Inspection on 07/08/08 for Edenmore Nursing Home

This is the latest available inspection report for this service, carried out on 7th August 2008.

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

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

Edenmore Nursing Home 18/10/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Edenmore Nursing Home 7 Hostle Park Ilfracombe Devon EX34 9HW Lead Inspector Jo Walsh Unannounced Inspection 09:30 7 August 2008 th 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 Edenmore Nursing Home DS0000066336.V367805.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. Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Edenmore Nursing Home Address 7 Hostle Park Ilfracombe Devon EX34 9HW 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) 01271 865544 www.psphealthcare.com PSP Healthcare Ltd Mrs Elizabeth Mary Thompson Care Home 48 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30), Mental disorder, excluding learning of places disability or dementia (30), Old age, not falling within any other category (30) Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is permitted to admit up to three service users under the age of 65 at any one time The maximum number of persons accommodated at the home, including those under 65, will remain at 48. 15th November 2007 Date of last inspection Brief Description of the Service: Edenmore is a purpose built detached two-storey building in the Ilfracombe area of North Devon. The home is sited in a residential area, stands in its own grounds and has views over the nearby coastline. There are car park facilities for visitors. Private rooms (some with ensuite facilities) are situated on the ground floor and the first floor. Some shared rooms are available. There are two lounges, a dining room, conservatory and Snoezelan (stimulation therapy) room. The home has a large reception area and a keypad controlled entry/exit system for safety and security. The home has a wing named Bay Tree House. This is directly connected to the main building and accessed from the first floor. Bay Tree has two floors and is accessed by a modern lift. This extension has 4 ensuite single rooms with a lounge, kitchen area and assisted bathing facilities. The cost of care ranges from £550 to £1250 per week depending on individual needs. Additional costs, not covered in the fees, include chiropody at £12 per session, hairdressing at cost, and personal items such as toiletries and newspapers at cost. Current information about the service, including CSCI reports, is available to prospective residents, relatives and others who may have an interest such as care managers. Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. A random inspection was carried out on the 17/04/08. The reason for this inspection being carried out was as a result of a serious complaint that concerned a person receiving respite care at the home. The complaint issues were looked at as part of a safe guarding strategy meeting, and we agreed that as regulators it was necessary to check that individuals within the home were not being placed at risk. We did not follow up the specific issues relating to the individual in relation to the complaint, but did check compliance with ensuring that individuals who were new to the service had detailed assessments and plans of care in place. The safeguarding investigation has now concluded and no further action will be taken. The report for this random inspection has not been made public but can made available upon request to CSCI. Two areas of concern highlighted during the random inspection was the lack of detail in some assessments and care plans. We spoke with some staff team members who were able to demonstrate a good understanding of individuals support and care needs, and we did not feel people living in the home were at any risk, however we did make requirements to ensure that good written information be available to help staff provide good quality and consistent care. Following this random inspection we asked the registered providers to send us an improvement plan to show how they intended to meet requirements, which they did. This key inspection was completed by two regulation inspectors on a week day in August and lasted approximately 9 hours. During this time the registered manager was available and ensured access to some key documents including plans of care, staff records in relation to training, supervision and recruitment, and records in relation to administration of medications. The responsible individual was also present for most of the inspection. We also spent time talking to the staff group, including nursing staff, care staff, catering and administration staff. We spent time talking to the people who live at Edenmore and care practice was observed throughout different periods of the day. Prior to this inspection taking place surveys were sent to people who live at the home and to a sample of staff. We also sent surveys to local doctors. Their views are included in this report. Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 6 Prior to the inspection the home completed an Annual Quality Assurance Assessment (AQAA), which gives us information about how the home maintains a safe environment, what training has been completed and tells us how they are reviewing their services to improve the care and support provided. This information helps to inform the inspection process. What the service does well: What has improved since the last inspection? Assessments and plans of care are now much more detailed and give carers good guidance and instructions about how to meet individuals’ personal and health care needs. Additional support is now available for mealtimes, which enables more people who need assistance to be supported at appropriate times. More activities are available throughout the week to entertain and stimulate the people who live at Edenmore. Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 7 What they could do better: Medicines must be kept secure at all times whilst being given out to ensure they are taken only by people that are prescribed tablets. This relates to one incident where medication was left out on the medicine trolley, whilst the nurse was giving medication to someone in their room. The registered manager and provider have agreed to look at purchasing a secure hand held cases to ensure that medicines are supervised at all times and kept secure when being given out. They have also agreed to ensure that the medications policy and procedure is discussed as part of supervision. Peoples’ mental capacity should be assessed so that the team are clear about whether a person is able to make decisions about their care and life at Edenmore. If they are unable to do so, the assessment should clearly highlight who will be involved in the process and the issues that need to be addressed for the individual. In particular, restricting access to bedrooms, use of keypads or mats linked to the call bell system need to be carefully considered and agreed by all stakeholders. In exceptional circumstances, where a person is assessed by a medical practitioner as lacking ‘capacity to consent to treatment’ and the medicine is essential to their health and well being it may be given in a ‘covert’ way. Staff should follow the procedure of the home and also refer to the Mental Capacity Act and Codes of Practice, such as the ‘Standards for medicines management’ (Nurses, Midwives Council). If the decision is taken to give medicine covertly, it is not good practice to crush tablets or open capsules unless a pharmacist informs you that it is safe to do so. ‘The administration of medicines in care homes’ (CSCI publication) The recreational needs of people, particularly those with dementia or communication difficulties, should be assessed using a tool such as the ‘Pool Activity level instrument’. Activities would then be person centred and pitched at a level that is suitable for the individual. The home needs to be able to demonstrate that individual preferences have been accounted for by keeping a record of meals provided to them. Staff should be offered regular recorded supervsion to ensure they are supported to do their job. Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 8 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. Edenmore Nursing Home DS0000066336.V367805.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 Edenmore Nursing Home DS0000066336.V367805.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential new people benefit from a good admission and assessment process, which ensures that the home can meet their needs. EVIDENCE: We looked at four care files to establish whether the care delivered was based on detailed assessment of people’s needs. Nursing staff told us that the manager or deputy manager assessed people prior to admission to ensure that their needs could be met at the home. Assessments were comprehensive and considered risks with regard to tissue viability, falls, manual handling, oral health, mental health, behaviour and continence. Assessments had been regularly reviewed. We read a continence assessment and saw that appropriate aids had been obtained for the individual concerned. We looked at the assessment tool that ensures individuals complex nutritional needs are considered. This tool is based on other evidence based screening tools. Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 11 In another file nursing staff had completed a mental health risk assessment highlighting that the person was at risk of harming themselves and absconding, particularly at night. Records demonstrated that ‘close observations’ i.e. knowing where the person is at all times, were done initially after admission until it was decided that the risk had subsided. Additionally, door keypads and a pressure mat were highlighted as measures to reduce the risks highlighted from occurring. The person’s mental capacity had not been assessed. Such measures might be considered to be forms of restraint without careful assessment and agreement from all stakeholders, including the individual’s advocate. We discussed this with the manager who is aware of requirements in the Mental Capacity Act 2005 for there to be ongoing assessment of an individuals capacity at an exact moment about a particular decision/issue. They verified that policies and procedures covering this aspect of care were in the process of development. These will also incorporate the local authority procedures that come into effect in April 2009. Edenmore Nursing Home DS0000066336.V367805.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. Individuals’ personal, social and health care needs are well met. EVIDENCE: We looked at four care files, which demonstrated that the home has good professional relationships with general practitioners, nurse specialists and the consultant psychiatrist. For example, a person with dementia had been visited at the home by the consultant psychiatrist and their medication had been reviewed and changed in light of reports from the nursing team. In addition to this there are good links with the mental health and social services teams. Letters seen on files indicate good communication and partnership working that ensures that people living in the home receive appropriate care. The home had clear policies and procedures about risk assessment and management, which had been robustly implemented. All of the care files had guidance on action to be taken to minimise identified risks with regard to tissue viability, falls, manual handling, and continence. All of the assessments had been regularly reviewed. We particularly looked at the decision making process linked to the use of bedsides. Detailed records were seen in individual Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 13 care files that were explicit and clarified why bedsides were being used for an individual. It was apparent that nursing staff had carefully considered the risks and had outlined measures to ensure that bedsides were used safely for the individuals concerned. Similarly, where a high risk of development of pressure ulcers had been highlighted for an individual we read ‘turning charts’ and saw pressure-relieving equipment in place on chairs and beds. Additionally, ‘body maps’ and daily records in files demonstrated that none of the four people whose care was tracked had pressure ulcers. There was a high standard of information to ensure that nursing and health care needs were assessed and monitored, and the staff are commended for this improvement in recording and monitoring of needs. Verbal information and feedback in respect of individuals’ personal and health care needs is given to staff at the start of each shift. This process was