CARE HOMES FOR OLDER PEOPLE
Eagle View Care Home Ltd Phoenix Drive Scarborough North Yorkshire YO12 4AZ Lead Inspector
Pauline O`Rourke Unannounced Inspection 09:30 8 December 2005
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Eagle View Care Home Ltd Address Phoenix Drive Scarborough North Yorkshire YO12 4AZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01723 366236 01723 369050 Eagle View Care Home Ltd *** Post Vacant *** Care Home 40 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (9) of places Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th May 2005 Brief Description of the Service: Eagle View is a care home providing personal care and accommodation for 31 older people who have a dementia, and 9 older people. Executive Care Management Limited owns the home. The home was purpose built in November 2003. It is situated on the outskirts of Scarborough. The accommodation is provided on three floors. All bedrooms provide ensuite facilities, and there is a passenger lift to each floor. The home has access to grounds. Due to the position of the building, some of the garden area is not suitably accessible. However, there are two areas of outdoor seating to a patio area. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection including preparation time took place over 10 hours. A tour of the building was conducted. A number of the service users records, staff records and records about the management of the home were inspected. 7 service users, and 8 of the staff on duty were spoken with. Due to communication difficulties a large part of the inspection was observation of the service users and staff. What the service does well: What has improved since the last inspection?
The staffing levels at the home have improved since the last inspection subsequently the staff feel under less pressure. The legal checks required for staff are now carried out prior to them starting work at the home. The manager is now able to visit all prospective service users and the information she obtains is used to produce a care plan. There is clearer information about the complaints procedure for relatives and service users. There are risk assessments available to staff when necessary for the service users. This enables them to promote the service users independence whilst being aware there may risks involved such as falling. The small repairs identified at the last inspection have been made good. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. The service users can be assured their needs can be met. EVIDENCE: The last inspection highlighted inconsistencies in the pre-admission assessment information obtained. Service user files seen during this inspection contained an assessment by the manager as well as social service and/or health assessments. This information now gives a clear picture of the assistance required by the service users and whether their needs can be met at Eagle View. The home does not provide intermediate care. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9. The service users benefit form basic care plans, but they need to be developed further to ensure all their needs can be properly met. Medication practice has improved and is carried out in line with good practice guidelines. EVIDENCE: 4 care plans were seen and there was evidence to show they are now being reviewed on a regular basis. Whilst the plans now include reference to the service users mental health needs, more detail is needed regarding intervention and distraction work that staff can do with them. All of the plans only said that ‘reassurance was needed’ and made no reference to a pertinent response to an individuals needs. The staff record once a day in the service user files. This does not always give a full account of a service users day, as a matter of good practice and to allow for an holistic overview of a service users needs the manager should expect staff from each shift to record in the service user contact sheets.
Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 10 At the last inspection it was observed that senior staff were recording service users’ details in a collective way. This practice is still happening although the book has now been moved from a public area to the medication room. The information recorded in this book must only be a reminder to look at a service users’ individual file where any personal information should be recorded. The medication was seen to be stored securely and the repairs required to the controlled drugs cupboard have been completed Lockable storage has now been provided for the medicines received during the handover period. Staff are completing a learning distance course in the Safe Handling of Medication. The administration and recording of medicines was seen to be managed appropriately. Staff spoken with confirmed that the senior member of staff on duty was responsible for the medicines and they are administered directly from the Monitored Dosage System. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14. Service users are encouraged to exercise choice in their daily lives. Activities are provided but there is no record of what happens when. EVIDENCE: Several service users spoken with during the inspection said that they could follow their own routine within the home. Those service users who have a dementia were seen to exercise choice about where they were in the home, what they ate for their meals and whether they participated in the activities. Staff spoken with were knowledgeable about an individuals needs and their way of communicating what they want. Social activities were taking place during the inspection and several service users said that this usually happened. There was no record kept of activities taking place and in the afternoon one member of staff was sitting with the service users but was not interacting with them. Guidance should be given to staff as to what activities are appropriate with the service users when they are in the lounge with them. A record should be kept of what activities take place and how long they lasted for. