Inspection on 05/07/05 for Ascot Lodge Nursing Home

This inspection was carried out on 5th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Lodge Nursing Home 11/03/08

Ascot Lodge Nursing Home 06/03/07

Ascot Lodge Nursing Home 10/04/06

Ascot Lodge Nursing Home 01/11/05

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 05 July 2005 01:30. The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ascot Lodge Nursing Home Address 48a Newlands Road, Intake, Sheffield, South Yorkshire, S12 2FZ 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) 0114 264 3887 0114 264 3969 ascotlodge@schealthcare.co.uk 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 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8-Sep-2004 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 were landscaped. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 5th July 2005, between 1.30 pm and 7pm. The opportunity was taken to tour the premises, examine records and talk with service users, relatives and staff. The inspector met most of the service users during the day. The inspector was able to speak to two visitors during the day who gave their views of the service. Since the inspection the CSCI has received comments from eight relatives about the service. There was a calm and friendly atmosphere among the residents and staff at the home. Staff and service users were friendly and welcoming and there was a positive rapport between staff and service users. What the service does well: What has improved since the last inspection? At the last inspection requirements were made that the staff must undertake training in adult protection and this has been achieved. The manager has completed NVQ Level4 in management training. Staff recruitment files have all the necessary information required by the Care Home Regulations 2002. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 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. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5. Standard 6 is not applicable for this service. The home provides the prospective residents and their families with sufficient information to make an informed choice. Before moving into the home service users take part in a professional needs assessment by the placing authorities and are assured by the home that the identified needs will be met. Each resident is provided with a statement of terms and conditions once decided by the resident with the help of the care manager and / or the relatives to take up permanent residency at the home. 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: Two relatives, a resident and staff said that there was information available to check what type of care was offered at the home. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 9 Three care plans were checked. There were needs assessments by the placing authorities in the files for the respective residents. 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. One service user and a relative said that they were confident that the home was suitable when they made the choice. 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 this 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. Only then the resident or the appropriate person and the home sign a contract with the terms and conditions. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10 and 11. All residents have care plans. In order to meet individual needs the care plans are completed fully at the earliest possible opportunity by staff. However not all care plans were fully completed. The manager ensures that the health and social care professionals in the hospitals and in the community are involved when necessary. This enables residents at Ascot Lodge to receive seamless service at the home. The nurses are familiar with the residents’ medications, including the effects and side effects. However, the care staff have not received medication training. Since the care staff work closely with the residents it is essential that they are able to recognise any signs of side effects of the medicines so that they could inform the nurse in charge of the units. The residents are treated with respect and the staff value their right to privacy. Therefore the residents are able to live in a comfortable and happy environment. Most relatives are consulted about funeral arrangements when the staff feel it appropriate, so that the residents’ last wishes are respected. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 11 EVIDENCE: Three care plans were checked in detail. There were risk assessments on falls, movement & handling and tissue viability. The action plans based on the outcome of the assessments were noted in the files. None of the residents in the home had the capacity to self-medicate. Therefore the nurses administered the medication. Some of the individual prescriptions had not been reviewed and old prescriptions, which were not in use had not been discontinued by the GP. Failures to up date the MAR (medication administration record) sheet can result in medication error by nurses. The inspector checked the nurses’ knowledge of the medication given to those residents who were case-tracked. The nurses had a good understanding of the medication. The nurses and the manager agreed that the carers should be trained in the effects and side effects of drugs. There were no unexplained gaps on the MAR sheets checked. The inspector ascertained during staff interviews that the care staff were encouraged to read the care plans and get involved in the planning and the changes made to the individual’s care plans. There was good teamwork within each team and staff supported each other. Although not all care plans checked had documentation on residents’ last wishes, the manager said that he had requested the information from the relatives and that not all relatives were forthcoming with the information. There had not been any formal training on palliative care, pain management or bereavement counselling; the deputy manager and the staff interviewed confirmed this. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 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 standard(s) 12,13,14 and 15. Although not all residents wanted to participate in social and recreational activities there are arrangements for those who are able to take part in activities. There is an activities room and the co-ordinator of activities works with small groups of residents and also with individuals. This stimulates the residents and gives them some independence. 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 activities co-ordinator was undertaking activities with small groups of service users on the afternoon of inspection. The staff and the residents said that there was always something for the residents to do. The relatives said that they were made welcome by the staff and that some staff had become part of their family. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 13 The residents and 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 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 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 standard(s) 16,17 and 18. The relatives and the residents are given the opportunity to raise any concerns and complain to staff or the manager. The complainants are not penalised and corrective action is taken without delay. This is to enable residents to voice their opinion of the service and also for the staff to review and make improvements to areas of concern. The residents are enabled by the staff to exercise their legal rights and for those who lack in capacity an advocate service is offered. Such arrangements help residents to receive independent advice and help. The staff were aware of the home’s complaints policy. They need to be familiar with the timescales and keep records of all the complaints. There is a lack of awareness of the homes’ policies and procedures among staff. It is acknowledged that staff will not be able to know all of the home’s policies and procedures. But the staff knew where to find the policies and procedures. EVIDENCE: The home had a complaints policy, which the staff said that they were aware of however some relatives said that they were unaware of this. A relative and a resident 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. The manager had records of complaints and the action taken by Ascot Lodge. