Inspection on 26/11/09 for Elliott House

This is the latest available inspection report for this service, carried out on 26th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elliott House 14/09/06

Elliott House 13/12/05

Elliott House 17/08/05

Elliott House 04/01/05

Elliott House 16/08/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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 13/03/2010.

Key inspection report Care homes for older people Name: Address: Elliott House 22 Reculver Road Beltinge Herne Bay Kent CT6 6NA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Eamonn Kelly     Date: 2 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 35 Information about the care home Name of care home: Address: Elliott House 22 Reculver Road Beltinge Herne Bay Kent CT6 6NA 01227374084 01227740750 michelle.guest@elliotthouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Ian George Nicoll care home 71 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 71. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home Elliott House provides care and support for up to 71 older people. It is registered as a specialist home for people with dementia and, at any one time, all residents may have dementia. Bedroom accommodation is provided over 3 floors. Residents and staff have the benefit of two shaft lifts. There are 3 lounge areas and a further room for staff training, Care Homes for Older People Page 4 of 35 2 4 1 0 2 0 0 8 71 0 Over 65 0 71 Brief description of the care home storage of activities materials and for residents to meet visitors in private. There are two dining areas. Elliott House has 49 single bedrooms. All but 6 have an en-suite facility. There are also eight shared bedrooms all of which have an en-suite facility. There is parking space at the front of the premises. Weekly fees are £328 to £386 for residents funded by Kent County Council. The latter fee is for people diagnosed as having dementia. Residents and their families may have to pay a top-up fee of approximately £25 per week. Privately funded residents are charged a weekly fee of from £500 to £635. The latter fee is for a single ground floor bedroom with an en-suite facility. A shared bedroom used by one resident is charged at £550 per week. Information on the homes services (Service users Guide) and a copy of CQC reports may be obtained from the manager on request by prospective residents and their advocates. CQC reports may also be obtained on the internet. Care Homes for Older People Page 5 of 35 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: one star adequate 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 quality rating for this service is 1-Star. This means that people who use the service experience adequate quality outcomes. The inspection took place on 26th (11.30 am to 7.30 pm) and 27th November (1.30 to 6.30 pm) 2009 . It comprised discussions with the manager and deputy manager, senior carers, carers, two visitors and eight residents. A case tracking exercise relating to three residents was carried out to assess how they were being supported. The care needs of residents were discussed with members of staff who had a good knowledge of their support needs. Care practices were discussed and all parts of the premises were visited. Some records were seen during the visit principally those addressing the personal and healthcare support of residents. Care Homes for Older People Page 6 of 35 The Commission received an annual quality assurance assessment (AQAA) from Mrs Baker (manager). This provided information about how residents are currently supported and how the service is being developed. The previous inspection report was checked as part of this inspection. The need for sufficient carers to be on duty was contained in the previous inspection report and this requirement remains outstanding. The previous inspection report also contained a requirement for staff to be better supported. Some progress has been made in this area following Social Services interventions in October 2009. The evidence of this inspection visit and that contained in the AQAA (annual quality assurance assessment) indicated that progress is being made in the interests of resident welfare and comfort and towards meeting the overall objectives of the service. The report also contains reference to recent issues that were drawn to the attention of Kent County Councils Social Services department and to the Commission. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: This report contains a requirement that steps are needed to increase the numbers of staff on duty and to maintain these staffing levels. The need for sufficient carers to be Care Homes for Older People Page 8 of 35 on duty was contained in the previous inspection report and this requirement remained outstanding at the end of this inspection visit. Reference is made in the report to areas where improvement should be considered. The beneficial impact of the training initiatives currently underway was clearly visable during the inspection visit. The managers clear intention to move beyond awareness courses and initiate more in-depth training in essential topics (for example, appropriate training auch as the VRQ Certificate in Dementia care) is acknowledged. The programme of implementing new care plan records to help ensure that residents support needs are identified, addressed and reviewed needs to be completed and evidence that the procedure is being sustained needs to be obtained. The support provided for residents who are receiving nursing care (and whose continuing care has been agreed with care managers) needs to be reviewed and improved. The individual time and support for vulnerable people needs to be provided by the availability of sufficient staff time outside the time available to staff for domestic activities. It is acknowledges that activity specialists visit each of the three lounges to provide 30-40 minute sessions for groups of residents but throughout the day and evening sufficient staff support must be in place. The