Care Home: Ascot House

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What the care home does well The Company ensures that comprehensive information is available about the services the home provides to enable people to make informed choices about living in the home. Prior to admission each person requesting to come to the home has a holistic assessment, which is used as a basis to form a more detailed care plan. Each person`s care plan is very detailed and shows the careful attention to detail staff take in ensuring peoples` current needs are regularly evaluated and they are free from harm. The management team ensure there are sufficient staff on duty to meet every ones needs. Staff ensure that they are safe practioners and that each person is given their medication as prescribed by their doctors. People living in the home have Ascot House DS0000062843.V377589.R01.S.doc Version 5.2 commented on the kind and caring way they are looked after both day and night. A varied programme of activities are in place to meet people`s social, cultural and religious expectations. Events take place both inside and outside the home. People have the freedom of staying in their rooms and enjoying pastimes such as crafts and reading or can sit in different communal areas, use the library services or the computer. Opportunities are also available for people to take part in health related courses in the home. A balanced diet is on offer and food is prepared in a clean and safe environment. Daily menus are on display in both word and picture format. A robust complaints system is in place and people feel confident in raising concerns, knowing they will be dealt with promptly. Staff have been trained to recognise abusive situations and know how to report this, should the need arise and they need to protect people. People live in a safe and comfortable environment suited to their needs. They also have access to garden areas and visitors can park off road in safety. A robust recruitment and retention policy is in place and adequate checks are made prior to staff commencing employment to ensure they are safe to work with people in the home. They are then trained and supervised to ensure they can do their jobs. A detailed quality assurance programme is in place to ensure the local management team and the owners liaise with people living in the home, visitors, staff and outside agencies and that the home is being run for the benefit of the people living there. They also ensure by a regular maintenance and auditing process that the building and all equipment is safe to use and a safe place to live and work. What has improved since the last inspection? There were no requirements set at the last inspection but the home has decided to implement the good practise recommendation and liaise with the local fire brigade about door closure devices.Ascot HouseDS0000062843.V377589.R01.S.docVersion 5.2 What the care home could do better: No requirements or recommendations have been set at this inspection. Key inspection report CARE HOMES FOR OLDER PEOPLE Ascot House 88-90 Oswald Road Scunthorpe North Lincolnshire DN15 7PA Lead Inspector Theresa Bryson Key Unannounced Inspection 18th August 2009 10:00 DS0000062843.V377589.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ascot House DS0000062843.V377589.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ascot House DS0000062843.V377589.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ascot House Address 88-90 Oswald Road Scunthorpe North Lincolnshire DN15 7PA 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) 01724 867261 01724 844103 ascothouse@kapilcre.co.uk Statepalm Ltd Mandy Preston Care Home 40 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (40) of places Ascot House DS0000062843.V377589.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 40 Dementia - Code DE, maximum number of places 40 The maximum number of service users who can be accommodated is: 40 23rd July 2007 2. Date of last inspection Brief Description of the Service: Ascot House is registered to provide residential care and support to forty service users. The home is situated close to the town centre of Scunthorpe within easy reach of the high street and local amenities. The accommodation is provided over three floors serviced by a passenger lift. There are adequate numbers of toilets, bathrooms and communal areas and people can personalise their own bedroom areas to suit their individual tastes and needs. The home has a garden to the front of the building and an enclosed courtyard accessed from one of the lounges. There is parking for a few cars at the front and more spaces at the rear. Comprehensive information is available to enable people to understand the types of services the home can provide. The fees are reviewed annually. Ascot House DS0000062843.V377589.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3-star. This means that the people who use this service experience excellent quality outcomes. Prior to this site visit in August 2009 we sent out a number of surveys. Of these eleven were returned by people who use the service, two by health and social work professionals and one by a member of staff. We also looked at the service history of the home since the last inspection and the last annual service review. The home also sent us their Annual Quality Assurance Assessment which gave us a lot of information about how the company feels the home is meeting the needs of people who live there, what it is planning for the future and other statistical data. During the site visit we looked at a number of records and documents. We also spoke to six people who live in the home, six staff, three relatives and another visitor. We toured the home and grounds and observed care practises of staff. The manager was present through out the site visit and one of the owners was around during the lunch time period. What the service does well: The Company ensures that comprehensive information is available about the services the