Inspection on 21/05/09 for Elizabeth Court

This is the latest available inspection report for this service, carried out on 21st May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elizabeth Court 08/08/07

Elizabeth Court 28/04/06

Elizabeth Court 14/12/05

Elizabeth Court 11/07/05

Elizabeth Court 03/11/04

Elizabeth Court 14/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elizabeth Court Grenadier Place Caterham Surrey CR3 5YJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marion Weller     Date: 2 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Elizabeth Court Grenadier Place Caterham Surrey CR3 5YJ 01883331590 01883347423 Sam.ndlovu@anchor.org.uk www.anchor.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Nqobani Ndlovu Type of registration: Number of places registered: Anchor Trust care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 59. The registered person may provide the following category/ies of service only: Care home only - (PC) top service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Elizabeth Court is a care home located in Caterham, Surrey in a village setting close to local shops and public amenities. Care Homes for Older People Page 4 of 32 Over 65 0 59 59 0 Brief description of the care home The home provides personal care for older people and resident accommodation is arranged over three floors and in five seperate units. All floors above ground level can be accessed by stairs or lifts. The home has communal lounges, dining rooms, toilets, bathrooms, kitchenettes and a laundry. The garden is well maintained, private and secure. Bedrooms are for single occupancy and have en-suite facilities. Residents meals are prepared in the main kitchen and transported to service areas in heated trolleys. The home has private parking available to the front of the property. The home is managed by Anchor Trust. Fee levels in 2009 ranged from a minimum of #729 to a maximum of #765 Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key unannounced inspection of this service was completed on the 13th December 2007. An annual service review was undertaken on the 10th December 2008. Marion Weller, Regulatory Inspector, conducted this key unannounced inspection of Elizabeth Court on the 21st May 2009 and was in the home from 10:35 am until 5:35 pm. This inspection was brought forward from the original scheduled date of December 2009 as a result of a management review decision taken by the CQC at a meeting in April 2009. The home evidenced an escalating number of notifications, complaints and safeguarding alerts. It was therefore considered necessary for the regulator to undertake a comprehensive key inspection to review the homes published quality rating and ensure service users were safe and their needs were continuing to be met in the home. Care Homes for Older People Page 6 of 32 During the site visit the inspector spoke with some residents, residents relatives visiting the home, the registered manager and the deputy manager, the chef, one of the activity organisers and numerous members of the care staff team. The inspector looked at some of the bedrooms at the invitation of residents and the communal areas. Some records and documents were inspected. The inspection report takes into account all the information obtained about the service since the previous site visit. This includes formal notifications, phone calls and letters received by us and any complaints or allegations notified to the CQC. The manager was asked to complete the homes Annual Quality Assurance Assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The completed document provides information as to what is happening in the service and their plans for further development. Surveys were given to residents, some relatives or representatives of residents, staff and other professionals involved with the home to find out their levels of satisfaction with the service prior to the inspection taking place. This had to be arranged at very short notice. The home organized the return of surveys to the inspector after the site visit had concluded. The inspector was therefore not aware of some emerging themes raised by survey respondents at the time of the site visit. Survey respondents were overall very satisfied and complimentary about the care provided at the home. Survey forms included the comments: .....I am extremely happy and confident that my relative is very well cared for. .....In the two years that my relative has been resident, the service has improved enormously and staff are always keen to have our feedback. And .....Staff are friendly and cheerful, providing a pleasant environment. Meals are well presented and smell appetising. .....Generally everything is very good at Elizabeth Court. It is well run by the manager and the deputy manager. I have had no reason to complain about anything. Other statements made by survey respondents are included throughout the text of the report where they are required to inform and further illustrate the judgments made for the outcome area assessed. The registered manager and all the staff gave their full cooperation throughout the site visit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 32 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives are provided with information about the home before moving in. The manager is in the process of ensuring that documentation is updated and contains all the information people need. People using this service benefit from comprehensive assessments before moving in, which ensures their needs are identified and they can be met by the home. Either they or their representatives are encouraged to visit the home prior to making a firm decision to move in. Evidence: The home has a Statement of Purpose and Service User Guide. The content of the Statement of Purpose was checked and found to need minor changes to ensure it meets all the demands of regulation. Where shortfalls were seen they were discussed with the manager who stated his intention to revise the document. Once completed, this will ensure that people have all the information they need to make an informed Care Homes for Older People Page 11 of 32 Evidence: choice about moving in. As a result of a recent safeguarding investigation, the manager has revised the homes policy regarding the provision of staff escorts to accompany residents having to attend hospital. It was recommended that staff escort