improvements to aspects of premises are acknowledged and there must be evidence of compliance with all Social Services requirements in respect of contracts and with Care Home Regulations. Following this inspection visit, the manager advised the Commission in writing that improved staffing levels would be implemented. The revised plans were stated as the following: Between 7.30 am and 2.00 pm, the same level of staffing would be in place (ie. eight carers and two senior carers). From 2.00 to 9.00 pm, there would be six carers and one senior carer: an activity coordinator would be on duty until 5.00 pm and this person would be replaced by a carer at 5.00 pm. From 9.00 pm to 7.30 am, five working carers would be on duty. The written notification from the manager outlined the intention to increase staffing levels in the light of difficulties in attracting and retaining staff. The plans included pay incentives for current staff to take overtime shifts. An account has been opened with a staff recruitment agency to meet staffing difficulties whilst recruitment of permanent staff is underway. The stated intention is to recruit a further six full time care assistants and two night carers. Contact has been made with the local job centre and advertisements placed in a number of newspapers. Care Homes for Older People Page 9 of 35 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 35 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 11 of 35 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 supporters receive initial advice and guidance to help them assess the facilities and suitability of the service. An assessment is carried out to see if the service can provide support that meets their needs. Evidence: Prospective residents and their representatives receive assistance and guidance to help them decide if the home is able to meet their support needs. The manager and/or deputy manager carry out an assessment of prospective residents support needs with assistance where necessary from Social Services care managers. Some residents have support needs associated with the onset of dementia as well as substantial mobility problems and other disabilities. Two residents have COPD and have oxygen equipment in their bedrooms. The evidence was that safety Care Homes for Older People Page 12 of 35 Evidence: arrangements are in place in respect of the use of this equipment. Notes are taken at this stage that form part of subsequent care plan records. The care plan record begun at this stage outlines the support needs of the prospective resident and how these needs would be met. A review of three care plans that contained preadmission assessments suggested that relevant information was gathered at this stage of admission. Care plans are being improved and the manager and deputy manager are aware that sufficient information should be recorded at this stage to enable carers to subsequently care for the resident. A resident said that he has been well looked after and that the manager and staff were fully up to date about his support needs. It was stated that potential residents may not always visit the home prior to taking up residence. However they (and their representatives) are invited to do so. The home admits residents for respite care. It is understood that full care plan records are maintained for these residents. New residents were said to receive a personal contract that contains information on the rights and responsibilities of both parties. Amongst other improvements noted in the AQAA, the service has reviewed and changed its admission pack to reflect a more person centred approach and an end of life plan is now included. Prospective residents receive a copy of a residents guide that outlines the services and facilities of the home. This information/declaration informs them of the levels of support and care to which they are entitled. The stated intention is that they receive the support outlined and as described in the admission plan and subsequent reviews. Care Homes for Older People Page 13 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal needs are met. Individual plans of care have the potential of contributing to better knowledge by staff of residents changing support needs. The lack of staff means that residents do not receive the level of social care to which they are entitled. Evidence: Care plan folders seen for three residents contained information about residents support needs and how these were being met. These included risk assessment information, pre-admission outline, fluid charts, weight records pressure sore prevention/treatment record, healthcare checks and access to healthcare services, and care plans outlining assessed needs and how to address the needs. In the case of three residents who were met during the inspection and whose care folders were checked, there is room for essential improvement for the benefit of residents and staff. The care plan information needs to be more accurate, up-to-date and comprehensive Care Homes for Older People Page 14 of 35 Evidence: for maximum effectiveness in meeting residents extensive health needs. Following assessment of care plan folders by Kent Social Services, the method is being updated. One of the three folders checked on this occasion was one of the new ones. The residents needs were seen to have been assessed and goals of care identified. The evidence was that the other two folders were were not as effective in this respect as they might have been. These care plans are being adapted to meet the standards required under the new scheme. Some issues concerning resident support that were identified when residents were met during the inspection were not shown on current care plans. It was agreed with the manager and deputy manager that the plans of care should be more specific rather than general. Members of staff complete daily records in respect of important aspects of residents health and changes in health or disposition. These issues were said to be discussed during staff changeover to enable in-coming