Care Home: Ascot House

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What the care home does well All six residents completed and returned surveys to the CSCI prior to the inspection. All state they were asked if they wanted to move to the home and that they received enough information about it, reinforcing that information and assessment processes meet residents` needs. Comprehensive care plans that include aims and goals for identified needs ensure residents` needs are appropriately monitored and met. Residents are supported to made decisions relating to their care and activities they participate in. As one person explained, "Residents meetings are useful, they help us sort things, problems can discuss anything" and another "we do lots of activities. College for reading and writing, Dudley for a coffee, college for computers, Saturdays hovering and housework and Sunday I go to Bescot market". All residents spoken to confirmed their satisfaction with meals provided and confirmed they are able to make their own meals if they choose and have access to facilities for making drinks. As at the previous inspection privacy and dignity are respected at this home within a risk-managed framework. All of the people who live here require as a minimum at least one to one staffing, however we observed that attempts are still made by staff to ensure privacy and dignity is respected. For example staff only entered bedrooms upon approval of the resident and wishes in relation to times of rising, bathing and mealtimes were seen to be respected. People can be confident concerns are taken seriously. All of the surveys completed by residents and returned to the CSCI prior to the inspection state that they know who to speak to if unhappy and how to make a complaint. Additional comments were also recorded as `I have been given a complaints procedure booklet` and `I would see the manager`. Intervention policies and procedures are in place that appear appropriate, with the low numbers of incidents occurring since residents having moved to the home evidencing that care planning and support in this area are meeting the needs of individuals. The home should be congratulated for its efforts in this area. The house provides a warm, comfortable and caring environment. As at the previous inspection relationships between staff and residents appear good, with many compliments made about the staff working at the home. As a resident explained, "Staff are all ok, they are pleasant and that`s important. I have two key workers; they help sort things for me". A resident confirmed that they are involved in the induction process for new staff, giving a tour of the premises and informing of fire procedures and matters relating to health and safety. The home should be commended for actively involving residents in the recruitment of staff. The management of health and safety is good within this home, ensuring risks to residents are minimised. We randomly sampled a number of maintenance records and found all to be up to date and in good order. Staff are qualified to perform their duties and support residents, with high proportions of staff have undertaken training in areas including National Vocational Qualifications, first aid, moving and handling, fire, infection control, non violent crisis intervention and autism. What has improved since the last inspection? Since the last inspection the service user guide has been reviewed, is displayed on the residents notice board and has been discussed within a residents meeting, ensuring people are fully informed. Also care plans relating to finances have been expanded to encompass practices currently in place including the withholding of information as agreed within a multi disciplinary setting. The frequency of residents meetings has increased with these now occurring monthly, with subjects such as complaints and policies and procedures being regularly discussed, promoting residents involvement in decision making relevant to the home and the services they receive.Risk assessments have been incorporated into individual care plans, promoting a holistic approach to support/management. Residents have attended `Well Man` clinics, promoting a holistic approach to health care management. Stocks of medication have been reduced ensuring a maximum of 28 days supply of medication is maintained at any one time, as is good practice. The adult protection policy has been reviewed so that it makes reference to local authority adult protection guidelines and actions the manager must take in the event of an allegation, offering greater protection to people. Improvements to quality monitoring have taken place. For example the company has completed an annual quality assurance audit that includes obtaining the views of residents, monthly unannounced visits are being undertaken by the operations manager, with detailed and informative reports published, policies and procedures have been reviewed to reflect changes in legislation or good practice and regular staff meetings are now taking place in order that staffs views are obtained. What the care home could do better: Management confirmed that menus have been reviewed internally, that they had not been able to access external advice such as a dietician with regards to nutritional screening tools but that they were still exploring this. The home should ensure the named residents weight is recorded monthly as per instructions in the care plan, to ensure appropriate monitoring is undertaken. This information could not be found and confirmation could not be given that this was occurring during the inspection. A signature was missing on the medication administration record (MAR) for one dose of medication. It was also noted that for the same resident a medication had not been administered due to the person undertaking an activity. We recommend