3 2 x 2 Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 Page 19 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 3 and 7 Regulation 14 and 15 Requirement The home must monitor and audit assessments and care plans to avoid contradictory and inaccurate information. Care plans must provide information about medical history and health needs that required monitoring to ensure that health needs are met. Baths must be consistently offered and care plans must note when there is a problem with bathing. A risk assessment must be undertaken regarding the identified individual whose challenging behaviour posed dangers when assisted to bathe. Staff must immediately question whether medication has been administered when they note a gap in the medication administration record and observe and record any adverse impact on the resident. The medication fridge must be kept locked. Details must be put in the service user plan over the decisions reached over service users with mental frailty not receiving their own mail. Timescale for action 5/10/05 2. 8 13 and 15 5/10/05 3. 8 13 5/10/05 4. 9 13 5/10/05 5. 10 20 5/10/05 Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 Page 20 6. 7. 8. 9. 36 38 16 26 18 23(4) 22 16 10. 19 13 All staff must receive appropriate supervision All fire safety work highlighted at the home’s last fire authorities visit must be addressed. Managers and staff must have training in dealing with complaints and customer service Cleaning arrangements should be reviewed where the management of continence was an issue. The use of bar soap and cloth towels in toilet areas must cease. The layout of furniture in one unit must be reviewed so that it does not restrict safe moving and handling. A risk assessment must be completed to address this issue. 5/10/05 5/12/05 5/12/05 5/10/05 5/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 13 15 Good Practice Recommendations It is recommended that the focus group meetings are held more frequently to obtain residents views. It is recommended that menu choices are documented. Ascot House F55 F05 s32526 ascot house v225542 050905 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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