staff to be aware of changes in residents temperament or health. During the inspection, carers were seen to be completing daily records. The need for this has been as a result of recent Kent Social Services recommendation following complaints about aspects of the service. On the second day of the inspection, the staff changeover was seen to include discussion about residents current disposition. During the inspection visit, members of staff treated residents with understanding and respect. Discussions about the profiles of residents and how they are supported also indicated a high level of understanding of and respect for clients. Where difficulties occur in the continuing support for some residents, there was evidence that care managers and family members are involved in reviews and any necessary changes in the levels of support. A care manager had recently checked an example of a new care plan for the resident he was visiting and it was said that the care manager was satisfied with the level of detail and accuracy. According to the manager and records seen, GPs visit as necessary. The services of district nurses are, according to the manager, routinely obtained and they have an increasingly important role as the support needs of residents increase. Residents have good access, according to profiles of residents discussed during the inspection and records checked, to local NHS community services. Two residents with copd (chronic bronchitis and emphysema) as the primary disability said they receive very good healthcare support particularly when they were feeling most vulnerable. They also said that carers have a good understanding of the Care Homes for Older People Page 15 of 35 Evidence: difficulties they faced and are skilful in providing the personal support needed. The manager and a carer administering medicines explained how medications are administered. MAR sheets are completed at the time of administration. A photograph of each resident accompanies their MAR sheet. In the case of residents receiving respite care, a MAR sheet was said to be completed manually to control and supervise their medication. Each member of staff administering medicines receives training according to the manager and deputy manager. Following advice from KCCs contracts officer, the method of administering and storing medicines has been reviewed and updated. An important declared aim of support is to help residents remain as independent as possible. This involves encouraging them to move around on their own with any necessary staff observation. The layout of the premises contributes to this objective and residents were seen to be able to move about safely. However, the evidence was that they are often without sufficient staff supervision. At tea-time, twenty five residents received their evening meal in the main dining area and thirteen received theirs in the second dining area. This meant that 26 people received their evening meal in their bedrooms. Some residents said that, apart from seeing staff at meal-times or when AM/PM tea is delivered to them, they rarely see staff. A resident said that she does not like to use the call-bell because of the pressure staff are under. On the second day of the inspection, the needs of 64 residents with high support needs and living in dispersed premises (three floors) were being met by a senior carer and four carers (4PM on 27.11.09). A member of staff described how, in her opinion, a resident who probably needs nursing care was not receiving the level of support she needed. When this was discussed with the manager, she outlined how the residents care would be immediately reviewed and how a new care plan would be prepared and maintained. Members of staff help residents who have hearing aids to keep them in working order and they encourage them to continue using the aids. Records indicate that residents weights are recorded monthly or more often if necessary. The AQAA states that the intention is to provide a better service in relation to answering the call-bell and the front door and to ensure that staff know the importance of keeping residents family and friends informed of changes to residents health. Care Homes for Older People Page 16 of 35 Evidence: Following the inspection visit, the manager provided details of how increased staffing would be in place and how the new staffing levels would be maintained. Care Homes for Older People Page 17 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive support on a day-to-day basis to remain mentally and physically active and alert. The objective of the home is to help residents gain and retain their independence. Residents are not receiving, in all cases, the levels of support they need. Evidence: The manager and deputy manager stated that members of staff help residents to remain physically and mentally active. There are a number of activities provided in the mornings and afternoons by staff and some were observed on this occasion. The AQAA provided examples and notice boards indicated the types of planned activities particularly in the afternoons. The service employs activities co-ordinators. On the first day of the inspection, bingo was being provided. On the afternoon of the second day of the inspection, a visiting therapist provided 30-40 minute music and movement sessions to residents in each of the lounges in turn. In the case of the example seen, there were about 15 residents present. An activities coordinator delivers goods to residents and collects payment. The goods provided included, for example, drinks and confectionery and items of clothing. Care Homes for Older People Page 18 of 35 Evidence: Residents said that relatives and visitors provide good support and that they may visit at any time. Residents are encouraged to continue the patterns of their former lives as far as possible within their changing circumstances and to exercise control over longer and shorter-term decisions. Weight charts and nutritional assessments were said by the manager to be maintained. Residents are able