Care Home: Ascot Lodge Nursing Home

CARE HOMES FOR OLDER PEOPLE Ascot Lodge Nursing Home 48a Newlands Road Intake Sheffield South Yorkshire S12 2FZ Lead Inspector Marina Warwicker Key Unannounced Inspection 19th January 2009 10:20 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 Lodge Nursing Home DS0000021765.V373753.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 Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ascot Lodge Nursing Home Address 48a Newlands Road Intake Sheffield South Yorkshire S12 2FZ 0114 264 3887 0114 264 3969 ascotlodge@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd 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) Kerry Angela Green Care Home 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care Home with Nursing Dementia over 60 years. Date of last inspection 11th March 2008 Brief Description of the Service: Ascot Lodge is a purpose built fifty-bedded home providing service for older people with dementia. The home is situated in the Intake area of Sheffield. It has good access to public services and amenities. The accommodation is on two floors and each floor is divided into two units. Each unit has it’s own dining room and lounge. Most rooms are single with ensuite facilities. There is a car park to the front. The weekly fees during our site visit were between £372 and £622. The administrator explained that the fees were charged according to the dependency levels of the individuals and also according to source of funding. The people using the service buy their own toiletries and pay for hairdressing and chiropody with their pocket money. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. An inspection of Ascot Lodge was carried out by a lay assessor who is an expert by experience and myself (a regulation inspector) on Monday 19th January 2009 between 10:30 am and 4:30 pm. The staff, the management and the people using the service were not informed of our first visit and therefore it was unexpected. Five people were consulted and ten people were observed. Four relatives, three professionals and seven staff were spoken with. We sent out surveys to staff and multidisciplinary professionals seeking their views of the service. Comments received from the surveys have been included in the body of the report. Any comments received after the publication of this report will be shared with the management of the home. Time was spent observing and chatting with people using the service, the staff, the management and the visitors. We gave feedback throughout the day to the manager. Another home manager joined us during the latter part of the inspection and were both present at the final feedback. The premise was inspected, which included bedrooms of the people using the service, the communal areas and the service areas such as the kitchen and the laundry. The outside areas surrounding the building were also checked. Forty-eight people were using the service on the day of the site visit. Samples of individuals’ care plans, daily records; staff recruitment and training files were some of the records checked. We would like to thank the people who live at Ascot lodge, their relatives, and the staff who took part and the management including the visiting manager for their contribution towards this process. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home is in receipt of sufficient funding so that the people at the home are able to receive appropriate food at the correct intervals. The people using the service have access to drinks and snacks throughout the day. The management of the home have ensured that suitable arrangements are in place for the disposal of general and clinical waste to avoid health & safety hazards. Some parts of the home are free from offensive odour. The action taken has included eliminating the unpleasant odour emitted from the hairdressing room. The management have ensured that at all times there are sufficient numbers of staff employed to promote the health safety and welfare of those living and working at the home. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 7 The staff rotas are completed in advance to ensure sufficient staff have been allocated for the shifts. The management have taken reasonable actions to protect the people using the service and the staff working at the home by; taking prompt action when staff receive bruises from people using the service. Using bank and agency staff during shortage of staff so that one carer is left on the unit where people are having to be moved using the hoists; thus preventing the staff and the people using the service from injury. Making sure that the care staff receive handover prior to commencing their shifts. Therefore being aware of the changes during the previous shift. Appointing a co-ordinator to be in charge if the manager is away. Maintaining records of activities and the involvement of each resident to make sure everyone is given an opportunity. The management creating a positive and inclusive atmosphere so that the staff are encouraged to be creative, innovative and take ownership of their best practices. The care staff feel part of the team. The complaint procedure ensures that following complaints, the complainants are confident that the action taken by the management would help the other people. The staff meetings are used to include staff ideas and listen and discuss matters involving the running of the home. What they could do better: The management need to carry out an environment audit and take immediate action to eliminate the underlying stale smell around the home. The rigorous cleaning of floors and carpet has not helped and therefore replacement is required. The repair work needs to be prompt and there needs to be system for monitoring it. Daily checks by the person in charge and the unit managers need to ensure that: • Alarm cords are accessible to residents at all times so that they are able to summon help, • Footstools are used to help the residents sit comfortably, • Maintain records of checks carried on those who stay in their rooms so that they receive food and fluids and also keep in contact with staff. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 8 • Persuading residents to move by changing their position and encouraging residents to use the toilet to prevent pressure sores and urinary incontinence. 