CARE HOMES FOR OLDER PEOPLE
Ascot House Care Home 34 Percival Road Sherwood Nottingham NG5 2EY Lead Inspector
Lee West Unannounced Inspection 3rd April 2006 11:30 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 Care Home DS0000002187.V287963.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 Care Home DS0000002187.V287963.R01.S.doc Version 5.1 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.V287963.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21/10/05 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 on street parking to the front. Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over four hours and the method used was Case Tracking, which involved selecting 4 service users, discussing their care with them, interviewing members of staff on duty, touring the building and examining the records and other sources of information to analyse whether the home is meeting the needs of the services users. Mrs. Shipp, Matron, assisted during the inspection and Mr. Scott the Proprietor and Manager attended and assisted from 11.30am. There were no visitors present during the inspection. What the service does well: What has improved since the last inspection?
Regulation 37 notification reports are now being sent to the Commission, to notify the Commission of death or other incidents involving the service users. The Proprietor, Manager has enrolled on the National Vocational Qualification Level 4 Management course and Care staff are continuing to achieve success in NVQ Level 2. Staff training certificates were displayed within the home and staff records tracked contained two professional references and Criminal Records Bureau checks. New staff were not employed until these had been received. Duty Rotas seen identify the staff roles and the mix and numbers appropriate to meet the care needs of the service users.
Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 6 A service user’s room has been refurbished into a bedsitter style to meet the needs of the service user. There has been some improvement in the care plan documentation for each service user, and this continues to be developed. What they could do better: All service users must have a pre-admission assessment carried out and documented within the care plans. Evidence must be documented, within the care plan, that the service user is within the home’s registered category of service user, that his needs have been assessed and how they can be met when admitted to the home. Risk assessments to identify individual risks like ability to safely get up and down the stairs, risk of falls, risks if want to go out alone, should be identified and recorded clearly within a service user’s care plan. A programme of regular activities, such as reminiscence and other mental stimulation activities would assist those with developing memory problems. Complaints are at present recorded in a book, but do not follow the complaints procedure and requires bringing up to the necessary standard. The radiator cover in the lounge area is in need of repair, as is the glass in the door to the patio. Staff records did not contain any supervision records and a formalised system of staff supervision is necessary to monitor not only the care provided by the carers, but also their training and personal development requirements. The collection of data from service user surveys is required to identify and address any areas of improvement or satisfaction. Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 7 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 DS0000002187.V287963.R01.S.doc Version 5.1 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.V287963.R01.S.doc Version 5.1 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): 3, 6 Quality in this outcome area is poor. Pre-admission assessments are not always recorded. There are no service users at present referred for intermediate care. EVIDENCE: The service user files case tracked had evidence of pre-admission assessment from the community social services teams and the new service users spoken with said they had discussed this with the Matron, who confirms she does visit before admission to Ascot House. However, these visits are not yet recorded in the care planning documentation, so cannot be evidenced. Previous medical and present medical histories are also not recorded by the home to assist with the formation of assessment documentation, to ensure the home can meet the needs of the service users and that they are within the registration category of the home. At present the home does not have any service users referred for intermediate care, and no specific procedures for this were seen during the inspection. Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 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): 7,8,9,10,11 The quality of this outcome is good. Care plans seen set out the service users’ individual needs, which the home is meeting. Service users are treated with respect and their wishes at time of death are respected. No service users are responsible for their own medication and the procedures for dealing with medicines are in place. EVIDENCE: Care plans case tracked had risk assessments and planning documentation to show the individual’s needs and how these should be met. They were also reviewed regularly and the service users spoken with said they were satisfied with the care they received, that the staff treat them with dignity and are always helpful. The care plans though require further development, particularly with individual service user’s risks, such as ability to use stairs, risk of falls, of going out alone and addressing these risks. Medication was observed being given to service users at lunchtime. The procedure followed was appropriate. Medication was stored correctly and the Medicines Administration Records case tracked were completed correctly. None of the service users are responsible for their own medicines, but the
Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 11 home does have procedures in place to follow if anyone is assessed as suitable and wishes to do this. During the inspection records of funeral planning and wishes on death were seen within the individual service users care plans. Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is adequate. The lifestyle within the home matches the service users’ basic expectations and religious interests are met, but more activities to stimulate mental capabilities are required. Family and friends can visit at any time and service users exercise control over their lives. The food is wholesome and appealing. EVIDENCE: Service users spoken with all said the home does meet their needs, they said they preferred to “do their own thing” and that they enjoyed watching the television. Daily newspapers were being read and service users confirmed that if they want a paper they can have one. There is though no regular, structured programme of recreational activities to meet the needs of the service users, although occasional trips out are organised, so the majority of the service users are in the various lounges with the televisions on. Service users said their family and friends can visit and are made welcome when they do visit. They also said that they are “free to come and go as we please, so long as the staff know where we are”. Service users said that they were satisfied with the control they had over their current lives. The staff
Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 13 within the home also said that they tried to make sure that service users are in control of what they are doing and the choices they make. The food today looked appetising and plentiful, and choices were available, some service users preferred to eat in their rooms, and this was observed to be catered for. Service users said they enjoy the food. It is served in a clean, hygienic dining area. Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 14 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): 16,18 Quality in this outcome area is adequate. Procedures are in place for service users to complain and to report any incident of abuse, but the complaints procedure is being followed. EVIDENCE: There is a complaints procedure in place, however, the complaints are logged in a complaints book with no timescale, actions or outcomes. Service users spoken with all said they would make any complaints to Mrs Shipp, and that she would deal with them. There is a copy of the adult protection procedures available in the home, and staff have received training in this, no incidents have been recorded. Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 15 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): 19,20,23,24,25,26 Quality outcome in this area is good. Ascot house attempts to keep a homely, reasonable state of décor and repair, but routine maintenance is not organised. Service users have access to all indoor and outdoor areas and their own rooms suit their needs, are safe and comfortable and the home is clean and hygienic. EVIDENCE: There is no routine maintenance personnel for the home, but professionals are contracted when necessary. The wooden cover on the radiator in the back lounge area was broken and in need of repair. The glass in the door to the back garden area was broken, caused by the wind, but repair was being organised. The home is clean and hygienic, with décor and furnishings of an acceptable standard. The kitchen, during the inspection was seen whilst lunch was being prepared and it was seen as clean and tidy with appropriate storage of goods.
Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 16 One of the service user rooms has been revamped into a bedsitter style with appropriate furniture and decorations and the service user is very happy with this “transformation” he says he feels very relaxed in this room. Other rooms seen during the inspection were adequately decorated and furnished and had personal possessions in them. The service users said they were satisfied with their rooms. Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 17 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 Quality outcome in this area is good. Staff levels were adequate to meet service users’ needs and recruitment processes have improved. Staff training enables competent working. EVIDENCE: The duty rota clearly identifies the role and shifts covered and all shifts were noted to be covered appropriately. Service users said they felt there was enough staff present to help them and they said they were happy with the level of help given. Certificates on the all within the dining area evidenced the ongoing training of the care staff. Some NVQ certificates, together with Dementia training were seen. Staff files seen during the inspection had some evidence of training and induction training having been carried out. Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 18 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 Quality in this outcome area is adequate. The provider, Mr Scott, continues as manager and must be committed to fulfilling his obligations as registered manager, or implement alternative management arrangements. The financial and accounting procedures safeguard the service users financial interests. Staff supervision is not being carried out at present. Service users questionnaire have not been collated to identify strengths and weaknesses in the standards of care within the home. The health and welfare of service users are promoted, but record keeping requires some improvement. EVIDENCE: Mr. Scott has enrolled on the National Vocational Qualification Level 4 Management course and is at present waiting for input from the assessor.
Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 19 Evidence of this was seen during the inspection. The course has not yet been started though. As the Registered Manager, Mr Scott is responsible for all aspects of the running of the home, but the Matron, Mrs. Shipp, evidenced throughout all the documentation seen during the inspection, carries out the day to day management, and preparation of care plans, policies, procedures and financial accounting. The financial records were inspected and found to be in order, with appropriate safeguards in place to protect the service users’ financial position. Service users said they were satisfied with the money they are given each week to use as they want, and they said that they did sign for the money and that if they want anything extra, or for something special they only have to ask. Staff supervision is also one of Mrs Shipp’s responsibilities, but this has not been recorded within staff records as having taken place. There was no evidence seen of any staff reviews or appraisal. The health and safety of the service users are promoted, mandatory checks are carried out regularly, as evidenced in the home’s records, however, the records require improvement to ensure all the required checks are monitored and recorded. In particular, the procedure for missing service users requires updating. Risk assessments also require improvements to include the service users’ safety around the home and on outside visits. Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 20 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 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 2 17 X 18 3 2 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 3 1 x x Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? none 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 OP3 Regulation 14(1)(a) Requirement The Registered Person shall not provide accommodation to a service user, unless the needs of the service user have been assessed by a suitably trained person and needs are identified to be within the Registration category Ensure that any activities in which service users participate are free from avoidable risks and unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Consult service users about their social interests and provide facilities for opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities Ensure complaints are recorded in accordance with data protection rules and procedures include the stages and timescales for the process, are dealt with promptly and
DS0000002187.V287963.R01.S.doc Timescale for action 22/05/06 2 OP7 13(4) 22/05/06 3 OP12 16(2)mn 22/05/06 4 OP16 22 22/05/06 Ascot House Care Home Version 5.1 Page 22 5 OP19 23(b) 6 OP36 18(2) effectively. The premises are of sound 22/05/06 construction and kept in a good state of repair externally and internally, and carrying out repairs to the cover of the radiator in the lounge area and the glass repaired in the door to the patio The registered person must 22/05/06 ensure all staff are formally supervised, care staff supervision to be at least six times a year to include all aspects of practice, philosophy of care in the home and career development needs. All other staff to be supervised as part of the normal management process on a continuous basis. 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 OP33 Good Practice Recommendations Establish and maintain a system for reviewing and improving the quality of care provided at the care home. Ascot House Care Home DS0000002187.V287963.R01.S.doc Version 5.1 Page 23 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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