Inspection on 01/11/05 for Ascot Lodge Nursing Home

This inspection was carried out on 1st November 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 Nursing Home 11/03/08

Ascot Lodge Nursing Home 06/03/07

Ascot Lodge Nursing Home 10/04/06

Ascot Lodge Nursing Home 05/07/05

Ascot Lodge Nursing Home 08/09/04

Ascot Lodge Nursing Home 09/06/04

Ascot Lodge Nursing Home 18/02/04

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

CARE HOMES FOR OLDER PEOPLE Ascot Lodge Nursing Home 48a Newlands Road Intake Sheffield South Yorkshire S12 2FZ Lead Inspector Marina Warwicker Unannounced Inspection 1st November 2005 07:45 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 Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ascot Lodge Nursing Home Address 48a Newlands Road Intake Sheffield South Yorkshire S12 2FZ 0114 264 3887 0114 264 3969 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) Southern Cross Healthcare Services Limited Mr Keith Harold Parr Care Home 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2005 Brief Description of the Service: Ascot Lodge is a purpose built fifty-bedded home providing service for older people with dementia. The home is situated in the Intake area of Sheffield. It has good access to public services and amenities. The accommodation is on two floors and each floor is divided into two units. Most rooms at the home are single rooms with en-suite facilities. There is a car park and the gardens are landscaped. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on the 1st November 2005 between 7.45am and 2.30pm. The inspector spoke to residents, relatives and staff. The inspector checked samples of staff and residents’ files. Some staff were formally interviewed and the acting manager was informed of the findings. What the service does well: What has improved since the last inspection? 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 Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 6 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 Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 7 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): 3,4&5 The service users take part in a professional needs assessment by the placing authorities or by the home’s manager and are assured by the home that the identified needs will be met. The staff at the home encourage trial visits by service users, their families and friends to help them decide on the suitability of the service. EVIDENCE: Four relatives and six staff were interviewed. Four care plans were checked and delivery of care was also observed. The respective residents have had their needs assessments carried out by the placing authorities. There were also copies of the home’s individual assessments of the residents prior to admission. This indicated how the identified needs were to be met. The relatives said that they were confident that the home was suitable when they made the choice. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 8 The relatives and the staff said that due to the condition of the residents it was considered more appropriate to offer a six to eight weeks trial period. Following the settling in period a meeting is held between the resident, relatives, the social worker/ placing authority and the home when a decision is made on the suitability of the home. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 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 the following standard(s): 7,8,910&11 The residents have care plans. However not all care plans were fully completed. The staff said that the health and social care professionals in the hospitals and in the community are involved when necessary. The residents are treated with respect and the staff value their right to privacy. The relatives are consulted about funeral arrangements when the staff feel it appropriate, so that the residents’ last wishes are respected. EVIDENCE: During the last inspection the Inspector was informed that the service user plans have been revised and Southern Cross was introducing new documentation. It was agreed that the staff will receive training on the revised documentation and that there will be a planned transfer of documentation from the old to the new with little disruption. This has not happened and there were Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 10 several gaps noted in the care plans checked. The following are some of the examples: • • • • • One of the care plans indicated that continence pads were to be used however; there were no instructions on the types of pads to be used and how often the pads must be changed. One of the care plans specified that to maintain continence the service user needed to be toileted every 3-4 hours. The daily evaluation did not comment on this. Not all care plans had photographs of service users for identity purposes. One of the care plans did not have any information on informing the next of kin if the service user were to become seriously ill or die during night time. One care plan acknowledged that the service user’s nutritional intake needed monitoring. However there wasn’t any food chart for this service user. There were photos of pressure sores and the progress made. This is good practice. Although the nurses and the manager agreed during the last inspection that the frontline staff ‘carers’ should be trained in the effects and side effects of drugs. There had not been any training offered to the care staff. During staff interviews the inspector ascertained that the care staff read the care plans and liked getting involved in the planning and reviews of resident’s care plans. However the staff said that this was rarely the practice due to time constraints. The acting manager was informed of this. The care plans checked had documentation on residents’ last wishes; the staff said that often the relatives were uncomfortable talking about the service users’ last wishes. There had not been any formal training on palliative care, pain management or bereavement counselling. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13&15 A new activities co-ordinator has been appointed. There is an activities room and the co-ordinator of activities said that she uses the room to work with small groups of residents. Visitors are encouraged and residents are able to maintain contact with family, friends and members of the local community. Thus the residents are able to maintain outside contacts. Meals served at the home are of a good quality and the residents are offered a choice. The residents are able to have snacks and drinks in between meals if they so wish. EVIDENCE: The inspector interviewed the activities co-ordinator. The Inspector suggested to her that she should collate information on the leisure, social and cultural interests of all the individual residents at the home so that she will be able to offer appropriate activities. There was a section within the care plan, which addressed this, and it was often not completed. The activities co-ordinator told the inspector what activities she had planned for the next few weeks which included Bonfire Night celebrations. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 12 The relatives said that they were made welcome by the staff and that often they were offered a cup of tea when they were visiting. The relatives commented on the choice of food and how good it was. The staff were seen helping residents with feeding. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17&18 The home has a complaints policy, which complies with the Care Home Regulations. There are systems in place to protect the service users’ legal rights. There are procedures at the home to protect the abuse of service users. EVIDENCE: The staff were aware of the complaints policy. Four relatives said that when they have concerns they felt comfortable taking the issues up with the staff. They said that they had been happy with the outcome. Staff told the inspector that when anyone complains if appropriate they take immediate action to resolve it and then inform the person in charge. There had been complaints since the last inspection, however; there were no records of this. Three staff said that they had received formal training on adult abuse and protection of vulnerable people. They also said that they knew how the whistle blowing policy worked. On checking the staff records the Inspector became aware that not all staff had received the above training. During staff interviews, it was evident that the staff understood and respected the legal rights of the residents at Ascot Lodge. The staff said that they knew where the policies and procedures were kept and sometimes they had referred to them for clarification. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,25&26 The layout and the location of Ascot Lodge are suitable for it’s stated purpose. The rooms are naturally ventilated. There are pleasant outdoor areas. The residents use the lounges on the units day and night. This demonstrates that no restraint on the residents’ movement has been imposed by the home. The laundry is sited away from the kitchen and food preparation areas, thus preventing infected and soiled clothing from being carried through these areas. EVIDENCE: The inspector found some parts of the home clean, bright and welcoming during the tour of the premise. However, some areas were dirty, emitted unpleasant odour and needed attention. Discussion took place between the domestic supervisor and the Inspector. It was identified that between 3.30pm and 7am there was no housekeeper. This has resulted in communal areas Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 15 being left dirty after use by service users in the evenings. The acting manager was made aware of this. Residents looked comfortable and relaxed. Care staff were interacting with the service users whilst delivering care. The residents had access to communal areas. In one of the lounges car mats were placed in front of the chairs where residents were seated. On questioning the staff it was apparent that the mats were there to protect the new carpets. The inspector informed the acting manager that this practice is an infringement of the service users’ dignity and that an alternative should be sought. During the day the inspector observed that some service users on each unit required a hoist for their moving and handling. However, there were only two hoists between the four units. This was unsatisfactory. Therefore an immediate requirement notice was served to rectify the problem with the lack of hoists. Lack of equipment was having an impact on the way service users were handled and also putting the staff at risk of harming themselves at work. The inspector noted that the hoists that were in use were stained, dusty and dirty. The staff and the acting manager were made aware of this. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29&30 Staffing levels and skill mix are in accordance with the agreed levels. The recruitment procedure at the home is based on equal opportunities and it needs to be more rigorous. The staff training and development programmes are in need of modification and improvement. EVIDENCE: The home is divided into four units and these are located on two floors. There were two qualified nurses on duty, one on each floor. On each unit there were two carers. The staff stated that most of the time the staffing levels were adequate. The care staff said that they had worked hard towards NVQ award and have been let down by the agencies facilitating the training. Four staff files were checked (2 nurses and 2 carers). There were gaps in the information required by the Care Home Regulations 2002. For example: • There were unexplained gaps in the employment histories of staff. DS0000021765.V259713.R01.S.doc Version 5.0 Page 17 Ascot Lodge Nursing Home • • On one of the staff files the home had received two unsatisfactory references. There was no explanation for over riding the information received and obtaining two further references. The quality of the photographic identification was not always clear and identifiable. The administrator helped the inspector with the checking of the staff files and she was aware of the gaps in the information held on staff. The staff informed the Inspector that they were unable to complete the NVQ level2 and some commented on the organisation not supporting them to achieve NVQ level 3 in care. The category of registration of Ascot Lodge is for people with dementia however the staff have not had specific training on caring for service users with dementia. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 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): 31,33,35,36&38 An acting manager runs the home. Staff supervision is carried out. All records belonging to the residents, staff and others are kept safe and secure. This demonstrates that the home adheres to the data protection act and promotes confidentiality. The acting manager said as far as is possible that the health, safety and wellbeing of the residents and the staff are maintained through the home’s policies and procedures. EVIDENCE: Training files of four staff were checked. The mandatory training such as Fire safety, Moving and handling and health and safety records were up to date. However, training on the following was ad hoc. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 19 Infection controls, Tissue viability, continence care, Nutritional assessments and needs, first aid are some of the examples. During staff interviews it was highlighted that: • • • • • • More attention and training was needed in dealing with infection control. There was a lack of monitoring of good practice by the management. The staff also raised their concern about the management maintaining the staffing levels but not focusing on the capability of the staff. The staff made comments about the unclear job definition between senior carer and carer. Some staff said that they have had supervision but they were not happy with the way it was carried out. Some staff were disappointed with the lack of organisational commitment to training especially NVQ. The acting manager was made aware of this at feedback. The relatives and the staff said that they found the home to be safe from intruders and hazards. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 3 3 X 2 X X 3 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 3 2 Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12 Requirement In order to meet the individuals needs the care plans must be completed in full at the earliest possible opportunity. Previous requirement not met. Timescale for action 05/09/05 2 OP8 14, 13 There must be clear instructions for identified needs. Records must be maintained to monitor the progress. (e.g. food charts, what types of pads to be used) All staff must receive training on palliative care; pain management, bereavement counselling and dementia care at appropriate intervals. Previous requirement not met. 15/12/05 3 OP11 18 24/10/05 4 OP12 14,16 The activities must be varied, flexible, suit residents’ expectations, preferences and capabilities. There must be records of activities and the involvement of residents. 15/12/05 Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 22 5 OP16 22, 18 6 OP18 12,17 7 OP22 16,23 The staff must be aware that the 05/09/05 home is required to keep a statement containing a summary of the complaints made during the preceding twelve months and the action that was taken in response. Previous requirement not met. All staff must receive training 15/12/05 and deemed competent on responding to suspicion or evidence of abuse or neglect. The training must include whistle blowing. The home must provide 01/11/05 sufficient numbers of moving and handling equipment. Immediate requirement served on the day of inspection. 8 OP26 13,16 9 OP28 18 10 OP29 7,12,19, Schedule2 11 OP30 12,18 12 13 14 OP31 OP33 OP36 9,7 24,26 18 All parts of the home must be kept clean and free from offensive odour throughout 24hours. All equipment must be kept clean at all times. Staff must be facilitated by Southern Cross to achieve the appropriate levels of training. (i.e. NVQ awards.) The manager must operate a thorough recruitment procedure complying with the Care Standards Regulation 2002 and the associated schedule. The staff training must be revised to meet the aims of the home and the changing needs of the service users. A qualified and competent manager must be appointed. The quality monitoring must include feedback from staff of the performance of the home. All staff supervision must include all aspects of practice, philosophy of care including the new care plans and their career development. DS0000021765.V259713.R01.S.doc 15/12/05 05/01/06 15/12/05 05/01/06 15/12/05 15/12/05 05/12/05 Ascot Lodge Nursing Home Version 5.0 Page 23 15 OP38 12,13,16, 23 The management must ensure safe working practices for staff and compliance with relevant legislations. 15/12/05 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 Refer to Standard OP9 OP26 Good Practice Recommendations The care staff should be trained in the medication the residents are taking. The training should include effects and side effects of medication. Car mats should not be used to protect the lounge carpet. Alternative means should be sought. Ascot Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ 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 Lodge Nursing Home DS0000021765.V259713.R01.S.doc Version 5.0 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. 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