to have their meal over an extended period in either of two dining areas and members of staff give them assistance as needed. Residents using the smaller dining room are said to need more assistance. The AQAA indicated that residents and family members are encouraged to say what they feel and to give their views about any issue they feel affects them. Residents and members of staff gave examples of particular activities promoted by the service. There were a number of examples seen during the inspection that suggested they are helped in a number of ways to remain mentally and physically active. This included staff assisting residents on a one to one basis, helping them to walk about the premises including using the stairs and shaft lifts, provision of books and newspapers, talking to them, providing music and helping residents visit the garden. Amongst other improvements stated in the AQAA, the intention is to distribute purchased daily newspapers at a reasonable time and not around lunchtime as sometimes happens. During the inspection, there was a positive atmosphere and carers were working actively with residents when they were not engaged in household activities. The AQAA outlines how special consideration is given towards enabling residents to continue practicing their religion. Residents were met during their mid-day meal and evening meal. Some also gave their views whem met in their bedrooms. During the mid-day meal, all but one received the main meal. The cook said she is aware of residents preferences and information about allergies. A resident said that she had become aware that the owner had ordered that the provision of soup during the evening meal had recently been discontinued to bring the home into line with his other home in Essex. She said this had been done without consultation. This was Care Homes for Older People Page 19 of 35 Evidence: checked later with the manager and found to be true. Since the inspection visit, the Commission was informed by the manager that the change has been reversed. During tea-time, there were too few staff on duty to tend properly to the needs of residents. Residents having their midday meal in the dining room areas said that they enjoy their meals. Two visitors said that, as far as they could ascertain, meals provided were good. Observations made during the inspection were that some residents were spending a significant time alone in their bedrooms. Between 5-6PM, some 26 residents were alone in bedrooms and were receiving their evening meal there. The evidence was that with one senior carer (in charge) and four carers, the provision of meals, toiletting, dressing of residents to visit the dining areas, dealing with visitors (including having staff available to let them out, the support needs of 64 highly dependent people are not being met properly. The very low staffing complement was also affected by the dispersed nature of the premises (bedroom and lounge facilities spread over 3 floors). A minibus from the owners other residential home in Essex was at the premises on the second day of the inspection. It is available on limited occasions when pre-booked. It would be useful if a similiar investment was made specifically for this service given the large number of residents at the home. Care Homes for Older People Page 20 of 35 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 views and concerns are taken notice of and acted on and they are protected from abuse. Evidence: The AQAA stated that the views of residents are sought and all views are treated seriously. It referred to the complaints procedure (said to be known by residents, staff and visitors) and residents are encouraged to talk to staff about any concerns they may have. It also stated that the home encourages relatives to express their views, comments, complaints and suggestions in order to enhance the service. Examples discussed with the manager and deputy manager suggested that careful consideration is given to outcomes of direct contact with users of the service. They outlined how they have reviewed the outcomes of a Social Services Adult Protection investigations relating to medication administration and support for a resident. The latter is now with a Coroner for investigation and report. The former has led to a review of medication storage and administration and changes were made as a result. Discussion with the manager and deputy manager about the background to adult protection referrals suggested that procedures are being adopted to improve the support of residents. Care Homes for Older People Page 21 of 35 Evidence: Policies and procedures for safeguarding adults were said to be available to all members of staff and these give specific guidance to those using them. A member of staff met during the inspection had a good knowledge of her personal responsibilities for protecting vulnerable people. The manager said that, following staff training and day-to-day advice to staff, those working at the service know when incidents need external input and who to refer the incident to for guidance. She was very confident that carers understand Local Authority procedures for Safeguarding Adults. The Commission has been notified of incidents that occurred and reflection on these is reportedly used as part of quality assurance measures for the protection of residents. The recruitment procedure contains the checks (including CRBs) necessary to help contribute to the protection of residents and all members of staff receive training for their responsibilities under current POVA arrangements. The manager said that they are updating all staff about the implications of the new ISA (independent safeguarding authority). The AQAA stated that all members of staff are aware of the rights of residents and of how their interests must be identified and promoted. It outlined how the quality assurance system focuses on issues consistent with current care standards with emphasis on making residents quality of life progressively better. It also highlighted the fact that current stable management conditions have had a positive effect on residents and on the staff team. Reference was also made to staff guidance on relevant aspects of the Mental Capacity Act and how essential procedures might be affected as these measures come into being more fully. The manager and deputy manager have undertaken a number of improvements following visits from Kent Social Services care manmagers and contracts officer. These are referred to later in this report. The safety and comfort of residents is not ensured because of the low numbers of staff on duty. These low numbers of staff must support up to 71 older people (64 at the time of the inspection) with widely differing levels of disabilities over very dispersed premises (three floors containing lounges and bedrooms). Steps are being taken to address this concern. Please refer to sectio0n on Staffing. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable for use by frail older people. Shared bedrooms are not equipped to enable occupants to have sufficient privacy. Evidence: The premises contain mostly single bedrooms for residents (with currently seven rooms for people wishing to share), a kitchen, two dining areas and three lounge areas. A fourth lounge area is used for private meetings with relatives, for staff training and for storage of activities materials (for example, library books). Most bedrooms have an en-suite facility. Residents bedrooms are situated on the ground, first and second floors. Two shaft lifts are in place for the convenience of residents, staff and visitors. Some shared rooms are only marginally suitable for purposes of sharing (shape/space, beds too close to each other, no proper separation of toiletries). A charge of £550 per week is made if one person is occupying such a bedroom. The garden is a major asset for staff, visitors and residents. Handrails have been fitted throughout the premises for residents safety. Bedrooms have been personalised with residents possessions. Care Homes for Older People Page 23 of 35 Evidence: A laundry assistant was said to be on duty throughout the week. The AQAA referred to the practice of identifying areas which require maintenance and some areas that are earmarked for refurbishment were outlined. It also included a declaration that all essential safety certificates are in place and are up-to-date. The premises were maintained in a clean and tidy way at the time of the inspection visit. Following inspection by Kent Social Services, the manager has undertaken a number of improvements and others are in the process of implementation. Two areas have been identified to provide commode washing facilities. A Parker bath has been replaced. thin plastic gloves have been replaced by a more suitable type for the purpose of infection control, carpet joiners will be used to make floor coverings more safe, liquid soap and paper towels have been placed in bathrooms and toilet frame systems are shortly to be upgraded. Other recommended improvements are underway, according to the manager and deputy manager. For example, a new programme of staff training is being developed. Updated risk assessments are being carried out, for example, use of lap-straps on wheelchairs. Care plans are being amended to make sure that residents support needs are identified, adressed and reviewed. Carers will have better access to care plans and they will produce better daily records of residents health and disposition. It was seen during a shift change-over that carers had a good understanding of changes in residents health. Residents weights are taken and recorded. The system of medication storage and administration is being improved following concerns expressed by Social services. This includes giving medication at the required times, for example, it was said during an Adult Protection inquiry that some medicines were being administered nearer to lunch-time that morning. The method of maintaining the injection needle sharps box (insulin for diabetics) has been improved. The Social Services concern that there are too few staff to meet the needs of residents remains outstanding. Care Homes for Older People Page 24 of 35 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. Residents are protected by the use of a range of checks in the recruitment of staff. The training provided to staff is not extensive enough to enable them to meet the full support needs of residents. The number of staff on duty is not sufficient to meet the support needs of such a high number of residents in dispersed premises. Evidence: The AQAA contains a statement that most members of care staff have achieved an NVQ 2 or 3 qualification and all are encouraged to do so. The manager said that members of staff also undertake training in moving and handling, infection control, health and safety, and medication administration. She stated that the service places a high priority on enabling members of staff to receive relevant training focussed on delivering improved outcomes for residents. This is included in the process of formal supervision carried out at intervals with each member of staff. A new training matrix outlines the types of support being put in place for staff. A senior carer is now responsible for inducting new members of staff. The range of short courses outlined in the training matrix evidences the good progress made by the manager and deputy manager since Social Services intervention over the Care Homes for Older People Page 25 of 35 Evidence: last two months. Staff receive a short introduction to dementia from an external source. On the basis of this, they are led to believe that they are dementia trained (the new staffing procedure refers to this as certificated dementia awareness training). There is a stated intention to enable senior care staff and carers to obtain an appropriate qualification in dementia care. The manager outlined how she is making progress in this respect [the VRQ Certificate in Dementia Care is a possible appropriate qualification under active consideration]. An introduction