home provides to enable people to make informed choices about living in the home. Prior to admission each person requesting to come to the home has a holistic assessment, which is used as a basis to form a more detailed care plan. Each person’s care plan is very detailed and shows the careful attention to detail staff take in ensuring peoples’ current needs are regularly evaluated and they are free from harm. The management team ensure there are sufficient staff on duty to meet every ones needs. Staff ensure that they are safe practioners and that each person is given their medication as prescribed by their doctors. People living in the home have Ascot House DS0000062843.V377589.R01.S.doc Version 5.2 Page 6 commented on the kind and caring way they are looked after both day and night. A varied programme of activities are in place to meet people’s social, cultural and religious expectations. Events take place both inside and outside the home. People have the freedom of staying in their rooms and enjoying pastimes such as crafts and reading or can sit in different communal areas, use the library services or the computer. Opportunities are also available for people to take part in health related courses in the home. A balanced diet is on offer and food is prepared in a clean and safe environment. Daily menus are on display in both word and picture format. A robust complaints system is in place and people feel confident in raising concerns, knowing they will be dealt with promptly. Staff have been trained to recognise abusive situations and know how to report this, should the need arise and they need to protect people. People live in a safe and comfortable environment suited to their needs. They also have access to garden areas and visitors can park off road in safety. A robust recruitment and retention policy is in place and adequate checks are made prior to staff commencing employment to ensure they are safe to work with people in the home. They are then trained and supervised to ensure they can do their jobs. A detailed quality assurance programme is in place to ensure the local management team and the owners liaise with people living in the home, visitors, staff and outside agencies and that the home is being run for the benefit of the people living there. They also ensure by a regular maintenance and auditing process that the building and all equipment is safe to use and a safe place to live and work. What has improved since the last inspection? There were no requirements set at the last inspection but the home has decided to implement the good practise recommendation and liaise with the local fire brigade about door closure devices. Ascot House DS0000062843.V377589.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Ascot House DS0000062843.V377589.R01.S.doc Version 5.2 Page 8 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 DS0000062843.V377589.R01.S.doc Version 5.3 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1,3 and 6 were checked. Comprehensive information is available to ensure people know what services the home can provide and the company undertakes an holistic assessment prior to admission. EVIDENCE: Prior to the site visit the service sent us their Annual Quality Assurance Assessment (AQAA) when we asked them to. This contained the latest information about how the home is currently running and what they hope to achieve in the future. It also gave us a lot of statistical data. Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 10 Since the last visit the web site has changed and the name of the manager. They have updated their Statement of Purpose and Service Users Guide so people have this information. These documents also tell people about the service, what they can expect and what the fees are for. It also tells them something about how the home is run, which enables them to make informed choice about using the service. We looked at the records of the latest admission to the home, which was in a comprehensive, detailed package. Prior to admission senior staff assess each person, (sometimes taking one of the senior care staff with them), to ensure they understand that person’s needs and expectations and whether the home can meet their needs. This is then used as a basis for a fuller care plan. Of the latest admission’s records all these details had been recorded in one document and looked at every aspect of the person’s well being in a holistic way. It was very thoroughly written. This also assists staff to prepare for an admission. People told us they were “comforted” by the amount staff knew about them when they first were admitted. The home does not provide intermediate care and therefore Standard 6 is not applicable. Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10 were checked. The documentation kept on each person using the service is very detailed and evaluated on a regular basis with their or their next of kin’s help. Staff provide a high level of care to each individual. EVIDENCE: Prior to the site visit we sent out a number of surveys to people. We had eleven returned from people who use the service, two from health care professionals and one from a staff member. On the day of the visit we spoke to six people who were living in the home, three relatives, another visitor and six members of staff. We also spoke to some health and social work staff by telephone. Each person made positive comments about the home. Saying Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 12 “staff are excellent” and “it’s a lovely, lovely home”. Others told us how “kind and caring” the staff are and “they are all lovely, no bad apples here”. Of the care they described how staff “give us time to do things for ourselves, which sometimes takes ages, but they are so patient” and “they treat me like a volunteer and when I ask if I can do jobs they find me something, I feel like I am putting something back into the home then”. Relatives told us how welcoming staff are, as did health professional and social work