arrangements are made clear in the homes information documents and discussed with prospective residents and their representatives prior to admission. Individual wishes and/or alternative arrangements for family members to escort residents in emergencies should be clearly recorded in the persons plan of care. The manager was aware that the home should have firm arrangements in place for accessing additional escort staff at short notice, especially during night hours. It was discussed that other service users in the home should not be placed at risk by the expectation that staff from the existing night staffing allocation are used for this task. The home has a clear process for undertaking pre admission assessments. The care needs assessment viewed covered personal, health and physical needs, leisure and social interests and the religious and cultural preferences of the individual. It is usual for the manager or deputy manager to visit the prospective resident to make a decision about whether the home can meet their needs. Information is also obtained from other parties, including relevant health and social care professionals. Pre admission assessments form the basis for all residents care plans in the home. Additional assessments are made when the person is admitted to ensure their changing needs will continue to be met. Residents or their representatives are able to visit the home before moving in and some people spoken with said staff had been very helpful in assisting them to settle in. Survey respondents said they felt involved in the assessment process and felt that their views and choices were taken into account. Comments made evidenced high levels of satisfaction with the home. Intermediate care is not offered at Elizabeth Court. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care plans and daily record content has significantly improved but both systems in place require further development to better evidence the health and care needs of people living in the home are consistently being supported and met. Residents are protected by the homes policies and procedures regarding medication administration and people are treated with respect and their privacy is maintained. Evidence: Each resident has an individual plan of care plan drawn up with them or their representative and content is clearly based on the homes full assessment of their needs. Care plans are being regularly reviewed and content changed where necessary. The home uses a care planning system provided by the provider organisation, Anchor Trust and introduced by them during the later part of 2006/07. Three care plans were inspected in detail on this site visit. Care plans are designed to set out the actions which need to be taken to ensure that all aspects of the health, personal and social care needs of the person are met. In response to a statutory requirement issued in Care Homes for Older People Page 13 of 32 Evidence: the last inspection report, care plans have been further developed to include more about peoples social care needs and daily records now evidence what activities they are being supported to take part in. Although meeting regulatory demands, it was discussed that care plan files were rather large and unwieldy documents, divided into numerous separate sections, each with its own monitoring records, which in practice proves difficult to audit and track and raised the question about how dynamic and useful they are for staff in their current format. A recommendation was made in the last inspection report that the way daily records are maintained be reviewed to ensure they provide all the information needed for monitoring purposes. This is again recommended for further review in this report. The manager is aware of the limitations of the current system and spoke of plans to revise and further develop it. Records relating to the personal care provided to people in the home have clearly improved since the last inspection, but still further work is needed to ensure that care plans are being used correctly and monitoring records clearly evidence the demands of the care plan are being met. Five of seven staff surveys received highlighted care plans as needing further development for ease of use. One survey respondent, when asked what the home could do better recorded.....Nothing really, except reduce the massive amount of paperwork and another said.....Cut down on paperwork. Health needs of individuals are addressed through their care plan and records of visits from GPs and other health care professionals are being maintained. Feedback from health care professionals involved with the home was largely very positive. One health professional recorded....Over the last year Elizabeth Court has striven to improve their residents health and well being. They actively contact health professionals to support them in caring for the needs of their residents. The same respondent recorded that the home could improve still further by ensuring that care plans are closely followed by carers and monitoring records are completed as requested by health professionals. In addition, staff must act on information gained promptly. Another health professional recorded....they need to understand the importance of handing over clients with concerns when we first go in the home, sometimes it is not always easy to find a member of staff to speak to. People that live in the home said that they are supported to see a GP when they need to and they felt the care staff responded to their health needs quickly. Individual preference regarding the gender of the staff that supports them with their personal care has been included in care plans. One survey respondent recorded....medical issues are dealt with promptly, doctors appointments made when necessary and Care Homes for Older People Page 14 of 32 Evidence: relatives kept informed. Following three notifications to the CQC regarding medication errors in the last year, the homes medication procedures and practice have been further reviewed by the manager to ensure the safety of people who have their medication administered by the home. Evidence was seen that staff who administer medication have completed two seperate training courses. One that deals specifically with ensuring safe practice in this important area and one that deals specifically with the Monitored Dosage System that the home uses. All medication administrators have ongoing competence