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Inspection on 27/04/05 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 27th April 2005.

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

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

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

What the care home does well

What has improved since the last inspection?

There were a lot of outstanding requirements from the previous inspection, which have now been met. This included a number requiring decoration and replacement of furnishings. A stair lift has now been fitted to one staircase to help those who find stairs difficult to use.

What the care home could do better:

More thought is needed on how to respect the privacy and dignity of residents and this then being done by staff on duty as such practices as shaving a resident in the dining room need to b improved upon. The television picture quality was poor and it was noted that there were a number of portable aerials in use suggesting that there is a problem with the main aerial. There is no provision for washing soiled clothes or linen and there were a number of small maintenance tasks seen that nothing is being done about. Training is not well organised and a training programme and staff training records are needed. The manager has not registered on a training course he is expected to get this year. The staff rota did not fully show when staff were on duty and the cook is working some time as a care assistant yet is not employed to do this. Correct recruitment practices have not been followed and staff have not been issued with copies of the Code of Conduct issued by The General Social Care Council. Some requirements set following a recent inspection by the Environmental Health Officer have not been complied with.

CARE HOMES FOR OLDER PEOPLE Ascot House Care Home 34 Percival Road Sherwood Nottingham NG5 2EY Lead Inspector Stephen Benson Unannounced 27 April 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ascot House Care Home Address 34 Percival Road Sherwood Nottingham NG5 2EY 0115 960 6506 0115 969 1646 N/A Mr William Scott 7 Woodthorpe Drive, Woodthorpe, Nottinghamshire NG5 4FT Mr William Scott Care Home (CRH) 20 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of Old age, not falling within any other category registration, with number (OP) 20 of places Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 20/10/04 Brief Description of the Service: Ascot House is a care home providing personal care and accommodation for 9 older people. The home provides short or long term care and will accept emergency admissions. The home is owned by William Scott which is run as a family business. The home is located in Sherwood close to shops, pubs, the post office and other amenities. The home was opened in 1980 and consists of 3 terraced houses joined together.. 7 of the home’s bedrooms are single, and none of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a stair lift. The home has an enclosed garden to the rear and there is unrestricted on street parking to the front. Since the last inspection the home has fitted the stair lift The home does not have a website but further information about the home is available from the manager Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first of two unannounced inspections to be carried out between April 2005 and March 2006. The inspection lasted for 6 hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records and discussing this with them. Other residents were spoken with and additional records were seen. A discussion was had with the manager, 2 of the 3 care staff on duty were spoken with and care practices were observed. In addition, speaking with other residents and no relatives or visiting professionals were seen during the inspection. The premises were not inspected in detail but various areas of the home were visited as part of the inspection What the service does well: What has improved since the last inspection? There were a lot of outstanding requirements from the previous inspection, which have now been met. This included a number requiring decoration and replacement of furnishings. Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 6 A stair lift has now been fitted to one staircase to help those who find stairs difficult to use. 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 Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 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 standard(s) 3 The needs of residents will be assessed prior to admission EVIDENCE: The majority of residents are funded through care management arrangements and therefore already have a community care assessment carried out as part of that process. In the eventuality that a resident does not have a care management assessment then the deputy manager said that she would carry out an assessment, and a form has recently been prepared for this. There has been one admission to the home since the last inspection and there was a community care assessment on file. There were care plans prepared for the service user, however see comments made in next section of this report regarding detail. Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 and 11 Health care needs are attended to but more emphasis is needed in promoting residents’ privacy and dignity. EVIDENCE: Each service user has a care plan, which are reviewed on a monthly basis. Residents had signed to say hat they agreed with their plans. Plans are prepared for key areas of need, including personal care, mobility and worship although this does not include social need. Plans seen tended to be somewhat general and there is a need for greater detail to be included so that how each service user’s assessed need is going to be met. An example of this is one service user regularly prays in his room and this was recorded, however it did not detail when this is. One service user described a restriction placed on him because of an identified problem. He did not like the restriction but accepted that this was there in his best interest. A record is kept for each service user for all contact with community healthcare professionals and this showed that district nurses, GP’s, dentists, opticians, chiropodists and psychiatric nurses all regularly visit residents. One service user said he could se a doctor whenever he wanted and he had recently been Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 10 in hospital and another two are still there. Care plans show that each service user’s personal hygiene is addressed within their care plan, although this would be clearer if more detail was included on how this is to be done. Mobility was seen being encouraged and two residents were carrying out domestic tasks one explained that they liked to do so to keep active. One service user self medicates their own inhaler and an agreement for this was seen on his file. There is a self-medication assessment form in the policy and procedures file but one had not been completed for this. Medication Administration Records (MAR) were fully completed, but photographs are needed on these. Residents confirmed that staff give them their medication. One service user was seen being shaved in the dining room. This was explained as being because the service user concerned can be difficult to shave because he is continually on the move. There was no record of this in the care plan and promoting issues of privacy, dignity and choice were discussed and these must be promoted. Another service user said that he felt that his privacy is respected and that he only has to ask for help and this is provided. He also said that staff do their best. Staff were seen knocking on doors before entering service user’s rooms. Screens are provided in double rooms except one where the occupants have chosen. This is recorded in their care plans. There has been one recent death on the home and arrangements for the funeral were being made at the time of the inspection. The Commission for Social Care Inspection has not been notified of the death and they must be notified in the event of a death of a service user. Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 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 standard(s) 12, 13 and 15 The daily routine is flexible and meals and mealtimes are well managed. Nobody has taken responsibility for sorting out the poor quality television picture. EVIDENCE: Residents described being able to exercise choice over parts of their daily routine, including when they get up or go to bed. It was also observed that residents freely wandered between their rooms and communal areas also that they chose to have their lunch at differing times and some had chosen to eat in their rooms rather than the dining room. There are several televisions placed around the home, and some residents have their own in their rooms. The picture quality was poor and it was noted that there were a number of portable aerials in use suggesting that there is a problem with the main aerial. Individual interests are known and staff described playing games of cards and dominoes, but residents did not mention these. Staff said that visitors are welcome but those residents spoken with said that they did not often have visitors, but they were made welcome when they do visit. There is a rolling menu, which provides a choice of main meal. Residents were seen having a mixed grill for lunch, which was being adjusted to take into Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 12 account individual preferences, likes and dislikes. Residents spoken with said that they had plenty to eat and were happy with the food. One service user said that he eats what he wants when he wants. Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 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 standard(s) 16 and 18 Procedures are in place for residents to complain and to report any incident of abuse although it is not known how effective these are as they have not been used. EVIDENCE: There is a copy of the complaints procedure displayed in the dining room and a copy of the adult protection procedures were in the office area. No training has been provided in either of these areas. There has not been any complaint made or incident of abuse reported. There is a complaints book to record any complaint in, but none have been recorded in the last 2 years, although residents said that they told staff if anything is not right. Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Attempts are made to provide a homely environment but routine maintenance is not organised and the laundry is not adequately equipped. EVIDENCE: The house has plenty of character and the décor and furnishings are of an acceptable standard, although there were a number of small maintenance tasks seen. These have not been recorded in the maintenance book and the manager must record all repairs needed and then arrange for these to be carried out. The home was clean and tidy and cleaners were working at the time of the inspection. The laundry dos not have a sluice or sluice programme on the washing machine. There are occasions when soiled clothing or linen has to be attended to and this is likely to increase. A sluice facility is therefore required. Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The procedures used for the recruitment of staff are lapse and do not follow the required robust checks. The lack of a training programme or staff training records means that it is not possible to ascertain whether suitably trained staff are on duty. EVIDENCE: The staff rota was seen but this did not show any cover being provided between 8 and 10pm. The senior staff member said that she covers those hours every day. An immediate requirement was set at the last inspection that the staff rota always accurately the hours actually worked by each member of staff. There is one staff vacancy, which must be recruited to. The rota also showed that the cook undertook some care duties, but there was not a job description or terms and conditions on his file covering these duties. No health check is carried out on new staff and one recently recruited member of staff commenced duties without references being taken up or a Criminal Records Bureau Check being obtained, although she has now ceased her employment. Staff have not been issued with copies of the Code of Conduct issued by The General Social Care Council. There were various staff training certificates displayed on the dining room wall and there was a training and competency record, however this did not show which staff were trained. Staff talked about training they had recently received including infection control. No staff are registered on NVQ’s. A detailed training programme and staff training records are required. Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 3 and 38 The provider must either be committed to fulfilling his obligations as the registered manager in running the home or seek an alternative management arrangement. Residents safety has been compromised through not fulfilling the requirements set by the Environmental Health Officer. EVIDENCE: The manager, who is also the provider, has been in post since the home opened in 1980. It is evident that much of the day to day management is carried out by the deputy manager. The manager is required to be qualified to NVQ level 4 in management and care (or equivalent) by 2005, but he has not registered on a course. The requirement was repeated to the manager who said he would attend to this as a priority and either register himself on a course or make alternative management arrangements. All residents have recently filled in a quality assurance questionnaire and total satisfaction was expressed with the areas asked about, which included the building, meals, laundry and their bedroom. Residents spoken with recalled Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 17 filling in the questionnaires. The previous inspection report is available in the dining room. Following a visit by the Environmental Health Officer on 22/2/05 a report was issued setting a number of requirements. Only the one regarding gas safety has been fully complied with and one for protection against Legionella partially complied with. Requirements for a health and safety policy to be in place and fixed wiring test have not been met despite exceeding the time allowed. These requirements must be complied with. Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 3 x x x x 1 Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 7 9 Regulation 15 13 Requirement Include greater detail in care plans explaining how each need is to be met Complete a self medication assessment for the service user self medicting and attach photographs to MAR sheets Ensure issues of privacy, dignity and choice are promoted at all times for service users Notify the Commission for Social Care Inspction in the event of a death of a serivce user Ensure that there is a good quality televsion picture Identify all required maintenance by recording in the maintenace book and attend to all repairs Provide a sluice facility Timescale for action 1st June 2005 1st June 2005 1st June 2005 As required 1st June 2005 1st July 2005 1st July 2005 1st May 2005 1st June 2005 1st June 2005 As required Page 20 3. 4. 5. 6. 7. 8. 9. 10. 10 11 12 19 26 27 27 28 12 37 16 13 13 18 11. 29 The staff rota must accurately show the hours actually worked by each member of staff 18 Recruit to the vacant care staff post Employme Staff must be issued with terms nt and conditions for duties they Relations undertake Act 1996 19 Ensure that new staff do not commence work until a CRB C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Ascot House Care Home Version 1.30 12. 13. 14. 29 30 31 CSA section 62 18 9 15. 38 12 check (or POVA) has been obtained and 2 references have been sought Issue all staff with a copy of the Code of Conduct issued by the General Social Care Council Prepare a staff training programme and staff training records The manager must enroll and complete NVQ leve 4 in management and care (or equivilant) or put alterntive management arrangements into place Fully comply with the requirements set by the Environmental Health Officer 1st July 2005 1st July 2005 1st June 2005 1st June 2005 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 Good Practice Recommendations Ascot House Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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 © 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 Care Home C53 C03 S2187 Ascot House V223862 270405 Stage 4.doc Version 1.30 Page 22 - 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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