observed at the beginning of the afternoon shift. The nurse gave care staff details of how each person had been during that morning and identified any issues that needed to be monitored. This handover also gave staff time to ask questions and give their view about how an individual was doing. The nurse providing the handover was very informative and provided younger care staff with positive ways of working with people with dementia. One area where we felt the information was less robust was in recording individuals’ personal preferences, routines and social activities. This has started to be addressed with the introduction of ‘personal profiles’ that family are asked to complete. We discussed this as part of our feedback following the inspection, and said that plans could be made more person centred by including preferred daily routines for individuals. This would enable all staff to have a good understanding of how each person prefers their care and support to be delivered. The home uses a monitored dosage system. Senior qualified staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and we tracked medication given to four people. Records accurately reflected medication having been given as prescribed by the GP. One person’s care file highlighted that they were ‘non compliant with medication’ when they first moved into the home. We read a risk assessment and care plan, which covered this issue and it gave detailed guidance to staff about managing the situation. The care plan had been signed by the individual’s nearest relative and advocate. Nursing staff told us that the person’s GP had also agreed for medication to be given ‘covertly’ in tea or in meals because it was essential for their health. We discussed this issue with the manager and responsible individual and were shown a form that is used, which the person’s GP, advocate and nurse sign confirming aggreement of the practice. However, the home’s procedure had not been followed in this Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 14 instance in terms of recording who had been involved in the decision making about this exceptional circumstance. All medication was kept in a secure place; controlled drugs were stored in accordance with legislation(Misuse of Drugs Safe Custody Regulations 1973). We observed medication being given to people after lunch and during the evening meal. At lunchtime, safe procedures were followed. Records were completed appropriately after each person had taken their medication. Care staff told us that medicines are only adminstered by qualified nursing staff. Later in the day, we saw a trolley with medicines that had been left unsupervised by the nurse doing the evening medication round. Whilst we waited for the nurse to return, we observed two confused people show an interest in the medicines and we had to intervene by distracting them so that they did not pick up tablets. On return to the trolley, the nurse responsible told us they should not have left the medication unattended and had been preoccupied giving someone their tablets in another part of the building that was close by. They told us that constraints of the building meant that the trolley could not be taken safely to the particular part of the home where the person was located. We discussed this issue with the manager and responsible person at the end of the inspection. They told us that the nurse concerned had informed them about the incident. Both said that this was a “one off” and not the norm. They verified that there are handling constraints with the trolley in some parts of the building. As a way forward, they told us they would purchase secure hand held cases to ensure that medicines are supervised at all times and kept secure when being given out. Additionally, all staff would be reminded to follow safe practice as outlined in the home’s procedure. We observed some good practice during the inspection day. Staff were observed to show a great deal of patience and kindness to one person for example, who over the lunchtime period repeated the same questions and asked for assistance to go to the toilet several times. Each time staff went to support the person they changed their mind about what they wanted. Throughout the whole lunchtime, they showed compassion and respect for individuals who needed support to eat and drink. We did observe one person standing when assisting one individual over the tea time period, but this was the exception. Staff sat with individuals and assisted in a relaxed pace that suited the individual. One person spoken to confirmed that staff knocked on their door, provided care in the privacy of their room and treated them with respect and kindness. One commented ‘’ some are better than others, but they all treat you nicely.’’ Another person said ‘’Staff treat us well’’ and other comments included ‘’Staff are very good, they have helped me settle in, staff are really very good, we are treated very well.’’ We did not receive any surveys back from people who live at the home. We discussed this during the feedback and the registered manager and provider Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 15 believe this may be due to the fact that people have been completing surveys for the home and other agencies. The quality assurance completed by the home shows that there is a high level of satisfaction from people who live at the home and their relatives. 5 local doctors returned surveys and all gave positive views about the home. Comments included • Whenever I visit this care home the staff are friendly and caring. I have not noted anything that has caused me concern • Does a good job. Edenmore Nursing Home DS0000066336.V367805.