assessments and individuals are sent for retraining if shortfalls are evidenced. As the result of a recommendation made in the last inspection report, guidance has now been produced for staff to ensure they know when prescribed PRN medication is to be given to residents. There are plans to further develop this in line with good practice. There are designated medication storerooms and mobile drug trolleys on service floors. Standards of storage and cleanliness in the storerooms are good. The Medication Administration Record sheets inspected are completed appropriately. The only shortfall was that hand transcribed entries to MAR do not consistently evidence a second signature to confirm accuracy of transcription and in addition there is inconsistency in ensuring hand written transcriptions include all the warning text printed on the chemists original dispensing label. This is required to inform and direct the medication administrator and to fully safeguard the residents welfare. The manager spoke of his intention to address both issues immediately. Residents felt that staff were kind and caring and this was confirmed by observation and discussion with visitors. Staff are considerate of the age and dignity of residents and treat them with courtesy. A survey respondent recorded....Staff always treat my relative with respect and they are warm and friendly. Another said....My relatives carers are very patient and they genuinely care for her and look after her well The home aims to care for people until the last stage of life. Last wishes are identified and recorded in a compassionate way in residents care plans, where this information is known to the home. Relatives and friends can stay with the resident if they wishe at end of life. The home provides dedicated accommodation for this purpose. The manager records in the homes AQAA that care plans and systems are to be further developed for end of life care in line with gold standards, such as those evidenced in The Liverpool Care Pathway. The manager is aware of the homes limitations in some health matters regarding end of life care as Elizabeth Court is not a Nursing Home. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities offered to residents in the community and current opportunities for mental stimulation and diversion in the home are well managed and provide daily variation and interest for the people who live there. Residents will benefit further from plans to improve social care provision in the home in a more person centred way that will focus on peoples diverse expectations, preferences and individual capacities. Wherever possible residents are given opportunities to make choices in daily life, allowing for an important level of control over their lives. Residents enjoy the meals and have plenty of choice. Evidence: Residents are consulted about their social interests and needs as part of the homes initial assessment. Social needs are recorded within care plans. There is a diverse programme of activities arranged in the home led by two dedicated activities coordinators. Their hours of work cover evenings and weekends as well as weekday hours, which clearly supports residents individual leisure and social care preferences. Residents spoken with said they enjoyed the activities arranged and could decide if they wanted to be involved in them or not. Their decision was always respected by Care Homes for Older People Page 16 of 32 Evidence: staff. During the site visit a paid entertainer was leading residents and some visiting relatives in a musical sing along. The event was clearly tailored to meet the needs of the group attending. A range of music was offered which was lively and motivating. Some residents were enjoying singing along and others were assisted by staff to dance and enjoy the music in that way. The activities coordinator spoken with had a good understanding of the diverse needs and interests of all the residents living at Elizabeth Court. The needs of those residents who are unable to attend group sessions were discussed with the deputy manager, who said that activities staff aim to visit these people individually. The managers AQAA records that he continues to challenge the homes rather traditional culture, through ongoing staff training programmes, to break away from a dependence on group activity, to more individual activities that focus better on peoples diverse expectations, preferences and individual capacities. The home has a Wii (Interactive Computer Games Console). The people that live in the home use this to play games such as tennis and golf. This has been particularly successful for people that used to enjoy these sports as a hobby. The feedback from people in the home was positive about this and photographs of people playing and laughing were seen. Since the last inspection the home has introduced two personal computers that give people living at Elizabeth Court free access to the internet and email facilities. This enables and supports people to keep in touch with relatives and friends and supports life long learning. Visitors are welcome at any reasonable time and during the site visit at least 8 visitors were seen in the home. Visitors can stay and enjoy a meal with their relative if they wish and the home offers some limited accommodation, made available to relatives if required for a specific purpose. Residents are supported to go out in the community and some attend local churches, day centres and other community based special interest groups. Regular trips out for residents are also arranged to places of interest and to community resources such as libraries. One resident survey respondent recorded, .....Activities of a wide variety are available if you want to join in. Another survey respondent said.....I can do what I want when I want, like being able to go to bed early if I want. The home completed a project on the nutritional needs of people with Dementia. Their research showed that having the main meal of the day in the evening helped some people to sleep better at night. Everyone in the home has since been consulted about the times they would prefer their main meal and the homes Chef arranges for this to happen where it is requested. Care Homes for Older People Page 17 of 32 Evidence: There is a 4-week seasonal menu offered and this was displayed on notice boards. In response to a recommendation made at the last inspection, the written menu is now