Care Home: Ascot House

Similar services:

• Chirnside House
• Sunny Bank (P.R.S.) Ltd
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Ashwood Court Unit 1
• Langrigg House
• Parkside

What the care home does well They make prospective service users, their relatives and friends feel welcome. They are invited to look around the home, view rooms and observe the day to day routines. Some service users told us they were able to visit a number of times before moving in. This process helps support prospective service users to make the right decision about their future and where they would like to live. It also and enables them to make contact with others living at the home and allow them the opportunity to ask questions. Service users have detailed written care plans in place which they have access to. They are kept up to date and reflect the current their current needs. They also receive the health care attention they require. Service users were complimentary about the service at the home and about the staff who supported them. They told us "The staff are very good to me." " I am happy with the care given. And staff are very helpful." another said "Staff are always helpful. and get me medical support when needed." One relative commented "They have a very good understanding of my mums needs and limitations and do their very best to give her the quality of life." This tells us that though the home may still have areas it needs to improve on, service users are generally happy and contented with the care and support they receive. What has improved since the last inspection? New fire safety measures have been put into place with a new fire alarm system being fitted since the last inspection. We are told that the homes activities programme has improved, and that the registered manager and team are considering how to develop activities to ensure that service users have daily opportunities to join in social events. The levels of sickness by staff have reduced, which we are told has improved the continuity of staff. However relatives have noticed that staffing levels have impacted on services and have said "They seem to have had many recent changes in staff. My mum sometimes does not know who they are and neither do I when I visit." "A shortage of staff sometimes means the agency staff are not as competent as the regular staff." Parts of the home have had replacement windows. We are told that plans are underway to redecorate parts of the home and provide some units with new dining furniture. What the care home could do better: In order to assure itself that it can meet the needs of prospective service users. The registered manager should have systems in place that enable staff from the home to visit prospective service users in their current placement or home to assess their needs before they move in. Management systems must also ensure it receives the required information from placing authorities and prior to making any decisions about the prospective service users accommodation. Service users who are at risk of losing weight or at risk of malnutrition must be closely monitored. Management systems must be in place to monitor records and the practices of staff to ensure. This should ensure service users are receiving the support they require and that records accurately reflect their current intake and weight. To ensure that service users are not place at increased risk of infection, staff administering medication must cease handling medication. Specialist advice and service should be sought to ensure that the specific needs of service users with a learning disability are not overlooked. Staff should also be trained in supporting people with a learning disability and information provided to them should be in a user friendly format. Each unit should have a planned daily activity, which encourages service users to meet together and socialise. Further activities could be provided for those who wish to meet with others within and outside of the home. Such activities should promote a sense of well being, belonging and encourage positive mental health. The independence of service users could be better promoted at meal times. Table should be laid with items which will enable them to service themselves and or others if they require and as they are able. So service users are able to live in surroundings which offer comfort and that are cared for, we have asked for a full assessment of the building with the aim of upgrading all parts of the home which show signs of wear and tear. To ensure that this is done in a timely manner, we have asked for timescales for completion of the upgrading.Kitchenette areas within the units need to be better cared for to ensure that hygiene standards are maintained for the safety of service users. We have asked that a full review of staffing levels is undertaken to ensure that the home is appropriately staffed. CARE HOMES FOR OLDER PEOPLE Ascot House Ascot Avenue Sale Cheshire M33 4GT Lead Inspector Sylvia Brown Unannounced Inspection 3rd June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ascot House DS0000032526.V365253.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 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 House DS0000032526.V365253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ascot House Address Ascot Avenue Sale Cheshire M33 4GT 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) 0161 962 0996 0161 973 6780 carol.barber@trafford.gov.uk Trafford Metropolitan Borough Council Mrs Carol Ann Barber Care Home 45 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0), Old age, not falling within any other category (0) Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home provides accommodation for a maximum of 45 service users, 17 of whom require care by reason of old age (OP), 19 of whom are older people who require care by reason of dementia (DE(E)) and 9 of whom are older people who require care by reason of their mental ill health (MD(E)). Separate lounge and dining space is provided to meet the needs of the service users who require care by reason of dementia (DE(E)) and the needs of the service users who require care by reason of their mental ill health (MD(E)) There are currently 3 additional named older service users who require care by reason of old age (OP) and 2 additional named older service users who require care by reason of dementia (DE(E)). Should any of these service users no longer require accommodation at the home, the places will revert to the category (MD(E)). The Statement of Purpose must be maintained in line with the requirements of Schedule 1 of Regulation 4 (1) of the Care Homes Regulations. The Statement must be kept under review and updated. Any changes to the home’s purpose must be agreed with the Commission for Social Care Inspection prior to implementation. The staffing arrangements at the home must be maintained in line with the minimum levels set out in the guidance published by the Residential Forum, `Care Staffing in Care Homes for Older People`. This must be reflected in the Statement of Purpose. The home must be managed at all times in accordance with the guidance and regulations issued in respect of older peoples` homes by the Secretary of State for Health under Sections 22 and 23 (1) of the Care Standards Act 2000. The authority must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. 