Inspection on 08/06/05 for Ascot Lodge

This inspection was carried out on 8th June 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.

Other inspections for this house

Ascot Lodge 04/11/08

Ascot Lodge 07/11/07

Ascot Lodge 27/06/06

Ascot Lodge 16/11/05

Ascot Lodge 29/09/04

Ascot Lodge 21/04/04

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

CARE HOME ADULTS 18-65 Ascot Lodge 17 Ascot Road Moseley Birmingham B13 9EN Lead Inspector Sarah Bennett Unannounced 8 June 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ascot Lodge Address 17 Ascot Road Moseley Birmingham B13 9EN 0121 449 3849 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) Dr Kandiah Somasundara Rajah Vacant Care Home 3 Category(ies) of Younger Adults, Learning Disability registration, with number of places Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years. Date of last inspection 29 September 2004 Brief Description of the Service: Ascot Lodge is situated on the ground floor of a three storey Victorian house in a quiet cul-de-sac in Moseley. The upper floors of the property are let to private tenants with a front entrance shared by tenants and care home residents. Ascot Lodge comprises of three bedrooms, a small kitchen, bathroom and WC, lounge, dining area, office and rear garden with a shed and garden furniture. There is off road parking available for three cars at the front of the property, which is shared with private tenants who occupy the rest of the building. The home provides a vehicle, which is used by residents to access community based facilities, attend appointments and day trips. All bedrooms at the home are single and there are no en siute facilities. The home provides a service to three adults who have a learning disability and autism spectrum disorders. The home is not suitable for people who have mobility difficulties. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over six hours. A tour of the premises took place. Two residents records were sampled. Staff and health and safety records were looked at. Four of the staff on duty and three residents were spoken to. What the service does well: What has improved since the last inspection? Residents have been asked if they want two chairs in their bedroom. If they do not want these, a record of why is kept in their file. More electric sockets have been fitted in one residents bedroom so they do not have to use the extension lead now. Health appointments that residents go to are now recorded in their own file not with the other resident’s records. A new medication cabinet has been bought that is fitted onto the wall so it is easier for staff to get into to take out resident’s medication. Risk assessments are now in place for moving and handling and for residents who have epilepsy. Residents go to the weight clinic. If they need to they are referred to see a dietician. A new washing line has been bought, as the other one was broken. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 6 Staff have received some training to help them to meet the needs of residents. Staff records show that appropriate checks are made before staff start working at the home. 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 Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 5 Residents have an individual written contract and are aware of the terms and conditions of their stay at the home. EVIDENCE: Residents records sampled included an individual written contract between the resident and the home. This has been signed and dated by the resident and/ or their representative and the deputy manager. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 , 8 & 9 Residents assessed needs and goals are reflected in their individual care plans so that staff know how to support each individual. Residents are consulted on, and participate, in many aspects of life in the home to ensure good outcomes for them. Further development is needed to ensure that residents are supported to take risks within a risk assessment framework. EVIDENCE: Resident’s records sampled included individual care plans. These included how staff are to support the resident with communication, personal hygiene, daily living skills, behaviour, health, diet, leisure activities, medication, social activities and personal safety. An independent living assessment had been completed for each resident. Records included an activity timetable for each resident. Resident said that they have regular meetings where they discuss holidays, activities and food. All residents had fire safety training with staff the day before this inspection. Residents meeting minutes indicated that residents discuss activities, food, holidays, medication, going to the gym, college courses and new staff recruited to work at the home. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 10 Resident’s records included individual risk assessments including using gym equipment, holiday, self-medication, using keys, road safety, smoking and challenging behaviour. Some risk assessments required reviewing and updating as necessary. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14, 15, 16 & 17 Resident’s are part of the local community and participate in appropriate leisure activities. Arrangements are in place to support residents to have appropriate family relationships. Residents choose what they eat and enjoy their meals and mealtimes. EVIDENCE: Two residents went to college and one resident went to a placement at a farm during this inspection. Residents participate in a variety of college courses including English, Maths, pottery and crafts. Residents were observed taking part in cooking their breakfast and preparing their lunch. One resident had recently celebrated their birthday by going out for a pub meal. They said that they had asked staff if they could have the day off from college for their birthday and this was agreed. All residents went on holiday for four days in May to Weston – Super- Mare. All residents said they had a good time and enjoyed themselves. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 12 Residents said that they go out shopping for their clothes with support from staff. Residents said they like going out and they go out a lot. One resident said they like helping out with household tasks. Residents said and records sampled indicated that they go shopping, to parks, for drives, to the gym, to a multi-sensory room and the cinema. Residents sometimes use public transport and sometimes use the vehicle provided by the home. One resident who has epilepsy has a listening monitor switched on in their room at night. An agreement signed by the resident is in place for this, however this has not been reviewed since November 2004. This must be reviewed at least every six months to ensure the resident is still in agreement as this has an impact on their rights and privacy. Residents said and records sampled indicated that where appropriate their relatives visit the home and they visit their relatives and go out with them. Records of food eaten by residents are maintained. These indicated and residents said that each resident has a choice of what they eat. One resident said that they are following a healthy eating plan and this was indicated in their record of food. At lunch time on the day of this inspection residents chose what they had to eat and were involved in the preparation of their food. Staff sat with residents to eat to enhance the social aspect of mealtimes. Space in the dining room is limited as are chairs. However, staff said that they are going to buy some foldaway chairs so that all staff can sit with residents during meals. Residents said they often go shopping for food supported by staff and two residents went food shopping during this inspection. Residents prepared the shopping list before going shopping. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Further development is needed through the use of Health Action Plans to ensure that residents physical and emotional health needs are met. The arrangements for the medication ensure that residents are protected from harm. EVIDENCE: Resident’s records sampled included details of health appointments attended. These included the dietician, optician, epilepsy clinic and psychiatrist. Each resident is registered with a local GP. Residents are weighed weekly and a record of their weight is maintained. Health Action Plans are not in place for each resident. The manager said that the dietician would have some input into these. The manager is currently liaising with the GP regarding their input. Since the last inspection a new medication cabinet has been purchased. Previously the medication cabinet was stored inside a cupboard that made access to it by staff difficult. The new medication cabinet is secured to the wall in the hall and is accessible. A local pharmacist supplies the medication to the home in blister packs. Each resident’s medication administration record has a photograph of the resident at the front. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 14 All medication administration records had been signed for correctly. A stock control record of medication received and given is kept. Each resident is assessed on their ability to self-administer their medication and staff support residents to improve their skills in this as appropriate. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Resident’s views are listened to and acted on. Arrangements are in place to protect residents from abuse. EVIDENCE: The complaints policy was looked at and contains all the information required for residents to make a complaint. Since the last inspection there has been one complaint made from one resident about another residents behaviour. This has been satisfactorily resolved. Resident’s records sampled included an inventory of their belongings. One of those sampled required updating. Two residents financial records were looked at. These included bank statements that indicated that benefits were paid directly into their bank accounts. One resident has a cash point card for which they require staff support to withdraw cash. This was discussed at the last inspection. Since then a risk assessment has been put in place. Records indicated that staff have asked the resident whether or not they would wish to have a passbook or card. The resident has agreed in writing that they wish to have a cash point card. Bank statements and financial records cross – referenced to evidence that the resident was using the money withdrawn from the cash point for their personal spending. Receipts are kept of all expenditure. One residents bank statements indicated that a large amount was withdrawn by cheque. Staff said that the resident had not been paying their money to accommodation and charges and this was to pay off their debt. Staff said that a monthly standing order has now been set up for this and bank statements showed this. Staff have received training in how to recognise abuse and what action to take if an allegation of abuse is made. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28 & 30 Residents live in a homely and clean environment. The limited space prevents the home from being comfortable. Resident’s bedrooms suit their needs and lifestyles and promote their independence. EVIDENCE: One resident’s bedroom was looked at. This was personalised and the resident said it was decorated and furnished to their taste. Communal areas in the home are limited in space. There is a small lounge, dining room and kitchen. It is difficult to accommodate more than two people in the kitchen at any one time. In the dining room there is a table and four chairs. Staff said they plan to buy some foldaway chairs in the dining room so that all staff can sit with residents at mealtimes to enhance the social aspect. The home has one bathroom with a WC, wash hand basin and a bath with an overhead shower unit. Staff and residents share the bathroom. The laundry facility is housed in a cupboard, which permits extremely limited space for the storage of laundry items. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 17 This provides little opportunity for residents to be supported by staff to participate in doing their own laundry. Since the last inspection the broken washing line has been replaced. However, the broken washing line is still in the garden and needs to be removed. The home was clean at the time of this inspection and decorated to a good standard. The rear garden was neat and well maintained and included a shed and garden furniture. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35, 36 An effective staff team supports residents. Residents are protected by the home’s recruitment practices. Staff have received some appropriate training to meet residents individual and joint needs. Staff are supported and regularly supervised which benefits the residents. EVIDENCE: Since the last inspection three staff have been recruited to work at the home, one of these staff has since left. Rotas indicated that some staff have recently been working long hours. The manager said that this was due to participation in training courses, which were indicated on the rota. Two staff records were sampled. These included a completed application form, a recent photograph, two written references, proof of identity and a Criminal Records Bureau check. Records include notes of formal supervision sessions indicating that these are taking place regularly. Staff said and training records indicated that staff have received training in food hygiene, health and safety, fire safety, first aid, infection control, challenging behaviour, autism, abuse, epilepsy and the accredited ‘Safe Handling of Medicines’ course. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 19 Two new staff have enrolled on the ‘Safe Handling of Medicines’ course that they should complete in November 2005. New staff had completed an induction checklist at the beginning of their employment at the home. All staff were due to receive training in manual handling a week after this inspection. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Some progress has been made to ensure the health, safety and welfare of residents are promoted and protected. However, further development is needed. EVIDENCE: Fire records indicated that an engineer regularly services the fire equipment. Staff test the fire alarm weekly and the emergency lighting monthly. Fire drills take place at least every six months. One bedroom door and the lounge door were wedged open with plastic wedges. An electrician tested all the portable electrical appliances in July 2004. The gas safety record dated February 2005 stated that remedial action was needed to the flue termination on the central heating boiler. Staff stated that this work has been completed. It also stated that a hook chain and stability bracket needed to be fitted to the gas cooker. Staff stated that this work has not been completed. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 21 A vehicle is provided by the home. A valid certificate of insurance for this vehicle was seen. The manager is the only driver of the vehicle. A copy of his driving licence was forwarded to the CSCI after this inspection. Water temperatures are tested monthly. Thermostatic valves are fitted. Records of these indicated on the last test that temperatures ranged between 38 – 40 degrees centigrade. Staff said that no action has been taken to ensure these are maintained at 43 degrees centigrade. The accident book showed that no accidents have occurred in the home since the last inspection. Residents records sampled indicated that an incident of challenging behaviour had occurred for one resident. However, this has not been reported to the CSCI as required. Risk assessments for staff and the premises require reviewing. The manager said that a member of staff is currently reviewing these. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 2 2 x 3 Standard No 11 12 13 14 15 16 17 x x 3 3 3 2 3 Standard No 31 32 33 34 35 36 Score x x 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ascot Lodge Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 23 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. Standard 9 Regulation 13 (4) (a, b, c), HSWA 1992 12 (1) (a), 4 (a) Requirement All risk assessments must be regularly reviewed and updated as necessary. The agreement with the resident who has a monitor in their bedroom at night must be reviewed and updated as necessary. Each resident must have a Health Action Plan in line with Valuing People. A Health Action Plan is a perosnal plan about what a person with a learning disability can do to be healthy. It lists any help people might need to do those things. It helps to make sure people get the services and support they need to be healthy. All staff must receive training in manual handling. A record of such training must be kept at the home.(Previous timescale of February 2005 not met). Fire doors must not be wedged open. Timescale for action 31st July 2005 & ongoing 31st July 2005 & ongoing 31st August 2005 & ongoing 2. 16 3. 19 12 (1) (a) (2) 4. 35 5. 42 18 (1) (a, c), HSWA 1992, Manual Handling Ops. Regs 1992 12 (1) (a), 13 (4) (a, b, c), 23 (4) 30th June 2005 Immediate & ongoing Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 24 (a, b, c) 6. 42 Gas Safety Regs 1994, 23 (2) (c) 12 (1) (a), 13 (4) (a, b,c) 37 The recommendations from the gas engineers report must be actioned. A hook chain and stability bracket must be fitted to the gas cooker. (Previous timescale not met). Appropriate action must be taken to ensure that water temperatures are maintained at 43C. Any event, which affects the well being of a resident, must be reported to the CSCI without delay. 30th June 2005 7. 42 31st July 2005 & ongoing Immediate & ongoing 8. 42 9. 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. 2. 3. Refer to Standard 23 24 Good Practice Recommendations All residents inventories of belongings should be regularly updated. The broken washing line should be removed from the garden. Ascot Lodge E54 S17108 Ascot Lodge V232575 080605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ 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. 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