additionally displayed in a pictorial format to meet the communication needs of everyone accommodated in the home. Upon admission to the home the likes, dislikes and dietary requirements of people are recorded in their care plan. There are always two choices per meal and the choice of a cooked or cold breakfast. People are supported to make their choice from the actual meals in front of them rather than pre order. The deputy manager said they can always have something else from the kitchen if they do not like the choices available. In addition to the main meals provided there are always fresh fruit, biscuits and other snacks on each unit. The chef makes homemade cakes daily for afternoon tea. Each unit has a water cooler and a fresh fruit juice machine. Feedback from the people in the home showed they enjoyed their meals and felt they had sufficient choice. One survey respondent recorded.....I am a vegetarian and the food given to me is excellent. Another said.....meals are very good here. A residents suggestions book evidenced that the Chef Manager gets frequent written feedback about menu items and the quality and quantity of the food provided from residents. The chef confirmed that he acts on suggestions offered and critiscisms wherever possible and speaks regularly to the resident group to gather verbal feedback. Staff were seen to support residents with their meals in a respectful and dignified manner throughout the lunch time period. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know any concerns they have will be taken seriously and acted upon and they are safeguarded from abuse. Peolpe involved with the home will benefit further when information documents are revised and contain all the information they need. Evidence: The home has a published complaints procedure with appropriate stages and timescales for responding to complaints. This is displayed for people to refer to. The complaints procedure was however missing from the homes Statement of Purpose sent to the CQC prior to the site visit. To ensure people involved with Elizabeth Court have all the information they need about the service, the manager stated his intention to review information documents to ensure their content meets all the demands of regulation and also includes updated information about the new regulator for health and social care, together with contact details for the local Social Services Department who hold the statutory power to investigate complaints about registered homes. Our records indicate that there have been four complaints made to the CQC against this care home since the last inspection. Three of these were raised anonymously. The registered manager was asked to investigate issues around poor infection control and respond to us in writing. Information provided to us evidenced that the informants complaints could not be substantiated. The AQAA records that the home has received sixteen complaints in the last twelve months. Data received illustrates that of the sixteen complaints, two were upheld following investigation. Issues raised were swiftly Care Homes for Older People Page 19 of 32 Evidence: acted upon by the home. The manager is aware that the responsibility for the quality of the service offered at Elizabeth Court, is that of the registered persons. One formal complaint remains outstanding at the time of this inspection. This matter continues to receive attention by the manager and the provider to achieve a satisfactory outcome for the complainant. Actions taken to date have improved service provision in relation to end of life care, care of deceased residents property and the support of relatives. Feedback from people that live in the home and those surveyed evidenced that they knew how to make a complaint and felt their concerns would be listened to and acted upon. The managers AQAA records that the home wants to be as transparent with complaints and feedback about service provision as possible, and complaints are welcomed by him as a mechanism to improve service. It was noted that of the sixteen formal complaints, some were in fact made in connection with some fairly minor feedback received. It is arguable if they should all have been recorded amongst those of a more serious nature. It is however to the managements credit that they see all feedback received, and at whatever level of censure, as important. Numerous letters of compliment were also seen on file during the site visit. One stated about the home....The staff at Elizabeth Court are amazing people, with an amazing ability to care. Survey respondents also evidenced high levels of satisfaction with the service. A resident recorded....It is a nice comfortable place and I am lucky to be here. Another said.....this home is excellent, what more can I say. Five adult safeguarding alerts have been raised in connection with people who live in the home. The manager contributed openly and honestly during each investigation process and was eager to ensure that changes and improvements were made. All investigations are now closed and the home continues to focus their efforts on further service development to the benefit of service users. The Manager and Deputy Manager have a copy of the Surrey Adult Protection Policy dated 2008 and both individuals completed update safeguarding training in January 2009 delivered by the local Authority. All the staff have received training in safeguarding procedures and update courses are ongoing and planned for staff during 2009/10. Elements of good practice around the inappropriate use of restraint in residential homes are covered in safeguarding adults training and specialist training arranged by the home for staff. The Safeguarding Adults Policy for the home has been reviewed. In addition, and as a result of a statutory requirement, the whistle blowing policy has also been revised and informs staff that they can contact the CQC if they need to. Staff spoken with Care Homes for Older People Page 20 of 32 Evidence: understood the reporting procedures for allegations of abuse and evidenced their knowledge of how to access procedure documents for their information and direction. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy living in a comfortable and overall well maintained and spacious environment that largely meets their needs. Their levels of satisfaction will be further increased by the maintenance of an odour free environment, monitoring of resources that promote their dignity and independence and an assurance that the homes infection control policy is being followed, to fully protect them from any potential for harm. Evidence: The location and layout of the home is suitable for its stated purpose. It offers disabled access throughout and is overall being well maintained. Each person has a single bedroom with ensuite facilities that include a shower, sink and toilet. There are additional bathrooms with assisted baths on each wing of the home. The bathrooms have been decorated to provide a pleasant environment for people. The feedback from people who live in the home evidence they are very happy with their bedrooms and feel they meet their needs. All the bedrooms have telephones for personal use and bedrooms have been further personalised to reflect the interests and the personality of the occupant. The home is divided into five wings and on each there is a large lounge, dining room and kitchenette. All the communal areas are furnished to meet the needs of the Care Homes for Older People Page 22 of 32 Evidence: people that live there. Handrails are fitted in the hallways, hot surfaces are protected and the layout of the home is suitable for access by wheelchair users. There is a passenger lift to all floors above ground level. New pathways have been added around the building and trees cut back from pathways to make it safer for people to access and walk around the exterior grounds. The garden has pleasant seating areas and a BBQ for use in the summer. The deputy manager said outside areas are very well used and enjoyed by people living in the home and their relatives. A relative who responded to our survey said.....Elizabeth Court provides a very pleasant environment and my relative is happy and contented living there. There is now a housekeeper in post who carries out all the laundry and also supports people living in the home to do any items of laundry they may wish to do themselves. Laundry is washed separately for each person in the home and they have their own laundry basket in their room. The Deputy Manager said that the improved organisation of laundry procedures has stopped incidents occurring where items of clothing were either damaged or lost. The homes AQAA records some environmental improvements that have been made over the last year. In addition, it records the Department of Healths Essential Steps to Infection Control have been used by the manager to develop an action plan for the maintenance of good infection control measures in the home. This included the development of a new hand washing regime for staff and an auditing tool to monitor the effectiveness of the procedures put in place. Despite these measures survey respondents, including a health professional recorded concerns about a lack of liquid soap and hand towels for hand washing in the home on occasions. Two other respondents raised concerns about effective monitoring by staff that toilets had a sufficient supply of toilet rolls for residents use. One respondent said the absence on occasions of toilet paper was particularly frustrating as residents who lacked capacity were not always able to ask for replacements. The situation compromises life long personal hygiene routines and fails to maintain peoples independence. During the site visit it was evidenced that some pedal bins in the home lacked foot operated pedals, which also has the potential to compromise infection control. The deputy manager said this matter would be attended to without delay. One service area of the home evidenced an unpleasant odour and this was discussed with the deputy manager. Some chairs in the lounge area were aged and due for replacement. The issue was attributed to the need to replace these articles. When asked what the home could do better, one survey respondent recorded.....Occasionally Care Homes for Older People Page 23 of 32 Evidence: there are unpleasant smells, urine etc which are apparent in corridors and the lounge area. This can be very off putting. A few times it has been so overpowering that I have cut short my visit... The service must address environmental shortfalls which compromise good infection control measures and potentially place residents at risk. All areas of the home should be pleasant and kept free from offensive odours. A requirement will be issued to that effect in this report. Care Homes for Older People Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a robust system for the recruitment, induction and development of staff which is designed to ensure service users are in safe hands at all times. However, current staffing levels do not consistently demonstrate that residents needs are being met and must be reviewed. Evidence: People that live in the home, their relatives and representatives and the other stakeholders involved with Elizabeth Court returned a total of 27 surveys given to them prior to the site visit taking place. Overall survey respondents evidenced high levels of satisfaction with the service. There were however a significant number of comments with regard to there being occasions when care staff were not available to help residents and people had had to wait for attention. One respondent records....toileting on a regular basis varies according to the staff on duty and residents are not always able to ask for help. Another said....Staffing levels at meal times are sometimes particularly problematic, often you can not find enough people around to help. As mentioned elsewhere in this report a health professional said.... sometimes it is not always easy to find a member of staff to speak to. Staff surveys also evidenced some concerns in this area. One respondent recorded.....They should ensure better rota cover at busy times in the home, like lunchtimes. Another said when asked what the home could do better.....put enough staff on all shifts. A third said.....More organisation and monitoring is required in the home and staffing rosters Care Homes for Older People Page 25 of 32 Evidence: should be done by the senior staff. Staffing levels must be based on the homes statement of purpose: admission criteria and the specific needs of service users. They must also take into account the numbers of service users, their level of dependency, the social, recreational and cultural activities taking place, the training and development requirements of staff, the design and layout of the home and