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 Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 9 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 Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 10 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&5(6 Not applicable) People who use this service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service People who may wish to use the service have the information needed to make an informed decision about the home. EVIDENCE: We spoke to three visitors and two staff to find out the process for admitting people into the home. We also checked four recently admitted peoples’ needs assessments, which had been completed by the placing authorities. The following were our findings. All four new admissions were referred to the home with up to date multidisciplinary team assessments by the placing authorities. The staff said that the manager or one of the senior nurses visited the people in their Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 11 environment (in their own homes or in other care settings) and made further assessments to make sure they were able to meet the needs of the individuals. Two relatives said that people had come to live at Ascot Lodge through recommendations from relatives. We found out that the majority of people using the service were unable to visit the home and make their own judgement due to their deteriorating condition. Therefore placing authorities carried out reviews following admission to ascertain whether the people were settling in or not. The care staff said that each individual took a different length of time to settle in and some never settled and wanted to go home since they were unable to understand why they had come into the home in the first place. We observed the residents to be contented and comfortable. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 12 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 & 11 People who use this service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice by the staff and monitored by the management of the home. EVIDENCE: We observed the residents, checked four care plans, consulted three visiting professionals and interviewed five staff on duty. The care plans had been prepared from the individual assessments. There were several examples where the care plans had been changed to reflect the changing needs of the people. During interviews, the staff said that until they developed a good rapport and gained the trust of the residents they kept close and regular contact with the Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 13 relatives. One staff said, “It takes time to get to know the residents and the families and develop mutual trust. We are mindful of the anxiety of the next of kin when they leave their loved ones with us.” Another said, “A lot of the relatives work and are unable to visit every day so it is important for them to speak to us and find out how their mum or dad has been. It is better if we have met them and get to know them.” One of the visiting professionals said that the staff were open to suggestions and not shy to ask for help/advice and that the staff worked hard and looked after the residents well. Another said, “I observe what goes on here when I visit. The staff are very kind and comforting towards the ones who are anxious. I see them helping with drinks and spending time with the residents.” During the tour of the premise we noticed that there were five residents who remained in their bedrooms. Apart from two who were nursed in bed due to their condition, the others chose to stay in their rooms. The manager and the staff told us that none of the residents had pressure sores. We witnessed residents who were prone to developing pressure sores were being turned regularly and records maintained by the care staff. Those residents we observed were clean and nicely dressed although two ladies were not wearing socks or stockings. Residents were sitting in the lounges and listening to music. Staff were seen spending time talking to residents and one resident was helped to the toilet and then onto the ‘smoke room’ for a cigarette by a care staff. Several residents were asleep with blankets over their knees. One lady was in a special chair. We did not see many footstools in the lounges and none of the residents had their feet on footrests. Whilst there were occasional tables for drinks in the lounges there were one or two residents who could not easily access these. Not all the residents had easy access to the ‘alarm assistance call cord’. Sometimes they were behind the chair they were sitting on or placed by the headrest where the resident was unable to find it easily. We observed a nurse administering medication to residents in one of the units. We noted before moving on to the next resident s/he made sure the person had taken the medicine. The supplying pharmacist had carried out medication audits and made some recommendations to improve the management of medicines. The manager said that these were actioned by the nurses. The nurses said that the disposal of medication was contracted out and it was collected regularly from the home. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 14 The general practitioner visited the home each Monday and saw people who needed medical attention. During this visit reviews of medication also took place. We sought comments from the general practitioner. She was happy with the care the people received and the commitment shown by staff. She said that weekly visits helped her maintain contact with the residents and review their medical management. We observed the staff treating the residents with dignity and respect. One of the staff said; “I always think that it could be my mum/dad and what they would like. Often they’re not here through choice but because of their illness and they can’t do anything about it.” Some residents thought staff were prompt in attending to them if anything was wrong. However, one visitor thought that the staff were not quite good at asking residents if they wanted to go to the toilet and this left his/her relative sometimes wet and a bit sore; another relative said that whilst his/her relative was taken to the toilet before tea, the staff did not come round asking if the others wanted to go to the toilet. Staff said residents were taken to the toilet after lunch and before tea and that any accidents were dealt with immediately. We also asked the manager and two care staff how they made sure people were toileted during the day. The following were some of their comments. “Toileting people needs to be discreet. As part of maintaining the individuals’ privacy and dignity we don’t ask people in the communal areas especially when visitors are around, but take them for a walk.” “Sometimes when we take people to the toilet they are not successful but soon after returning to their chair they become incontinent. They can’t help it so we then take them and change them.” “Some of the behaviour in residents indicate (e.g. agitation) that they want to go to the toilet and we take them straight away. Don’t forget there are two care staff for a unit and we get to the residents as soon as we are able to.” There had been some bereavement during the past months within the home. The staff said that they had support and training in the way to care for people during end of life and also how to take care of the relatives. One staff said;” I make sure they are kept clean and comfortable and the family are kept informed. I always talk to the person even though they may not respond.” Ascot Lodge Nursing Home DS0000021765.V373753.