Care Home: Ascot Nursing Home

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What the care home does well There is a nice atmosphere in the home and staff are friendly. The home provides a good range of activities that residents like to take part in. Comments offered by residents are as follows, "Nice food." " Nice home it is cleaned everyday". "The staff are very kind". "On Thursday we have bingo or a blind card, I go to that." "We do cake decorating" "On Saturday we had a BBQ, it was a brilliant day despite the weather" "The other week we had a gentleman entertainer" "I have been up to the Village with care staff, I would like to go out a bit more" Comments offered by relatives are as follows, "The home is very good at keeping us informed". "I think the staff do everything to meet peoples needs and more". "The activities coordinator is fantastic". Each vacant room is nicely set out and has a welcome pack that includes information about the home and also a gift basket for each prospective resident. This contains an assortment of toiletries and a cuddly toy and offers people a pleasant welcome when moving into the home. The residents receive nice appetizing meals of their choice and any special diets are catered for. A good range of activities is available to the residents. The home is well maintained and any repairs are addressed quickly. What has improved since the last inspection? The complaints policy has been updated to include information about how any complaint can also be referred to other agencies such as the Local Authority and the Commission. The home has employed a maintenance person. A range of new equipment has been provided in the laundry, kitchen, and dining room. And new furniture and carpets have been provided throughout the home. Staffing levels have been increased to provide extra cover and support for residents. And robust recruitment, induction and training are in place for new staff. Regular fire alarm tests are carried out and staff has received and are receiving updated fire training. Records are kept to confirm that regular checks of hot water are carried out to ensure that it does not exceed the recommended safe temperature. Improvements have been made to the records that are used to record monies held on behalf of the residents. With a receipt being obtained for any expenditure. The systems in place for the ordering and disposal of prescribed medicines are more robust and minimise the potential for an error to occur. CARE HOMES FOR OLDER PEOPLE Ascot Nursing Home 19-21 The Crescent Linthorpe Middlesbrough TS5 6SG Lead Inspector Clifford Renwick & Gerard Morris Key Unannounced Inspection 8th September 2008 09:00 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 Nursing Home DS0000061594.V366350.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 Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ascot Nursing Home Address 19-21 The Crescent Linthorpe Middlesbrough TS5 6SG 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) 01642 825283 01642 850412 ascotnursinghome@btconnect.com Mr George Dixon Mrs Susan Olive Ellis, Mrs Angela Catherine Allick, Mr Michael Dixon Ms Angela Catherine Allick Care Home 32 Category(ies) of Dementia (32), Old age, not falling within any registration, with number other category (32), Physical disability (5) of places Ascot Nursing Home DS0000061594.V366350.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 with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 32 Physical disability - Code PD, maximum number of places: 5 2. Dementia - Code DE, maximum number of places: 32 The maximum number of service users who can be accommodated is: 32 20th July 2007 Date of last inspection Brief Description of the Service: Ascot Nursing Home is registered to provide personal and nursing care to thirty-two older people. The home is a three-storey building providing single and double room accommodation. There are thirty single bedrooms, five of which have ensuite facilities, which comprise of a toilet and sink. There is one double bedroom with ensuite facilities. All bedrooms in the home environment meet space requirements of National Minimum Standards. There is a passenger lift giving access to upper floors. There is one large lounge, an adjoining quiet lounge and a dining room. Externally there is an enclosed garden area with patio for residents to enjoy. A small amount of car parking space is available at the front of the home for visitors. The home is situated on The Crescent in Linthorpe and as such is close to shops and amenities. The cost of care at the time of the inspection visit ranged from £405.00 to £550.00 per week. Ascot Nursing Home DS0000061594.V366350.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 stars. This means that the people who use this service experience good quality outcomes. Before the visit: We looked at: • • • • • • Information we have received since the last visits in July 2007 and from the annual service review that was completed in March 2008. How the service dealt with any complaints & concerns since the last visit. Any changes to how the service is run. The provider’s view of how well they care for people. The provider in the annual quality assurance assessment (AQAA) submitted information to confirm what they are doing in the service. We looked at information we received in surveys from staff, residents and their relatives and other professionals who use the service. The Visit: An unannounced visit was made on the 8th September 2008. During the visit we: • • • • • • • Talked with all of the people who live in the home and also staff who were on duty. Held discussion with the manager and assistant manager. Observed staff working practices. Looked at information about the people who live in the home & how well their needs are met. Looked at other records, which must be kept in relation health and safety and staffing. Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. Looked around the home to make sure it was well maintained, safe and free of any hazards. DS0000061594.V366350.R01.S.doc Version 5.2 Page 6 Ascot Nursing Home • • We also gathered information from looking at care records to assess how staff supports the residents with their assessed needs. We also focused upon looking at care files for 3 residents as a part of the inspection we refer to this as “case tracking”. And this involves looking at all records of the care for a named individual. We told the manager what we had found. What the service does well: There is a nice atmosphere in the home and staff are friendly. The home provides a good range of activities that residents like to take part in. Comments offered by residents are as follows, “Nice food.” “ Nice home it is cleaned everyday”. “The staff are very kind”. “On Thursday we have bingo or a blind card, I go to that.” “We do cake decorating” “On Saturday we had a BBQ, it was a brilliant day despite the weather” “The other week we had a gentleman entertainer” “I have been up to the Village with care staff, I would like to go out a bit more” Comments offered by relatives are as follows, “The home is very good at keeping us informed”. “I think the staff do everything to meet peoples needs and more”. “The activities coordinator is fantastic”. Each vacant room is nicely set out and has a welcome pack that includes information about the home and also a gift basket for each prospective resident. This contains an assortment of toiletries and a cuddly toy and offers people a pleasant welcome when moving into the home. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 7 The residents receive nice appetizing meals of their choice and any special diets are catered for. A good range of activities is available to the residents. The home is well maintained and any repairs are addressed quickly. What has improved since the last inspection? What they could do better: The manager must ensure that a written record is kept on the administration records for prescribed medicines if for any reason medicines are omitted. All staff that issue prescribed medicines must undertake accredited training in order to support them with their work. The manager should consider reviewing some of the dining room practices, which should include introducing menus in the dining room, and withdraw from use the large teapot that is currently used to serve hot drinks. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 8 With steps being taken to look at supporting the independence of those residents who are able with smaller teapots. Steps should be taken to increase the temperature of hot water used for bathing to as close to the recommended temperature of 43 degrees centigrade. As water tested in two bathing facilities was registering as 38 degrees and could be seen by some residents as being to cool for a bath. The manager should ensure that all staff has signed their conditions of employment. When receiving receipts for resident’s expenditure the manager should number the receipt and then enter this number on the transaction sheet. This will assist in retrieving information and also with the audit process that the home carries out. Staff should sign the fire record that confirms they were present during a fire drill. 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 Nursing Home DS0000061594.V366350.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 Nursing Home DS0000061594.V366350.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&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A full pre-admission assessment of needs ensures that new residents are offered the right type of care at the home. Intermediate care is not provided in the home so this standard was not assessed. EVIDENCE: Three resident’s files were looked at as part of a process we refer to as case tracking. Each of the files contained assessment information, which confirmed that an individual assessment of need had been carried out prior to admission into the home and from this the staff had developed written plans of care. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 11 Discussion with the assistant manager confirmed that a prospective resident is always seen by the homes staff prior to being offered a place in the home. Families of a resident are also involved in the assessment process and offer additional information to staff so that a care plan can be developed that demonstrates how staff will meet assessed needs. The home use a standardised document referred to as “NAPA” as part of the assessment document and this includes a section known as a daily living planner. This is a good way of staff compiling a full social history and background of the person to assist with the care process. Staff are currently developing these documents and as such some were undated so it was not easy to determine when they were introduced for each individual. Ascot Nursing Home DS0000061594.V366350.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive care in a way that they prefer and health care needs are effectively met and medication administration follows good practice. These ensure that residents’ general health and wellbeing are safeguarded and promoted. Furthermore, excellent staff interactions with residents confirms that residents are treated with dignity and respect at all times. EVIDENCE: We looked at the records of care for three persons and this process is known as case tracking where we look at the information held about each person. The three files we looked at confirmed that each person has a written plan of care that confirms how staff will assist residents with their assessed needs. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 13 The files contained an appropriate assessment of needs and from this an individual plan of care has been developed. Where possible the resident and their relative has been involved in the development of the care plan. The layout of the care plans and the fact sheet that supports them list every individuals needs and what support is required by staff. The care plans are clear and easy to understand. This ensures that staff knows what they have to do and also if any relief staff are used in the home they too are clear about an individuals needs. Regular health checks are carried out by staff, which includes monitoring residents weight and blood pressure. If required advice is sought from the G.P and for those residents who require support from the community nurse staff arranges this. Good records are in place to confirm when a resident has been seen by a health professional. For those people who may be at risk of developing pressure sores appropriate assessments have been completed. Positional turn charts are in place to instruct staff what to do and when as part of the care process and this has ensured that people have not developed pressure sores. A falls assessment is also carried out for those people at risk of falling and appropriate equipment is ordered to support people identified as being at risk. Though this was noted on the records for one person there was no date to confirm that the equipment had been obtained. And this was discussed with the manager who was advised to ensure that these records were updated. The home operate a key worker system and this means that every resident has a named worker as well as a named nurse who are responsible for dealing with personal areas of care. Care plans are evaluated every month and if there is any change in needs this is documented so that staff can continue to deliver care consistently. Medication is dealt with in accordance with the appropriate guidelines. The manager has also implemented a regular audit of the medication systems to ensure that staff follows the correct guidelines. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 14 However there were several gaps on administration records and as such it could not be confirmed if a resident had been given this medicine or not. A record should always be kept on the administration sheet stating the reason if a medicine is omitted and this was discussed with the manager. Only staff that hold a professional qualification administer prescribed medicines and the manager deals with the monthly ordering of medicines. An audit system is in place to ensure that the correct medicines are ordered and any medicines that are not required or require disposal are dealt with using the appropriate guidelines. It was good to see that one resident has been supported to continue to manage and administer his or her own eye drops. None of the staff that administer medicines have undergone accredited training and this was discussed with the manager with advice being offered as how to access accredited training. Ascot Nursing Home DS0000061594.V366350.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 good. This judgement has been made using available evidence including a visit to this service. Residents lead fulfilling lifestyles with support from staff to exercise choice and control over how they spend their day. People’s lifestyle is good with regular contact being maintained with relatives and friends and the residents receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: A range of activities are carried out in the home and a list is on display in the main lobby that reflects what is happening on a day-to-day basis. The home have their own activities coordinator who is instrumental in organising a range of activities that reflect residents interests. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 16 Staff spoke of the garden fete that was held earlier in the year and how this was successful both financially and in terms of enjoyment for those residents who contributed to the fete. Residents were complimentary about the level of activities provided in the home. “ I like to read. The library visits the home every 3 weeks. I get 4 or 5 books.” In discussion with residents they confirmed that staff respected their privacy and dignity. Residents are free to choose how they spend their day and a number of residents spend time in their rooms before joining other residents for meals. Records available confirmed that people could get up when they want and choose what time they go to bed. Residents meetings are held 2 monthly and minutes are kept of these. These demonstrate how the resident’s views are sought on all matters relating to the home. As a suggestion made at a residents meeting menus were changed to include meals that the residents wanted included. A newsletter is also compiled giving an update on what is happening in the home. This is not currently circulated to residents and their families but is displayed on the notice board in the main lobby. There are no restrictions on visiting the home and residents are able to maintain contact with friends and family. Comments made by relatives were, “We looked at two or three homes but this one was the best” “I am made to feel welcome on my visits to the home. I always get offered a cup of tea but I never have one” Lunch was taken with the residents and this was a good opportunity to have a conversation about the food provided in the home. The dining room was nicely set out and tables were set with tablecloths and crockery and napkins. The meal was very tasty, hot and well presented and of sufficient quantity. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 17 Residents said that the food was always nice and that there was always a choice. Other comments made were, “I don’t care for the dinners but that’s not the home that’s me. I have a good breakfast. I have porridge then a fried egg sandwich or toast and marmalade” “The food is very good” There were no menus available in the dining room to refer to however discussion with the cook confirmed that there is a menu in place. And each resident is asked on daily basis what he or she would like to choose from the menu. This operates on a seasonal basis, spring, summer, autumn and winter with meals being changed according to the season. Discussions with the cook confirmed that an alternative meal is always available and records were in place to confirm that this does happen. The cook also has a record of special dietary needs and provides a variety of meals to meet people individual health requirements. Though tables are nicely set the residents are served their tea from a very large teapot by a member of staff. This takes away the opportunity for those residents who are able to serve their own tea. Ascot Nursing Home DS0000061594.V366350.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. A clear accessible complaints procedure gives residents and their relative’s confidence that they will be listened to and taken seriously. The manager and staff have a good understanding of local adult protection procedures, which helps to ensure the protection of residents from abuse. EVIDENCE: The complaints procedure is on display and information is also given out to residents and their families when first moving into the home. Staff were clear as to what action they would take if they received a complaint and a record would be kept detailing what actions are taken in respect of a complaint that is made. In discussion with residents they said that they had no complaints and went on to say, “I am quite content, I am quite happy” Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 19 “I’ve been in the home since March 2008. It took a bit of settling, but everything is fine now. The staff are very good”. Staff have received training in safeguarding adults and in discussion confirmed that they have a good understanding of the homes policies and procedures. Staff offered clear examples as to what action they would take and whom they would report it to if they suspected any resident of being at risk of abuse. The manager confirmed that training in safeguarding adults is ongoing for all staff. Ascot Nursing Home DS0000061594.V366350.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, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, well maintained and has a good range of facilities. This promotes a positive image for residents and furthermore ensures that they remain safe and well. EVIDENCE: Within the inspection, all communal areas and a number of residents’ bedrooms were viewed. This also included the external garden area, which staff refer to as the sensory garden, and the rear patio area that residents and staff can use as a smoking area. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 21 Residents have been encouraged to personalise their bedrooms with items that they have brought into the home with them. This made each room different and gave a homely feel to the room. All areas of the building were clean and maintained to a good standard, with no noticeable defects or safety hazards with the exception of the rear patio area. In the patio area there is a low-level heating vent protruding from the wall that is close to where people sit. And though protected by a grille could potentially be a hazard due to the hot fumes. This was discussed with the manager who took immediate steps to deal with this. There is a dedicated housekeeping team who are responsible for cleaning the building and there were no unpleasant smells anywhere in the building. Lounges were comfortable with a range of specialised chairs for those residents who required additional support. Staff record hot water temperatures at baths weekly and other outlets such as sinks on a monthly basis and a record is kept in a logbook. This is to ensure the health and safety of the residents and to ensure that hot water does not exceed the recommended safe maximum bathing temperature of 43 degrees centigrade. We tested hot water temperatures at all bathing points and this confirmed hot water in one bathroom and one shower did not exceed 38 degrees centigrade. This is lower than the maximum recommended temperature of 43 degrees centigrade and may seen by residents as being to cool. This was discussed with the manager who made arrangements for the thermostatic vales to be adjusted. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to ensure that residents’ needs are met and staff receive sufficient training to support them in their work, to ensure residents receive good quality care. Furthermore robust recruitment procedures are in place to prevent unsuitable people being employed. EVIDENCE: A good level of staffing was on place during our visit and this included qualified nurses, care staff and staff that dealt with housekeeping and catering. In addition to the nurse in charge there is also a person who works as a residential manager and has responsibility for supervising care staff whilst working along side them Administrative support was also available which meant that the nurse in charge did not have to deal with all administrative matters. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 23 The home has continued to work extremely hard to assist care staff to undergo NVQ training. 