Inspection on 18/10/05 for Ascot Nursing Home

This inspection was carried out on 18th October 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 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 Nursing Home 19/09/07

Ascot Nursing Home 02/05/06

Ascot Nursing Home 04/05/05

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Fountain View

Wardington House Nursing Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Ascot Nursing Home Burleigh Road Ascot Berkshire SL5 7LD Lead Inspector Mrs Rhian Williams-Flew Unannounced Inspection 09:45 18 &19th October 2005 X10029.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 Nursing Home DS0000062218.V260341.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 and Care Homes for Adults 18 – 65*. 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 Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ascot Nursing Home Address Burleigh Road Ascot Berkshire SL5 7LD 01344 620656 01344 621606 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) www.robertsonhomes@ukonline.co.uk Ascot Nursing Home Limited Mrs Jill Chufungleung Care Home 72 Category(ies) of Dementia (15), Dementia - over 65 years of age registration, with number (29), Mental disorder, excluding learning of places disability or dementia (22), Mental Disorder, excluding learning disability or dementia - over 65 years of age (26) Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2005 Brief Description of the Service: Ascot Nursing Home is an Edwardian house with a purpose-built extension set in its own grounds close to Ascot Village and Ascot racecourse. The home is registered to provide nursing care for up to 72 people of both sexes who have mental health needs. The home is registered to take people who suffer from dementia either in older age or under 65 years of age. Also, people who suffer from a mental disorder either in older age or under 65 years of age. The home is divided into three units. Each unit functions independently with unit offices, dining rooms, sitting rooms and distinctive staff teams. Unit One cares for residents of all ages who have been diagnosed as suffering from moderate to severe dementia. Unit Two cares for older residents who have enduring mental health needs. These residents may also need some physical assistance. Wrens Unit cares for residents with enduring mental health needs who are generally able to maintain their own physical care with support and encouragement. Mrs Jill Chu, the Registered Manager, is responsible for the overall management of the Units and the care home. This information has been taken from the homes Statement of Purpose. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report should be read in conjunction with the report that was completed in May 2005. During each inspection different parts of the home, and the service it provides, were inspected. In May 2005 the emphasis of the inspection was in Units One and Two. This inspection primarily focused on the service provided in Wrens Unit. In addition, particular issues concerning the management of the home, staffing and safe work practices were inspected in relation to all the units. A significant proportion of residents on Wrens Unit were spoken with, some of them in private. Random samples of care records were reviewed. In addition, the members of staff of this unit were spoken with. The inspection was unannounced. The intention had been to conduct an inspection on 18 October 2005 however; this was extended to a second day, 19 October 2005. On the first day the inspection took place between 9.45 and 19.00 hours; on the second day between 10.30 and 16.00 hours. The Registered Manager was present throughout the two days of inspection. What the service does well: What has improved since the last inspection? The home has continued to progress with its three-year refurbishment/redecoration plan. The two lounges in Unit One and the main entrance hall of the home have had their wooden floors refurbished and varnished. This has greatly improved the cleanliness of these environments. The areas are also much brighter. Velux windows have been installed in Wrens Unit, which has brightened the environment considerably as well as improving ventilation. New furniture has been purchased for some of the units. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 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 Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 (OP & YA); 2 (YA) This home provides up-to-date information for prospective residents and their relatives. The Registered Manager ensures that all prospective residents are assessed prior to admission to ensure that the home can meet their needs. EVIDENCE: The home has revised their Statement of Purpose. A copy of the revised document needs to be forwarded to the Commission for Social Care Inspection. Up-to-date copies are available in the home. The Registered Manager assesses all new referrals to the home. An assessment of each persons needs is completed. A random sample of 3 residents assessments were reviewed and these assessments were all in place. In addition, the Registered Manager had sought additional information from Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 9 Care Managers and other professionals who may have made an assessment of the persons needs. Evidence was seen of psychiatric reports and occupational therapy reports. All this information had been used to assess the persons needs prior to them being offered a placement at the home. This is good practice. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 6; 9; 16; 18 & 19 (YA) The care plans for residents in Wrens Unit are poor. They do not reflect the residents current needs, aspirations, wishes or risks adequately. EVIDENCE: The evidence that follows was found in the Wrens Unit. 4 care plans were reviewed in their entirety. The care plans were not detailed and did not adequately reflect the assessed needs of the residents. Personal goals were not identified. The care plans had not been reviewed in line with the homes own guidance of monthly reviews; all had not been reviewed in the Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 11 last four months. Following a detailed discussion with one resident, who was able to tell the Inspector of their very specific needs and aspirations it was not possible to find any reference in their care plan to these issues and how the person was to be supported. For another resident who had been in the home for nine years it was not possible, from their care plan, to establish why they used a wheelchair. For