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 People who use this service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service People who live in Ascot Lodge are able to make choices about their lifestyle, and supported to maintain their life skills as much as they are able to. A notice in the reception area outlines the arrangements for social, cultural and recreational activities but there was a lack of evidence on the day of the site visit of any activities. EVIDENCE: At the entrance we noticed a list of activities displayed for each day of the week. However, on the day of the site visit we did not witness any formal activities. On questioning we were informed that the activities co-ordinator was on leave and that they had not allocated anyone to co-ordinate the activities that week. We saw staff spending time with groups of residents chatting. In one unit staff were dancing to music with residents. The manager informed us that usually a care staff was allocated the job of co-ordinating activities during holidays and that it was an oversight that no one was responsible that week. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 16 We saw relatives visiting during the day. They were made welcome by the staff at the home. One person said when they wanted to spend time alone they used the bedrooms of the residents or if the dining room was free they went in there. Due to the medical conditions of the people using the service, the family or their advocates handled their finances. Two relatives and the administrator for the home confirmed this. The lunch was observed and our Expert by Experience had lunch with some of the people using the service. Her observations were as follows: Meals were brought to the Units by the kitchen staff but meals were taken to each resident by care staff. Meals were served in shallow dishes. Staff said this was easier for the residents to handle. The food was hot and nicely served. A hot sweet was served and yoghurt was available for those on a diabetic diet. There was also a jug of soup and a plate of sandwiches on the trolley for anyone who did not want their meal. One resident having finished her meal started eating another resident’s lunch who wasn’t eating; when staff noticed a further meal was immediately brought for that resident. The residents said they enjoyed their meals and that the food was nice; a visitor too confirmed the meals were nicely presented “and the puddings lovely”. Juice was served with the meal. One resident thought there was no choice of meal but this may have been because she had chosen the meal the day before. At lunchtime the staff did not remind residents what meals they had chosen. Two residents were assisted with their meals; this was unhurried and on a one to one basis each carer sitting at the table with the resident. A resident had lunch in the lounge; the staff promptly cleaned the table and chair following lunch. One resident was offered her meal in her room as she had a visitor. There were food supplements given to those who were unable to have a wholesome diet. One of the relatives said; “The staff tell us the day before what is for dinner and I can tell the staff if it’s not suitable. But there is no point in telling X because X can’t remember.” Another relative said; “I like to feed my H so I am here most meal times. I see staff sat with the ones who can’t feed themselves and helping them. Recently the meal times have been better and there seem to be staff about the place to help the residents.” Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service People who use the service are able to express their concerns and have access to a complaints procedure. The people using the service and the staff working at the home are protected from abuse and their rights are protected by the management and the systems in place. EVIDENCE: We checked the complaints records; spoke with the visitors and the staff to find out how the management handled formal complaints. There had been four complaints during the past 12months. These complaints had been investigated and reports had been prepared with action points to make improvements when the issues raised had been upheld. We were informed by the staff when concerns were raised by the relatives, they try to correct the issues immediately if possible and let the nurse in charge be aware of the complaint. Two relatives were asked for their comments. One said that s/he used the open door policy of the manager and discussed any matter however small it might be and did not leave matters to escalate and get out of context and become a complaint. The other said when concerns were raised s/he had to keep chasing the staff and reminding them of the issues since some staff did not read the care plan and were not fully informed of the residents needs. A relative had expressed concerns to the manager that Bank Staff to be made aware of the procedure of Ascot Lodge when to call the general practitioner, Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 18 when to inform relatives and the passing on of information between shifts. The same person told us that there had been other issues with regards to the home and that they have spoken to the manager and that they were been dealt with. Three staff training records were checked and there was evidence that they had received training on Protection Of Vulnerable Adults. Two staff interviewed were able to tell me what actions they would take if they were to witness any type of abuse at the home. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 25 & 26 People who use this service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service The physical design and layout of the home enables people who use the service to live in a safe and comfortable environment, which encourages independence. However the continuing problem with the odour from the floor covering and ventilation needs attention. EVIDENCE: We measured this outcome area from a tour of the premise, speaking to the residents, the visitors and the staff and also using our observations on the day. The outdoor area was tidy and kept safe allowing access for the people using the service during warm weather. The corridors were colourful with lots of pictures posters and memorabilia on the walls. The lounges had budgies in cages, televisions and music centres. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 20 There was signage with pictures for the toilet and bathroom in the corridors. The Dining Rooms were pleasant with decorations on the walls. A programme of routine maintenance and renewal was in place. We made the following observations. When we entered the home at around 10.30 am there was a stale unpleasant smell at the reception area. During the tour of the premise one unit in particular emitted unpleasant urine/faecal smell. Some bedrooms too emitted urine smell and the manager said that there was an ongoing programme of replacing floor covering in the home. Although carpets have been cleaned regularly there was an underlying smell of stale food and urine. Two toilets were out of order and one had been reported on 7th Jan 09 to Southern Cross estate management and on 19th Jan 09 no action had been taken. This toilet was the nearest to the dining room and would have caused difficulty for the residents on the unit. Discussions took place as to the lack of efficiency of the extraction fan in one of the toilet opposite to the dining area. This area including the corridor emitted unpleasant smell due to the lack of air extraction after usage of the toilet. Bedrooms were kept personalised and tidy. They were heated and people were able to adjust the setting if they so wish. The staff said that they had sufficient aids, hoists and equipment to help them look after the people. Laundry facilities were sited away from the food preparation area. The laundry assistant was on duty during our visit. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 21 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 & 30 People who use this service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service The staff working at the home are trained, skilled and employed in sufficient numbers so that they are able to support the people who live at Ascot Lodge and contribute to the smooth running of the service. EVIDENCE: The staff rotas were completed in advance and the manager said that they took every effort to use bank or agency staff if there were to be any shortage. We looked at 3 weeks rota and there had been sickness due to the winter ‘flu’ epidemic and extra staff had been brought in to help. Domestic staff were also employed in sufficient numbers to deal with cleaning cooking and house keeping. Generally staff were happy but one member of staff did not think two were enough to deal with the residents’ personal care and everything which had to be done and wanted to be done. Our expert by experience entered a resident’s room with his/her visitor and found another resident going through the wardrobe. The relative wondered why the rooms were not locked when residents were not in them. Locking rooms can be construed, as restraint i.e. stopping access to ones room. But to Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 22 avoid such incidents there need to be adequate number of staff around to supervise the residents. The care staff were given the opportunity to take part in National Vocational Qualifications in care and this had been taken up by most care workers. We checked four staff training records and spoke to two staff about the training they receive at the home. Records checked were up to date. One staff said, “I have received more training here than I had in the last employment. They are good at putting us down on study days.” “Manager is aware of my development needs. She includes me in training and other workshops.” Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 23 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, 36 & 38 People who use this service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service The management and administration of the home is based on openness and respect to those who use the service and those who work at the home. The management have developed effective quality assurance systems and the staff are encouraged to use the tools and monitor the service. EVIDENCE: The manager is an experienced first level nurse with many years of management experience. She and the senior staff were familiar with the disease and conditions associated with old age, especially caring for those with Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 24 Dementia. We observed that there was a clear line of accountability within the home. There were minutes of staff and relatives meetings held by the management during the last year to seek peoples’ views of the service. The staff too have completed audits involving the people using the service in order to self monitor. We sought three peoples’ comments. One person said that they did not know that there had been relatives meetings and that if it were during the day they would not be able to attend due to working arrangements. The other two said that they meet with the nurse on the unit or the manager and raised any issues they want to discuss and did not feel the need to attend meetings. Two care staff and a nurse told us that they received regular supervisions and support from their line managers and that they found this very useful. During the record checks there was evidence of staff supervision. The manager had records of all accidents, injuries and incidents and these events have been notified to the Commission for Social Care Inspection. The staff training records showed that there was a rolling programme of training on health & safety, moving & handling, fire safety, food hygiene and Infection control. The manager confirmed that all service certificates (such as lift checks, electrical circuit, portable appliance checks ---etc.) were up to date and that regular maintenance checks had been carried through. Two recently employed staff confirmed that they had induction training and worked alongside experience staff before they were allowed to work on their own. The manager showed us the completed induction workbooks of two staff; they were in line with the Skills for Care training standards. Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 25 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 4 X 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X X 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP26 Regulation 13,16 Requirement All parts of the home must be free from the underlying stale offensive odour. Previous requirement 27/04/07, 02/05/08. The staff must make sure that call alarm cords are accessible to people at all times especially those who remain in their bedrooms so that they are able to summon for help. Immediate Repair work to the toilets must be carried out without delay. Timescale for action 31/03/09 2. OP38 16 19/01/09 3. OP19 23 19/02/09 Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 27 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 OP12 Good Practice Recommendations Arrangements should be made to cover the activities coordinator’s holidays so that people using the service are able to continue taking part in activities to keep them stimulated during the day. The staff should be able to prove that they have had contact with residents and that they had kept a check on those who chose to stay in their rooms. So that the residents had been offered drinks, meals and toileted during the day. The staff should make sure that the residents are regularly persuaded to change position and move to promote pressure relief and also encourage residents to use the toilet. The footrests should be used to elevate legs and make people comfortable when sitting out. However if people did not want to use or it is deemed hazardous to the individuals then it should be recorded in the care plans. 2. OP8 3. OP8 4. OP8 Ascot Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Lodge Nursing Home DS0000021765.V373753.R01.S.doc Version 5.2 Page 29 - 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. 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