CARE HOMES FOR OLDER PEOPLE
Ascot House Care Home 34 Percival Road Sherwood Nottingham NG5 2EY Lead Inspector
Lee West Unannounced Inspection 21st October 2005 10:00 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 Care Home DS0000002187.V256135.R01.S.doc Version 5.0 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 Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ascot House Care Home Address 34 Percival Road Sherwood Nottingham NG5 2EY 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) 0115 960 6506 0115 969 1646 Mr William Scott Mr William Scott Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th April 2005 Brief Description of the Service: Ascot House, opened in 1980 consisting 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. Accommodation includes 7 single bedrooms. All located on 2 floors with stairlift access. There is an enclosed garden area to the rear of the home and unlimited on street parking to the front. Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The was an unannounced inspection carried out over 5 hours. The method of inspection used was called Case Tracking, which involved selecting 3 service users, discussing their care with them, interviewing members of staff on duty and examining the records to analyse whether the home is meeting the needs of the service users within the home. Mr. Scott and Mrs Shipp both assisted with the inspection and other service users were spoken with during a tour of the building. No relatives or visitors were within the home during the inspection. What the service does well: What has improved since the last inspection?
Reception on all television sets was clear at the time of inspection. Routine maintenance is being identified and dealt with. Staff were observed during the inspection treating the service users with respect and maintaining their dignity and the service users confirmed that this has improved. There is a sluice sink within the laundry room, with two machines; one for badly soiled items and one for lightly soiled items, with one dryer. The duty rota gives a clear picture of the staff on duty and their roles.
Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 6 Staff employed have signed and dated terms and conditions, with job description in their files. 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
Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 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 the following standard(s): 1,2,3, Service user guide and contracts have information and conditions and assessments are carried out before admission. EVIDENCE: The service user guide and contracts give information that prospective service users require to help them make an informed choice about being admitted to the home. They are funded through care management and have a community care assessment carried out before admission and this is used as the basis of the care plan. Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 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 the following standard(s): 7,8,10,11 Care needs are set out in care plans, but plans require further improvement, but care needs are met and service users are treated with respect. Time of death wishes are identified. EVIDENCE: The care plans use the community care assessment as a basis for the plan. Health needs are identified, however, the plans do not include social need and tend to be general and they do not show how the needs are to be met, but service users spoken with all said they were satisfied that their needs are met fully. They confirmed that they feel the staff treat them with respect and always knock when entering rooms and try to maintain privacy at all times. The service users also confirmed that they have been consulted on their wishes at time of death. Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 11 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): 12,13,14,15 Service users maintain their lifestyle as they wish and have contact with relatives, friends and the local community as they choose. Meals are provided in homely surroundings and appear nutritious. Service users were involved in routines within the home. EVIDENCE: Service users spoken with were all satisfied that they are able to exercise choice over their daily routine, including when to go to bed and when to get up. During the inspection service users were wandering between their room and the communal rooms as well as some going into the community when they wished. Lunch was served within the rustic dining room, but some preferred to have their meals in their rooms. The lunch today was fish and chips but choices were given. There was a delivery of fresh fruit and vegetables and dry foods whilst the inspection was in progress. This delivery was being put away by staff and service users, who were observed to be enjoying the activity. Some service users do assist with routines around the home and others go shopping for other service users if necessary. “This helps me to feel ok” one service user explained. The service users said they don’t often get visitors, but when they do, they are made to feel welcome. There are few formally organised activities, but the service users confirmed that there is a trip organised and that staff have
Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 12 played cards and dominoes with them, one said “I prefer to do my own thing” and all said they enjoy watching the television. Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 13 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): 16,17,18 There are procedures in place for service users to complain. They are assisted to maintain their legal rights and procedures for protection from abuse are in place. EVIDENCE: There is a complaints book, but nothing entered for some considerable time. However, service users and staff are aware of complaints procedure and service users said “I know who to speak to and am not frightened to say something if I want to”. Everyone spoken with confirmed that they would approach Iris (Matron) first. Staff interviewed are aware of the Protection of Vulnerable Adults procedures and Whistleblowing policy. The home has a copy of the procedures in place. Service users said they are encouraged to vote still and their personal mail is never opened before they get it. Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 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 the following standard(s): 19,20,21,22,23,24,25,26 The home’s environment is homely, décor and furnishings are of an acceptable standard. There are adequate washing and toilet facilities. Service users have specialist equipment they require and their own rooms are personalised and suit their needs. The home did have two rooms which had a slight odour. EVIDENCE: On the day of inspection the electrician was carrying out major work around the home and the back corridor was stripped in preparation for redecoration. One service user’s room inspected required redecoration. The laundry had a sluice sink in it and the staff confirm this is used when necessary. There are two washers and a dryer to deal with the laundry and service users said they were happy with the way their clothing was washed. Service users who need assistance have access to walking aids and other specialist equipment, which one service user said “I’d be beat without it”when talking about the walking frame being used. Rooms inspected were comfortable and service users have their own possessions around them. Two rooms did have a slight odour, but the remaining areas of the home all were
Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 15 pleasant and clean and hygienic. The majority of the flooring within the home is laminated flooring, but one service user’s room seen does have a fitted carpet which is personal choice. Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 16 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): 27,28,29,30 All shifts were covered appropriately and the skill mix on duty met the needs of the service users at the time of inspection, however, not all shifts have adequate staffing. Staff training is being recorded and staff on duty during the inspection were competent. Recruitment procedures were again observed to be lax and do not follow the required robust checks. EVIDENCE: The staff rota was seen and this showed all shifts were covered, however, the rota again showed that between 8.00 and 10.00pm there is insufficient staff on duty to maintain safety and meet service user needs. Service users spoken with though said that staff were always around and that they felt safe with the staff. Staff on duty at the time of inspection included one carer who already has NVQ Level 2 and one who is undergoing NVQ level 2 training. They confirmed that they have received training and dementia awareness was the next area to be covered. The staff files show developing training programme records. Staff records case tracked showed staff had been employed using previous Criminal Records Bureau documentation. Current documentation was seen during the inspection which had been obtained after the member of staff had commenced work. Staff still have not been issued with copies of the Code of Conduct, however, a request for these had been seen during the inspection, and they are awaited. Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 17 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): 31,33,34,35,36,37,38 The provider continues as the Manager, but still has not accessed any managerial training at NVQ4 level. The financial records are kept up to date and accurate. The staff supervision, whilst taking place is not being recorded and the home’s record keeping, although showing improvement still requires more work to safeguard the service users’ best interests. The requirements from the Environmental Health Officer are being addressed. EVIDENCE: Mr. Scott continues to act as Registered Manager as well as being the provider, having been in post since 1980. However, the day to day management is being carried out by the Matron, Mrs. Shipp. Mr. Scott has still to enrol on an NVQ4 Management course, which was a requirement within the last inspection. The records within the home are developing, but there are many areas that require improvement. Care planning, recording of staff reviews and appraisals and informing the Commission of incidents and deaths are areas requiring attention. The Environmental Health requirements were being addressed and
Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 18 an electrician was carrying out major works to the electrical wiring during the inspection. Financial records are kept individually and any service user’s money is kept locked safely away. The service users spoken with were satisfied with the way their finances are monitored and kept. They also felt in safe hands with Mr. Scott and Mrs. Shipp “when they are in charge everything goes well.” Records in accordance with health and safety requirements were seen today and fire alarm tests, water temperature and fridge temperatures were recorded and the appropriate liability insurance was up to date at this inspection. Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 19 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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 2 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 3 3 2 2 2 Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Prepare a written plan as to how the service user’s needs in respect of health and welfare are to be met. Ensure that at all times suitably qualified competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users Ensure new staff do not commence work until a new Criminal Records Bureau check (or Protection of Vulnerable Adults check)has been obtained and two references been sought The Manager must enrol and complete National Vocational Qualification Level 4 in Care Management(or equivalent) Notify the Commission for Social Care Inspection in the event of the death of any service user, outbreak of any infectious disease, serious injury or serious illness affecting any service user; any event which adversely affects well-being; any theft or
DS0000002187.V256135.R01.S.doc Timescale for action 03/01/06 2 OP27 18(1)(a) 06/11/05 3 OP29 19 06/11/05 4 OP31 19(1)(i) 03/01/06 5 OP38 37 06/11/05 Ascot House Care Home Version 5.0 Page 21 burglary; any allegation of misconduct by the registered person or anyone who works at the care home. 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 OP29 Good Practice Recommendations Issue all staff with a copy of the Code of Conduct issued by the General Social Care Council Ascot House Care Home DS0000002187.V256135.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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