another resident it was unclear as to why they were in a home for people with mental health needs as their primary need was indicated as being physical. This last issue will be followed through in correspondence with the Registered Manager. Similarly, the risk assessments for these residents did not accurately reflect some of their known needs and the potential risks for them. In conversation with one resident they were able to tell the Inspector that they enjoyed using the assisted bathroom (with staff attendance) as the use a hoist had allowed them to bathe again. This persons safe bathing risk assessment referred to the fact that they needed no help to get in and out of the bath. This was clearly inaccurate. Since August the home has contracted with another local GP service. The service provides a twice-weekly surgery at the home and residents are able to visit the practice themselves if they so wish. The Inspector met one of the visiting GP’s as she was due to commence one of the surgeries. The GP service is reviewing the health-care needs of all patients in the home. Indeed, the GP was able to provide written information as to why the resident noted above was using a wheelchair, as she had recently completed a full review of this person’s medical needs. Evidence was also seen that the psychiatrist employed by the home does review the residents every three months (or sooner if required). The Registered Manager assured that the home did have a policy of seeking medical advice when residents sustained head injuries. However, one resident had sustained a head injury the previous evening yet, there was no evidence that medical advice had been sought until the day of the inspection. The person had received first aid treatment from nursing staff. The residents right to make choices in their daily life was seen. They are able to visit other areas of the home and the local community without restriction (subject to an individual risk assessment). The residents are offered keys to their own bedrooms and the majority of them take up this option. The home does provide a full programme of activities, which the residents are encouraged to participate in. Some of the residents were enthusiastic whilst others chose to sit and watch from afar. This appeared appropriate and unpressured. On the day of the inspection at least three activities took place. The members of activities staff were noted to be particularly compassionate and encouraging. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 12 From conversations with the residents they all commented that the majority of staff were supportive and easy to get along with. Some residents said that they know when I want to be alone and others said, you really are cared for. Most of the resident spoken with saw the staff as kind and considerate. These expressed views were observed during the inspection. There was an exception to this. A member of staff was observed to have conducted an interaction with a resident about their wish to have a cigarette with no verbal communication whatsoever. This member of staff was also seen to “wave away” the same resident a few moments later. The daily routine is individualised to peoples personal preferences however, peoples individual preferences are not noted in their care plans. It was noted that a number of the residents were dressed in clothing that was stained and very creased. Whilst this might be their personal choice, support and guidance from the staff team could have promoted a more positive selfimage. These are issues that should be included in individual care plan needs. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 (OP) 7; 12; 13; 14; 15 & 17 (YA). The home provides a good activities service with dedicated staff so that residents have a number of activities available to them each day, if they choose to participate in them. The residents are able to visit the local community and pursue their own hobbies and interests. The ambience of the dining room needs to be improved. EVIDENCE: The activities available to residents are varied and regularly available. The activities programme is discussed at the monthly quality assurance meetings held for the residents. There is a dedicated activity staff team. Their presence Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 14 around the home is well recognised by the residents and the rapport between them was noted to be good. A number of the residents spoke of their own interests and hobbies. The mobile library was visiting the home on the day of the inspection. A number of the residents use the local shops and visit the town centre. They also use local community resources. In recent times an animal farm has visited the home, which was very popular with all residents of the home. A number of the residents told the Inspector of the forthcoming plans for a Halloween party, a trip to the circus, a Christmas Carol service and a Christmas party, which includes a staff pantomime. Support for the residents from their family and friends, is encouraged by the staff. The residents who were spoken with indicated that their visitors were welcome and they were also able to go out with their relatives. The lunchtime meal was observed. The menu offered choice and the members of staff who served the meal offered the residents the choices they had made the previous day. The food was appetising and presented well. The portion size was good and all residents were asked if they wanted more. It was noted that one member of staff was exceptional in his interaction with the residents whilst serving and presenting their meals however, the other members of staff had minimal interaction with the residents. The presentation of the dining area was poor. The tablecloths were very creased, no napkins were available for residents to wipe their hands and mouths after the meal and disposable plastic cups were used for drinks. This appearance of the dining area reduced the mealtime to a functional process rather than an opportunity for social interaction in a relaxed atmosphere. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) 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 (OP); 22 (YA) The home has a clear policy and procedure for dealing with complaints. The home has demonstrated that it deals with complaints promptly. EVIDENCE: There have been no complaints since the previous inspections in March 2005. The home has a complaints procedure. This clearly details the expected actions if a complaint is received. A record of all complaints and any subsequent investigations are kept in the home. The Registered Manager holds monthly quality assurance meetings with the residents. From the record of these meetings it was clear that residents to take the opportunities to raise matters of concern and compliment with the management team. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) 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 (OP) 24; 26 & 30 (YA) Some areas within Wrens Unit and the rooms used by residents from Wrens Unit in the rest of the home are in need of refurbishment as their condition is poor. This includes the fabric, furnishings and the cleanliness of the unit. EVIDENCE: A previous requirement has been met. The small lounge in Unit One has had its carpet removed and the wood flooring beneath has been refurbished and varnished. The Registered Manager reports that this has been very successful Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 17 in terms of maintaining a clean environment and has made the environment brighter in appearance. As a result of this success the main hallway in the home and large lounge of Unit One have been similarly refurbished. The first year of the three-year refurbishment plan is drawing to a close. There is evidence throughout the home that refurbishment and redecoration is taking place. However, during a tour of Wrens Unit it was evident that refurbishment and improvement in a number of the resident’s rooms, bathrooms and corridors should be viewed as a priority as the environment is poor. A number of the resident’s rooms and a bathroom smelt strongly of urine odours. In addition some of the rooms and corridors had damaged flooring, which could present health and safety risks to the residents and members of staff. The Registered Manager was asked to assess each area of the Wrens Unit (including the rooms of the Wrens Unit residents in other parts of the building) and develop an action plan with timescales to address the deficits. This assessment should include the furnishings and fittings in each room to ensure that they are of good quality and are robust enough to meet the needs of the residents. Including the residents in the choices for the refurbishment would be best practice. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the 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 (OP) 32; 33; 34 & 35 (YA) Members of staff are working for extended periods of time. Some of these members of staff are working up to 70 hours consecutively. These lengthy periods of work are affecting the ability and competency of staff in caring for vulnerable residents. EVIDENCE: The staffing establishment and deployment of staff for the whole home were reviewed. It was noted that each member of staff works 14 hours for each shift they work. A high proportion of the staff consecutively works three shifts or more. With some members of staff regularly working 70 hours within a five-day period. The Registered Manager confirmed that this shift pattern and shift duration was the preferred choice of the staff. The members of staff spoken with confirmed that they take their meal breaks whilst remaining on the units they work on. One member of staff commented that there is no staffroom to retire to during a break. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 19 During the early evening the Inspector visited the small lounge area of Unit One to find at least one member of staff asleep and another intently reading a newspaper and appearing to have no regard to the residents in his charge. The Charge Nurse was called to observe the scene and the Registered Manager was promptly advised. It has been confirmed by the Registered Manager that these individual staff matters are being dealt with through the homes disciplinary procedures. It was noted that these two staff members regularly work consecutive shifts totalling 56 hours or more. The Registered Manager has been asked to review the staffing deployment in all of the units, the length of time members of staff are on duty and how and where they take their breaks. Staff must be alert and competent when they are on duty. The recruitment records of three of the most recently recruited member of staff were reviewed and it was noted that deficits were apparent including incomplete information on application forms, no authentication of references, no interview format record all note as to whether caps and service had been explored during the interview process. The Registered Manager accepted that changes would need to be made to the recruitment procedures. There is a dedicated Training Manager who visits the home regularly. All members of staff have completed their mandatory training and it is anticipated that 50 of the care staff will have achieved NVQ 2 by the end of 2005. The Training Manager has a record of everyones training needs however each member of staff does not have an individual training and development profile. The Registered Manager accepted that this needed to be implemented. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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; 38 (OP) 37; 39 & 42 (YA) Communication and accountability between the Registered Manager and the Charge Nurses of each unit must improve as presently it has been demonstrated to be less than adequate. This is affecting the overall management of the home, which in turn is having an impact on the delivery of care. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 21 EVIDENCE: The Registered Manager is qualified and experienced to run the home. She ensures that the day to day running of the home is achieved and ensures that members of staff have clear policies and procedures to guide their practice. As the home has three defined units within it (each with a Charge Nurse in charge of the unit) the Registered Manager devolves the day-to-day running and management of the units to them. During the inspection it was revealed that whilst the Registered Manager sees each of these Charge Nurses on a daily basis to review any issue she should be aware of she does not formally meet with them on a regular basis for supervision. During the inspection various issues were revealed which she confirmed she was unaware of. Within a devolved structure of management it is imperative that the Registered Manager is aware of important issues that affect the delivery of care to residents as the Registered Manager has overall responsibility for ensuring that the home is run efficiently, effectively and safely. The home does have quality assurance and quality monitoring systems in place which the Registered Manager uses. These records