CARE HOMES FOR OLDER PEOPLE
Ascot Nursing Home 19-21 The Crescent Linthorpe Middlesbrough TS5 6SG Lead Inspector
Julia Connor Unannounced 25 July 2005 09:45 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 Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ascot Nursing Home Address 19-21 The Crescent Linthorpe Middlesbrough TS5 6SG 01642 825283 01642 850412 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) Mr George Dixon Mrs Helen Hutton Care home with Nursing 32 Category(ies) of OP - Old age registration, with number PD - Physical Disability of places Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th February 2005 Brief Description of the Service: Ascot is a care home providing both nursing and personal care for older people. It is a three storey building providing single and double accommodation for 32 Residents; the 30 single bedrooms are a minimum of 10 sq.m. and the 1 double bedroom is a minimum of 16 sq.m. There is a passenger lift giving access to the upper floors. There is one large lounge and one communal dining room. The home is close to local shops and amenities with a small area for parking at the front of the home. Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection commenced at 9.45 a.m. and concluded at 3.15 p.m. Four Residents, one visitor and three members of staff were spoken to during the inspection. What the service does well:
Many of the staff have worked at the home for many years and have a good knowledge of the Residents they care for. One Resident informed the Inspector that she lived in the ‘penthouse’, which is the flat on the third floor of the home and consists of a bedroom with en-suite facilities and a lounge. This Resident went onto say that she lives her life as she wants and goes out regularly with her Grand daughter and her great grand children. She stated that she was very happy in the home and received lots of visits form her family and friends, who were always made welcome. She stated that she used to be a cook, and had been cook to King George V, and found the food at the home very good. She stated that there might be homes as good as Ascot but she was confident that there were none better. She stated that there were activities available for those who wanted to join in, for example there had been an entertainer last week singing for the Residents and the Vicar visited the home regularly for those Residents who wished to receive Holy Communion. She stated that the best thing about the home was the company and went onto say how she had made friends in the home. Another Resident informed the Inspector that the staff were very nice and would do anything for her. She stated that it was not as good as being at home but she knew that she would not be able to care for herself at home. She liked the staff to help her keep clean and tidy and she had her bed linen changed regularly which she thought was important. She stated that you only had to ask for something and the staff would get it for you. She liked the choice of meals and enjoyed the food that was served to her. She stated that she liked to spend most of her time in her room but the staff helped her to the lounge or dining room on her request. Another two Residents informed the Inspector that they found the staff very nice and always helpful, nothing was too much bother. They stated that they liked the food but if there was something served that they did not like or did not fancy that day they only had to ask for something else for it to be provided. Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 6 The visitor who spoke to the Inspector is at the home most days to be with her husband. She stated that moving her husband into the home had been the best decision she could have taken. She continues to give her husband personal care, which makes her feel better and the staff appreciate her help. She stated that she and her husband often go out for a walk to the park or visit the pub or the local coffee shop; the children also visit their Dad and they all go out for lunch, she particularly enjoys her husband going home and having Sunday lunch with her. She stated that she feels comfortable in the home and helps the staff out as much as she can. This lady stated that the staff always discussed her husband’s care with her and always listens to her if she thought he was unwell, as they appreciated that she knew him best. She stated that she could go home and not worry because she knew that her husband was in good hands and the staff would contact her if they had any concerns, which gave her peace of mind. She stated that the staff had a laugh and joke with her husband and he confirmed this to the Inspector by a thumbs up sign and a lovely smile. When the Inspector asked him if he was happy in the home he again gave the thumbs up sign. 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 Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 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 Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 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) 2 and 3 Residents have a written contract with the Providers of their care. Residents are assessed prior to being admitted to the home. EVIDENCE: New contracts have been supplied to the Resident’s, the contracts that had been signed by the Resident or their next of kin were in the individual Residents care notes. The contracts which where waiting to be signed were evidenced by the Inspector in the Residents bedrooms. There was evidence in the care files that the home received information from the Social Worker or discharging ward regarding the Resident prior to them being admitted to the home. A member of the home staff also visits the Resident prior to admission to ensure that the home can meet the prospective Residents needs. Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 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 standard(s) 7, 8 and 10 The Residents health, personal and social needs are recorded in an individual plan of care. The Residents health care needs are met and Residents are treated with respect and dignity. EVIDENCE: Three sets of Residents care files were audited and all contained an adequate amount of information. There was evidence that Residents or their representative had had access to their files and agreed the plans of care. The Residents have access to out side health professionals e.g. Doctor, District Nurse, Dentist and Optician. The Residents who spoke to the Inspector stated that the staff always treated them with respect and dignity. Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 10 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) 13 and 15 Residents maintain contact with family and friends. Residents are served a wholesome and balanced diet. EVIDENCE: The Residents who spoke to the Inspector stated that they maintained contact with their family and friends. One Resident stated that she goes out with her family on a regular basis. The visitor who spoke to the Inspector stated that she was always made welcome and the staff always ensured that her husband was ready for her when she was taking him home or out for the day. The Residents stated that the food was good. All of the Residents stated that there was an alternative offered if they did not like what was on the menu. The cook bakes her own cakes and pies, which the Residents stated were nice. On the day of the inspection the kitchen was clean and there was a good stock of dried food. New crockery had been purchased. The home has a four-week menu plan. There were staff available in the dining room to offer assistance to those Residents who required it. Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 11 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 Residents are confidant that their complaints would be listened to seriously and action taken. EVIDENCE: There is a complaints policy and procedure in place, which outlines the stages the complainant should take to make a formal or informal complaint. The Residents who spoke to the Inspector stated that they would speak to the Manager if they had any complaints or concerns and were confident that she would take the appropriate action. The home has received no complaints since the last inspection in February this year. Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 12 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, 21, 23, 24 and 26 Residents live in a well-maintained environment, which is clean and hygienic, and there are sufficient toilets and bathrooms. The Residents bedrooms are comfortable and meet their needs. EVIDENCE: On the day of inspection the home was clean, pleasant and odour free. The Residents who spoke to the Inspector were satisfied with décor of the home. The patio area at the back of the home has been tidied up and new patio furniture bought. The lounge has been decorated and new lounge chairs bought. New chair scales, commodes and hand towel dispensers have been provided. There are sufficient bathrooms and toilets available to meet the needs of the Residents.
Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 13 Residents’ bedrooms had been personalised by the Residents and/or their family to meet their needs. The flat on the top floor of the house is very homely and the Resident who occupies it is very pleased with it and calls it her penthouse. The Inspector observed telephones and fridges in Residents bedrooms. Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 14 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 The Residents needs are met by the number and skill mix of the staff on duty. The home does not have the recommended 50 of NVQ trained staff. The Residents are protected by the home’s recruitment practices and the staff receives training to do their jobs. EVIDENCE: An audit of four weeks duty rota was carried out. There are two trained nurses and six care assistants on a morning shift, one trained nurse and four care assistants on an afternoon and evening and one trained nurse and two care assistants on a night shift. 70 of the care staff are currently studying for their NVQ Level 2. Six personnel files were audited; all contained the required information as stipulated in Schedule 2 of the Care Homes Regulations 2001. The following is an example of the training that has taken place; Manual Handling. Fire Awareness. Clinical Waste First Aid. Catheter and Pressure Area Care.
Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 15 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, 33, 35 and 36 The home is managed by a person who is fit to be in charge. There is a quality audit, which is accessible to those who wish to read it. Residents’ finances are safeguarded. The Staff are appropriately supervised. EVIDENCE: The Manager has the required nursing and management qualification to ensure that the needs of the Residents are fully met. There is a quality assurance and quality monitoring system in place within the home. There is a suggestion box on the wall as you enter the home. The audits cover the different departments within the home e.g., Residents care documentation, the kitchen and the environment. Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 16 Each Resident has their own money wallet. A record is kept of all the money a Resident receives and spends and receipts are obtained and kept in the individual wallets. There are two signatures when money is deposited or withdrawn. An audit is carried out on the Residents personal finances on a regular basis. There is a policy and procedure in place for Residents finances. The care staff received regular formal supervision. This was evidenced within the personnel files and confirmed by the staff that spoke to the Inspector. Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 17 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 x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 3 x 3 3 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x 3 x 3 3 x x Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 18 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP28 Good Practice Recommendations The Registered Manager must ensure that 50 of care staff achieve NVQ Level 2 in care by 2005. Ascot Nursing Home B51-B01 S61594 Ascot V238921 250705 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Unit B, Advance House St Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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