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 15 The manager also had records of incidents and accidents that had occurred at the home. The inspector noted that these had been reported to the relevant authorities, which included CSCI. The staff said that they had received formal training on adult abuse and protection of vulnerable people. They were able to verbalise the action to be taken if there was an incident of abuse at the work place. 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, but they were not familiar with the frequently used policies and procedures. The inspector discussed this with the deputy manager and the manager. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25 and 26 The layout and the location of Ascot Lodge is suitable for it’s stated purpose. The home is clean, tidy and some residents’ rooms are personalised. The domestic staff maintain a good standard of housekeeping. The rooms are naturally ventilated with windows conforming to recognised safety standards. This makes Ascot Lodge homely and a safe place to live. There is a maintenance programme underway in order to keep the home in good repair. There are pleasant outdoor areas, which are used by the residents and relatives during good weather. The residents use the lounges on the units day and night. This demonstrates that no restraint on the residents’ movement has been practiced 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. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 17 EVIDENCE: The inspector found all parts of the home clean, bright and welcoming during the tour of the premise. Residents looked comfortable and relaxed. Care staff were seen sitting with groups of residents and chatting. The residents had access to communal areas. The inspector saw a range of equipment available for the staff. The staff said that they had mechanical baths and mobile hoists to help with the delivery of care. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28.29 and 30. Staffing levels and skill mix are in accordance with the agreed levels before 2002. The care staff on duty are trained to NVQ level 2. This ensures residents are cared for by trained carers. A nurse allocated to the units supervises the care staff. The recruitment procedure at the home is robust and based on equal opportunities. This is to protect residents and other staff at the home from inappropriate persons working at the home. The staff training and development programmes comply with the workforce training targets of the National Training Organisation (NTO). Therefore all staff are trained to a similar standard which is nationally recognised. EVIDENCE: The home is divided into four units and these are located on two floors. There were two qualified nurses on duty, one for each floor. On each unit there were two carers. The staff stated that most of the time there was an adequate staffing level. The manager said that out of 25 care staff 14 had completed NVQ level 2. The staff said that they had enjoyed the NVQ course. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 19 Four staff files were checked (2 nurses and 2 carers). The information required by the Care Home Regulation 2002 was found on each file and they were satisfactory. The manager and the deputy discussed the way they used the NTO targets and delivered induction to the new recruits. The staff said that they were supervised until they were found to be competent before working alone. Staff said that they are able to attend relevant training with the permission of the home’s manager. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36,37 and 38 The registered manager is competent and experienced in managing Ascot Lodge. He ensures that the home meets the aims and objectives set out in the statement of purpose. The manager has strategies such as formal meetings, regular questionnaires to relatives and being available for discussions with staff, residents and other stakeholders. These help to influence the way in which the service is delivered. Continuous self-monitoring and internal audits are used by the management to verify the quality of care and any trends or gaps in the service. Quality monitoring helps to improve and enhance residents’ care. The residents and their relatives are encouraged to handle their financial affairs. Those who are unable to do so are referred to advocacy agencies or solicitors. Thus enabling the residents to receive independent help. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 21 The home handles the pocket monies of the residents and keeps records of any transactions. The staff receive supervision so that all staff working at the home are competent in what they do. 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 manager has ensured as far as is possible that the health, safety and wellbeing of the residents and the staff are maintained. EVIDENCE: The manager is a first level nurse and has completed NVQ level4 in management. The inspector noted that there was a clear line of accountability among all levels of staff. The relatives, residents and staff said that the management were helpful, listened to any comments they made and were happy to discuss matters. They also said that the manager was approachable and visible. The manager is an appointee for a small number of residents. The pocket monies of four residents were checked and these were handled correctly by the home. Not all staff interviewed had a clear understanding of supervision. However, during conversation it was evident that the staff have had individual and group supervisions but these were done ad hoc. The manager was aware of this and showed the inspector the most up to date forms, which are being piloted to record supervisions. The inspector noted three supervision records. These were user friendly. Training files of four staff were checked. The mandatory training records were up to date. The relatives, residents and staff said that they found the home to be safe from intruders and hazards. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 3 3 3 3 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 Standard No 16 17 18 Score 2 3 3 4 3 3 x 3 2 3 3 Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 23 no 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 7 Regulation 12 Requirement Timescale for action 05/09/05 2. 16 22, 18 3. 36 18 4. 11 18 In order to meet the individuals needs the care plans must be completed in full at the earliest possible opportunity. 05/09/05 The staff must be aware of the complaints policy including the timescales. The staff must also be aware that the 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.Staff must also be familiar with frequenty used policies and procedures. All staff must receive supervision 05/09/05 at least six times a year. There must be documentary evidence to support this. All staff must receive training on 24/10/05 palliative care, pain management, bereavement councilling and dementia care at appropriate intervals. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 24 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 9 Good Practice Recommendations The care staff should be trained in the medication the residents are taking. The training should inculde effects and side effects of medication. Ascot Lodge Nursing Home 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Ground Floor Unit 3 Waterside Court Bold Street Sheffield S9 2|LR 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 20050824 Ascot Lodge SUI X00015 J55 V219873 S21765 Stage 4.doc Version 1.30 Page 26 - 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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