Inspection on 06/02/07 for Ascot House Care Home

This inspection was carried out on 6th February 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ascot House Care Home 18/02/09

Ascot House Care Home 31/10/07

Ascot House Care Home 03/04/06

Ascot House Care Home 21/10/05

Ascot House Care Home 27/04/05

Ascot House Care Home 20/10/04

Ascot House Care Home 21/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ascot House Care Home 34 Percival Road Sherwood Nottingham NG5 2EY Lead Inspector Lee West Key Unannounced Inspection 6th February 2007 11:00 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.V329575.R01.S.doc Version 5.2 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.V329575.R01.S.doc Version 5.2 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.V329575.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 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. To be able to admit the named person of category DE(E) named in application no V35244 dated 20/9/06 The maximum number of persons the registered provider may accommodate in Ascot House is 20. The home may only accommodate male residents. Date of last inspection 14th August 2006 Brief Description of the Service: 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. 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. The fees are currently £295 to £305 per week, dependent on the care needs of service users. Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, over 5 hours, starting at 11:00am The Registered Manager, Mr. William Scott, and the deputy manager, were present and assisted throughout. The method used was Case Tracking. A number of service users were spoken with about their experiences and expectations of living at the home. Their care plans and other records, prepared and made available by the deputy, including the pre-inspection questionnaire, were analysed. A tour of the premises was also undertaken to see the rooms used by service users case tracked. Staff, visiting professionals, and other visitors’ views were also sought to inform the judgements within this report. What the service does well: What has improved since the last inspection? The care plan of a recently admitted service user contained thorough preadmission and risk assessments, which formed the basis of the care plan. Variations to category for three service users, previously admitted outside the home’s category, are now in place and new service users meet the home’s registration category. Staff supervision has now begun and records were seen. A regular service users’ meeting has been set up, chaired by a relative, with no staff present, to enable them to have their say about the quality of care they receive. A formal letter is sent from the meeting and the deputy responds. Records of the meetings and letters are kept in the home to monitor quality Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. New service users have pre-admission assessments. There are no service users admitted for intermediate care. EVIDENCE: Care plans case tracked showed good pre-admission assessment from the Social Services, which provides the basis for the development of the care plan. All the service users within Ascot House are admitted under the current categories, following the granting of variations to cover a number of service users who had previously been admitted out of category. The care plans of newly admitted service users contained a thorough preadmission assessment and were placed in accordance with the registered category. Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Care plans set out individual needs and service users are treated with respect. Generally, medication is stored, recorded and administered appropriately, but some errors were noted and service users are therefore not appropriately protected by the policies and procedures of the service. EVIDENCE: Care plans case tracked identified individual needs and risk assessments, and carers confirmed these were followed. Service users spoken with said they felt the care they received met their needs. Medication was stored appropriately locked away. However, whilst observing the administration of medication for a service user, it was noted that the carer, contrary to the medicines regulations, took tablets from a pack labelled for another service user. On discussing this with the carer she indicated that this Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 Page 10 was the common practice, as the service user was not prescribed his own tablets. A dangerous practice, this could cause serious harm to service users if the wrong quantity was given, or it interacted with other medication. At present there are no service users responsible for their own medication, and, other medication was stored and marked correctly and the Medicines Administration Records appropriately completed. Carers were observed interacting with the service users and these interactions were positive and supportive, respecting their dignity and privacy. The service users said, “the staff are great, they are really helpful and always knock on my door if I’m in my room.” Another said, “I’m always given time to make my mind up about what I need, as I sometimes forget what I’ve been asked.” Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users’ spoken with said their lifestyle within the home matches their basic expectations and religious interests are met, but more activities to stimulate mental capabilities would help to improve their memory and provide opportunities to socialise. Family and friends can visit at any time and service users exercise control over their lives. The food is wholesome and appealing. EVIDENCE: Responses to surveys, completed by the service users, indicated a majority preferred to go to their own room and “watch my own t.v.” But, when spoken with directly, some contradicted this and said, “we could do with something to do in the afternoons.” After lunch, service users were observed in the lounge areas to be falling asleep, with the televisions on and no-one watching. Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 Page 12 Although evidence of paintings were on the wall in the dining room, there was no other evidence of any regular, structured programme of recreational activities, and there hadn’t been any trips organised for, according to service users, “many a long day.” This lack of mental stimulation could lead to service users having lower expectations and also to a reduction in mental capabilities, especially for service users with any memory problems. Service users said their family and friends were free to visit at any time and were made welcome. This was also observed during this inspection, when relatives visited. Spoken with, they also confirmed they were made welcome and their relatives were “well looked after.” The food today looked appetising and plentiful, consisting of corned beef pie, potato and a variety of fresh vegetables, followed by sponge and custard and choices were available. Some service users, who preferred to eat in their rooms were catered for. Service users said they enjoy the food. “I always come back for seconds.” “I can choose something else if I don’t like what’s on offer.” Food was served in a clean, hygienic dining area and at times convenient for the service users. One service user requested the meal be postponed, as he had “only had breakfast a couple of hours ago and I’m still full.” This was done for him. Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The complaints procedure has been updated and improved, but is not followed by staff. Generally, the service users are protected from abuse, but there are some gaps in available records, which could leave service users vulnerable. EVIDENCE: The complaints procedure has been updated and improved by the deputy. This was seen to identify timescales, actions and outcomes appropriately. No complaints were recorded, and service users spoken with were sure that they would speak to the deputy or “Billy” if they had any problems. However, a concern received by the commission about a window had not been recorded, which indicates the complaints procedure requires more improvement. Staff said they would inform the deputy if there were any complaints and it would be dealt with. There was no evidence in staff files of training in safeguarding vulnerable adults, but those spoken with were clear on their responsibility for protecting the service users and who to go to if there were any suspicions. Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24, 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service users’ own rooms suit their personal needs, with their own possessions around them. Décor and maintenance work is needed in some communal areas to provide a well-maintained environment. EVIDENCE: Service users spoken with said they were happy with their rooms, “I have everything I need in my room, and can come and go as I please.” The home was clean and hygienic, the cleaner was working during the inspection and the lounge areas were clean and homely. The kitchen was clean and hygienic, after serving the lunchtime meal. During a partial tour of the building there were many areas in the corridors and communal areas where the décor was tired looking, chipped and scuffed and in Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 Page 15 need of redecoration. The window catches on the window above the main entrance door were broken and a complaint had been received at the Commission concerning this, but no maintenance had been carried out to repair it. During the winds and rain this window constantly banged, causing irritation to the service users whose rooms were near it. Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers of staff are not always sufficient to meet the service users’ needs and recruitment practices require improvement. There is a commitment for staff to obtain National Vocational Qualifications, but there are times when staff are not suitably competent to carry out their role. EVIDENCE: At the beginning of this inspection there was only one carer, assisted by the administrator, assisting the service users. Another carer had escorted a service user to hospital for an outpatient appointment. As the deputy carries out the routine day-to-day management role of the home, despite Mr. Scott being on the rota as manager, she is not always available for assisting with care, leaving the service users with unmet needs. This was evidenced with one service user who had not been shaved by lunchtime and he said, “I prefer to have my shave earlier, but what can you do?” Later, one carer was observed sitting in a position where she could see both lounges and the dining room. She was not communicating with any of the service users and when questioned, stated this was done as the other Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 Page 17 carer, who had returned from the hospital, was in the laundry room. Again, this indicated that as Mr. Scott was not always present in the home and the deputy acts as manager during his absences, this left the service users vulnerable and the staff numbers low. Staff files were examined and required evidence of identity, including a photograph. References were also missing, although those examined all contained evidence of Criminal Records Bureau checks, and police checks from abroad. There were no responses to questioning at interview, or any indication of previous experience in care work. This lack of evidence of identity and experience could put service users at risk of abuse. Ascot House does have a commitment to training staff and 50 have already achieved National Vocational Qualifications in care, with the remainder undergoing the training. However, there was no evidence of induction in the file of one of the workers, who had poor command of English, and had little understanding of the language, having recently been employed from abroad. It was noted that an employee, who had severe difficulties with