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Inspection on 13/05/09 for Eastside House Rest Home

Also see our care home review for Eastside House Rest Home for more information

This is the latest available inspection report for this service, carried out on 13th May 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is clean, bright and tidy. The care staff are trained and are able to provide care that meets the residents` needs. The people who use the service are able to choose meals that meet their needs. The home`s admission procedure and care plan systems are good. The residents are admitted to the home only if their needs can be met. There are opportunities for friends and families to visit the residents in private and to make comments or complaint if they have a concern. The manager is supported by the owner of the home who is committed to improve the services.

What has improved since the last inspection?

The manager and the owner of the home have worked hard to address the shortfalls identified at the last inspection. The home has now stopped changing the prescribed dosage without a doctor`s advice. New fire policy, procedure and plan have been developed as required at the last inspection. A needs assessment and care plan have been completed for a resident. The home has a programme of activities and the room of a resident where there was an offensive odour had been cleaned.

What the care home could do better:

There is still a problem with the management and administration of medication. There is a need for the home to improve the administration and auditing of medication so that the people who use the service receive correct medicines at the correct time. The people who use the service are not engaged with proper activities. The home needs to provide activities that meet the needs of the people. The number of falls at the home needs to be well managed. The manager and owner must introduce effective systems which enable to reduce and eliminate the risk of falls. The number of staff, especially, in the afternoon needs to be reviewed to ensure that there are sufficient care staff to provide care and support to the people who use the service.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Eastside House Rest Home 22-24 Eastside Road Golders Green London NW11 0BA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Teferi Degeneh     Date: 1 3 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Eastside House Rest Home 22-24 Eastside Road Golders Green London NW11 0BA 02084554624 02084580739 josiane@eastside-house.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Rosalind Virasinghe care home 16 Number of places (if applicable): Under 65 Over 65 16 16 dementia old age, not falling within any other category Additional conditions: 0 0 Limited to 16 people of either gender who fall into the category of old age (OP) and who may have dementia (DE(E)). Date of last inspection Brief description of the care home Eastside House Rest Home is a privately owned care home which is registered to provide personal care and support for up to sixteen people of either gender. The home is located in a residential area close to Temple Fortune, Golders Green and Brent Cross shopping centre. There are very good transport links with shops and amenities close by. The home consists of a two storey detached building with a small car park at the front and a large attractive garden at the rear of the premises. Accommodation is provided in single rooms on the ground and first floor. None of the rooms have en suite facilities but each has a hand washbasin. There is a passenger lift available to the first floor. There are two bathrooms with two toilets on each floor. Two Care Homes for Older People Page 4 of 26 Brief description of the care home separate toilets are also provided for residents and one for staff. The stated aims of the home are to provide care for people who are physically disabled or elderly and are unable through physical or mental frailty to care for themselves. The cost of placements for residential care is £550.00 per week. Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to residents and other stakeholders. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a surprise inspection which meant that the home did not know in advance that we were visiting. The manager and the owner of the home were present through most of the inspection. The inspection activity included a tour of the building and the examination of the records such as the residents files, the staff files, rotas, menus, the homes policies and procedures. We were also able to speak to and observe a number of residents and care staff. A healthcare worker and some carers who were visiting the home were spoken to individually. We had received the homes annual quality assurance assessment (AQAA) before the inspection. An AQAA is a self assessment which the home completes yearly. Through the AQAA the home informs us how they plan to improve the services for the people Care Homes for Older People Page 6 of 26 who use them. We have used the information from the AQAA, the last inspection report and all other information we have received, for example, through notifications as part of this inspection. What the care home does well: What has improved since the last inspection? 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 set out 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. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good admission procedures to ensure that the residents are admitted only if their needs can be met by the facilities and services of the home. Evidence: Two visitors, who were spoken to, said that they came to the home to find out if it is the right place for their relative who currently lives in the community. They said they came on the recommendation of a person who has known the home for many years. They confirmed that they were impressed with what they have seen and how the staff welcomed them. They also said that they have been given written information about the home by the manager. Another visitor, who was separately spoken to, said that they had visited the home before their relative was admitted. They also confirmed that the owner of the home and the manager visited the service user at their own home to complete an assessment before admission. Care Homes for Older People Page 10 of 26 Evidence: Five residents files were chosen and examined. Each of these files contained evidence of assessments before the residents were admitted. It was evident from the files that information was received from the residents, relatives or health and social care professionals. It was clear from discussions with the manager that the home does not admit residents whose needs cannot be met by the services and facilities of the home. Currently there are no vacancies and most of the present residents have lived at the home for many years. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment and care plan processes are good and the residents can be confident the home can identify and meet their needs. However, the medication administration system is below the residents expectation and they can be worried that their health and safety is risk. Evidence: The home has a needs assessment and care plan form which it has bought from a company. This form has details of needs which the home completes for each resident. The five files, which were examined, contained evidence of completed assessments and care plans. The care plans were based on the assessments which means that the residents needs are identified and appropriate ways of meeting them are planned. It was also evident in the files that risk assessments are completed. From a discussion with the manager and from the files it was clear that the home has liaised with the local authority to complete a deprivation of liberty safeguarding form for a resident who has been believed to lack capacity to make decisions. The manager said the home is planning to join The Gold Standards Framework (GSF) which helps the home to be Care Homes for Older People Page 12 of 26 Evidence: able to support people in end of life care. It was evident from the files that the home keeps daily records of interactions and significant events for each service user. It was clear from the residents files that the residents have access to health professionals and regular medical checks. The manager confirmed that the residents regularly see their general practitioners, dentists, physiotherapists, chiropodists, hairdressers, and hospital consultants as required. On the day of the inspection a district nurse was at the home. It was clear from discussions that the nurse visits the home twice a day to provide medical care for a resident. From observations it was clear that the residents were well dressed and appeared comfortable in the home. Many of the residents said they are happy living at the home. The visitors and the district nurse said the residents are well looked after. The staff were seen to be treating the residents with respect and dignity. During individual interviews, the staff were able to give satisfactory description of how to support older people in a care home by ensuring their privacy, dignity and choice. Medication is administered and signed by named care staff during each of the shifts. The manager said there is a medication auditing system. An inspection of the medication record sheets and the medicines showed that there were some gaps. On one occasion the medication administration record sheet (MARS) was not signed, while on another occasion medication was signed but not given. This was discussed with the manager who agreed to review the medication administration and auditing system. The manager informed us that all the staff who administer medication had training in the handling and administration of medication. The staff files which were seen contained evidence of medication training that the staff had. All medicines are kept in locked cabinets in the managers office. The temperature of the room is monitored and recorded. The manager confirmed that changes to the dosage of medicines are only made by the doctors. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The meals provided at the home are good. The residents can be sure that they eat meals that meet their dietary, cultural and religious needs. The arrangements put in place for the residents to have visitors have enabled the people who use the service to be visited by friends and families. The activities provided at the home need improvement in terms of type and presentation in order to stimulate and engage the residents. Evidence: The activities programme, which was inspected, indicated that the residents are provided with some activities at midday. On the day of the inspection two staff were observed in the lounge providing some activities. Out of the eight residents in the lounge at the time only a few of them were seen participating in the activities. One of the activities was a game of ball which appeared to be inappropriate for some of the residents. From discussions with the manager, some visitors and examination of the residents files it was not evident that the residents are fully engaged and stimulated. We discussed this with the owner and manager who explained that an entertainer comes to the home twice a week and the home is also in the process of recruiting volunteers. Many of the residents seemed to be happy and satisfied with their own Care Homes for Older People Page 14 of 26 Evidence: routine of activities such as reading books, watching television or films in their rooms or talking to each other. From the visitors book, the residents files and discussion with the residents and the visitors it was clear that families and friends visit the residents. Two residents said that they are visited by their relatives almost everyday. There is a telephone in each of the bedrooms which the residents can use to contact friends and families. Observations confirmed that the residents have access to all communal areas. The inspection of the menu showed that there is a two weekly rotating menu. The owner and the manager said the residents are consulted about the meals. Lunch was served at 12:30 PM and it reflected the menu of the day. The residents seemed to enjoy their meals. A number of the residents spoken to said the meals are good. It was noticed in the files that the residents preferences in relation to their dietary, cultural and religious needs of meals are identified and catered for. The staff were present during lunchtime to support the residents who needed assistance. During a tour of the premises we noticed that there is a jug of water and glass in each of the bedrooms. The manager said the staff fill the jugs with fresh water frequently. Discussions with the manager and the owner confirmed that the home does not manage the residents finances. However, the home sends invoices to the residents or their families for toiletries, newspapers, chiropody expenses and hairdressing costs which the home pays for from its own petty cash. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are confident that their concerns can be listened to and dealt with by the home. The are also confident that they are safeguarded from abuse by good management of the home. Evidence: There is a complaints policy. The residents and the visitors spoken to confirmed that they know how to make a complaint if they have a concern. A visitor said the manager and the owner are easy to talk to and they can talk to either of them if they have a complaint. There have been no recorded complaints since the last inspection. The homes policy on safeguarding was inspected. This has details of what abuse means and the steps that the staff should take to safeguard the residents from abuse. It was evident that the home has obtained the local authoritys policy and procedure on adult safeguarding. The AQAA states that the staff are made aware of the homes policies on complaints, adult abuse and whistle blowing. Two care staff, who were interviewed individually were able to demonstrate their knowledge and experience of safeguarding people. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The facilities and furnishings are good and the residents live in a comfortable and safe environment. Evidence: The home was clean, bright and tidy. There were two cleaners who were undertaking the cleaning of communal areas and bedrooms. The residents said that they like the home and their bedrooms. There was no unpleasant odour or smell and a visitor and a district nurse who have been coming to the home regularly said that they always found the home clean and spotless. Observations and discussions with the manager confirmed that the residents were able to choose decorations and furnishings. The residents have personal items, family photos, pictures, telephones, television sets and ornaments in their rooms. Two residents said they have their bedroom keys. At the last inspection a requirement was made for the manager to address an odour in a residents bedroom. The manager said this was an isolated incident which was dealt with immediately on the day. As mentioned earlier in this report each resident has a jug of water and a glass in their bedroom. Care Homes for Older People Page 17 of 26 Evidence: The laundry facilities are provided on site and the residents confirmed that their clothes are washed and cleaned well. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Even though there is a robust recruitment system and there are committed and dedicated staff to provide care, the residents are not reassured because of the insufficient number of staff especially after 2 pm every day. Evidence: Conversations with the residents and the visitors confirmed that the staff are nice and caring. A resident said: You cant fault them [the staff]. The visitors spoken to said they felt welcomed whenever they visited the home. Observations showed that the staff treat the residents with respect and dignity. The staff were able to explain how they support the people who use the service by ensuring their respect, privacy, dignity and choice. Five staff files were checked and all contained evidence of written references from previous employers, job descriptions, application forms, employment contracts and checks by the criminal record bureau (CRB). The home has a robust recruitment procedure. The manager said jobs are advertised and candidates are short listed for an interview. Successful candidates are employed only after CRBs and references are obtained for them. On the day of the inspection the manager and the owner were interviewing staff for the chefs position. The home has an equal opportunity policy which states: For employee recruitment and selection, to eliminate possibilities of Care Homes for Older People Page 19 of 26 Evidence: discrimination or prejudice prior to interview, employment application forms do not include questions concerning race or ethnic origin, creed, colour, religion, political affiliation, parenthood or sexual orientation. From the AQAA, staff files, and discussion with the staff and the manager it was clear that a number of the staff have attended training programmes in moving and handling, health and safety, basic food hygiene, dementia, infection control and fire safety. The manager has a training plan for all the staff to attend all mandatory training programmes such as dementia. It was evident from discussions with the manager, staff and the AQAA that most of the staff have either completed or embarked on training a national vocational qualification (NVQ) level 2 in care. The staff rota and conversations with the manager showed that there are four care staff and the manager between 9 am and 2 pm; three care staff between 2 pm and 6 pm and two care staff between 6 pm and 8 pm. The manager works between 9 am and 6 pm Monday to Friday and the owner is at the home at least five days a week. Night shifts are covered by two waking night staff. The manager said the chef has resigned and they are recruiting into the post. The home has domestic assistants who clean the premises and a kitchen assistant. We believe that the current staffing level, especially between the hours of 2 pm and 8 pm are not sufficient and need reviewing to ensure that the residents are appropriately supported and safeguarded. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are reassured that there is good management system which allows them to have a say in how the home is run. However, the health and safety of the residents is at risk due to the high number of falls at the home. Evidence: The manager has a long experience of managing the care home. The residents and the visitors spoke positively of the manager and the owner of the home, who also spends most of the week working at the home. They said both are very caring, approachable and helpful. The staff also confirmed that they are happy working at the home and they receive support and guidance from the manager and the owner. The home has a system of quality assurance which includes questionnaires for the residents, health professionals and relatives. The last quality assurance exercise was completed with the outcome being available for the inspection. This showed that the people who gave feedback were satisfied with most of the questions asked. The Care Homes for Older People Page 21 of 26 Evidence: manager has summarised the feedback and put a plan of action to improve the service further. The AQAA confirms that regular residents, staff and partnership meetings take place. From discussions with the staff it was clear that they receive regular supervision. As stated earlier in this report there is a training plan for the staff. A requirement was made at the last inspection that the manager must amend the fire prevention policy and procedure to include the homes evacuation plan. This was done by the manager. Records and discussions with the manager also showed that fire alarms, emergency lights, fire equipment have been serviced or checked. The manager has confirmed in the AQAA that all health and safety checks including portable electrical appliances have been tested and all the facilities and equipment in the home are safe to use. The incident and accident books were examined and it was found that there have been thirty-one recorded accidents or incidents since April 2008. These incidents and accidents involved a a few residents who fell over and were found on the floors in their bedrooms. From the records it would appear that the residents did not use the call bells in their rooms to seek assistance. None of the recorded incidents or accidents resulted in a serious injury or admission of a resident to a hospital. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 There must be robust and affective regular auditing system to ensure that medicines are administered and recorded correctly. This is to protect the health of the residents. 31/05/2009 2 12 16 After consultation with the people who use the service, the registered person must ensure that there are appropriate activities for the residents. This will ensure that the residents are stimulated and engaged. 31/07/2009 3 38 13 Appropriate arrangements must be in place to reduce, eliminate and manage falls. Risk assessments must be reviewed regularly for the residents who are prone to falls. 21/06/2009 Care Homes for Older People Page 24 of 26 This ensures the health and safety of the people who use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!