98 of care staff working at the home have achieved an NVQ level 2 in care. All staff receives formal supervision and the manager has linked this to cover the National Minimum Standards. This has assisted in giving staff guidance as to how they should be working in the care home and how the National Minimum Standards have to be met. Files were looked at for persons most recently employed in the home and this confirmed that a thorough process of recruitment was in place. And this ensured that all of the necessary checks are carried out before someone is employed to work in the home. These checks include taking up references, full employment history and the necessary criminal record bureau check to prevent unsuitable people being employed. When commencing work in the home staff undergo induction training and their work performance is evaluated after a given period of time. All staff are issued with a conditions of employment some of which still required to be signed by staff. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 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. 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. An experienced and qualified manager is in post, which ensures that the service is effectively run in the best interests of the residents; that they are safe and well cared for and their rights are safeguarded. EVIDENCE: At the time of our visit the service was being managed by the nurse in charge we were joined later in the visit by the registered manager. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 25 In discussion it was confirmed by the registered manager that the nurse in charge would be applying for registration as the manager of the service as part of the ongoing development. Good procedures are in place to ensure the health and safety of the residents particularly in the event of a fire occurring. All staff spoken to was clear as to what actions they would take in the event of the fire alarm sounding or on discovering a fire. Arrangements have been made for fire training to take place from an external source with 6 dates being set for this training to take place between June and November. This will ensure that all staff by November will have attended at least one of these fire-training sessions. The manager has also prepared additional information about some residents who may require additional support from staff in the event of a fire or having to evacuate part of the building. This has ensured that as part of a risk assessment staff have plans in place to ensure the safety of everyone in the home and this includes the use of slide sheets to assist people with poor mobility. Fire safety notices are on display at all exits and fire drills and fire instructions are carried out with staff on a regular basis. Staff take part in fire drills but they do not sign the records currently in use to record who has taken part in a fire drill. Monies are held on behalf of residents and an individual recording sheet is kept to confirm what transactions are carried out on their behalf. Receipts are obtained for any purchases made on behalf of a resident. This is a good system however the receipts are not numbered or entered on the transaction sheet so there is the potential to lose information. This was discussed with the manager who was advised how this could be rectified. The owner’s carry out quality assurance audits and this has covered all operational areas of the home some of which have been updating policies and procedures. A quality audit is carried part of which seeks the views of the residents and their relatives in order that the service can continue to be improved. Good health and safety checks are in place and there is a robust maintenance programme. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 26 Staff carry out weekly checks of the hot water to ensure that water is not being supplied above the recommended safe bathing temperature. However, the temperatures that were recorded were listed as 38 degrees centigrade as previously stated within this report. This was discussed with the manager as this temperature is slightly lower than the recommended temperature and as such may not be hot enough for the residents. Most of the bedroom doors have been fitted with a device to enable the door to be kept open to assist those residents with poor mobility. Whilst at the same time not compromising fire safety within the home. An accident book that complies with the Data Protection Act is in place and this records any accidents in the home and what actions staff have taken. Ascot Nursing Home DS0000061594.V366350.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 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 X X 2 Ascot Nursing Home DS0000061594.V366350.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. 1. Standard OP9 Regulation 13 Requirement The Registered manager must ensure that a written record is kept if any prescribed medicine is omitted. All staff that administer medicines must undergo accredited training in the safe handling of medicines. This will ensure that they are kept up to date with their professional practice. Timescale for action 31/12/08 Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 29 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. 2. Refer to Standard OP15 OP38 Good Practice Recommendations The Registered Manager should review the dining room arrangements as discussed during the visit. The Registered manager must address the problem of shower and bath water temperatures. That was identified during the inspection as being lower than the recommended temperature. And adjustments must be made to ensure hot water is being provided close to the recommended safe temperature of 43 degrees centigrade. Ascot Nursing Home DS0000061594.V366350.R01.S.doc Version 5.2 Page 30 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. 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