were reviewed and it was noted that when deficits are highlighted they are addressed promptly. It is advised that the Registered Manager refines the process she has in place, which she has accepted. The home has clear policies and procedures with regard to safeguarding resident’s money. A random sample of various resident accounts was examined. A random sample of procedures regarding the management of health and safety issues were reviewed and all were found to be compliant with the relevant legislation. Risk assessments for the home have been carried out to ensure safe working practices. The homes fire risk assessment has recently been updated. The accident record book on Wrens Unit was reviewed with particular reference to a recent injury to a resident who had trapped their finger in a fire door. On further examination of the incident it became apparent that the information recorded in the accident record book was not confirmed to the Inspector by the member of staff who said they witnessed the incident. It was therefore apparent that two Charge Nurses had different perspectives on how the incident had occurred. These differing viewpoints were highlighted to the Registered Manager for her to take further action on. As a result of examining the cause of the accident it was revealed by one the Charge Nurses that the office door of Unit 2 had a faulty Dorgard mechanism which had not been repaired since the incident, some nine days before the inspection, with the result that the door was found with a door wedge in place. This should not occur as it compromises the fire safety precautions of the home. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 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 Standard No Score 1 2 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X ENVIRONMENT Standard No Score 19 1 20 X 21 X 22 X 23 X 24 2 25 X 26 1 STAFFING Standard No Score 27 1 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 X 36 X 37 X 38 2 Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO 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 YA1OP1 Regulation 4(2) Requirement A revised copy of the Statement of Purpose should be forwarded to the Commission for Social Care Inspection. Within 14 days of the inspection (2/11/05) the Registered Manager is to provide an outline plan of action to CSCI to demonstrate how the care plans for the residents on Wrens Unit are to be revised. Subsequent to this the Registered Manager is to provide a detailed plan with timescales as to when all the care plans will be reviewed and rewritten. The residents should be included in the development and ongoing review of their care plans. Within 14 days of the inspection (2/11/05) the Registered Manager is to provide an outline plan of action to CSCI to demonstrate how the risk assessments for the residents on Wrens Unit are to be revised. Subsequent to this the Registered Manager is to provide a detailed plan with timescales as to when all the risk DS0000062218.V260341.R01.S.doc Timescale for action 30/11/05 2 YA6 15 30/11/05 3 YA9 13 (4) 30/11/05 Ascot Nursing Home Version 5.0 Page 24 4 YA16 12(5)(b) 5 YA24 23(2) 6 YA26 16(2)(c) 7 YA30 16(2)(k) assessments will be reviewed and rewritten. The residents should be included in the development and ongoing review of their risk assessments. The Registered Manager should monitor the attitudes and interactions of staff with residents to ensure they are inclusive and attentive. If deficits are found then appropriate action must be taken. This should include training and supervision of all staff. The Registered Manager should conduct a detailed review of the environment of Wrens Unit (including rooms in the rest of the home used by residents from Wrens Unit) and devise a refurbishment plan with timescales to ensure that the areas concerned are in good repair, decoration and are safe. This plan is to be forwarded to CSCI. The Registered Manager should conduct a detailed review of the furnishings in the rooms of residents assigned to the Wrens Unit. Following this review, devise a refurbishment plan with timescales to ensure the furniture meets the standard and is robust enough to meet the needs of the residents. The Registered Manager must ensure that areas and rooms within Wrens Unit are clean and free from offensive odour. If the odour cannot be removed by cleaning then appropriate replacement flooring must be provided. This standard should also be observed in the rest of the home. DS0000062218.V260341.R01.S.doc 31/12/05 30/11/05 30/11/05 30/11/05 Ascot Nursing Home Version 5.0 Page 25 8 YA33OP27 9 YA34OP29 10 YA37OP31 11 YA42OP38 The Registered Manager must 18(1)(a) &19 (5)(c) review the deployment of staff in the whole home and the length of time staff are on duty. This will necessitate a change in shift duration and patterns. Staff must be competent, physically and mentally fit in order to protect and care for residents. 19 (1) The Registered Manager must ensure that the recruitment procedures for staff comply with regulation 19 and schedule 2. 12(5)(a) The Registered Manager must establish clear lines of accountability through formal supervision with the senior members of care staff to ensure that there is clear communication in the senior management team. The Registered Manager must be confident that she has senior staff of integrity and competence. 13(4) Fire doors should not be wedged. The immediate repair of door closure mechanisms should occur when faults arise. The Registered Manager is to ensure that all the members of staff comply with fire safety precautions and procedures. 31/12/05 23/11/05 30/11/05 30/11/05 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 YA17 YA19 Good Practice Recommendations Improving the appearance and presentation of the dining rooms and the utensils used needs to be positively pursued. Members of staff need to be reminded to follow the homes DS0000062218.V260341.R01.S.doc Version 5.0 Page 26 Ascot Nursing Home 3 4 5 YA33 OP27 YA35 YA39 own procedure of seeking medical advice when residents sustain head injuries. Members of staff are enabled and encouraged to take their breaks away from the units that they work on, preferable in an area that they can rest and relax. Each member of staff needs to have their own individual training and development assessment profile. The quality assurance systems should be considered for revision and developed further. Ascot Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 Nursing Home DS0000062218.V260341.R01.S.doc Version 5.0 Page 28 - 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!