Inspection on 09/05/06 for Ascot House

This inspection was carried out on 9th May 2006.

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

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

Other inspections for this house

Ascot House 28/06/10

Ascot House 19/05/08

Ascot House 12/11/07

Ascot House 20/12/06

Ascot House 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 9th May 2006 09:30 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.V290176.R01.S.doc Version 5.1 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.V290176.R01.S.doc Version 5.1 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.V290176.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One resident is under pensionable age, within the DE category. Date of last inspection 12th July 2005 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 comprised of four floors the basement being staff and office accommodation and the upper three floors being residents accommodation. There are a number of lounges and dining rooms on the ground floor. The current fees are between £365 and £400. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 7 hours and involved a tour of the premises, discussions with staff, visitors and residents, and inspection of records. The inspector ate lunch with the residents. The home were making progress towards meeting some of the outstanding requirements from previous inspections, and that requirements made in March about serious safety concerns have been met. There remain some outstanding requirements, and aspects of the care that need to be improved. Staff and managers were helpful during the inspection. There were no comment cards returned to CSCI from residents or their representatives. Some residents spoken to during the inspection said they were happy with the care they receive. Some visitors were also happy but some others felt there were some aspects of the care that could be improved such as fingernails are sometimes long and dirty and there are not enough activities. Visitor comments are detailed in the relevant areas in the body of the report. What the service does well: What has improved since the last inspection? Window restrictors have been fitted to all windows. Water temperatures are regulated and are being monitored regularly. The desk and filing cabinet have been moved from the main foyer to an office, which improves confidentiality. Spare seat cushions covers have been provided. Some redecoration has taken place, including painting walls and paintwork. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 6 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 DS0000000391.V290176.R01.S.doc Version 5.1 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.V290176.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Intermediate care is not provided. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. No service user moves into the home without having his or her needs assessed. EVIDENCE: A pre admission assessment is carried out before anyone is admitted to the home. This is usually done by the manager, and records of these assessments were found in individual files. Most of these are detailed and additional information is also provided by the care manager prior to admission. Care must be taken to ensure all information that may affect the care of a person moving into the home is used effectively. It was found that a comprehensive assessment prepared by the social worker detailed a history of hearing problems and use of a hearing aid. Staff were unaware of this information. Copies of terms and conditions are held for each resident in a separate file. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,and 10. Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. Not all the service user’s health, personal care and social care needs are recorded in an individual plan of care. Service user health needs are not always fully met, for example, pressure area (bed sores) care needs to be improved. Service users are not always protected by the home’s policies and procedures for dealing with medicines. There are numerous examples of procedures not being followed. In the majority of cases service users are treated with dignity and their right to privacy respected. Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 10 EVIDENCE: Care records for 5 residents were examined. Care plans are of a reasonable standard although some care plans should have been in place for physical illnesses such as Diabetes and were not. Care plans are generally of a good standard and evaluated regularly. Assessments are carried out of nutritional status, manual handling needs, behaviour, pressure sore risk (sometimes called bed sores), and falls risk. The home provides specialist care for people with dementia. Some good practice in dementia care was observed. Staff have received training in the use of doll therapy. Staff report that this has been very beneficial for some residents, and some people were seen using the dolls to which appeared to make them happy and contented. However, communication is not always clear which is necessary for people with memory problems. It is recommended that some staff are provided with more training in how to communicate more effectively with people with dementia. A radio was playing loudly on Magic FM on the first floor; staff said that the radio was played when residents were downstairs however one person was observed coming out of her room next to the nurse’s station where that radio is located. It was not felt that this was an appropriate channel and it is recommended that this should be stopped and another channel used. There are currently no residents who use cot sides on their bed. Cot sides were found in a wardrobe of one resident and the manager confirmed they do not use them. These must be removed and stored elsewhere. A pillow was found wedged under a mattress, and the manager could give no reason for this. This must be investigated to ensure this is not being used as an alternative to cot sides. Some residents sit in reclining chairs or have lap straps on their chair. The manager agreed that an assessment should be carried out to ensure that this is a safe seating arrangement for people and doesn’t prevent them from being independently mobile. Where there is a falls risk, the Physiotherapist should be consulted to ensure the most suitable seat is used. It is recommended that the homes policy on restraint includes guidance that addresses the issue of falls and how to ensure people are safe but also free to move independently (E.g. with supervision). Some residents spoken to said that they felt well cared for. Some relatives expressed dissatisfaction with the standard of care provided such as dirty fingernails and a lack of choice of activities. Others were very happy with it. No resident or visitor questionnaires were received by CSCI. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 11 Social care plans are in place and recording of social activities is limited but needs to be expanded. There are some very good biographies which detail past interests and family history. It is recommended that staff try to obtain this information for all residents. This can then be used to develop a very personalised social care plan. It was discovered during the inspection that a resident had developed two pressure sores. Following a discussion with the manager it was found that adequate preventative action had not been taken. An examination of the care plans relating to the pressure sores found that dressings were not being completed daily as prescribed in the care plan. Both care plans were evaluated regularly but no wound measurements were recorded making it difficult to measure progress. Wound assessment charts to be completed monthly were not up to date. A warning letter was issued and requires that wound assessments are kept up to date, wounds are measured regularly and that nurses receive further training in tissue viability (care of pressure sores). During the inspection, an open unattended medicine trolley was found in the dining area and residents were sitting close by. On the top of the trolley was some medicine that had been decanted into medicine pots, although the people it belonged to were still upstairs. An insulin syringe was also on top of the trolley. The clinic room that stores the medicine trolley was unlocked and a blister pack of medicine was lying on the windowsill. A bottle of surgical spirit was stored in an unlocked cupboard in this room. Medication records were checked for 5 residents and there were 3 gaps in the records of one person. The medicine trolley contained items that should be stored in the fridge. The fridge contained items for a person no longer in the home, which should have been removed. There has been an outstanding requirement from the 2 previous inspections that medicine must be stored and administered in line with Nursing and Midwifery Council (NMC) guidelines. This has not been met so a warning letter has been issued in respect of this. Privacy has improved with the removal of the desk and telephone from the main foyer. A poster about the personal care of one resident was on the wall in their room. This information should be contained in care plans. This has been discussed before and other posters have been removed. Net curtains have been bought and will be offered to people in overlooked rooms. Some staff refer to residents by nicknames or pet names, and while this is meant affectionately, this did sound patronising at times and should be avoided. At the inspection in March 2006, one person was observed wearing very ill fitting and therefore revealing clothes that compromised their dignity. Staff have been reminded to make sure people are helped to keep themselves tidy and dignified in appearance. It was also noted at this inspection that residents sometimes have food on their face and clothing a long time after meal times, which compromises dignity. Attention should also be paid to Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 12 helping residents keep their fingernails clean and to remain clean- shaven and have facial hair removed if necessary. A number of people were observed to have dirty teeth. Some staff were observed being very discreet for example when asking people if they needed to use the toilet. One staff member was noted to be abrupt at times when talking to residents and tended to issue instructions in an abrupt manner. It is recommended that the manager monitors this and encourages staff to examine their own communication style. It was not felt that this was deliberate, and in the main staff are kind in their manner and well intentioned. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Social cultural religious and recreational needs are partially met. Service users maintain contact with family and friends and the local community if they wish. Service users are sometimes helped to exercise control over their lives, although more choices must be offered, for example what people would like to drink. Service users generally receive a wholesome and balanced diet in pleasing surroundings at a time convenient to them. EVIDENCE: An activity coordinator is in post, and they carry out mainly group activities in the home. Despite the best efforts of the activity coordinator there appears to be insufficient social activities carried out in the home with groups, or individuals. A list of activities was provided and these include; Bingo, chair exercises, dominoes, skittles, manicures, hand massages, doll therapy, reminiscing, memory boxes, pub lunches, and trips to the park or local shops. Some visitors to the home said that they wished that there was more for Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 14 people to do, and that trips were more frequent. Biography information should be used to develop the social care plan, which should include individual interests. There was little recorded by way of activities enjoyed