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Inspection on 18/02/09 for Ascot House Care Home

Also see our care home review for Ascot House Care Home for more information

This inspection was carried out on 18th February 2009.

CSCI found this care home to be providing an Adequate service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ascot House Care Home 34 Percival Road Sherwood Nottingham NG5 2EY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dragan Cvejic     Date: 1 8 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ascot House Care Home 34 Percival Road Sherwood Nottingham NG5 2EY 01159606506 PF01159606506 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr William Scott care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: 0 The home may only accommodate male residents. The maximum number of persons the registered provider may accommodate in Ascot House is 20. To be able to admit the named person of category DE(E) named in application No. V35244 dated 20/9/06. To be able to admit the named person of category DE(E) named in application V35244 dated 20/9/06 To be able to admit the named person of category DE(E) named in application no V35244 dated 20/9/06 Date of last inspection Brief description of the care home Owned and managed by Mr. W Scott, Ascot House, consists of 3 terraced houses joined together and situated in Sherwood, close to shops, pubs, post office and other local amenities. The home provides personal care and accommodation for 20 male older people. Care Homes for Older People Page 4 of 27 Brief description of the care home Accommodation includes 7 single bedrooms, with the remainder being double rooms, none of which have en-suite facilities. All bedrooms are located on 2 floors, staircases are steep, but there is a stairlift enabling people with mobility difficulties to gain access to the upstairs rooms. There is an enclosed garden area to the rear of the home and on street parking to the front. The fees are currently agreed with the council rate and apply equally to funded and self-funded residents, dependent on the care needs of service users, and includes general toiletries, but not the cost of hairdressing or chiropody. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection of the service. We followed the service through notifications that the home sent, notifying of events that affected residents. The owner was present for the arrival of the inspector and commented on residents and the homes improvement since the last inspection. This inspection included a site visit on 18/02/09 and lasted for 4 hours during which three residents were case tracked. A further 3 residents spoke to the inspector, as well as two staff members and the new manager. A community nurse that had been visiting the home for the last 25 years and was present during the site visit gave her opinion Care Homes for Older People Page 6 of 27 about the home, staff and care for the residents. Previous requirements were checked and most of them were met. Some documents, residents and staff files and were also checked. A tour of the home provided direct information about the environment. Care process was observed in the home and interactions between staff and residents provided evidence used in this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 8 of 27 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided sufficient information to people so that they could choose the home with confidence. The initial assessment ensured that both the home and the prospective resident knew whether the residents needs would be met. Evidence: The home provided good information about the service it offers. Statement of purpose and service users guide were checked and were very good. Three residents files checked showed that initial assessments were carried out thoroughly, ensuring that all relevant details were recorded and used to create a care plan. The manager showed suggested a form for the future assessments that contained sufficient areas that needed to be assessed to ensure residents needs would be met if admitted. The home had the capacity to meet the residents needs. Three of the residents spoken to had different needs and all three confirmed that staff knew how to and were Care Homes for Older People Page 11 of 27 Evidence: meeting their needs. One of them stated: I am pretty independent and I only occassionally rely on staff. All my needs are met here, I like this place. The visiting nurse stated: I have been coming here for the last 25 years and I can tell you that they meet residents needs. Most of them are somehow eccentric,but this place is ideal for them. The home did not offer intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good records helped staff learn and offer appropriate care to residents. However, although staff showed respect, the environmental issues, such as inability to close the toilet door, undermined respect for dignity Evidence: Three residents files were checked. Care plans were detailed and residents spoken to confirmed that they knew that staff kept records in forms of care plans. Evaluation sheets used for recording reviews showed that reviews were carried out monthly. Risk assessments were part of the care plans and the dates corresponded to aims and goals set in care plans. One of the assessments addressed risks such as smoking that was discussed with residents and a community nurse, aggression under the influence of alcohol, aggression towards female staff and self-medicating Ventolin, inhaler. This plan with suggested actions demonstrated that the home used risk assessments to reduce and minimise risk both to residents and staff. The other two risk assessments checked were similar in content. All were evaluated at the time when care plan reviews took place. Care