Inspection on 17/11/09 for Etheldred House

This is the latest available inspection report for this service, carried out on 17th November 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Etheldred House 27/02/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Etheldred House Clay Street Histon Cambridge CB24 9EY     The quality rating for this care home is:   two star good 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: Janie Buchanan     Date: 1 7 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 26 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 26 Information about the care home Name of care home: Address: Etheldred House Clay Street Histon Cambridge CB24 9EY 01223236079 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): santall.steytler@excelcareholdings.com Excelcare Holdings Name of registered manager (if applicable) Mrs Santall Steytler Type of registration: Number of places registered: care home 80 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 who can be accommodated is 80 The registered person may provide the following categories of service: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Older People, not falling within any other category - Code OP Date of last inspection Brief description of the care home Etheldred House is a large new purpose built care home, providing nursing and residential care to 80 older people. The home is divided into 4 units Apple, Pear, Cherry and Strawberry each with its own communal lounge, dining area bedrooms, kitchenette and bathroom facilities. The home has 3 secure garden areas that are accessible to residents. The home is situated in the village of Histon with good access Care Homes for Older People Page 4 of 26 Over 65 0 80 80 0 0 9 1 2 2 0 0 8 Brief description of the care home to local shops and a library. Cambridge City Centre is about 4 miles away. The registered provider of the home is Etheldred Healthcare Limited, which is a subsidiary company of Excelcare Holdings Ltd. 18 of the beds are contracted to the local Primary Care Trust at their benchmark cost, with the rest being available to people self-funding their own care. Weekly charges vary between £662 and £832 per week depending upon the peoples needs. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: For this inspection we (The Care Quality Commission) visited the home and talked with residents, staff and the manager. We took lunch with the residents so that we could assess the quality of food and also watch how staff interacted with, and supported, residents. We received 12 surveys completed by residents and their relatives (although we received none from staff) asking them for their opinion of the service. We undertook a tour of the premises to check on health and safety, and viewed a small sample of residents medication administration records. We also undertook a specialist observation called SOFI-(Short Observational Framework for Inspectors) of care practices on the nursing dementia care unit. As part of this we observed five residents for a period of two hours and recorded their experiences at regular intervals. This included their state of well being, how they interacted with staff, other residents and their environment. The findings of this observation are included in this report. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 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 Care Homes for Older People Page 8 of 26 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 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have information about the home to help them choose if it is right for them. They have their needs assessed and a contract that gives details of the service they will receive Evidence: There is a statement of purpose and service user guide that give good information about the home, its admission procedures, the staff and the services it offers. These have both been updated since the last inspection and include the new contact details of the Care Quality Commission. Each resident is also issued with a contract that states the terms and conditions of their stay, the fees payable, the care and support services offered, and details about terminating the contract. Residents and relatives who completed our survey told us they received enough information about the home before moving in. One stated: I was given a brochure and shown round the home, we even got to choose mums room. Another relative was particularly impressed with her fathers admission stating: from the start the staff were compassionate and Care Homes for Older People Page 11 of 26 Evidence: understanding-this enabled my father to make the very difficult transition not just from home to residential care, but also from up north to down south a lot easier. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health care needs are clearly documented, monitored closely and reviewed regularly by staff at the home. Evidence: One relative told us: all round caring is very good i.e. hair chiropody hospital visits doctor and dentist. We found good evidence that residents health care needs were met at the home, with their weights, blood pressure, dependency levels, nutrition and pressure sore risk monitored every month. We viewed the care plan for one resident with pressure sores. Information about the sores and how they were to be managed was good. In particular the wound progress chart was very detailed and had been completed every 4 days ensuring that the sores were monitored closely. We read another plan for a resident who uses a lap belt to stop her falling out her chair. A risk assessment had been completed for this, her family had been consulted, and also advice taken from a social worker in regards to the