by the residents in the social care plans of some people. It is suggested that the manager carries out an exercise to establish how many activities people are involved in during one week, and how many opportunities people get to go outside. It would also be useful to record who is involved in activities to ensure there is an equal balance. The activity coordinator visits the home just prior to lunch- time, and then has to wait for people to finish their lunch. People are also often very tired after lunch so some variety in the timings of activities may be beneficial, particularly to those who may be more alert at different times of the day. Visitors are able to visit the home at any reasonable time of day. A hairdressing salon is available and is tidier since stored furniture has been removed. New pictures and posters are being purchased to brighten the room and add interest for the people using it. Residents were joined for lunch, which was served at the correct temperature and was very tasty. The inspector was offered salt and pepper but no one else was. Staff must remember to offer choices especially where tables are not fully set with condiments. Two types of drinks were available; either strawberry flavoured milk or juice. Drinks were observed being poured, and in most case no choice given. Plates were mismatching, and in order to try to provide a matching set, smaller plates were used. Some people found it difficult to keep the food on their plates so it is recommended that larger plates are used. It is also recommended that a new set of matching plates be purchased. A lot of people were noted to require help with eating and there were not enough staff available to ensure everyone could eat at the same time. It is recommended that all staff assist at lunch -time, and that dependency levels are reviewed to ensure that sufficient staff are available. Staff sat at the same level as residents to help them, which is good practice. The family of one resident expressed a concern that portion sizes are too small and it is recommended that the manager monitors this. They were also concerned about the pressure on staff to provide help to so many people. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. Complaints are taken seriously and acted upon in most cases but there was a concern that the home failed to uphold any parts of one complaint yet CSCI’s investigation upheld most parts of it. Service users are not fully protected from abuse, as adult protection procedures are not always followed. EVIDENCE: There have been 3 complaints since the last inspection. Two were substantiated and one partially substantiated. Complaints are recorded and 75 were responded to in 28 days. A recent complaint investigated by the home found that it was unsubstantiated. An inspection found that many of the elements of the complaint were upheld and a number of requirements were made, a number of which have been met. The remainder are being worked towards. Most of the concerns were relating to the décor and furniture and general environment. There has been one Protection of Vulnerable Adults (POVA) referral to social services but this was not progressed by Social Services. There has been no adult protection training in the last 12 months and this is planned and must be carried out as a matter of some urgency. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 16 Staff in the home are employed upon receipt of an enhanced criminal records check. As an interim measure staff may be employed in the home under supervision. A formal request must be made, however, to check that the applicant is not included on a list of people unsuitable to work with vulnerable adults before staff are employed. One staff member has been employed under this guidance but was found to be working unsupervised during the inspection. At an inspection last year it was found that someone had been allowed to live temporarily on the premises, without a criminal record check. As adult protection procedures have again not been followed, a warning letter has been issued. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 19 21 and 26 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Service users live in a safe environment that is well maintained in some areas. Not all areas in the home are clean, pleasant and hygienic. EVIDENCE: At an inspection in March 2006, it was found that the home appeared generally shabby in appearance in some areas, and in need of redecoration and refurbishment. Many of the bedrooms were, however, quite pleasant and decorated to a good standard. It is recommended that where people do not have family or visitors to help them, staff assist them to make their bedrooms more homely in appearance. An improvement plan is in place, which has started with the re-painting of a number of rooms, particularly bathrooms which were especially bare or untidy. A general improvement was noticed at this inspection, but the overall appearance of the home will only improve when Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 18 some of the older and damaged pieces of furniture are replaced. There are plans to replace these and it is recognised that this will happen in stages for cost reasons. The home is not purpose built for people with dementia and there are some problems due to this. There are a number of people who walk around the home for most of the day, and due to the layout of the building this can cause difficulty with supervision. Staff expressed a concern that there is the possibility that residents may go upstairs unsupervised where they may also gain access to other areas. There are currently plans to place a door at the bottom of this staircase and the fire officer has been consulted. Another problem observed on the day of the inspection was due to metal carpet strips that have been fitted where the carpet is lifting. It is very common for people with dementia to have perceptual problems and to misinterpret patterns on flooring or changes