Homes for Older People Page 13 of 27 Evidence: The community nurse praised the home for organised healthcare. Residents were regularly checked by the sentist, optician and chiropodist. Health professionals visits were recorded in individual residents files. Medication records were checked for 3 residents. The administering medication process was observed. All three residents asked about medication confirmed that they were happy for staff to administer their medication. The records of when needed medication allowed easy audit of the amount, as the brought forward amounts were appropriately recorded on each current medication sheet. The visiting nurse confirmed that medication process was much better and safer since the home arranged with Boots to prepare residents medication. Residents privacy and dignity were respected during the care process. Staff talked to them and even were observed suggesting: Lets go to your room, we can see what you have to wear. However, due to unresolved problems with the environment, two toilets doors could not be closed or locked and undermined respect for privacy, especially when all residents were male and all staff were female. Residents capable of doing so kept the keys for their bedrooms. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offered a variety of activities and allowed residents to choose when they wanted to take part, although internal activities could be improved by suggesting new activities based on recorded residents preferences, likes and dislikes. Evidence: Residents files contained entries about their likes and dislikes and preferences regarding daily life. A user stated: I do not like going out much. I prefer to stay here to watch telly. One of the residents proudly showed his room and explained his experience of living in the home: Its very nice here. I am more than pleased with my room. Food is good, well cooked, we have a choice of two meals. I have a kettle here and can make my drinks when I want. I dont like going out much. The visiting community nurse talked about residents daily routine: Most of them prefer the institutional approach. As they dont like going out, they prefer to stay in and watch TV. Most of them like football and old western films. It is also recognised that not all residents enjoy or are used to social activities, although they seemed relaxed and happy wandering around the house. One of the residents used to go to the nearby orthodox church, but lately had stopped Care Homes for Older People Page 15 of 27 Evidence: going. The manager stated that they call in an entertainer regularly. They also record which individuals take part in communal activities. Autonomy was promoted as most residents did not have significant mobility problems. One of the residents who spoke to us stated: I do my own washing. The menu showed a variety of meals and the cook stated that residents could choose alternatives if they wanted. Meal times were fairly flexible. A resident was seen having a late breakfast during the site visit. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clearly displayed and appropriately followed complaints procedure reassured residents that they could complain with confidence and that they were protected by the appropriate protection measures in place. Evidence: The manager reported that the home had not received any complaints in the last year. The records of complaints showed that the last complaint was made several years ago. The homes complaint procedure was in the information pack and also was displayed around the home. There were no referrals to the Protection of Vulnerable Adults register, no staff were added to the register and there were no allegations of abuse. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the old style of the environment was to the liking of residents, there were elements addressed here that could not guarantee the safety of residents. Evidence: The location of the home in a residential area of Sherwood was appropriate for residents. They did not like going out much and preferred to use the facilities provided in the home. However, good access to the city centre by public transport was appropriate for its purpose. Although regular maintenance programme was in place, the inspection showed that certain elements did not fully ensure the protection of residents. Residents enjoyed the new smoking lounge. However, the back door from this room did not have basic fire protection measures. A self closing device was not installed on this door. There was no intuminance strip around the door or door frame. A toilet door next to bedroom 1 was not lockable and the door on the toilet next to bedroom 6 could not be closed and impinged on the privacy of residents. The toilet next to bedroom 6 did not have soap for handwashing. The radiator in a residents bedroom did not have protection and there was no risk assessment for the resident who occupied that bedroom. The resident, however, stated that he did feel safe without a radiator cover. Steep steps to the upper floor did not affect current residents freedom to move around Care Homes for Older People Page 18 of 27 Evidence: the home, but a risk assessment was not drawn up to indicate how any potential new resident would be affected, or how the initial assessment of a potential new resident would be affected by this. One of the bedrooms had a faulty self closing device. Requirements from the last inspection regarding the environment were met, new carpet was laid in certain areas, new bedding was obtained for residents and the garden was made much more attractive and accessible for the residents. Although infection control policy and measures protected residents, the lack of a soap in a toilet demonstrated that the current procedure needed review and clearer measures to protect residents. Laundry room was safe, but the home should consider replacing normal household washing mashines with the ones that would have a sluice programme, as residents continence problems have recently emerged and needed addressing by reviewing infection control measures and facilities. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefited from being cared for by a dedicated, experienced and stable staff team, who were appropriately checked during the recruitment process and well trained to their job. Evidence: Staff seen working in the home worked unhastily and found the time to talk to residents. This showed that warm words shared with residents made the atmosphere pleasant, homely and friendly. A staff member was observed speaking to a resident who suffered from dementia. The staff talked calmly and skilfully distracted the resident from negative thoughts. Staff training, including NVQ qualifications had been significantly improved. Staff spoken to stated that they were encouraged to attend training and that they felt supported by the new manager. Training records checked for night staff showed 7 training sessions were attended by that staff member. Three staff files were checked and contained all required evidence, applications for the job, references, CRB disclosures (Criminal Records) and, as seen in one file, one written and one verbal reference obtained prior to receiving a written reference for a new staff member. The home did not use agency staff, but engaged current workers to cover for staff absences, thus ensuring continuity and consistency of care. All residents spoken to confirmed that they felt comfortable with staffing presence and Care Homes for Older People Page 20 of 27 Evidence: their ability to meet the asaessed needs. The visiting nurse also added that there were sufficent staff employed on each shift to meet the assessed residents needs. The new manager continued to monitor and promote the new training programme. An induction list checked for one of the new staff members showed that the induction provided was detailed and appropriate. Thus protecting her and residents better. All comments received from residents praised staff for their good work. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of care provided in the home was strongly influenced by the new manager that organised and managed work well and ensured that residents were not only well cared for but respected and treated as individuals. Evidence: The new manager introduced some positive changes that impacted on quality of outcomes for residents. Although she had worked in the home previously, her promotion to the managers post made a significant improvement and was promising for further improvements in the future. The home conducted a quality assurance survey a year before and the results were seen during the site visit. The manager stated that she was preparing quality assurance review for this year. Residents who were unable to manage their finances were supported by the home with clear records of all transactions. Money was stored securely as well as records that were kept up to date, as seen in three checked records. Care Homes for Older People Page 22 of 27 Evidence: A service user spoken to expressed full confidence to the home for helping him handle his finances: They keep my money safe. I always get money when I need it, for the hairdresser or anything else. The manager recently attended training on Mental Capacity Act and was preparing to pass on her knowledge to the rest of the staff. This would further protect residents rights. Staff supervision was improved by the appointment of the new manager, but was not given high priority, as the manager and staff concentrated on support and help for residents. However, spaff spoken to stated that, although supervision was not up to date, they felt very supported by the managers open door principles, wherby anyone could approach her at any time to discuss work related issues. Records of accidents and incidents were minimal, were kept up to date and were used to minimise reoccurrence. Health and safety was affected by shortfalls addressed in the environment section of this report. The requirements in that section and the managers determination to further improve safety for residents ensured sufficient, adequate protection of residents at the time of this site visit, if the home meets the requirements within the given time scale. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 12 Privacy for residents must be ensured by: the toilet door next to bedroom 6 being repared so that it can close and the lock on the toilet next to bedroom 1 must be operational and capable of being locked locked. This would ensure respect for the privacy of residents. 30/04/2009 2 19 23 Self closing devices must be 25/05/2009 installed and in working order on all doors to protect residents in case of fire. Smoking room door must have a self closing device and fire and smoke containing equipment installed to protect residents in case of fire. Residents must be well protected in case of fire. Care Homes for Older People Page 25 of 27 3 22 23 A risk assessment must be 30/04/2009 drawn up for the steep stairs to indicate the needs for a detailed initial assessment of all potential new residents. This would better protect both existing and any potential resident. 4 25 23 All radiators must be guarded, or an appropriate risk assessment must be in place to show how the risk to residents is reduced. Residents must be protected from the risk of scalding. 15/05/2009 5 26 23 Toilets must have soap for handwashing to ensure infection control and protection of residents. Residents must be protected by effective infection control measures. 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!