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): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines and activities are flexible for people. Some people are consulted and listened to regarding the choice of daily activity, but this process could be improved further for people with dementia or communication difficulties. EVIDENCE: According to information sent to the Commission, 33 people currently living at Edenmore have dementia. We wanted to establish how those peoples needs were met with regard to meaningful activity. We examined a care file for someone with dementia and saw that the home had information about the individuals interests and had tried to accommodate them where ever they could. Additionally, relatives of the individual had provided information about their mother’s past life, interests and hobbies. The assessment did not detail any of this information. We spoke to the activities organiser about what activities four people had done over a two week period. We were shown a plan of events covering a three month period, which included visits from outside entertainers such as singing Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 17 groups and ‘PAT’ dog visits. Staff told us that animals are important for some people that have had pets in the past – the home has a cat named ‘Molly’. Staff said that some people appeared to relax by having her sit on their lap. We were told that one person had a ‘pet’ seagul that visited them and she enjoyed feeding at the window. Individual records are kept and demonstrate the activites people have done. For example, one person who is known to enjoy sea life and boats had been taken down to the harbour for the afternoon a few days before the inspection. Another person, who is known to like music took part in the ‘caribbean day’ held at the home in which people dressed up and had caribbean food. We spoke to one person who was busily painting and showed us flags that had been painted to celebrate the olympics. One person confirmed ‘’if there is any outings I always take advantage of that.’’ During the site visit, an hour was spent in the lounges observing how staff interacted with the people living there. This highlighted examples of good practice. During the period of observation, staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. However, this occurred when care was being given to the person e.g. Whilst feeding them or taking them to the toilet. People with advanced dementia were somewhat disengaged when not receiving care. We asked staff what they did to help these people pass the time. Staff said that it was difficult to sometimes know what these people could actually do or wanted to do. We were told that one person, whose care we tracked, was known to like classical music so had classic fm on in the background. Another person had hand massages. The activities organiser verified that staff tended to act more on instinct rather than on assessed knowledge. We discussed specific tools that might be useful to gain in depth information about individual capability and interest such as the ‘Pool Activity level instrument’. This would also ensure that activities are person centred and pitched at the right level for people. 89 of people living at Edenmore are of christian faith. The remainder do not follow a religion or their faith is unknown. People said they like going to church and are enabled to do this. Staff told us that either they take them to church or relatives or congregation members do so. Four Christian groups visit the home every month: Christian fellowship, Emmanuel church, Church of England and the Salvation Army. A Holy Communion service is held by the Church of England. We examined the visitor’s book and saw that a wide range of people including relatives see people over the course of a week. Individuals during lunch told us that they could see whom they wanted to when they wanted to. A relative verified that they were welcome in the home at anytime and could visit their relation in private. Another visiting friend confirmed that they were always made welcome and could pop in at anytime. Lunch and the evening meal were served during the inspection, which was balanced. We saw at least three different choices being served, the main one Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 18 being ‘toad in the hole’ with baked beans and tomatoes and sweet potatoes. We thought that the combination of vegetables was somewhat unconventional and had expected ‘toad in the hole’ to be served with a green vegetable, potatoes and gravy. However, we sought informal feedback from people throughout the meal and observed staff doing this also. People we spoke to made comments like “lunch is lovely” and “they know what you like . Later in the day, kitchen staff told us that they monitor levels of waste to establish whether a meal is liked or not. They told us that they were low that day. We were shown a four week rota demonstrating varied menus that are served to people. Individual records highlighted what people liked and disliked. No record of meals actually provided was kept. The responsible individual said that as a company they were looking at ways they could improve their standard of food and have arranged for one of their established chiefs from another home to do visists to this and other homes to advise on menu choices. We observed staff supporting people that needed help with eating their meals. Carers focussed all their attention on the individuals concerned chatting with them, gently explaining what was on the plate and at a pace that suited the person. We saw that equipment such as plate guards were used enabling people to continue feeding themselves without assistance. We examined four care files, which demonstrated that weight is checked on a monthly basis to ensure that people stay within a healthy weight. These records showed that people had either steadily gained or decreased weight towards more healthier levels dependent upon their needs. We observed some individuals having to wait for their meal, as there was not enough carers to assist at one time. This did not create any difficulties, as the meal was kept warm. The lunchtime period appeared relaxed and unhurried, and carers assisted people in a way that respected individuals. Edenmore Nursing Home DS0000066336.V367805.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals’ views and concerns are listened to and acted upon EVIDENCE: The home has a stated complaints procedure as well as more informal ways of seeking the views of the people who live at the home. The AQAA gave the following information to the question about what the service does to seek the views of the people who use the service. ‘’We did a full resident and supporters survey in December 2007. The results are posted on the notice board….conduct regular random quality assurance phone calls from head office. We hold regular relatives meetings, which are well attended. The operational director checks minutes at the regulation 26 visits to ensure all actions have been taken. We have a quarterly newsletter that actively encourages feedback.’’ We saw the survey results available on a notice board in a communal corridor and also on the notice board in the staff office. Minutes of relatives meetings were shown to us and discussed. There has been one serious complaint since the last inspection. This resulted in the Devon County Council safeguarding coordinators being involved and a Police investigation in respect of possible neglect. The complaint was from the family of a person who had received emergency respite care for a week before Christmas 2007. The police have only recently completed their investigation and have insufficient evidence to proceed with any criminal charges. The assessment and care plan for the individual concerned did highlight the fact that there was insufficient detail to enable carers to provide care for this Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 20 person in a consistent way. The random inspection completed in April 2007 also found some assessments and care plans to be inadequate. The registered manager, staff and registered providers have worked hard to ensure that individuals’ plans and assessments are now more detailed. The providers gave us an improvement plan that included additional training in care planning. This has clearly been implemented and the documentation concerning health and personal care needs is now of a very high standard. This is also the view of the Primary care trust nurse team who have recently been reassessing people in the home. Three staff spoken to were able to say what may constitute abuse and what should be done if they suspect abuse is happening. All said they had received training in this and would be confident to report any issues of concern. We looked at staff files and were satisfied that appropriate checks were being completed to ensure that people who work in the home are suitable to work with vulnerable adults. Good systems are in place to ensure that individuals’ finances are protected. The records are held at the head office where there is a clear audit trail for individuals’ monies, which are held in a separate account from that of the business/company. Edenmore Nursing Home DS0000066336.V367805.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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Edenmore are able to enjoy a safe, comfortable and clean environment. EVIDENCE: We toured the premises and saw that radiator guards were in place throughout the building. Fire exits were clear and accessible. All the bedrooms were inspected and found to be clean, individualised and comfortably furnished. People living in the home told us that there is always a housekeeper on duty. All of the wcs and bathrooms had locks on the doors. Communal areas were comfortable and homely. Maintenance certificates were seen for assisted baths, electrical installation, and central heating and fire alarm systems. We spoke to one domestic member of staff who confirmed that there is a team of domestics who ensure the home is kept clean and fresh smelling throughout the week. Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 22 We looked at four bedrooms all of which were personalised. Two bedrooms were on the ground floor, both of which had a bolt on the outside of the door. We asked staff about this and were told that they needed to bolt people’s doors because some people tended to wander into the wrong bedroom. We spoke to the manager and responsible individual about this issue. They verified that bolts were used for the same reasons given by staff. However, we explained that being able to lock doors on the outside could potentially be abused. The manager and responsible individual said that they did not believe this would happen. However, they accepted our argument and concerns raised and told us that they would remove the bolts in the short term. In the long term, they told us that there are plans to fit appropriate locks to all doors. The environment at Edenmore has been significantly adapted to meet the needs of people with dementia or physically frail. Communal spaces i.e. lounge, conservatory, TV, and dining space all furnished to a high standard. Outside there is a garden, patio and roof terrace space. The vacant plot in front of the car park appears unkempt and we were informed that this does not belong to the home. It may be worthwhile screening off this piece of land from the car park so visitors are clear the vacant land is not part of the home’s land. Rooms were personalized with people’s own furniture and pictures. In the AQAA they say that people have also chosen the colour scheme of their room. Fire exits were clear and not blocked. The home was fresh and clean. The manager verified an audit using the department of health guidance had been carried out. All of the staff we spoke to had received training about the prevention of infection and management of infection control. Hand towels and soap dispensers were seen in wcs, bathrooms and bedrooms. Good hand washing practices were observed as staff were seen to deliver care to people. The laundry was clean and well organised. We observed good infection control measures being followed. We spoke to five staff that all understood good practice principles to minimise the risk of cross infection. A ‘no touch’ technique was observed as staff dealt with soiled linen. Staff told us that infection control training had been provided for them. Edenmore Nursing Home DS0000066336.V367805.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): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff group are experienced and sufficiently trained and supported to ensure the needs of the people who live at the home are well met. EVIDENCE: The staffing levels are sufficient to ensure that the personal needs of the people who live at the home are met. Normally there are two trained nurses and 8 carers, as well as ancillary staff to provide meals, do laundry and keep the home clean. Staff spoken to and those who returned surveys said that there were usually enough staff to meet the needs of the people who live at the home. The registered provider stated in their AQAA that ‘’our staff shift pattern is very flexible to allow us to have more or less staff depending on resident need.’’ They have also looked at ways they can utilise ancillary staff to assist with lunchtimes so that people are not waiting long periods for assistance to eat their meals. This seems to have worked to good effect, and improved the outcomes for people at mealtimes. Training records show that staff have training in all key areas of health and safety, as well as some specialist areas such as working with people with Dementia. Staff spoken to said that they were offered regular training updates, including opportunities to complete NVQ (National Vocational Qualifications) in care. The AQAA returned says that 53 of staff have or are working towards an NVQ2 or above. Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 24 A sample of staff files were looked at (4) and relevant checks and references had been taken up to ensure that individuals were suitable to work with vulnerable adults. Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the people who live there. EVIDENCE: The registered manager is qualified and experienced to run the home in the best interests of the people who live there. Throughout the inspection we found her to be competent at her role and she demonstrated this by having an excellent overview of all the areas of the home that collectively help the home to meet its aims and objectives. We observed that there are clear lines of accountability within the home. The Registered Manager has a team of people who assist her in meeting the needs of the people who live in the home and also the business. The responsible individual is also very much hands on and visits the home regularly every week. We Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 26 spoke to six staff and observed practice throughout the day and saw that there is an ‘’open door’’ policy that also allows people living there, visitors and staff to speak with the Registered Manager should they wish to do so. The Commission asked for, and promptly received, the AQAA (Annual Quality Assurance Assessment) document. The information provided was detailed and helped us to focus the inspection. Additionally, it was clear that the manager and provider fully embrace quality assurance. In discussion with us, they were open about what they could do better and were able to demonstrate continous improvement in various areas throughout the course of the inspection, for example the review process of assessments and care plans. There are good systems in place to ensure the views of the peole who live at the home and their relatives are sought to help improve the quality of care. Ways in which the home do this have been detailed in the section concerning complaints and protection (16-18) We toured the building and observed that cleaning materials were stored securely. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. We observed hand sanitizer being used by staff to minimise the risk of cross infection. Good manual handling practice was observed as carers transferred a person from wheelchair to chair at lunchtime. Records show that staff receive training in all areas of health and safety and follow an induction programme to help them understand their role. We did find there were some gaps in providing formal supervisions for staff. One member of staff who had transferred from another home had not received any formal supervion since they joined Edenmore and one of the nurses had not had supervision this year. The registered manager acknowedged that this was one area she knew she needed to improve on. She said that often she will have spent time with individuals checking how they are feeling about their role, whether they had any issues, but that she did not always record this, so could not evidence that formal supervision had taken place as regularly as it should. Information provided by the home prior to the inspection shows that they have up to date policies and procedures in place for all safe working practices, staff have training in these areas to ensure both they and the people they support are safe. Edenmore Nursing Home DS0000066336.V367805.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 X 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 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 X 3 X 3 2 X 3 Edenmore Nursing Home DS0000066336.V367805.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 Medicines should be kept secure at all times whilst being given out to ensure they are taken only by people that are prescribed tablets. Timescale for action 30/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations Peoples’ mental capacity should be assessed so that the team are clear about whether a person is able to make decisions about their care and life at Edenmore. If they are unable to do so, the assessment should clearly highlight who will be involved in the process and the issues that need to be addressed for the individual. In particular, restricting access to bedrooms, use of keypads or mats linked to the call bell system need to be carefully considered and agreed by all stakeholders. In exceptional circumstances, where a person is assessed by a medical practitioner as lacking ‘capacity to consent to DS0000066336.V367805.R01.S.doc Version 5.2 Page 29 2 OP9 Edenmore Nursing Home treatment’ and the medicine is essential to their health and well being it may be given in a ‘covert’ way. Staff should follow the procedure of the home and also refer to the Mental Capacity Act and Codes of Practice, such as the ‘Standards for medicines management’ (Nurses, Midwives Council). If the decision is taken to give medicine covertly, it is not good practice to crush tablets or open capsules unless a pharmacist informs you that it is safe to do so. ‘The administration of medicines in care homes’ (CSCI publication) 3 OP12 The recreational needs of people, particularly those with dementia or communication difficulties, should be assessed using a tool such as the ‘Pool Activity level instrument’. Activities would then be person centred and pitched at a level that is suitable for the individual. The home needs to be able to demonstrate that individual preferences have been accounted for by keeping a record of meals provided to them. Staff should be offered regular recorded supervsion to ensure they are supported to do their job. 4 OP15 5 OP36 Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Edenmore Nursing Home DS0000066336.V367805.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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