in colour of carpets. On one corridor that has been laid in 3 sections, there are 3 strips. Two residents were seen attempting to step over these strips by lifting their feet or legs quite high and clearly seeing them as some obstacle. It is an acceptable temporary measure but is not a suitable long-term solution due to the difficulties it may cause people. A staff member also expressed concern that the strips may catch on the bottom of a walking frame. The manager has been asked to monitor any difficulties people are having, and the Estates manager has been made aware of the specific difficulties that this may cause people with dementia. Some information was provided relating to environmental considerations for people with dementia. It is recommended that the manager is consulted before any changes to the premises are made to ensure they meet good practice guidelines. The assisted bath in the home has been out of use for approximately 12 months and the floor has recently been strengthened to enable it to be used safely. An appointment was made during the inspection for the hoist to be serviced by the manufacturer before use. The shower room floor downstairs was also flooding when used and action is being taken to ensure water runs towards the plug. New tiles have been fitted and a shower curtain purchased. The walls have been painted and murals on walls painted over. This has improved the overall appearance of these rooms and some blinds and pictures have been purchased to make these rooms more inviting. The mixer valve in the second bathroom is broken so it is also out of use and must be fixed as a matter of urgency. Some areas of the home are satisfactorily clean and tidy. There was some malodour identified in a small number of rooms. Two beds were found to have soiled sheets and the duvet had been pulled over the top of them. A drawer in a bedroom was found to contain items used to apply dressings to a wound. Other items were stored in the drawer so this was not hygienic. The treatment room was also found to be untidy, and not satisfactorily clean or tidy. The Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 19 laundry was chaotic on the day of the inspection and not very clean. Two large clothes bins were waiting to be washed and the washing machine was overloaded. Washing instructions and temperature charts are displayed on the walls in the laundry. One of the drier machines is broken. The linen store has clearly marked boxes for each resident however is disorganised with odd socks and odd items lying on the surfaces. Laundry staff are currently unavailable due to illness and holidays. Some ants were found in the new downstairs office. Appropriate advice must be sought if these are a problem in the home. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. There are sufficient staff on duty. Service users are in safe hands. Service users are not always protected by the homes recruitment policies and procedures. Most staff are trained and competent to do their job. EVIDENCE: There are sufficient staff on duty. Off duty rotas checked found that the home are working within minimum staffing levels. Some staff and relatives spoken to felt that there were insufficient staff on duty at times. They did appear to be very busy at times and there appeared to be a high number of people who needed maximum assistance. Staffing levels are based on dependency levels. In the pre inspection questionnaire staffing section, it states that there are only 6 service users with high needs, 20 with medium needs and 1 with low needs. Service user information states that there are 27 people with dementia, 24 are incontinent, 17 of whom are doubly incontinent, 11 are in a wheelchair, 23 require help to wash and dress and use the toilet, 11 need help to eat meals. It states that there are 4 people who require the help of two staff. On Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 21 the day of the inspection, it appeared that there were more people who required 2 staff and moving and handling assessments often dictate that 2 staff are required. The manager said that these dependency levels were determined by the assessment of the nurse assessor. It is recommended that these are reviewed to ensure an accurate picture is presented and that enough staff are on duty. This must be done regularly as a matter of routine, as dependency levels can fluctuate therefore staffing should vary too. Staff have criminal records checks prior to working for the home on a permanent basis. A POVA First check must be carried out until this is received. As previously mentioned staff must be supervised if full clearance is not yet confirmed. Most staff files checked contained all of the required recruitment information although some information was missing from one file, 2 or 3 references were available. Induction records are also held on file. In the past 12 months, staff have received training in moving and assisting, fire safety, food hygiene, COSHH, violence and aggression, dangers of bed rails, pressure damage and doll therapy. Training planned includes fire safety, first aid, moving and assisting, dementia awareness, diabetes, food hygiene and POVA (protection of vulnerable adults). One resident was observed being verbally abused for a long period of time by another and staff should have intervened but did not respond, as though this is a regular occurrence. Training should be provided to explore why they did not respond. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33,35, 36 and 38. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Service users live in a home managed by a person found fit by CSCI to manage the home. Due to the managers long absence there is a concern that some routine checking of the quality of care has not been carried out. Staff try to run the home in the best interests of service users, but there are sometimes concerns raised about lack of staff. Service user financial interests are safeguarded. Staff are not appropriately supervised. Supervision is out of date for a number of staff. Procedures have improved to ensure that Health Safety and Welfare of service users is promoted and protected. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 23 EVIDENCE: The manager of the home has been assessed as fit by CSCI to manage a care home. The manager has been absent for a long period this year due to sickness, which may have affected standards in the home as many of the concerns found during the inspection in March should have been picked up during routine checks by the manager. There has also been a delay in completion of the Registered Managers award and health and safety training. It is recommended that a tool be developed for the systematic auditing of areas recently identified as unsatisfactory. Staff try to run the home in the best interests of residents but some cite a lack of time as a reason for not being able to do as much as they would like to for the people living in the home. As there appears to be concerns coming from some staff and some relatives about the lack of time available and possible short staffing, this must be reviewed to see whether there are enough staff or to see whether existing staff are being deployed effectively. All personal allowances for residents are held in the home. There are charges for items such as toiletries hairdressing and some outings. Staff supervision is out of date and needs to be brought up to date as a matter of urgency. At the inspection in February 2006, a number of safety concerns were identified. These included no window restrictors on some windows, and the water was too hot in some bathrooms. The Health and Safety Executive issued improvement notices for the windows and for a sensor to be provided in the lift to stop the doors closing on people. Window restrictors have now been fitted and repairs are being arranged to window frames that are rotting. These rooms are not in use and are locked. The sensor has been added to the lift. The flooring in the lift remains bubbled and needs to be stuck down or replaced. This is an outstanding requirement. Water temperatures are checked regularly and work has been carried out on thermostats to stabilise temperatures. Fire drills are carried out regularly. Emergency equipment was checked by Fire officers in March. Staff have had fire safety training in the last 12 months. Alarms are tested weekly. New guidelines are being followed for the disposal of medicines, sharps and clinical waste. Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 24 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 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X 2 X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 2 Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 Regulatio n 15 (1) Requirement All relevant information from pre admission assessment must be carried forward to care plans to ensure care plans are in place where physical illnesses require monitoring E.g. Diabetes and heart disease. Social care plans must include information from Biography to ensure they are person centred and not generic. Assessments of wounds must be kept up to date. Dressings must be applied as often as prescribed in care plans. Ensure all service users are given maximum assistance to maintain their personal appearance including cleaning nails, teeth, glasses and changing clothes where required. Medication must be administered and stored correctly in line with NMC guidelines. OUTSTANDING Choices in all aspects of daily life must be offered. Review dependency levels and adjust staffing accordingly, and DS0000000391.V290176.R01.S.doc Timescale for action 09/07/06 2. OP8 12 1 (a) 09/06/06 3. OP8 12 4 (a) 09/06/06 4. 5. 6. OP9 OP14 OP27 13 (2) 12 (3) 18 1 (a) 09/06/06 09/06/06 09/07/06 Ascot House Version 5.1 Page 26 7. OP19 23 2 (a) 8. OP19 23 2 (a) 9. 10. OP10 OP19 12 (4a) 23 (2b) 11. OP21 23 2 (j) 12. 13. 14. OP26 OP26 OP26 16 2 (j) 16 2 (j) 16 2 (e,f) 15. OP30 18 1 (c) 16. 17. OP36 OP38 18 (2) 23 2 (b) 18. OP30 18 1 (c) review the deployment of current staff. Provide CSCI with a proposed date for the replacement of the ground floor carpet. Confirm plans regarding the provision of a door at the bottom of stairs on the ground floor, including evidence of consultation with fire officer. Confirm that overlooked bedrooms have been provided with nets. Provide CSCI with a programme of furniture replacement including dates. The mixer valve on assisted bath must be replaced and the bath brought back into use. Confirm ARJO bath now in use. Dressings must be stored hygienically and beds must be changed as soon as soiled. Pest control should be consulted regarding the ants in the downstairs office. The laundry must be kept clean and tidy and additional staff provided if necessary to cover absence. Training in communication in dementia care, tissue viability, POVA and administration of medicines must be provided to identified staff. Staff supervision must be brought up to date and carried out 2 monthly in future. Confirm date for the replacement of rotten windows and those affected by condensation. Staff are supervised unless in receipt of full CRB clearance. 09/07/06 09/07/06 09/07/06 09/08/06 09/07/06 09/06/06 09/06/06 09/06/06 09/08/06 09/08/06 09/07/06 09/05/06 Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 27 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 OP12 Good Practice Recommendations Record which service users are involved in activities on a weekly basis to ensure people have fair access to them. Review the timing of the activity coordinator visits. New matching dinner plates are purchased It is recommended that the manager develop a quality audit tool for the systematic inspection of the premises and adherence to policies and procedures. 2 3 OP15 OP31 Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ascot House DS0000000391.V290176.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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