Inspection on 10/10/07 for Eaton Court Care Home

This is the latest available inspection report for this service, carried out on 10th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Not yet rated. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Eaton Court Care Home 10/11/05

Eaton Court Care Home 23/05/05

Eaton Court Care Home 13/10/04

Eaton Court Care Home 25/05/04

Eaton Court Care Home 16/12/03

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Eaton Court Care Home Eaton Court Grimsby North East Lincs DN34 4UD Lead Inspector Mrs Jane Lyons Key Unannounced Inspection 10th October 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Eaton Court Care Home DS0000002783.V352708.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. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eaton Court Care Home Address Eaton Court Grimsby North East Lincs DN34 4UD 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) 01472 341846 01472 346185 eaton.court@btconnect.com Winnie Care (Eaton Court) Ltd Mrs Beverley Snape Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Date of last inspection 3rd October 2006 Brief Description of the Service: Eaton Court is a purpose built care home that is situated in a quiet residential area of Grimsby. It is within walking distance of shops and is also on a public transport route. The home provides care including nursing for up to 45 people over the age of 65 and included in that total has three places for persons under the age of 65. The home consists of two floors serviced by a passenger lift. There are fortyone single rooms and two shared rooms (although these are mainly used for single occupancy unless a married couple requests a shared room), and all have the benefit of en-suite facilities. There are six bathrooms, four of these are assisted and two have a jacuzzi facility. The home has two lounges and a large dining room downstairs; there is a further lounge upstairs. There are also easy chairs and occasional tables in the large reception area where people tend to congregate. The home has a pleasant atrium with patio tables and chairs. There are mature gardens to the rear of the building and ample car parking to the front. The whole feel of the home is one of comfort with pleasant, clean and homely surroundings. The home is part of a small group, Winnie Care which in turn is owned by a larger company. The responsible person is Mr Paul Hulbert and the registered manager is Mrs Beverly Snape. Weekly fees are: £440- £540. The home operates a system whereby the fees include a third party contribution. Additional charges are made for the following: toiletries, newspapers/magazines, hairdressing, chiropody, transport to appointments and escort fees. Information on the service is made available to prospective and current service users via the statement of purpose, service user guide and inspection report. Documents are made available prior to and following admission, copies are always held in the reception area. The home currently operates a waiting list. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and the site visit took place over 1 day in October 2007. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 3rd October 2006 including information gathered during a site visit to the home. • • • The visit to the home lasted from 9 a.m. until 6.30 p.m. Eight residents spent some time chatting to the inspectors. The inspector also talked to two care staff, three visiting district nurses, a community matron, an occupational therapist, six visitors, the senior nurse and the manager. Following the inspection the inspector had a discussion over the telephone with a Macmillan Nurse. Questionnaires about the home were sent to all the people who use the service and all the staff who work in the home. Twenty four questionnaires from the people who use the service and sixteen form staff were returned at the time this report was written. The inspector also looked around the home and looked at lots of records including care plans, staff training records and other records about the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. The inspectors observed how staff and people who use the service worked together throughout the day. People’s views about the home and what was found during the visit have been used to write the report and make judgements about the quality of care. • • • • What the service does well: Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 6 There was a relaxed and homely atmosphere in the home, residents were observed to be settled and comfortable in their surroundings. The staff were very friendly and knew a lot about the people who lived in the home. Staff helped the people who live there in a dignified and respectful manner. Some of the comments from residents included “ Over the years I have enjoyed being a resident here, carer’s are friendly, enjoy a laugh and a bit of banter” and “Eaton Court is well run, clean with caring staff” The home has an enthusiastic staff team who are keen and motivated to ensure that the care provided is of a good standard. The staff are eager to develop their skills further with the relevant training and support which results in residents being well cared for. The home has a good track record and reputation with the community health care team for providing a high standard of end of life care. People who use the service liked the food provided, are well fed and encouraged to eat a healthy diet. There were good visiting arrangements and visitors were made to feel very welcome, discussions with a number of relatives confirmed this. Proper recruitment checks were made before new staff start in the home to ensure they are safe to work there. What has improved since the last inspection? The manager has improved the way she records how complaints in the home have been managed this means that residents and their relatives are properly informed of the investigations and outcomes of any issues they have raised. The number of staff who have gained their NVQ level 2 qualification has significantly improved over the last twelve months which means that more staff have a better understanding and knowledge about caring for people. The home now has a proper system in place to monitor the quality of care and services provided to residents; the home has produced a report which shows how comments from residents, relatives and staff have shaped or altered the practices within the home and that the home is run in the resident’s best interests. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 7 The staff were well supported as they were provided with individual time to talk to the manager about how well they were doing, or if they needed more training or support with their work. This better ensures that they can provide a good standard of care for the people who use the service. All staff had accessed fire safety training since the last inspection which will better ensure their safety and that of the people who use the service. The home now arranges review meetings for all people who live in the home at least once a year; this means that they have the opportunity to discuss their care at the home and any issues they may have with their representative and a senior member of the staff team. What they could do better: 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. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 and 6 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives are provided with sufficient information to help them decide if the home is right for them. The admission process is thorough with staff ensuring that new residents feel welcome and secure. EVIDENCE: The service user guide and statement of purpose documents had been updated to provide prospective new service users and their families with current information about the service; the service user guide has been provided in large print and the manager confirmed that the document will include the views from people who use the service now the quality assurance programme Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 10 has been fully implemented. All surveys received from people who use the service clearly indicated that they felt they had been provided with sufficient information prior to moving to the home. A significant number of surveys returned by people who use the service indicated that they were not aware that they had contracts in place however there was good evidence from the records examined that the home has provided written contracts, which set out the terms and conditions of occupancy and include the room the service users would be occupying. These findings perhaps reflect the involvement of families or people’s representatives with the formal aspects of the admission process. There was also good evidence that the manager routinely writes to service users or their representatives following the pre-admission assessment formally stating the home’s ability to meet needs. Four care files were examined. The care files contained evidence that service users needs had been assessed before they were admitted into the home. Copies of the Local Authority assessment and care plans were obtained prior to admission for those residents referred through the local Social Services care management teams. In addition to the pre admission assessment the home undertakes a further assessment of strengths and needs once the person has arrived. It is on the basis of both these assessments that the person’s plan of care is formalised. The inspector spoke to two individuals who had recently moved to the home, both of whom had transferred from other homes in the area. They said that they had had the opportunity to look round the home before moving in and the staff had made them very welcome. A relative of a person who had recently moved to Eaton Court told the inspector that they had visited a number of homes in the area and had chosen Eaton Court because of the reputation for providing a good standard of care and although it was early days their relative had settled into the home very well. During the visit two people arrived at the home without appointment to have a look round on their relatives behalf and the manager duly obliged. The home has a good track record for meeting the needs of individuals admitted with dependent and complex needs and they regularly receive referrals for persons needing palliative care support; the inspector spoke to one of the Macmillan Team following the inspection who confirmed that the team have very positive working relations with the home. Staff spoken to confirmed that they were always informed of new resident’s care needs and that the manager and qualified staff communicated a clear sense of direction about the importance of using an approach that was person centred. There was evidence to demonstrate that the care staff had accessed a good range of service specific training courses over the last twelve months and that more courses are being arranged; this will help ensure that they have the skills Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 11 to enable them to deliver up to date care methods and have a good understanding of the varied conditions common to the elderly. The home does not provide intermediate care support. Eaton Court Care Home DS0000002783.V352708.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 and 11. Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. The health and personal care needs of people who use the service are well met in a way that respects their privacy and dignity. The home has good systems in place to provide a high standard of end of life support. The medication systems at the home are well managed ensuring the promotion of good health. EVIDENCE: Case tracking of four care files was completed, which included examination of care records and discussions with people who use the service and staff. People who use the service told the inspector during the visit that they were very satisfied with the standards of care provided; that the staff were always very kind, listened to them and treated them with dignity and respect. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 13 Relatives also commented on the kindness of the staff; they commented on the positive team approach and the quality of the care support; one relative said “The care is excellent, my mother is very well looked after and happy here, I have no issues whatsoever ” and another said “ The staff are all lovely and very kind, I visit the home regularly and see how well the staff work together”. The home produces and maintains generally well-written care plans for individuals which take into account their choices and decisions; the four examined set out the health, personal and social care needs identified for each person. Detailed individualised plans had been developed from the assessments; the manager completes detailed pre- admission assessment records however the quality of the post- admission assessment documentation would benefit from more detailed descriptions of individual need. In the main the care plans were well drawn up and clearly described all needs and contained clear tasks for staff to follow, with the exception of one plan which did not clearly detail the oral care support the staff were providing. There was good evidence that the care plans had been updated when changes in need had occurred. Evaluation