the levels of specific assistance and supervison required by the people living there. Comments received do not evidence that residents needs are being consistently met at all times and staffing levels must be reviewed. If necessary, adjustments must be made to reflect residents needs at busy times. To that effect, a requirement will be issued in this report. The service recognises the importance of staff induction,training and development and delivers a training programme that meets statutory requirements and the National Minimum Standards. The manager states that 80 of care staff are trained to NVQ Level 2 or above which is commendable. There are plans in place to ensure more people are offered the opportunity to gain recognized qualifications. The service has robust recruitment procedures that are regularly reviewed to ensure good practice is being consistently developed. Three Staff files were inspected. It was clearly evidenced that the providers recruitment procedures are closely followed in practice and there is accurate recording at all stages of the process, to secure the safety and protection of people living in the home. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered owner and manager are responding to the need for improvements to be made to the service. Some working practices require further development to ensure the safety and welfare of residents is being consistently promoted and protected. Evidence: The registered manager and provider are aware that a Management Review Meeting (MRM) was held at the CQC to discuss the homes escalating number of Regulation 37 notifications, complaints and ongoing safeguarding issues in line with our enforcement policy. A decision was taken at the meeting to bring forward the homes next Key Inspection originally scheduled for December 2009. The regulator wanted to evidence by means of a comprehensive inspection that the service continued to reflect the quality rating of GOOD awarded at the last Key Inspection and that the people living at Elizabeth Court benefit from the ethos, leadership and management approach of the home, and in addition were safe and protected from any potential for harm. Care Homes for Older People Page 27 of 32 Evidence: Upon assessment following this site visit, the service continued to be judged as good. Due to the level of activity in relation to complaints and safeguarding investigations since the last inspection, the manager feels that he has learnt valuable lessons and has already made significant improvements to the service offered at Elizabeth Court as a result. Overall the service has more strengths than areas for improvement. Some issues exist and remain outstanding at this time. These have been illustrated throughout this report. The key National Minimum Standards are generally met, and where there are areas for improvement we are confident from discussions with the registered persons that they will manage the improvements required well, and act swiftly to resolve them within the time frame given. The provider undertakes regular quality assurance exercises including sending questionnaires to the people who live in the home, staff, visiting GPs, and community nurses. It was clear from discussion with the registered manager that the views gained from residents, relatives and other stakeholders are being used to inform planning. The manager said .......Getting the views of people who use our services is really important to us. The homes AQAA also gives examples of where the service has incorporated residents and their representatives suggestions into day to day operations. For example, night check agreements have been reintroduced for residents and are used to inform their care plan. This ensures staff are clearly directed about what they must do for the individual to keep them safe during night hours. Some people have asked the home to manage their personal money on their behalf. The Manager has undertaken training in this area. No issues of concern regarding service users finances were raised by survey respondents. Residents were also observed to have a secure lockable space in their bedrooms to store their belongings safely. All equipment in the home has been safety checked. Risk assessments have been completed for risks relating to the care and support of individual residents and also risks within the general environment. The temperature of the hot water in the bathrooms is regulated and monitored. Radiators are covered throughout the home to avoid risks of scalding. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 13 Improvements must be 03/08/2009 made to the current arrangements in place to prevent infection, toxic conditions and the spread of infection in the home. In addition, the premises are to be free from offensive odours throughout. To provide service users with a clean, pleasant and hygienic environment that protects them from any potential for harm and promotes their dignity and independence. 2 27 18 A review of staffing levels 21/08/2009 must be carried out and thereafter periodically kept under review to ensure that care staff are provided on all shifts in the numbers required to meet the assessed needs of service users and the aims and objectives of the service as Page 30 of 32 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action recorded in the homes Statement of Purpose. The registered persons must ensure that there are sufficient care staff working in the home to consistently meet the assessed needs of service users, particularly during busy periods. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 It is strongly recommended that the registered person fulfill their stated intention to review and revise the homes statement of purpose and service user guide to ensure it includes all that is required under Schedule 1 and provides the information people need to make a firm decision about moving into the home. Consideration should also be given to including information about the homes revised escort policy. It is strongly recommended that the care planning system and the maintenance of residents daily records are both reviewed and further developed to better evidence that the health and care needs of residents are consistently being met and to ensure they provide all the information needed for monitoring purposes. 2 7 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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