possible deprivation of her liberty. The manager meets every month with a local community psychiatric nurse to review and discuss the needs of residents with mental health problems. All the plans we Care Homes for Older People Page 13 of 26 Evidence: viewed showed that residents see a range of health care professionals regularly to ensure their well being is promoted. The plans had been reviewed every month and updated according to changes in residents needs. We checked a small sample of residents medication administration records (MAR). These showed that residents were getting their medication as prescribed, that staff were signing accurately to indicate what had been given, and that medication was stored correctly and at the right temperature. Our SOFI observation showed that none of the residents we observed spent any time in a negative state of being. Nobody was left unattended and no one showed signs of distress. In total 45 of the time the residents were in a positive state of being, 28 of the time a passive state and the rest of the time they were either asleep or withdrawn. They spent 35 of the time engaged with staff and 3 engaged with other residents. However what our observation did highlight was that the quality of interaction between staff and residents could be improved. The nature of most interactions was very task centred either when staff were hoisting someone, giving them a drink, or moving them. Staff often failed to explain to residents what they were doing and there were many missed opportunities to verbally engage with them with everyday conversation. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to a range of activities and outings and the food is varied and plentiful. Evidence: The home employs a specific member of staff, five days a week, to undertake activities and there is a busy schedule of events which is well advertised around the home (although the poster for this could be made much larger and brighter so that residents can see it more easily). Forthcoming events for November included; a church service, a hand bag party, a clothes sale, smoothie making and hat games. The home also has a cinema room with a large screen and shows movies most afternoons. During our SOFI observation we watched a member of staff paint with some residents. Although those involved were clearly enjoying it, we felt more could be done by this member of staff to actively include and stimulate other residents who were watching this activity very nearby. There are outings to places of interest each month and recent trips have included the Botanical gardens and 24 residents recently took part in a sponsored walk round Milton Country Park organised with the Alzheimers Society. A visit to the Sedgwick Museum is planned later in November. However one relative commented: although a Care Homes for Older People Page 15 of 26 Evidence: monthly church service is conducted at the home I would like my mother to attend the church service in the village. Residents we talked to told us there was a good choice of food and in the morning of our inspection some were enjoying a fully cooked breakfast while others had cereal or prunes or porridge. We took lunch with the residents which consisted of bacon and onion roll or mushroom quiche and residents were offered sherry with their meal. Two visitors also joined their relative for lunch and staff made them welcome. One resident, who was very particular about his food, had a specialist menu specifically designed for him consisting of his favourite foods. Snacking buckets filled with fruit, sweets and biscuits have been put in corridors on the dementia units so that residents can help themselves Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to the homes complaints procedure and their concerns are taken seriously. Evidence: Details of how to complain are contained in the homes statement of purpose and service user guide that all residents receive. There is also a complaints/compliments hot line which is well advertised around the home that people can ring if they want to raise any concerns. Residents and relatives who completed our survey told us that the home had responded appropriately when they had raised concerns. One relative commented: I feel I can talk to the manager, carers and nurses at any time and that my concerns are responded to. We viewed the homes complaints log which showed us that all complaints received were fully recorded, investigated and suitably responded to by the manager within set timescales. Staff at the home have received training in protecting vulnerable adults and showed an adequate knowledge about the different types of abuse and reporting procedures and information is available on each of the homes units. A poster giving information about how to report any safeguarding incidents is also available in the main entranceway to the home. There have been a number of safeguarding incidents in the home since we last visited concerning amongst other things; inter-resident aggression, the alleged mistreatment of one resident by two staff and poor care practices. The manager reported these incidents appropriately and has been fully Care Homes for Older People Page 17 of 26 Evidence: involved in their investigations. Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable and well maintained environment. Evidence: The home has been purpose built to meet the needs of older people. It is spacious and fixtures and fittings are good quality. There is a comfortable reception area, visitors toilet and a reception desk which is staffed. Facilities for residents include a hairdressing and treatment room, a movie theatre, a prayer room and a relatives meeting room. All bedrooms have en suite facilities with level access shower, TV and telephone points, and fully profiling beds. Staff in the home have received training in assistive technology and large button telephones and remote controls are available to help residents use these objects more easily .There are a number of secure garden areas giving residents access to fresh air and light. There have been good improvements in the homes environment especially in the dementia units. Memory boxes have been placed on residents bedroom doors so they can be filled with objects that help them recognise their bedroom, sensory and tactile pictures have been hung on the walls for residents to touch and feel and seating has been placed at the end of long corridors for residents who walk a lot to rest. A reminiscence room has been created on Strawberry unit filled with old objects and memorabilia for residents to enjoy. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive their care from well trained and competent staff. Evidence: We received many positive comments about the staff from residents and relatives including: the staff are marvellous and look after mum really well especially now that shes gone downhill. Staffing levels vary depending on the type of unit and there were plenty available on the day we visited. Residents and relatives we spoke to, and those who completed our survey told us that staff were available when needed. Staff reported that they are rarely short staffed and felt there were enough of them on duty to meet residents needs. The use of agency staff has ceased and the home is fully staffed at the moment. We checked the personnel files for 2 recently appointed members of staff. These showed that each person had completed an application form, received a job description, had attended a thorough and well documented interview, and that the home had received appropriate references and CRB/POVA checks before they started working there, ensuring that only the right people were employed to look after vulnerable adults. Residents now routinely take part in interviews for prospective workers and have the chance to ask questions if they want. This is excellent practice and ensures that residents get a say in the people that will be looking after them. The manager told us having residents present at the interview gave her a good Care Homes for Older People Page 20 of 26 Evidence: opportunity to assess prospective workers ability to communicate with older people. Over 50 of staff have an NVQ level 2 or above and files that we viewed showed that staff had undertaken a range of training including challenging behaviour, dementia care and assistive technology. Staff reported they received good training relevant to their role Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well managed home where staff are supported and residents views are actively sought about the service they receive. Evidence: The manager is thought highly of by staff, relatives and by social care professionals. One relative told us: the general manager, care manager and admin staff could not be more helpful. They are wonderful; another Santall is tops. One staff member told us: she always takes time to stop and talk to residents. We checked the supervision files for three staff on duty which showed that they had received regular supervision and support. The quality of these supervisions was particularly good- in one instance a staff member received an entire supervision on the use of thick and easy (a food supplement to enhance residents nutrition). Staff told us their supervisions were very useful one stated: its really helpful to discuss new residents with the nurses so we can look after them better; another: Its good to be told what is right and what is wrong. Care Homes for Older People Page 22 of 26 Evidence: Monthly audits are conducted by a member of Excel Cares senior management team to ensure standards are being maintained and each year Excelcare conducts a customer satisfaction exercise where surveys are sent to residents, their relatives and other people with an interest in the service. This last survey was completed in September 2009 and respondents answers were closely analysed and used to improve the service. There are regular and well attended meetings with relatives and minutes we viewed showed that issues discussed included a recent visit from members of Excel cares Board, activities for residents, care plans, maintenance and the Christmas Party. We spoke with one daughter who attends these meetings who told us; the meetings are good I always go, we suggested once that they change the menu to more traditional food for residents and they did. They do listen you know. We checked recording in relation to health and safety including fire, portable appliance testing, hoist and lift servicing and gas safety. These showed that the home regularly checks and maintains equipment to ensure it safety. However we noted a total of 7 fire doors in Cherry unit that had been wedged open thereby preventing them from closing in the event of a fire and putting residents at unnecessary risk Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 23 Fire doors must be allowed to shut and not be wedged open. You must do this so they can close freely in the event of a fire. 01/12/2009 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 10 The quality and frequency of conversation between staff and residents should improve so that every verbal interaction is meaningful and improves residents sense of well being. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 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) 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. 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