to infection control procedures is given to staff. In-depth training such as the Certificate in Infection Control is being introduced. The manager has a definite plan to enable all care staff to achieve the Certificate in Dementia Care (taken by distance learning over about 3 months with competency testing by a visiting trainer)to equip them better in this important area of practice as the full registration is for people with Dementia Staff files seen indicated that job descriptions and specifications define the roles and responsibilities of staff. Residents and visitors met during the inspection reported that staff work hard in caring for residents. According to three staff files seen and statements contained in the AQAA, new staff are subject to full checks before they start work. These include CRB checks, references and other recruitment checks. The manager also showed how she takes up phone references as an additional check. The current metod of deciding on the number of carers to meet the needs of residents was shown in a staffing levels document. The number of carers on duty from 7.30 AM to 2.00 PM was stated as 10. On the first day of the inspection, the numbers were lower as two carers did not report for work. On the second day, there were 7 carers on duty. The staffing levels document claimed that the total number of care staff required on duty between 2.00 PM and 9.00 PM was 6. At 4.00 PM, sixty four residents were in the care of only five carers (a senior carer, trainee senior carer carer and three carers). The staffing levels document stated that four carers are supposed to be on duty between 9.00 PM and 7.30 AM. It was not established how many were actually on duty. It is understood that agency staff are not called upon to provide suitable staffing numbers. Members of staff use a clocking-in device to record their hours. The administrator calculates their pay based on the clock cards. Care Homes for Older People Page 26 of 35 Evidence: There were obvious pressures on carers at the time of the inspection on both days. More than twenty residents stayed in their bedrooms at tea-time and received their evening meal there. The low staffing number placed pressure on staff to help get residents dressed and mobilised for tea. They were under pressure in carrying out toiletting procedures. With the number of visits that had to be made delivering sandwiches, the provision of meals in two dining areas and to so many residents in their bedrooms placed pressure on staff. Residents expressed concerns about how lonely some had become as they were increasingly isolated in their bedrooms. Examples of comments were: Food is not very warm by the time it reaches me. The owner has stopped me having soup in the evening as this brings us into line with his other home in Essex. It is only when tea is delivered in the evening and at the morning and afternoon tea round that you see staff. Someone should come in to see you, they should check every half hour at least. Many residents made complimentary comments about the support they received. A residents said that she does not like to use the call bell because of the known pressures on members of staff. She said that she would be happier with a LifeLine alarm that would activate if she fell. She previously had one of these when she was in supported living and it would, she said, guarantee automatic assistance if she fell (which she is prone to do). A resident said she did not wish to criticise staff in any way because, she said, they work so hard and do their best to look after residents despite being so few in numbers. Two residents returned to supported living following good progress made at the home. This is a measure of the good care they received. During the inspection, a member of staff drew attention to a resident who probably should be receiving nursing care. The staff member had a good knowledge of how the resident should have been cared for and stated that the resident was not receiving the level of support she required. This was a measure of the thoughtfulness and skill of staff. The manager said that this resident would receive a full review and a new care plan would be produced. A resident stated that, although the home is aware of her food preference, she did not receive the meal of her choice that day. The manager agreed that this was the case. On the first day of the inspection, 63 of the 64 residents received the main meal. Whilst choices are said to be available, the exercise of this choice was seen to be a little limited. Care Homes for Older People Page 27 of 35 Evidence: The Commission has received a copy of a statement made to a Coroner by a former residents family of issues identified that, in the familys opinion, point towards acute staffing difficulties at most times of day and night. The AQAA stated that it is the intention of the service to maintain and improve staffing levels with high quality staff, to ensure a solid induction program for new staff is maintained, to ensure we continue with a training program relevant to our client group and to ensure regular staff supervisions and yearly appraisals. Following this inspection visit, the manager advised the Commission in writing that improved staffing levels would be implemented. The revised plans were stated as the following: Between 7.30 am and 2.00 pm, the same level of staffing would be in place (ie. eight carers and two senior carers). From 2.00 to 9.00 pm, there would be six carers and one senior carer: an activity coordinator would be on duty until 5.00 pm and this person would be replaced by a carer at 5.00 pm. From 9.00 pm to 7.30 am, five working carers would be on duty. The written notification from the manager outlined the intention to increase staffing levels in the light of difficulties in attracting and retaining staff. The plans included pay incentives for current staff to take overtime shifts. An account has been opened with a staff recruitment agency to meet staffing difficulties whilst recruitment of permanent staff is underway. The