records were detailed and well maintained. The inspector spoke to the relative of one of the service users with very dependent needs; she was extremely complimentary about the standard of care provided to her husband and the support she herself had received from the staff. Risk assessments were in place for nutrition, mobility, tissue viability, falls, use of bed rails and general issues. These had been reviewed regularly and all high-risk areas had an associated care plan in place. There was evidence that the home now accessed the support from the community falls co-ordinator when appropriate. Comments about the bed rail risk assessments are included in the last section of the report. Continence care is promoted and the inspector observed documentation recording the continence products supplied to the individual. Any concerns regarding pressure care are recorded and risk assessments clearly detail the type of pressure relieving equipment provided. People who use the service told the inspector that when they had appointments for their healthcare needs these were always carried out in private. Visitors confirmed in discussions that when their relatives were ‘unwell’ the home always kept them up to date on any changes in their condition. Evidence in records demonstrated that the health needs of residents are monitored closely and appropriate support accessed; of the files case tracked the home had accessed support from the community psychiatric nurse, care management, occupational therapist, G.P., dietician and palliative care team. During the visit the inspector spoke to an occupational therapist who said how Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 14 impressed she was with the care staffs’ level of understanding regarding the individual service user’s needs. The inspector also spoke with three visiting district nurses and a community matron; all of whom expressed their satisfaction with the standards of care provided at the home, the management and the levels of communication. One district nurse said that the home was excellent. People who use the service appeared well cared for and well groomed. Observation, records and discussions with staff and individuals evidenced that a good standard of personal care support was provided. Advice given at the previous inspection to provide all residents whether privately or publicly funded with an annual review meeting had been actioned, records evidenced that review meetings had been held. There was good evidence from discussion with staff and health care professionals that the home provides a very good standard of end of life care. The home utilises and implements specific documentation “The Liverpool Pathway of Care” in line with the community health care team. Many of the care staff have accessed courses in the last twelve months in palliative care and two of the qualified staff are currently accessing a course in pain control run by the local Macmillan Team. The home has developed and maintained very positive working relations with the local G.P’s, Macmillan Team, District nurses and pharmacy provider to support the end of life care of the residents. Staff spoken to confirmed that the manager and qualified staff always ensured that staff had enough time to spend with residents and their families to give them the support they needed. Medication systems were examined; policies and procedures were in place which covered all areas of management. There was evidence that the staff are proactive in ensuring that service user’s medication is reviewed by the G.P. Temperature recordings of the medication storage room and medication fridge are taken daily which were satisfactory. Systems were in place to support selfmedication, there were no individuals self- medicating at the time of the visit. Storage of all medications was found to be satisfactory; there was no overstocking. Transcribing and administration records were completed satisfactorily. Records of receipt and returns of medication were in place and up to date. There was an up to date British Formulary for staff reference purposes. The senior nurse has continued to manage the medication systems in the home well. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 15 Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 16 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 and 15. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are provided with choice and diversity in the meals and activities provided by the home, which met with their expectations. Relatives and visitors are made welcome and the home is developing better links to the community, which will further enrich the peoples social and leisure opportunities. EVIDENCE: Observation during the visit indicated that the home supports people who use the service to make decisions and operates flexible routines, these include the time people who use the service get up, go to bed, where they eat their meals and how they spend their time. Two individuals told the inspector how they liked to spend their time sitting in the main entrance area watching people coming and going; the inspector also spoke to a number of residents who preferred to spend more time in their rooms, they all confirmed that they had Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 17 opportunities to take their meals in the dining room and to join in with the activities and entertainment which they did when they wanted to. Friends and relatives are welcomed into the home and evidence in the case records confirmed staff kept them appropriately informed of important issues concerning the needs of people living in the home and also that people who use the service were supported to keep in touch with friends and family. The inspector observed a large number of visitors to the home throughout the day, all friends and relatives spoken to said that the staff were very welcoming and supported their visits and they were always offered refreshments. The activity organiser has been employed at the home for a year, it was clear at the visit that she had settled into her role well and is a very popular member of the staff team. All comments from surveys and discussions during the visit indicted that people who use the service were very pleased with the amount and variety of the activities, events and outings provided at the home. During the visit many of the residents enjoyed a reminiscence session in the upstairs sitting room and in the afternoon a number visited a local garden centre in the home’s minibus. The organiser is employed for two/ three days per week and has developed a formal programme which includes in – house activities such as Bingo, manicures, quizzes, dominoes