the language, speaking, reading, and understanding English, was being used each night as the sleepover member of staff. There was no record, within the staff file, of any previous experience of care, which puts service users at serious risk, should they need assistance during the night and the carer not able to understand what is required. Also, the waking staff member was also put at risk by this practice, as this person would not be able to assist, swiftly, in an emergency situation. Service users spoken with said they were “looked after well”, but during the inspection it was observed that the service users were not interacting with the staff member who could not speak English, because, service users said, it is difficult to get them to understand what was wanted. Staff spoken with said they found it difficult to communicate the needs of service users. However, during the day shift there is a member of staff who speaks the same language, which reduces risks to service users whilst she is available to interpret. During the inspection, this was discussed and addressed as a serious concern, with the deputy putting an immediate contingency plan into operation by using another member of staff to cover the sleepover duties, to ensure the safety of service users. Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Mr. Scott continues as registered manager, but does not fulfil his obligations as registered manager, which has implications on other members of staff and also the standard of care received by the service users, making it difficult to run the home in their best interests. EVIDENCE: Mr. Scott, as registered manager, is responsible for all aspects of running the home. He is counted on the duty rota as manager, but, is often in and out of the home, and has no input into the care provided. The deputy carries out the day-to-day management of the home, producing the records, care plans and updating policies and procedures, also covering for the manager’s absences. This has an impact on the staffing numbers for actual care of service users, as Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 Page 19 the deputy is unable to carry out any care responsibilities whilst acting as manager. This was evidenced during the inspection, as one carer was out of the home on escort duty, leaving only one carer to assist service users with their needs. 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 it and that if they wanted anything extra, or for something special they only had to ask. The health and safety of the service users are promoted; mandatory checks are carried out regularly, as evidenced in the home’s records, and recorded in the pre-inspection questionnaire completed by the deputy. Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 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 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X 3 3 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 2 Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 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 OP9 Regulation 13(2) Requirement The registered person, in accordance with the Misuse of Drugs Act 1974, must ensure that medication is given to the person for whom it is prescribed and no other service user. The general practitioner responsible for the service user must prescribe medicines. The registered person must consult service users about their social interests and make arrangements to enable them to engage in local, social and community activities and having regard to the needs of service users, provide activities in relation to recreation. The registered person shall ensure any complaint made under the complaints procedure is fully investigated and inform the person who made the complaint of the action(if any)that is to be taken. The Registered person must ensure that only suitable, competent and experienced persons carry out the “sleepDS0000002187.V329575.R01.S.doc Timescale for action 08/03/07 2 OP12 16(2) 30/03/07 3 OP16 22(3) 30/03/07 4. OP27 18(1) 08/03/07 Ascot House Care Home Version 5.2 Page 22 5. OP30 18(1)(i) 6. OP29 19(1) 7. OP31 10(1) over” to provide appropriate support to the service users and awake member of staff. The Registered person must 30/03/07 ensure that persons employed receive training appropriate to the work they are to perform. In particular Induction training which also includes knowledge of policies and procedures within the home. The Registered person must 30/03/07 obtain all the information required to authenticate a worker’s fitness and eligibility to work in the care home as set out in Schedule 2. The Registered person must 30/03/07 provide evidence that he is undergoing appropriate training to ensure he has the skills necessary for carrying on 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 OP19 Good Practice Recommendations The registered person must ensure the premises are in a good state of repair, by ensuring routine maintenance is regularly carried out, including repair of the window above the entrance and redecoration of the damaged, chipped and scuffed paintwork in the corridors and communal areas. Review of staffing levels, in view of Mr. Scott not always being present as manager and this role falling to the deputy, reducing the care staff available to assist service users, to ensure staffing levels always meet the needs of the service users. Formalisation of the relative and service users meetings, with an agenda to include service users’ preferences and DS0000002187.V329575.R01.S.doc Version 5.2 Page 23 1. OP31 2. OP33 Ascot House Care Home views on standards of care, activities, trips, food, state of the home and any other areas they wish to discuss to monitor quality and use the information from these meetings to identify areas for improvement in care standards. Ascot House Care Home DS0000002187.V329575.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000002187.V329575.R01.S.doc Version 5.2 Page 25 - 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!