professionals, who also told us how knowledgeable staff are about each individual person. This helps to promote a relaxed atmosphere in the home which enables people to live a comfortable life able to raise concerns, should the need arise. We looked at three care plans in depth. These were very comprehensive documents but detailed. Each had been formulated from the initial preassessment document and were broken down into sections such as mobility, personal care and social needs. The scoring system enabled staff to give a quick overview of a person’s dependency, which helped senior staff to ascertain, overall, whether enough staff were on duty to meet people’s needs. Where necessary a further in depth care plan was formulated which set out the specific need, the objective for that person and evaluation dates. For example where a person had mobility needs which had been picked up at the pre-assessment, a care plan was in place. This was accompanied, on the evidence seen, by a risk assessment which could affect their diet and social needs. It was coupled by a manual handling assessment, which detailed for staff the safe way to move that person. An important aspect of this care plan was also that the person was on medication which could cause easy bruising, which would affect how staff handled that person. This ensured that this person was moved carefully and did not put them at risk from skin damage. In another care plan a person had been assessed as having some weight loss. A specific care plan was in place to detail how staff should address this problem. Such as enticing meals, snacks, methods to encourage a person to eat and regular monitoring. The monitoring also consisted of regular evaluations of a nutritional score, which showed how at risk a person was by their weight, which was recorded regularly. Another care plan detailed the use of aids a person needed to be able to function on a daily basis. The assessments in place considered the use of the person’s Zimmer frame and stand aid, and how these should be maintained. An occupational therapist’s assessment as to what could be tried with this person. These were coupled with the same documents as stated above of assessments, a specific care plan, manual handling assessment, risk assessment and details recorded on a professional person’s sheet when visits had been made by a district nurse or hospital. Also in the records were daily report sheets, which were legible, detailed and signed by each member of staff. This gave a record of how each person had Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 13 been daily, including visits by family, friends or to hospital or GP. The visits by professional people such as district nurses were on a different form, but detailed what they had come for and any new instructions to staff. Where new instructions had been made, the records showed where the care plan had been adjusted. There was also written evidence that people using the service had been able to take part in the planning process and in putting together a profile of themselves. People also told us that “staff ask me on a regular basis if what they are helping me with suits me” and relatives told us that they too are consulted, where necessary. To ensure staff keep the information on each person up to date there were written records to show that senior staff monitor the content on a regular basis and the key worker makes regular evaluations. This ensures that staff keep up to date with peoples current needs and expectations and they are not put at risk of harm. During the day staff were observed delivering personal care to people, assisting them in moving around the home, liaising with families and a GP and chatting both in the home and in the garden area on a one to one basis. Each task was performed calmly and showed dignity and respect for each person cared for. A senior member of staff explained the medication processes which were in place and we were also able observe a medication round. Safe practises appeared to be in place to prevent people from being put at risk. We were informed that no one was using any alternative medicines but that one person could self medicate some medication. This person’s records were checked and they showed when the self assessment tool had been commenced, how this was being monitored, to ensure the person could still safely take medication. The home has also put together a “Flu Pandemic Action Plan” in the event of a major outbreak and had been liaising with the local pharmacy and hospital teams about any flu, bird flu or swine flu concerns. Staff were also able to verbally tell us what training they had undergone to ensure they were safe practioners and how they were still monitored through regular supervision. Safety checks were documented for ordering and receiving medication into the home and there was an up date reference book for staff to refer to should the need arise. This ensures that people will receive prescribed medication when required to help maintain their health and well being. The high level of monitoring by staff of peoples needs ensures they are free from harm and unnecessary risk and that their current needs are being met to ensure their well being and that they can lead as independent a life as their needs and wishes dictate. Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15 were checked. A varied programme of activities and contact with the local community enables people to meet their social, cultural and religious expectations and needs. EVIDENCE: People were able to tell us how they occupy their days. They detailed how staff enable them to take part in such events as card games, social events and crafts. In the care plans we saw that each person had a completed social needs assessment in place, which was evaluated regularly. This was complimented by the records kept by the activities organiser. On a more individual basis these records included who had organised an event, details of the event and what interaction had taken place with that person (for example “they enjoyed this” or “were only an observer”). Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 15 A programme of events was on display and showed a variety of topics covered. This included items which would suit a number of peoples needs. During the site visit staff were observed assisting people with a number of individual tasks, particularly for those with memory loss or were bed bound. There is also a designated staff member to help facility events through out the year. A newsletter has been commenced which keeps people up to date with what is happening in the local community and in the home. People told us how often they like to go out and are enabled by staff to do so. They particularly liked shopping trips, visits to the garden centre and church visits. One person told us how they had been encouraged to keep up their practise with a musical instrument. The home ensures that there are newspapers available each day and library books for people to use. They had recently installed a computer and people can now log time to keep in contact with family and friends and surf the internet for topics and information they require. They also offer regular training sessions, which people told us are popular. These cover topics on health issues and how to look after yourself. We were able to tour the kitchen with a senior member of the catering staff. The Environmental Health Officer had given this home a 4-star rating for standards in the kitchen, which is a high score for hygiene and general running of the kitchen and how it meets people’s needs. Food was seen to be prepared in a clean and safe environment and all written records seen showed that staff were monitoring all aspects of running a clean and efficient kitchen. People told us how much they liked the meals. Making such comments as “if we want more we can have more” and “always offered drinks in hot weather”. Others told us that the standard of food is “excellent” and “I get what I want as I have difficult tastes and needs”. The kitchen staff keep records of peoples likes and dislikes and record when they chat to people about their needs and the menu generally. A varied menu was in place and there was ample evidence that fresh vegetables, fruit and home baking was in place. Sometimes the cook assists people living in the home to put together some baking such as buns for tea but staff put mixes in the oven as a safety measure, which people told us they don’t mind as “saves us bending down”. The staff have also considered the needs of people who can not understand written English and the menus are also in picture format. This can also be taken to someone’s room so they can point to pictures to identify what food they would like if something on the menu is not suitable. The breakfast menu was displayed on Perspex on the tables on our arrival, but showed both hot and cold choices. The rest of the day’s menu was on the individual tables and also on a larger display board, (with pictures alongside each item). Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 16 Staff were seen through out the day assisting people with meals and drinks and each time showed good consideration of each person’s needs. Taking time to allow people, who were having difficulty, to swallow slowly and giving encouragement, where needed, to ensure people take a balanced diet. This all helped to ensure that staff assist where necessary every individual to maintain a balanced and healthy lifestyle and their well-being. Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18 were checked. A robust system is in place to ensure staff can recognise an abusive process and can refer matters if necessary. The complaints system allows people to raise concerns without fear of prejudice. EVIDENCE: People spoken to who are resident in the home could detail how they would raise a concern, should the need arise, and stated that they felt confident that matters would be looked at promptly. The process was on display in the home and was up to date. Since the last inspection no major concerns had been raised to us and the home, when sending in their AQAA listed three concerns they had dealt with internally. When we checked the complaints log during the site visit this information was correct. With only one still awaiting a final outcome. All other concerns detailed when the referral was made, what it was about and the outcome, plus any action if required from the home’s staff or complainant. Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 18 The service also had policies in place which detailed for staff processes they should follow in the event of an abusive situation arising. The staff records showed they had all been trained to recognise abuse. When spoken to staff were able to detail different types of incidents of when abuse may take place and appeared to understand this process to follow and how to use the whistle blowing policy if necessary. The AQAA also listed that the home had had fifteen admissions to the accident and emergency department of the local hospital, five deaths in the home and four admissions to hospital or hospice. The service is required to tell us about such incidents and although we had no record of them sending us these details, there was evidence to support these Regulation 37 notices as they are called had been completed. The manager assured us they had been sent and CQC will check their records. We looked at each individual notice and found that suitable action had been taken in each individual case and a challenge would not have been made by us for each event. Robust systems are in place to ensure people are protected from abuse and can raise concerns where necessary and they will be looked at promptly. Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19 and 26 were checked. People live in a comfortable environment suited to their needs. EVIDENCE: During the site visit we had a tour of the home and looked at all toilet, bathroom and communal areas plus a selection of people’s bedrooms. We also looked at the garden and car parking facilities. There is a rolling programme of maintenance in the home which looks at all areas both inside and outside the home. The handyman works to a 4-week schedule to enable essential work to take place. This also takes into Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 20 consideration items such as water temperature checks and the use of beds and other essential equipment such as bed rails. We visited the laundry area which was neat, clean and tidy. All equipment was in working order and there was an ample supply of linen available which was of a good standard. Separate laundry and domestic staff ensure that there are sufficient clean items available at all times for other staff to use. Each of the sections of the home had been named after local areas for example Appleby is a near by village. This has helped people living in the home to have an identify with where they live and helps them remember local areas. The whole home was clean and in a very good standard of repair. Care had been taken in the lounge areas to develop smaller sitting areas, to break an area down so people are not just sitting in large numbers staring at each other. There was ample space for those to manoeuvre with wheelchairs. In other parts of the home quiet areas had been developed to ensure people could have some space to themselves or receive visitors. A separate area was being developed for the recent installation of a computer system for residents use. The dining area was light and airy and displayed the menus on tables and on a large board. The condiments were clean and where necessary adapted cutlery was available for those who needed it. The home provides a pay phone for those who do not want a separate telephone line, which had a suitable seating area around it. There was also a post box which staff empty daily and will go the local post office on behalf of residents. People told us “this is most useful in the winter months when I cant get out”. The home is trying to be energy efficient and has appointed a “green team” to raise the standards of awareness in the home and ensure staff are as efficient as possible. Water butts for example have been put in the garden areas so plants can be watered from collected rain water. A display is always on show so people can see what the usage of supplies has been at any one time. When visiting individual peoples bedrooms some had pictures up to identify their rooms, which has been a help for those with memory loss. Documented evidence showed that this was only done with that person’s or their advocates’ permission. Others had chosen to have their names displayed and one person said “it helps my family to remember where I am”. Also to help people identify areas the toilet doors were painted red. There was also a reminder to visitors and staff to knock before entering a room. When staff were observed entering a room to give personal care to an individual they displayed a notice which said “privacy required”. They could then perform their tasks with that person undisturbed. There was ample evidence in each of the bedroom areas visited that people can personlise them as their tastes and needs suit. People told us “it was a comfort to bring so many of my personal belongs in with me” and “bringing my Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 21 photos helped me settle in”. Relatives told us that they feel they can contribute to their loved ones care by “doing the odd bit of dusting of their ornaments” and “finding things to decorate their rooms2. The front area of the home was partial car park and a garden. This was accessible for wheelchair users and was very colourful, with shaded seating areas. People told us they like to sit there in warmer weather and watch the bridal parties at the Registry Office next door and people driving and walking to the near by shops. There is further car parking to the rear of the building which was free from hazards. The inner garden had a smoking and non smoking section. It was colourful and well maintained and accessible to wheelchair users. Safety certificates were also seen to ensure us that the management team are making sure the building and all equipment in use is fit for purpose and well maintained and it is a safe place to live and work. Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30 were checked. Robust systems are in place to ensure staff are safe to work with people in the home and they are then trained to do their jobs. EVIDENCE: People told us when they returned our survey forms and when they spoke to us how well the staff look after them. Saying “this has been a good choice of home for me” and “senior staff are very approachable”. Others told us that at night the call bells are answered “very promptly” and “I don’t worry about calling for staff I know they will come quickly”. Others said they were “relaxed” and “had fun” living there as there were sufficient staff on duty at all times to meet their needs. Another person told us how well their “pals” were welcomed into the home. As did relatives, saying “we can always get a good cup of tea”. Staff also told us they felt there was sufficient staff on duty to meet every one’s needs and they could give quality time to each individual. Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 23 We looked at all the rotas for a 4-week period and also the latest staffing matrix which determines the dependency levels of each individual resident. We also looked at the job descriptions for each staff department in the home which showed that tasks were only allocated to suitable departments. For example laundry tasks were predominately the role of designated laundry staff and domestics only. This ensures that the home runs smoothly and all staff have a designated responsibility in their part in ensuring peoples lives, who live in the home, are stress free and their needs met. Five staff files were tracked in depth and there was suffiecnt evidence to show that robust checks had been made to ensure they were safe to work with people in the home prior to the commencement of their employment. Checks had been completed on night staff to ensure their health was suitable for them to be working night shifts. Staff are also expected, and evidence was seen in the files tracked, that staff have seen and understand policies such as confidentiality. There was also, in some files, a 10-year employment history check which is discussed at interview and supervision. This ensures the management team that staff are telling them the truth as at any time this history can then be checked with past employers. The AQAA sent in by the management team prior to the site visit detailed a lot about training which had been completed or was planned in the forth coming months. Staff told us there was always a “selection of training topics to do”. And were able to detail sessions they had individually attended. These were then checked against the training files and found to be correct. The Company has its own training department based in a sister home locally. Written evidence was on staff training files of when they had attended in-house sessions, when external trainers had completed sessions and when there had been a use of videos to teach. As the home has just added the category of dementia to there registration categories the most recent training recorded for staff has been on this topic. Since the AQAA had been completed which had stated 50 of staff had achieved their NVQ awards at level 2 or 3, this figure has risen to 65 . A high level, above the minimum standard required. The training matrix kept by the management team has split the training into three block sessions each year, which they say suits their training needs and the commitments of staff. This ensures that during any one period all statutory training can take place and topics slotted in for specific topics such as infection control. The individual supervision records seen also highlighted training needs of staff on an individual basis. This ensures that people can be looked after by staff who are trained to recognise their particular needs and are safe practioners. Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31,33,35,36 and 38 were checked. Peoples views are sought to ensure the home is being run for their benefit and their individual needs are being met. Policies and procedures are in place so staff can ensure people are free from harm. EVIDENCE: Since the last inspection the manager has become registered with CQC and has also completed their Registered Manager’s Award plus other training. This Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 25 ensures this person has the skills to lead their team and is up to date with the latest practises to look after people in their care. The management team and other senior staff and the owners have put together an effective quality assurance tool to enable them to monitor the needs of individuals and the safety of the building. There was written evidence that they frequently ask the opinions of people living there by surveying them on different topics and having group and individual meetings. People also told us they are frequently asked if “I am happy” and “is everything done right for me, which it is”. Regular audits also take place by the local team and also the training manager. Records were seen of recent health and safety and kitchen audits. And meetings with staff and relatives. The local management team also complete weekly and monthly monitoring sheets on various aspects of running the home, which are submitted to the owners. They in turn complete site visit forms, called Regulation 26 notices, which have to be open for CQC inspection. These were seen during the site visit and found to take place on a regular basis, which has assured as of the continual monitoring of the home by the Responsible Individual for the Company owning the home or their representative. Staff have also produced an action plan for “going green” and have implemented the first part of this as part of their energy efficiency drive. The team consists of staff from each of the departments plus a resident. The management team also take into consideration the financial aspects of running the home and ensuring the business plan is adhered. This ensures the home is not allowing finances to compromise the delivery of care to individuals. During the site visit we were given information about a bad debt a relative had incurred, but the evidence stated that this was in hand and did not compromise anyone else’s finances. Three personal allowance records of people living in the home were checked and found to have accurate recordings with no suggestion of any fraudulent use of funds. There is limited access to this information excepting most senior management staff. The home has also achieved two outside agency awards. The Local Authority of North Lincolnshire has an award scheme based on specific criteria for homes to achieve. The highest award is the gold award which this home has achieved. This showed excellent results in each area covered. It has also been awarded the Investors In People award for the standard of training and care it gives to its staff. The business plan the company produces was last reviewed in January 2009 and was very detailed about what the company was currently doing, what market forces were in the area and its strengths and weaknesses. It was also Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 26 looking to the future and how it can improve services for the people living in the home. Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 3 X 4 Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 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. Refer to Standard Good Practice Recommendations Ascot House DS0000062843.V377589.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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