3. 4. 5. 6. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 5 Date of last inspection 28th July 2006 Brief Description of the Service: Ascot House is a purpose built local authority residential home, which provides accommodation and personal care to 45 older people. The home is located in a residential area on Ascot Avenue, off Manor Avenue, Sale, Cheshire. The home is close to public shops and transport routes into Sale and Altrincham. The home is divided into 5 units, 2 of which accommodate 18 older people, 2 of which accommodate older people with dementia and 1 of which accommodates older people with mental ill health. Each of the 5 units has its own lounge/dining area and kitchenette. Bedrooms are located close off communal areas and easily accessed by service users in each unit. Accommodation is provided in 45 single rooms. Forty-three of the 45 single bedrooms are over 12 sq. meters and could therefore accommodate wheelchair users. The remaining 2 bedrooms measure in excess of 10 sq meters. The weekly fees are £380.29. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed on the28th July 2006. The site visit was conducted in one day and was unannounced, which means the registered manager and staff were not told that we would be visiting. The registered manager was available throughout. We gathered information from a number of people, which included talking with and seeking the views of service users. We sent out surveys to service users, relatives and members of staff. This gave them an opportunity to talk with us about their opinions on the services provided at Ascot House. Comments received are, where appropriate included within the report. We looked in depth at records and the care support of two people living at the home. We also spent time sitting with service users and observing their dayto-day routines as they received support from care staff. This helped us get a better view about how people living at home are looked after and supported. In April 2008 the registered manager of Ascot House completed a selfassessment form, which is called an Annual Quality Assessment Audit (AQAA). This told us what the home had been doing since the last key inspection to meet and maintain the National Minimum Standards. It also told us what they felt they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. We also gathered information through general contact with the home; through their reporting procedures, which are called ‘Notifications’, and through information we received from other people, such as the general public, including concerns and complaints procedures. We have received no concerns regarding this service. From the information gathered we made the judgment about how the home was meeting the National Minimum Standards (NMS) and we made the overall judgement on the quality of the service. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? New fire safety measures have been put into place with a new fire alarm system being fitted since the last inspection. We are told that the homes activities programme has improved, and that the registered manager and team are considering how to develop activities to ensure that service users have daily opportunities to join in social events. The levels of sickness by staff have reduced, which we are told has improved the continuity of staff. However relatives have noticed that staffing levels have impacted on services and have said “They seem to have had many recent changes in staff. My mum sometimes does not know who they are and neither do I when I visit.” “A shortage of staff sometimes means the agency staff are not as competent as the regular staff.” Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 8 Parts of the home have had replacement windows. We are told that plans are underway to redecorate parts of the home and provide some units with new dining furniture. What they could do better: In order to assure itself that it can meet the needs of prospective service users. The registered manager should have systems in place that enable staff from the home to visit prospective service users in their current placement or home to assess their needs before they move in. Management systems must also ensure it receives the required information from placing authorities and prior to making any decisions about the prospective service users accommodation. Service users who are at risk of losing weight or at risk of malnutrition must be closely monitored. Management systems must be in place to monitor records and the practices of staff to ensure. This should ensure service users are receiving the support they require and that records accurately reflect their current intake and weight. To ensure that service users are not place at increased risk of infection, staff administering medication must cease handling medication. Specialist advice and service should be sought to ensure that the specific needs of service users with a learning disability are not overlooked. Staff should also be trained in supporting people with a learning disability and information provided to them should be in a user friendly format. Each unit should have a planned daily activity, which encourages service users to meet together and socialise. Further activities could be provided for those who wish to meet with others within and outside of the home. Such activities should promote a sense of well being, belonging and encourage positive mental health. The independence of service users could be better promoted at meal times. Table should be laid with items which will enable them to service themselves and or others if they require and as they are able. So service users are able to live in surroundings which offer comfort and that are cared for, we have asked for a full assessment of the building with the aim of upgrading all parts of the home which show signs of wear and tear. To ensure that this is done in a timely manner, we have asked for timescales for completion of the upgrading. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 9 Kitchenette areas within the units need to be better cared for to ensure that hygiene standards are maintained for the safety of service users. We have asked that a full review of staffing levels is undertaken to ensure that the home is appropriately staffed. 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 DS0000032526.V365253.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service does not always ensure it has pre assessment information in place before service users move in. This could mean that service users who move into the home could be at risk of having needs which the staff cannot meet. Service users are able to visit before moving and receive information about the home. EVIDENCE: We looked at the care of two people, one of whom had recently been admitted to the home. We found that the homes admission procedure had not been followed. The local authority had not sent appropriate documentation and the manager had not been out to assess the service user prior to admission. We identified that there was no clear pre admission process undertaken by the manager on how they had assessed they had the individual skills to meet the service user’s needs or had planned to gain the correct knowledge. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 12 The registered manager explained that due to the demands of the home, there was insufficient time and staffing to ensure all perspective service users have their needs assessed by them before admission. We could find no information to support that services receive confirmation that the home after assessment, could meet their needs. Even though the home did not always visit the service users in their current placement before admission, we were told that service users are invited to visit before moving in. A service user told us “I came and visited with my social worker and had a staged admission.” Another said “I visited the home twice before I moved in.” When asked if they received enough information before moving in we were told by one service user “I would have liked more information at the time but I am happy with the home.” Of the seven relatives who responded to the surveys we sent, they stated they always or usually received sufficient information. Within each service users room is a file which contains all the relevant information including details of the specific unit they are accommodated on, advocacy services, complaints procedures and the most up to date inspection report from ourselves. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their health care and personal needs recorded, recognised and met. EVIDENCE: When asked about the care they received, service users told us “I am happy with the care given.” “Staff are very helpful.” And “staff always get me medical support when needed.” All service users have detailed care plans in place which are kept under review. They received medical support and attention when required and had access to routine health care checks. However some records which were required to monitor fluid and food intake were not appropriately detailed and were not monitored. Four records were looked at were found to be poorly maintained. The records showed that service users were eating small amounts or nothing at all on some occasions. The amount of fluids recorded indicated that some service users were at very Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 14 high risk of being dehydrated. There were no records to support that such essential checks were being monitored or that action was being taken. Similar findings were apparent for weight charts. One chart stated that the service user should be weighed weekly, but details kept indicated that this practice was not being followed. The records did not indicate the times of day individuals are weighted and if they are dressed or undressed or which scales are being used, all of which could impact on the weight outcome. One service user was recorded as losing 11lbs in weight, when weighed again three days later the weight had increased. When weight four weeks later the weight had decreased. Another service user appeared to have gained 8lbs in two weeks. There was no system in place to identify how weight loss and increases were being monitored and of any action taken as a consequence. Service users received their prescribed medication when required. Inspection of the records for administered medication were found to be correct. It was observed that during in one administration, the staff was seen to handle medication by hand and place it in a service users mouth. There was no hand washing procedures evident. This practice places service users at risk of cross infection. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all service users receive enough social stimulation to meet their needs or preferences. Meals and meals times routines need developing to make sure the independence of service users is promoted and encouraged. EVIDENCE: Service users were observed rising throughout the morning and receiving their breakfasts. Some were observed to receiving the support with their bathing routines, whilst others sat in their lounge chairs asleep, reading or listening to music. One service user who was observed attempting to walking around their lounge, and whose care plan stated they enjoyed walking around the home was repeatedly told to sit in a chair. Eventually the service user became compliant and was provided with a newspaper and drink where they sat. It was unclear why staff felt it necessary to keep the service user in one lounge and within the space of one or two chairs. There was nothing in the service users record which identified that the service user was at an unnecessary risk of harm should they walk around the home, neither was there any instruction for staff to restrict their movements. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 16 Throughout the inspection a number of service users were observed sitting in the same chair asleep. There was minimal interaction with them from staff other than when providing personal care support and support at mealtimes. A number of service users who live at the Ascot House who have a learning disability. Record could not confirm that staff had received training in supporting service users with such conditions or were aware of the best ways to provide daytime occupation and social stimulation for them. When spoken with service users told us they were generally satisfied with their routines, however there were mixed views from relatives. One told us “The days are monotonous for residents, and whilst settled routines are good for ensuring a safe and secure environment, some events would break up the day and be welcome.” “No music or interaction, which would help staff and brighten up the lives of the residents a little.” another said “There seems to be less people around during the day at Ascot House. No regular visitors from outside organisations, to talk with residents.” The completed AQAA identified that the activities programme had been extended, however the registered manager also acknowledged that further improvements need to be made to ensure that service users have sufficient opportunities to join in daily activities. Of the two service users case tracked their records could not identify that they had been encouraged to or joined in any activities within the home. Service users were spoken to in respectful and dignified manner, and where personal care support was provided it was done so discreetly. The routines for meals and mealtimes could be developed to make sure mealtimes were an enjoyable experiences and give service users an opportunity to meet and socialise with each other. The breakfast routine observed was basic, in that the environment within which service users received their meal lacked atmosphere. Tables were not laid and food was routinely given ready prepared. Toast was served buttered with jam or marmalade. Service users were not given the opportunity or supported to pour drinks for themselves or pour milk on their breakfast cereal. The one staff serving breakfast also had to leave service users while she supported others to rise. The lunchtime meal was delayed on the day of the inspection, however service users were not informed of this. They were observed to be sat at the dining table for in excess of 45 minutes before food was served. Some service users received food where they had been sitting all morning and continued to stay in the same seat in the afternoon. This meant they had not had any opportunity to mobilise, meet with other service users and or have a change of scenery. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 17 The lunchtime meal served was enjoyed by service users. They were offered choice and good quality food. They ere also offered second portions. When asked about the meals and food served, service users told us that they liked the meals prepared by the home. One service user stated “Sometimes I dont like the meals but staff will get me something else.” The home has opened visiting arrangements which means service users can receive visitors at any time and meet with them in private. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users who know how to make complaints and are kept safe by good adult protection and complaint procedures. EVIDENCE: Service users and visitors are kept informed of and have access to, the homes complaints procedure. Information about making complaints is it displayed within public parts of the building and within each service users room. Service users told us they had someone with whom they could talk to if they were unhappy or concerned about the care they received. One told us “I would know who to make a complaint to but I dont make complaints.” and another said “If I had any concerns I would speak to carers.” a relative stated “We haven’t any concerns about the way our mother is cared for.” Since the last inspection four complaints have been registered by the home, with records confirming the nature of the complaints, the action taken by the home to investigate and the outcome. Staff are trained in the local authorities adult protection procedures and service users are informed of who to report any concerns to, should they feel they are treated incorrectly by staff. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 19 We have received no complaints received about this service and no allegations of abuse made. Service users spoken with indicated that they felt safe and were more than satisfied with the care and support they received. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a home which is adapted and suitable to meet their needs, but needs upgrading to ensure that it offers a comfortable homely environment at all times. EVIDENCE: During the inspection we were able to spend time in various parts of the home including two lounges. We also looked at a number of bedrooms including those of the service users who were being case tracked. Though the home was found to be clean and free from odours, it showed general signs of wear and tear both in the public and private areas used by service users. Kitchenettes were observed to be shabby and below the required standard and did not ensure good hygiene standards. There was no Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 21 cleaning schedules and no indication when refrigerators were cleaned and defrosted. Food store that was not always dated or use by date detailed. Cleaning products were found in unlocked cupboards within the kitchenettes which could be accessed by service users, and used inappropriately could cause them harm. One kitchenette units also contained a staff’s hand bag and personal belongings. Bedroom doors contained glass panels which reduces the privacy for service users and should be replaced as part of a rolling programme to upgrade the home. Service users bedrooms were found clean and presentable with varying degrees of personalisation by the service users in place. Some wardrobes, sink unit and draws showed signs of general wear and tear. One service users draws had labels attached indicating ladies undergarments when the service user was a gentleman. This shows that thought had not been given to the preparation of the room for the service user, and indicated some institutionalised practice. The home was fitted with aids and adaptations, and offered service users ample space for walking around and having a variety of seating areas where they can sit and meet with each other. Some of the external parts of the home required garden maintenance, and algae needed removing from pathways and walk ways. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 22 Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are kept safe and receive support from staff who are recruited and selected appropriately and who are trained and competent. EVIDENCE: Thirty-one of the thirty-eight staff have received training in NVQ 2 or above. This exceeds the National Minimum Standards. The home also has a good training program in place which ensures that staff receive appropriate training. We looked at several weeks staffing rota to see if the home was appropriately staffed. However due to the complexities of the services provided at Ascot House we were unable to confirm they were appropriately staffed. Staffing levels are difficult to establish, in that the service has 5 units which offer support to people with dementia, who are older and who require a respite care service. Having observed practice of the morning routine within a small lounge where one staff member was in attendance, it was not felt the staff level was correct. The member of staff working alone had to support up to seven service users to rise and prepare for the day and serve them breakfast. A ‘floating’ support staff eventually came to assist with service users who required two staff. Service users were observed asleep in their chairs most of Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 24 the time and there was minimal opportunities for meaningful interaction between staff and service users. Observations in another lounge identified that staff again worked alone and were very busy and had little opportunity to talk and converse with service users. Two service users were not conversed with at all unless being assisted at meal times or with toileting. One of those did not receive any personal care or move position for approximately 4hrs at which time the observation ceased. When talking with the manager she explained that further staff demands are made for the staff on the short stay unit, which has a swift and continuous turn over. She explained that at week ends there can be considerable admissions and discharges which directly impacts on staffing levels and the standard of service provided. At this inspection we were unable to observe the staffing levels and level of service provision in all lounges within Ascot House, as a consequence we have asked for a review of staffing levels to be completed and are giving consideration to completing a specific random inspection to assess staffing levels at the home. Two staff files were looked at. We found that the home operated good recruitment and selection procedures which protected service users from receiving care from unsuitable people. One file did not contain a staff photograph or confirmation that the staff had started the Skills for Care Common Induction training. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home which is managed in their best interest and which keeps them safe from harm. EVIDENCE: There have been no management changes at the home since last inspection. The registered manager has achieved NVQ 3 training and the Registered Managers Award. That AQAA told us that the residential officers (Deputies/team leaders) have or are in the process of completing training at NVQ level 4. The monies held by the home on behalf of service users is kept to a minimum. For those who’s finances are managed small balances are held and accounting Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 26 systems are in place. The account are monitored and checked by people in a management position at the home and are audited by through Local Authority procedures. Health and safety records were check and found to be of a good standard. Environmental health officers visited the premises 11th/1/07 the report confirms that there was no requirements or recommendations made. Infection control procedures are in place and 75 of staff have completed infection control training. Furthermore 100 of staff have completed basic food hygiene training. Fire safety procedures are in place and the home has an up to date work place risk assessment. Ascot House was inspected by the Local Authority Health and Safety Department in April 2008. The home keeps us informed and we have received the regulation 37 notifications appropriately. And completes regulation 26 visits in accordance with regulations. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 27 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x x x 3 Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 28 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. 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 OP3 Good Practice Recommendations Systems should be in place which ensure that perspective service users have their needs assessed by the home prior to moving in. Pre-assessment information should be received by funding authorities and or medical professionals prior to the admission of a service user. Prospective service users and their relatives should receive information which confirms that the service is confident it can meet the assessed needs of the service user. To ensure assessments can be carried out for service users at risk of weight loss. Good systems should be maintained for the accurate monitoring and recording of service users weights as they individually require. A planned programme of activities should be in place for each unit. Service users should receive the individual support they require to join in meaningful activities both within the home and local community. After a full assessment of the building is undertaken, an DS0000032526.V365253.R01.S.doc Version 5.2 Page 29 2 3 OP5 OP7 4 OP12 5 OP26 Ascot House 6 OP26 7 8 9 10 OP27 OP30 OP9 OP27 action plan should be submitted to us which details the homes redecoration and upgrading programme. The plan should include timescales. All areas of the home should be maintained safely including kitchenettes. Cleaning schedules should be maintained and items which could cause harm to service users should be locked away. Training should be provided to all staff which will enable them to have a better understanding of the needs of those who have a learning disability. Systems should be in place which ensures that new employees start the Skills for Care induction programme and complete it within the set time frame. Staff should ensure they wash their hands prior to and after handling medication A full review of the staffing levels should be undertaken, ensuring that each unit is appropriately staff at all times to support the assessed needs of service users accommodated within that area. The outcome of the assessment should be provided to us. Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. Extracts may not be used or reproduced without the express permission of CSCI Ascot House DS0000032526.V365253.R01.S.doc Version 5.2 Page 31 - 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!