and games; trips out to the Auditorium, boating lake, garden centre and local pubs for lunch are regularly arranged and musical entertainers visit the home monthly. It is clear that the catering staff are also very involved in supporting organised events and parties at the home at times such as Christmas, Easter, Halloween and Bonfire Night. The home provides a trolley shop, which enables residents to make their own purchases of snacks, and toiletries etc. and many commented on how useful this service is. The activity organiser has joined a group of homes in the local area to provide communal activities; these events take place monthly and are very popular. She has also arranged a number of fund raising activities such as a summer fayre and a sponsored walk, which is also developing the homes links with the local community. The activity organiser maintains separate social care plans and records of participation; it was clear from discussions that she is keen to review the format and update many of the existing plans to provide more information about the individual resident’s current capacity and preference in their involvement with the programme. Many of the residents have documented pen pictures which describe their lives and interests however these have not been routinely completed in recent times, which the organiser is keen to reintroduce. It was also clear from discussions with staff that the more dependent residents receive one- to one support in the form of chats about their families, looking at photos, reading and sensory support such as hand massages and manicures although this time is not always documented in the records which the organiser will address. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 18 The religious needs of people who use the service are documented in the care plans; the staff confirmed that there are regular ecumenical church services (monthly) within the home and residents with specific religious denominations access support from their particular church; one resident regularly received holy communion from the Roman Catholic priest. Details about advocacy services are made available for individuals; they are displayed in the home. Formal consultation with people who use the service and their families has improved since the last inspection; surveys have been issued and more regular meetings arranged where they have the opportunity to influence the running of the service. Very positive comments were received from the people who use the service and their relatives about the quality of the meals provided at the home. Comments included “The meals are excellent” and “The variety of meals is very good”. The meal served during the visit looked tasty and well presented. The majority of individuals use the dining room and the mealtime was seen to be a relaxed and social occasion with the staff interacting well with the residents; individual support was provided patiently and discreetly. The cooks demonstrated a good knowledge of the individual residents’ nutritional needs and preferences. A number of individuals were receiving “fortified” diets; their weights are monitored regularly and any concerns are referred to community health services for support. The cooks had recently accessed a course on Diabetes which they said had been very informative and they had made some changes to the menu planning. The cooks confirmed that the menus are reviewed regularly and people who use the service confirmed that they were consulted regularly about menu choices. One resident who had recently moved to the home told the inspector that he had been advised by medical staff to reduce his intake of red meat, he had not however told the care or catering staff though which the manager confirmed she would follow up. The kitchen was seen to be generally clean and tidy; the monitoring and recording of fridge/ freezer temperatures were well maintained. A recommendation made at the visit in 2006 by the Environmental Health Officer to record all aspects of food management in the home had not been fully implemented due to a lack of understanding and advice was given to access further information from the officer concerned to enable implementation. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 19 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 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had a satisfactory complaints system with some evidence that people who use the service feel that their views are listened to and acted upon. Procedures are in place and training provided to staff to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. People spoken to showed a clear understanding about how to make their views and opinions heard and said ‘I would speak to the staff or the manager if I had any issues”. All the surveys returned from people who use the service detailed that they knew how to make a complaint, one resident had written “I have not had to make a complaint in the five years I have lived at Eaton Court, but would have no hesitation in speaking to the manager” The manager confirmed that the home had received one recent complaint and the issues raised had not been fully substantiated. The complaints investigation records were examined which evidenced that the complaint issues had been thoroughly investigated and the complainant had been Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 20 informed of the outcomes; there are some ongoing issues however and the home has accessed the support of other health care professionals to ensure appropriate support for the service user is being provided. The commission had received one anonymous complaint earlier in the year which was investigated by the manager and the issues were not substantiated. A referral was made to the safeguarding adults team in March 2007 however following an investigation by social services none of the allegations were upheld. People who use the service told the inspector that they felt very safe and secure at the home. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint in place. There was evidence that the staff had accessed training in safeguarding adults; when asked about abuse, what it was and what they would do if they saw a service user being abused, the staff answered correctly. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 21 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 and 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The standard of the environment in this home remains high, providing service users with a very safe, comfortable and attractive place to live although a number of the communal furnishings and fittings are now showing signs of age which impact on the overall quality of the environment. EVIDENCE: The inspector made a tour of the premises of the home. The home provides and maintains very comfortable and safe facilities. All areas of the home are decorated and furbished to a high standard although at this visit it was noted that a number of areas such as the furniture in the reception Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 22 area, the corridor carpets and the dining room carpet were showing signs of age and would benefit from renewal. There is a maintenance programme in place. The manager had secured funding through a local grant for environmental improvements and she is planning to provide improved door closure devices to the majority of people’s bedroom doors. The home benefits from having a number of lounges in which the people who use the service could choose to socialise, or have some private time in. The toilets and bathrooms were all close to the communal and bedroom areas. The communal areas were all well utilised during the visit; people who use the service commented on how happy and settled they were at the home. All of the rooms in the home had a call bell system in them. People who use the service confirmed to the inspector that when the call bell is activated the staff were generally quick to respond. The bedrooms are all decorated and furbished to a high standard; all the rooms are for single occupancy. There was good evidence that the rooms were personalised to the extent the chosen by the individual. The temperature of the hot water in the bathrooms was delivered at an acceptable limit to prevent scalding to people living in the home. Staff confirmed that there were adequate supplies of protective clothing; there were no specific infection control measures in place during the visit. On the day of the site visit, the home was clean, tidy and free from offensive odours; domestic staff are employed for seven days per week. Two relatives told the inspector that the home always smells nice and fresh. There was good evidence that the management of the home regularly consult with staff and review the equipment provision; a new hoist had been provided since the previous inspection. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriately maintained so that the needs of the people who use the service could be sensitively met. Staff are well trained, appropriately supervised and competent to carry out their work. Recruitment practices afford sufficient protection for people who use the service. EVIDENCE: The home had 43 residents at the time of the visit; the manager and staff reported that the dependency levels in the home remained stable. From examination of the staff rotas, levels of seven care staff in the a.m., six care staff in the p.m. and three staff on night duty were being maintained. There is a qualified nurse on each shift. All the surveys received from staff and people who use the service indicated that they considered there was enough staff rostered on each shift; the routines were observed during the day to be very calm and paced with staff ensuring their care was person centred and that individual attention could be spent with people who use the service. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 24 The manager confirmed that at times when the dependency levels have risen they have provided more staff, however the home does not currently utilise a recorded dependency tool which would more formally evidence how dependency levels are being monitored and support the rostering of extra staff in line with any fluctuating dependency changes. The workforce has continued to be very stable; this has supported positive moral amongst staff and provided continuity of care for the people who use the service. All people who use the service and relatives spoken to commented very positively about the staff; specifically about how kind and lovely they are. Some of the comments included “The nursing and care staff are of the highest quality” and “The staff are very cheerful, helpful, friendly and kind to residents, this promotes a good atmosphere”. Staff retention at the home is very good with just three members of staff leaving in the last twelve months. Employment records for three staff appointed since the last inspection were examined. This showed that all workers had Protection of Vulnerable Adult register checks (Pova 1st) or Criminal Records Bureau check (CRB police check) in place prior to commencing employment and that they all contained the relevant documentation to comply with Schedule 2 of the Care Home Regulations. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. The management and care staff showed a very good commitment to NVQ training with significant improvements since the last inspection, the home now meets the target of having 50 of care staff having achieved level 2 NVQ. (This is an increase of 30 ) The manager kept an overview of the staff training to assist her in the planning of training in the home. The home provides a good staff training programme with staff accessing annual updates in statutory courses and a variety of general and service specific courses; staff had recently accessed training in pain control, palliative care, dementia, care planning, challenging behaviour and PEG feeding. Records evidenced that staff were up to date with mandatory courses in fire safety and although there was some gaps in moving/ handling training provision, two staff had recently accessed training for trainers courses in this area and were scheduled to deliver one- one support for staff which will ensure the annual targets are met. Staff at interview and in surveys were very complimentary about the training they received. Senior care staff have also been attending regular “Train the Trainer” courses provided by the local Primary Care Trust; these courses include general and service specific areas with the onus on the attendee cascading the training/ information to the remainder of the staff at the home. The manager told the Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 25 inspector that the senior staff require some more support in presenting the training for the staff at the home, which she will provide. Records evidenced that newly employed care staff complete the skills for care common induction standards; although there was evidence that in recent times not all new staff had completed the in- house induction programme which must be completed during the first days of employment in the home. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 26 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): 31,32,33,35,36 and 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service were satisfied that they lived in a home that was well managed and they were provided with appropriate opportunities; there was better evidence that their views were considered and acted upon in the development of the service. The safety of people who use the service and the staff at the home is well promoted and protected. EVIDENCE: The manager is a qualified nurse, has many years experience in providing care for the elderly and demonstrates sound management practices. The manager Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 27 has completed her Registered Managers Award and updates her skills and knowledge through regular attendance at training sessions. Evidence from interviews with and surveys from care staff indicate that they consider the manager and nursing staff to be very professional; they encourage a team approach with a strong ethic on person centred care. Numerous positive comments about the management of the home were received from the care staff and some of these included: “The day to day running of the home is very good, the manager’s door is always open and she deals with issues quickly and professionally ” and “I enjoy working at Eaton Court and consider this to be the best care home I have ever worked in, the staff work as a team and care for the residents very well”. Health and social care professionals spoken to during and after the visit were also very complimentary about how the home is run and the standards of care provided. The manager has continued to develop and fully implement a formal quality assurance system. Regular audits and surveys in areas such as care plans, meals, laundry, bedrooms, bathrooms and lavatories, standards of cleaning, staff attitudes, response to call bells and the building/ grounds are completed. There was evidence that the manager analyses the results of the audits and surveys and where deficiencies have been identified, action plans have been drawn up. The results of the audits and surveys have been published and presented on a notice board for residents and visitors to see; these now need to be included in the service user guide. The manager has produced an annual development plan although this was seen to be somewhat minimal in content and could describe more fully the quality areas of improvement from 2006 and more clearly set out the standards to be achieved in this year. There was good evidence that staff and people who use the service are regularly consulted at meetings about the running of the home and suggestions are welcomed and actioned where possible. Although the policies and procedures are reviewed annually, a number of the documents were found to be limited in the depth of information they gave and advice was given to review them ensuring that they clearly reflected current practices in the home and that they were updated to cover all aspects of current legislation and good practice. There were accurate and up to date records relating to any personal allowances the home keeps on behalf of residents. Checks on staff supervision records showed that further improvements had been made to the programme and this had been well maintained; all staff now access regular sessions and the care staff had accessed the required amount of sessions (six) within twelve months. The supervision sessions with the staff are structured and cover all aspects of practice, philosophy of care in the home and any career or training/development needs of the individual. Staff had also accessed an appraisal session from the manager and there was evidence that Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 28 the individual training needs identified were more clearly linked to the home’s training programme. The manager confirmed that a company representative carries out monthly visits to the home in line with Regulation 26;staff confirmed at interview that they have the opportunity to speak to the registered provider/ representative however records evidenced that reports generated from these visits have tailed off in recent months. Examination of maintenance records identified that checks and certificates were in place for installations and equipment. The fire safety equipment, checks and risk assessment were all in place and up to date. The maintenance man completes regular checks of the hot water temperatures. Accident records were completed and in place; these are audited by the manager to review action taken to reduce reoccurrence. Risk assessments were undertaken for all safe working practices; an external audit has taken place for all the health and safety measures/ practices within the home. Safe working practices are also maintained by the provision of training to staff in the form of moving and handling, basic food hygiene, first aid at work, infection control and fire safety. Records evidenced that the staff completed risk assessments to support the use of bed rails and that the maintenance man checks the rails on a weekly basis. Guidance issued by the Medical Devices Agency details that the risk assessments should be detailed and cover areas of assessment such as: type of rail used, height of bed, distance from the headboard to the rail, height of mattress etc. The manager confirmed that she was currently in the process of reviewing the homes’ risk assessment in line with the current guidance. The staff and management have clearly worked hard to action all the outstanding requirements from the previous inspection visit and no new requirements were made at this visit. Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 3 3 X 3 3 X 3 Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP19 OP27 OP33 Good Practice Recommendations The registered person should ensure that the identified service user’s oral care needs are detailed in the care plan. The registered person should ensure that the furniture in the reception area and the carpets in the dining room and corridors are replaced or repaired. The registered person should implement a formal dependency tool to support effective staff rostering in the home. The registered person should ensure that the annual development plan is further developed to provide a more comprehensive overview of the improvements made in the previous year and areas identified for this year. The registered person should review all the homes key policies and procedures to ensure they are comprehensive, comply with current legislation and demonstrate current good practice. 5. OP33 Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 31 Eaton Court Care Home DS0000002783.V352708.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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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