stated intention is to recruit a further six full time care assistants and two night carers. Contact has been made with the local job centre and advertisements placed in a number of newspapers. Care Homes for Older People Page 28 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a residential service that generally acts in their best interests. The manager is addressing issues such as low staffing levels, support for staff, improved care plan records and provision of better activities for residents as part of a programme for improving the lives of residents. Evidence: For most of the past year, the service has been managed by Mrs Lynn Baker with the assistance of a deputy manager, senior carers, carers and other important staff. The last manager registered with the Commission left in December 2008. The registered provider has not complied during 2009 with the requirement (for sufficient care staff to be in place) requested by the CSCI. The other requirement for sufficient training to be made available to staff was also not acted upon at that time. The new regulator, CQC, has a duty to follow-up this failure by the registered provider to meet the requirement within the time period specified. In October 2009, the registered provider appointed a full-time manager (Mrs lynn Baker). This happened after Kent Care Homes for Older People Page 29 of 35 Evidence: County Council safeguarding adults department and the CQC became aware of shortfalls in the support provided and investigations by both organisations followed. Following identification of a number of issues (some of which have been referred to in this report), the evidence was that the manager had successfully addressed these and, at the time of the inspection visit, had arranged further improvements that were to be implemented without delay. The manager, Mrs Baker, had also made an application to the Commission for registration as manager of Elliott House. There was definite evidence of an improved management structure at the service for the past few months. The evidence was that this is leading to better outcomes for residents. The service aims, according to the AQAA, to provide a good quality of life for residents. There is a focus on person centred thinking with residents centrally involved in shaping the support they require. There was evidence during the inspection that the service was making progress towards a more person-centred approach. This report contains evidence of the progress being made through a better management structure, better staff training, improvement to the premises and to procedures and through the hard work and professionalism of staff. The progress being made towards improving care plan records for the benefit of staff and residents also reflects rapid development over a short period of time. The level of training as listed in the training matrix is crucial to the safety and support for residents and staff. The training of staff to meet the high care needs of residents needs to be improved and the manager said they would make the necessary improvements. A qualitative example is that the manager is already progressing training ooportunities for staff so that they receive in-depth training in dementia care. It is the stated intention to enhance the details in the training matrix by facilitating other in-depth training, for example, diet and nutrition and infection control. A recurring theme in several sections of this report has been the lack of sufficient numbers of staff to support up to 71 older people in a service registered to care for people with dementia. This continuing shortfall is reflected in such areas as Health and Personal Care, Protection of Vulnerable People and Staffing. Please refer to the section on Staffing for information about the managers proposed steps to provide suitable staffing at all times to meet the needs of such a large number of vulnerable people. These steps include short term arrangements to immediadely make a difference and longer term arrangements to help ensure that the changes are maintained. Care Homes for Older People Page 30 of 35 Evidence: Residents and staff are likely to benefit from improvements in the way staff are trained and in how staff induction is promoted through competency testing over variable periods of time (with the help of a senior carer to whom this responsibility has been delegated). The AQAA contains a declaration that all necessary safety checks and associated certificates are in place. The service has a file of policies and procedures that are said to be available to staff for their information and professional updating. Quality assurance and monitoring procedures are said to be in place for efficient running of the home, to give value for money and deliver effective outcomes for the people who use the service. Residents receive advice on how to obtain impartial legal and financial advice if they need this. The service does not act as an appointee for any resident. The manager stated that a written record of all financial transactions is maintained where additional charges are made to residents. Care Homes for Older People Page 31 of 35 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 32 of 35 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 27 18 The registered person (the 11/01/2010 registered manager) must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. There were only 5 care staff on duty (senior carer and four carers) when the inspection took place. The report evidences how residents were not receiving the support they needed because of very low staffing numbers working with people with high support needs and in large and dispersed premises. The evidence from the inspection and that emanating from Adult Protection requires that action is taken by the registered manager to Care Homes for Older People Page 33 of 35 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 ensure the safety and comfort of residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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