that in instances when medication is not administered detailed explanations be recorded on the back of the MAR charts to ensure everyone is fully informed. We also recommend that the temperature be monitored in the medication cabinet to ensure medication is stored in line with manufacturers guidelines. We recommend that all members of staff within the home responsible for residents` finances receive guidance regarding recording and auditing of finances to ensure residents are offered greater protection by the homes financial procedures. When we examined financial records we found that audits are identifying discrepancies but that records and monies maintained within the home are not being amended resulting in discrepancies continuing.Quality monitoring was discussed when giving feedback on the inspection, where it was agreed that the views of others such as health care professionals and possibly families would enhance further the monitoring systems already in place. We found that some staff detailed on the current staffing rota were not named as participating in a fire drill this year. We recommend that all staff, in particular night workers participate in a fire drill at least annually to reduce the risk of injury to residents in the event of a fire. CARE HOME ADULTS 18-65 Ascot House 23 Joinings Bank Oldbury West Midlands B68 8QT Lead Inspector Lesley Webb Key Unannounced Inspection 26th November 2007 09:00 Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 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 House DS0000067169.V350999.R01.S.doc Version 5.2 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 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 House DS0000067169.V350999.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ascot House Address 23 Joinings Bank Oldbury West Midlands B68 8QT 01384 872804 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) info@edgeviewhomes.co.uk Edge View Homes Ltd vacant post Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6) of places Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th February 2007 Brief Description of the Service: Ascot House is situated in the busy residential area of Oldbury in Sandwell. This detached house has been specially converted and refurbished; it is a large three-storey house within easy walking distance of all local amenities. The house provides a warm, comfortable and caring environment. Bedrooms are situated on the two upper floors with four bedrooms and a hydrotherapy pool on the first floor, and two bedrooms on the second floor. Each bedroom has its own en suite bathroom providing a shower, toilet and sink. The bedroom sizes vary but all are in excess of the National Minimum Standards, being larger in size than 12 square meters. Residents are encouraged to choose a colour scheme for their room and may assist in redecoration if they so wish. All necessary furniture is provided, however residents are welcome to personalise their rooms. All bedroom doors are alarmed to ensure the safety and security of the service user and his personal effects. Ground floor accommodation comprises of a large lounge with sky TV, dining room, a main kitchen where resident’s meals are prepared, the manager’s office, laundry room and therapy room. On the ground floor there is also another kitchen for residents to make drinks and if they so desire prepare their own meals. Outside in the garden area there is a conservatory and a patio area. Access to the conservatory is via a covered walk way. Ascot House provides 24-hour residential care for people with learning disabilities, mental health problems and autistic spectrum disorders. These may be complicated by the presentation of behaviour, which challenges services. Specific information relating to fees charged for living at the home is not included in the Statement of purpose. This states ‘our fees are based on the level of dependence and needs of the resident. The fee is calculated on the basis of the community care assessment, if available our own assessment and after due consultation with the care manager and family members. We feel that each resident should be treated individually and as such his or her care package will be tailor made for him or her’. Readers should contact the provider directly for further information. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out this inspection over one day, with the home being given no notice of the visit. Time was spent examining records, talking to residents, staff and observing care practices, before giving feed back on the findings of the inspection to the proprietor and members of the management team. Prior to the inspection the home supplied information to the Commission for Social Care Inspection (CSCI). Also all six residents completed surveys and returned them to the CSCI. Information from both these sources was also used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking two individuals care provided at the home. This was the second inspection of Ascot House since its initial registration in 2006. The atmosphere within the home is inviting and warm and we would like to thank everyone for his or her co-operation and assistance. What the service does well: All six residents completed and returned surveys to the CSCI prior to the inspection. All state they were asked if they wanted to move to the home and that they received enough information about it, reinforcing that information and assessment processes meet residents’ needs. Comprehensive care plans that include aims and goals for identified needs ensure residents’ needs are appropriately monitored and met. Residents are supported to made decisions relating to their care and activities they participate in. As one person explained, “Residents meetings are useful, they help us sort things, problems can discuss anything” and another “we do lots of activities. College for reading and writing, Dudley for a coffee, college for computers, Saturdays hovering and housework and Sunday I go to Bescot market”. All residents spoken to confirmed their satisfaction with meals provided and confirmed they are able to make their own meals if they choose and have access to facilities for making drinks. As at the previous inspection privacy and dignity are respected at this home within a risk-managed framework. All of the people who live here require as a minimum at least one to one staffing, however we observed that attempts are still made by staff to ensure privacy and dignity is respected. For example staff only entered bedrooms upon approval of the resident and wishes in relation to times of rising, bathing and mealtimes were seen to be respected. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 6 People can be confident concerns are taken seriously. All of the surveys completed by residents and returned to the CSCI prior to the inspection state that they know who to speak to if unhappy and how to make a complaint. Additional comments were also recorded as ‘I have been given a complaints procedure booklet’ and ‘I would see the manager’. Intervention policies and procedures are in place that appear appropriate, with the low numbers of incidents occurring since residents having moved to the home evidencing that care planning and support in this area are meeting the needs of individuals. The home should be congratulated for its efforts in this area. The house provides a warm, comfortable and caring environment. As at the previous inspection relationships between staff and residents appear good, with many compliments made about the staff working at the home. As a resident explained, “Staff are all ok, they are pleasant and that’s important. I have two key workers; they help sort things for me”. A resident confirmed that they are involved in the induction process for new staff, giving a tour of the premises and informing of fire procedures and matters relating to health and safety. The home should be commended for actively involving residents in the recruitment of staff. The management of health and safety is good within this home, ensuring risks to residents are minimised. We randomly sampled a number of maintenance records and found all to be up to date and in good order. Staff are qualified to perform their duties and support residents, with high proportions of staff have undertaken training in areas including National Vocational Qualifications, first aid, moving and handling, fire, infection control, non violent crisis intervention and autism. What has improved since the last inspection? Since the last inspection the service user guide has been reviewed, is displayed on the residents notice board and has been discussed within a residents meeting, ensuring people are fully informed. Also care plans relating to finances have been expanded to encompass practices currently in place including the withholding of information as agreed within a multi disciplinary setting. The frequency of residents meetings has increased with these now occurring monthly, with subjects such as complaints and policies and procedures being regularly discussed, promoting residents involvement in decision making relevant to the home and the services they receive. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 7 Risk assessments have been incorporated into individual care plans, promoting a holistic approach to support/management. Residents have attended ‘Well Man’ clinics, promoting a holistic approach to health care management. Stocks of medication have been reduced ensuring a maximum of 28 days supply of medication is maintained at any one time, as is good practice. The adult protection policy has been reviewed so that it makes reference to local authority adult protection guidelines and actions the manager must take in the event of an allegation, offering greater protection to people. Improvements to quality monitoring have taken place. For example the company has completed an annual quality assurance audit that includes obtaining the views of residents, monthly unannounced visits are being undertaken by the operations manager, with detailed and informative reports published, policies and procedures have been reviewed to reflect changes in legislation or good practice and regular staff meetings are now taking place in order that staffs views are obtained. What they could do better: Management confirmed that menus have been reviewed internally, that they had not been able to access external advice such as a dietician with regards to nutritional screening tools but that they were still exploring this. The home should ensure the named residents weight is recorded monthly as per instructions in the care plan, to ensure appropriate monitoring is undertaken. This information could not be found and confirmation could not be given that this was occurring during the inspection. A signature was missing on the medication administration record (MAR) for one dose of medication. It was also noted that for the same resident a medication had not been administered due to the person undertaking an activity. We recommend that in instances when medication is not administered detailed explanations be recorded on the back of the MAR charts to ensure everyone is fully informed. We also recommend that the temperature be monitored in the medication cabinet to ensure medication is stored in line with manufacturers guidelines. We recommend that all members of staff within the home responsible for residents’ finances receive guidance regarding recording and auditing of finances to ensure residents are offered greater protection by the homes financial procedures. When we examined financial records we found that audits are identifying discrepancies but that records and monies maintained within the home are not being amended resulting in discrepancies continuing. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 8 Quality monitoring was discussed when giving feedback on the inspection, where it was agreed that the views of others such as health care professionals and possibly families would enhance further the monitoring systems already in place. We found that some staff detailed on the current staffing rota were not named as participating in a fire drill this year. We recommend that all staff, in particular night workers participate in a fire drill at least annually to reduce the risk of injury to residents in the event of a fire. 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. The summary of this inspection report can be made available in other formats on request. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to decide if the home is suitable for them. Comprehensive assessment processes ensure prospective residents needs will be met. EVIDENCE: Since the last inspection the service user guide has been reviewed, is displayed on the residents notice board and has been discussed within a residents meeting, ensuring people are fully informed. Pre-admission processes are good within this home. There have been no new admissions to the home since the last inspection. Information supplied to the Commission for Social Care Inspection (CSCI) by the home prior to the visit demonstrates that management are knowledgeable and understand the importance of a thorough assessment being undertaken before offering permanent placements. For example it is states, ‘when requested to assess a prospective service user we request that the multi disciplinary team forward to us as much information as possible in respect of the referral in order that we have available to us all relevant information at the start of our assessment process. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 11 Our own assessment is then carried out by the homes manager and the operations manager for Edgeview homes, this entails a visit to the prospective service users place of residency to gather further information from the prospective service user, their family and there current carers. The aim of the assessment is to secure a firm profile of the prospective service user, their needs, desires and aspirations allowing them to influence the direction of care. Any special needs of the individual including cultural, social, or personal are fully discussed, documented and included in the care/support plans, including any potential restrictions on choice, freedom, services or facilities all are risk assessed. If we are satisfied that we will be able to meet the prospective service users holistic needs and deem that the placement would be suitable we recommend that the service user, with appropriate support be it family or carer, visit the unit to ascertain for themselves that it is the type of environment in which they would like to live. All six residents completed and returned surveys to the CSCI prior to the inspection. All state they were asked if they wanted to move to the home and that they received enough information about it, reinforcing that information and assessment processes meet residents’ needs. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are actively involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: We sampled two residents files with both containing comprehensive care plans that include aims and goals for identified needs including guardianship, learning disability/associated mental health issues, challenging behaviour, interpersonal skills/family contact, daily living skills, communication issues, choice/decision making/ independence, finances, social and educational, general hygiene and diet/fluid. Staff complete daily records, which are stored alongside the corresponding care plans in addition to completing monthly key worker notes in order that monitoring of the contents of care plans, can take place. The form used for recording the key worker findings asks for any issues since last report, changes to medication, changes in support needed and any other comments. It was noted that the key worker and manager sign these but currently residents are not asked to sign. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 13 We discussed this with members of the management team when giving feedback on the inspection findings who informed us that the format for recording these meetings has already been identified for improvement. Some of the people living at this home have specific needs in relation to the management of finances which result in them having restricted access to information and monies. Since the last inspection care plans relating to finances have been expanded to encompass practices currently in place including the withholding of information. This was explained further in information supplied by the home prior to the inspection, ‘it is the decision of the multi-disciplinary team as to the amount of information made available to a service user in particular with regard to finances. We have devised a money management programme in order to encourage where possible financial independence. The care/support plans also includes instances of decisions being taken independently by the service user and progress made, support being afforded by their key worker to enable them to take risks as part of an independent lifestyle’. All residents spoken to confirmed that they are supported to made decisions relating to their care. As one person explained, “Residents meetings are useful, they help us sort things, problems can discuss anything”. In addition to this all of the residents surveys completed and returned to the CSCI state individuals are always supported to make decisions about that they do each day. Since the last inspection the frequency of residents meetings has increased with these now occurring monthly, with subjects such as complaints and policies and procedures being regularly discussed, promoting residents involvement in decision making relevant to the home and the services they receive. As with care planning risk management systems are comprehensive and attempt to minimise identified risks without placing undue limitations on individuals. Since the last inspection risk assessments have been incorporated into individual care plans, promoting a holistic approach to support/management. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals’ expectations. EVIDENCE: As at the previous inspection evidence indicates residents lead full and active lives based on their individual needs and choices. Information supplied by the home prior to the inspection states ‘all service users have an individual activity care/support plan which details their activity programme to include social, recreational, therapeutic and educational activities. The activity programme, to include both activities in house and in the wider community, is agreed with the service user and takes into consideration their interests, hobbies, desires, stated choice, availability, provider, cost, location, level of supervision and transport requirements. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 15 Service users benefit from new and additional opportunities to develop existing interests further and experience new activities and are afforded the opportunity to reach their optimum level of independence. This information was found to accurately reflect services received by residents. As one resident explained, “we do lots of activities. College for reading and writing, Dudley for a coffee, college for computers, Saturdays hovering and housework and Sunday I go to Bescot market”. The home should be congratulated for the efforts it makes in this area. Information supplied by the home prior to the inspection relating to meals states ‘service users may choose to eat their meals in the dinning room or should they prefer the privacy of their own room. A variety of nutritious and well balanced meals are offered daily and chosen to take into consideration the likes and dislikes of the service user and any special dietary need that are to be met. In addition to the residential kitchen the home benefits from an industrial kitchen with a qualified chef preparing meals every day of the week for those residents who choose not to cook for themselves or return to the home at meals time having completed an activity in the community and for staff on duty’. Residents that we spoke to during the inspection confirmed they are able to make their own meals if they choose and have access to facilities for making drinks. All also confirmed their satisfaction with meals provided. Since the last inspection records of meals eaten by residents have been maintained (meeting a previous requirement). Management also confirmed that menus have been reviewed internally, that they had not been able to access external advice such as a dietician with regards to nutritional screening tools but that they were still exploring this. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: As at the previous inspection privacy and dignity are respected at this home within a risk-managed framework. All of the people who live here require as a minimum at least one to one staffing, however we observed that attempts are still made by staff to ensure privacy and dignity is respected. For example staff only entered bedrooms upon approval of the resident and wishes in relation to times of rising, bathing and mealtimes were seen to be respected. Health care is appropriately managed. Both residents’ files sampled contained care plans for health management including appropriate intervention for professionals including general practitioners, community psychiatrist nurses and psychiatrists. We noted that one persons health care plan states that they should be weighed monthly with the outcome recorded in the care plan. This information could not be found and confirmation could not be given that this was occurring during the inspection. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 17 Since the last inspection residents have attended ‘Well Man’ clinics, promoting a holistic approach to health care management. We examined medication records and stock. All was found to be in good order apart from a signature missing on the medication administration record (MAR) for one dose of medication. It was also noted that for the same resident a medication had not been administered due to the person undertaking an activity. Management were unable to state definitely why this might have occurred but suggested either the person accompanying the resident was not qualified to administer medication or that a member of staff might have been on emergency leave resulting in an unqualified person having to escort the resident. It was the opinion of management that if the activity had not taken place this would have resulted in the resident becoming distressed and potentially causing greater difficulties than risks posed by the medication not being administered. We recommend that in instances when medication is not administered detailed explanations be recorded on the back of the MAR charts to ensure everyone is fully informed. Since the last inspection the home has reduced stocks of medication ensuring a maximum of 28 days supply of medication is maintained at any one time, as is good practice. We also recommend that the temperature be monitored in the medication cabinet to ensure medication is stored in line with manufacturers guidelines. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse and have their rights protected. EVIDENCE: All of the surveys completed by residents and returned to the CSCI prior to the inspection state that they know who to speak to if unhappy and how to make a complaint. Additional comments were also recorded as ‘I have been given a complaints procedure booklet’ and ‘I would see the manager’. These comments were reinforced by all residents that we spoke to during the inspection, all of who named various members of staff they would approach if unhappy. As mentioned earlier in this report venues such as residents and key worker meetings are in place, where people are encouraged and supported to raise concerns and issues at an informal stage. Two complaints have been made since the last inspection, one of which was upheld the other that was not. Records evidence that full and comprehensive investigations have taken place ensuring people can be confident concerns are taken seriously. A selection of protection policies and procedures were examined with all appearing appropriate. Since the last inspection the home has reviewed the adult protection policy so that it makes reference to local authority adult protection guidelines and actions the manager must take in the event of an allegation. Ten of the twenty-nine staff have undertaken adult protection training. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 19 The majority of people living at this home have complex care packages to manage behaviours that can challenge, including physical and verbal aggression. Two members of the management team are qualified crisis prevention intervention trainers who instruct staff working at the home in this area. Intervention policies and procedures are in place that appear appropriate, with the low numbers of incidents occurring since residents having moved to the home evidencing that care planning and support in this area are meeting the needs of individuals. The home should be congratulated for its efforts in this area. Financial practices were examined and generally found to be acceptable with records in place of all transactions and monies maintained securely. The home completes audits both internally by members of the management team and externally by the organisations company secretary. When we examined the financial records we found that the audits are identifying discrepancies but that records and monies maintained within the home are not being amended resulting in discrepancies continuing. During the inspection the company secretary completed a full audit of all residents monies, making any required adjustments and agreed to review the current system to ensure any discrepancies are acted upon by the home as soon as they are identified. We recommend that all members of staff within the home who have responsibilities relating to residents finances receive guidance regarding recording and auditing of residents finances to ensure residents are offered greater protection by the homes financial procedures. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment that encourages independence. EVIDENCE: The homes statement of purpose states ‘Ascot House is situated in the busy residential area of Oldbury in Sandwell. This detached house has been specially converted and refurbished; it is a large three-storey house within easy walking distance of all local amenities. The house provides a warm, comfortable and caring environment. Bedrooms are situated on the two upper floors with four bedrooms and a hydrotherapy pool on the first floor, and two bedrooms on the second floor. Each bedroom has its own en suite bathroom providing a shower, toilet and sink. The bedroom sizes vary but all are in excess of the National Minimum Standards, being larger in size than 12 square meters. Residents are encouraged to choose a colour scheme for their room and may assist in redecoration if they so wish. All necessary furniture is provided, however residents are welcome to personalise their rooms. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 21 All bedroom doors are alarmed to ensure the safety and security of the service user and his personal effects. Ground floor accommodation comprises of a large lounge with sky TV, dining room, a main kitchen where resident’s meals are prepared, the manager’s office, laundry room and therapy room. On the ground floor there is also another kitchen for residents to make drinks and if they so desire prepare their own meals. Outside in the garden area there is a conservatory and a patio area. Access to the conservatory is via a covered walk way’. A tour of the building and examination of documentation confirm the above information to be accurate, with no issues identified, to which the home should be commended. Infection practices are good, offering protection to residents. Since the last inspection the majority of staff have received infection control training, meeting a previous requirement. All of the residents’ surveys sent to the CSCI prior to the inspection state that in their opinion the home is ‘always’ fresh and clean. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who live there. EVIDENCE: As at the previous inspection relationships between staff and residents appear good, with many compliments made about the staff working at the home. As a resident explained, “Staff are all ok, they are pleasant and that’s important. I have two key workers; they help sort things for me”. Further praise was given in all of the residents surveys returned to the CSCI prior to the inspection, all of which state that staff treat them well and listen and act on what they say. Information supplied by the home prior to the inspection in relation to recruitment and selection states ‘the staff recruitment procedure is robust is based on equal opportunities and ensures the protection of service users. A formal interview is conducted within a structured framework and is well documented and service users are afforded the opportunity to meet the person and form an opinion regarding their suitability to care and support them. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 23 Any gaps in employment history thoroughly explored. Two satisfactory written references are obtained, one of which from the last employer. New staff are only confirmed in post following completion of a satisfactory CRB check, satisfactory POVA check and in the case of a registered nurse confirmation of current nursing midwifery council registration. All staff are employed on a three month probationary period, receive a contract of employment and a copy of the GSCC code of conduct and practice’. We sampled the recruitment records of the three newest members of staff to be employed at the home and found this information to be accurate. For example they all contained the required records as detailed in the Care Home Regulations 2001 including references, enhanced criminal record bureau discloses (CRB) and application forms. It was noted that there appears to be a discrepancy with one persons CRB disclosure. This was brought to the attention of management who agreed to investigate. In addition to this a resident confirmed that they are involved in the induction process for new staff, giving a tour of the premises and informing of fire procedures and matters relating to health and safety. The home should be commended for actively involving residents in the recruitment of staff. Training information supplied by the home states of the twenty-nine staff currently employed, all have received an induction, the majority hold an National Vocational Qualification (NVQ) and specialist training has been undertaken specific to the needs of the people living at the home. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, with effective quality assurance systems in place. EVIDENCE: Since the last inspection there has been a change in management, with the person who was previously the deputy now undertaking the acting managers position. They are in the process of completing an application for registration with CSCI. The acting manager is currently undertaking the Registered Managers Award and NVQ level 4. The acting manager was not present during this inspection, however evidence indicates that they are fulfilling their responsibilities appropriately. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 25 There are various quality monitoring systems in place that allow the home to measure if it is achieving its aims and objectives. For example the company has completed an annual quality assurance audit that includes obtaining the views of residents, monthly unannounced visits are undertaken by the operations manager, with detailed and informative reports published, policies and procedures are regularly reviewed to reflect changes in legislation or good practice and regular staff meetings take place in order that staffs views are obtained. Quality monitoring was discussed when giving feedback on the inspection, where it was agreed that the views of others such as health care professionals and possibly families would enhance further the monitoring systems already in place. The management of health and safety is good within this home, ensuring risks to residents are minimised. We randomly sampled a number of maintenance records and found all to be up to date and in good order. In addition to this no health and safety issues were identified when we toured the premises. Fire records were examined detailing monthly drills involving residents and staff. We found that some staff detailed on the current staffing rota were not named as participating in a fire drill this year. We recommend that all staff, in particular night workers participate in a fire drill at least annually to reduce the risk of injury to residents in the event of a fire. This risk is however reduced as records evidence all staff having received fire training (this being separate from participating in a fire drill). Of the twenty-nine staff employed at the home all but one have undertaken moving and handling training, the majority first aid and five health and safety. Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 27 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. 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 YA17 Good Practice Recommendations That the home seeks professional advice in relation to nutrition and diet. That the home introduces a nutritional assessment and screening tool. 2 YA19 That the home ensure the named residents weight is recorded monthly as per instructions in the care plan, to ensure appropriate monitoring is undertaken That in instances when medication is not administered detailed explanations be recorded on the back of the MAR charts to ensure everyone is fully informed. That the temperature be monitored in the medication cabinet to ensure medication is stored in line with Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 28 YA20 3 manufacturers guidelines. 4 YA23 That all members of staff within the home who have responsibilities relating to residents finances receive guidance regarding recording and auditing of residents finances to ensure residents are offered greater protection by the homes financial procedures. That any gaps in employment history are explored, with outcomes recorded to offer further protection to residents. That the views of others such as health care professionals and possibly families be sought and included in the quality assurance system to enhance the monitoring stems already in place. That all staff, in particular nigh workers participate in a fire drill at least annually to reduce the risk of injury to residents in the event of a fire. 5 6 YA34 YA39 7 YA42 Ascot House DS0000067169.V350999.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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