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Service users were confident that any complaints or concerns they had could be raised and acted upon. Service users are not protected from possible abuse due to the lack of staff training. EVIDENCE: A complaints procedure is in place and contains all the elements required by the Care Homes Regulations 2001. Service users and a visitor spoken with said that they would go to the manager or one of the senior members of staff if they were not happy. A new recording tool has been developed for complaints and reminds the manager that all the details of the complaint and any subsequent investigation and action taken must be recorded. There have been no complaints received by the home or the Commission for Social Care Inspection since the last inspection. Whilst there is an Adult Protection Policy in place as not all staff were not fully conversant with it. Staff must receive regular training. One member of staff spoken with did not know what to do if someone reported possible abuse to her. Lack of training in the Adult protection procedure remains an issue within the home. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21 and 26. The home is clean, odour free and well maintained although the service users find the bathrooms cold. EVIDENCE: All of the bedrooms have ensuite facilities and there are sufficient bathrooms throughout the building. Several of the bathrooms were cold and measured below 21°C. Service users commented on this during the inspection and one said that the bathrooms were only warm when several baths had been carried out prior to their bath and due to a medical condition he was very sensitive to heat and cold. All other areas of the home were warm, clean and odour free. The laundry has washers and driers that meet the requirements of the home. Both the washers have sluicing facilities. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29. Staffing is provided in sufficient numbers to provide the care and support required by the service users. However, they do always receive the training required to undertake their role. EVIDENCE: The staffing rotas for the last two weeks were seen and the staffing levels have consistently improved. During the week there are 8 carers in total between the hours of 8am and 9pm and 4 carers on during the night. This includes senior carers’ the manager also works Monday to Friday. The weekends have 1 senior carer and 7 care staff. Staff spoken with said that when they are fully staffed as they currently are then there are sufficient staff on duty. The manager needs to ensure the staffing levels remain at their current levels to ensure there is sufficient cover to provide the same levels of cover for staff holidays and sickness. Staff files seen during the inspection contained all the documentation as required by the Care Homes Regulations 2001. The Criminal Records Bureau disclosure documents were available for inspection and staff are now commencing their employment when they have this clearance. POVAFIRST checks are carried out and the manager requests a copy of the e-mail sent by the Criminal Records Bureau for her records. Staff spoken with said that they had been through the recruitment process prior to the commencement of their employment.
Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 15 Two members of staff spoken with had worked at the home for 3 and 6 months respectively and have received no induction training. His or her induction to the home was working with someone more experienced for a week. Discussions with the manager revealed that Executive Care Ltd has their own training company and a trainer comes to the home every three months to provide training. Where staff are on holiday or days off then they miss this training and have to wait until the trainer returns. All new staff should have their induction within 6 weeks and their foundation training within 6 months of the commencement of their employment. Training should be a priority for all staff to ensure they have the skill base required to care for service users with complex needs. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The manager must apply to be registered. She is available to the service users and gives clear guidance to the staff. Whilst the home is well maintained, some areas were found to be cold. There were some practices, which do not ensure the health and safety of the service users. EVIDENCE: The manager has been in post now for 10 months and staff spoken with said that she was always available and they could approach her easily. Only one member of staff said that the manager was not approachable and this was discussed during the inspection. The last inspection report, produced on 13 May 2005 said that the manager must apply to be registered. This remains outstanding.
Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 17 There is a limited quality assurance system in place that consists of monthly visits by the managers line manager who carries out a mini audit using the National Minimum Standards for older people and company policies as guidance. This would benefit from being extended to include stakeholders and relatives of the service users. The information gathered from the monthly visits is used in an annual plan of development for the home. The personal allowance for several service users is held in the office and the records and cash held tallied. The staff retain receipts for any monies spent. There is a fire safety risk assessment has been completed and signed and all fire doors were held open by authorised means. The records available did not evidence that fire training is happening at the recommended intervals of twice a year for day staff and four times a year for night staff. The cooker was found to be clean on the day of the inspection. Risk assessments were in place for the use of steradent tablets and they are now locked away for staff access. There was an accident book in place and staff are using this appropriately with the exception of recording the full names of the service user and/or the witnesses. Accidents are not reported to the Commission for Social Care Inspection in accordance with the Care Homes Regulations 2001. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 X X 2 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13, 15 Requirement The care plans must contain detailed interventions needed for the service users who have a dementia. Use of the communication book for the collective recording of service user personal details must cease. Previous timescale of 13 May not met All staff must receive training in the Adult Protection issues. Previous timescales of 30.06.04 and 31.05.05 not met. The bathrooms must be kept warm before and during use. The manager must make application to the Commission for Social Care Inspection to become the registered manager of the home. The previous timescale of 30.06.05 not met. All staff must have fire training at intervals as recommended by the Fire and Rescue Service: Twice a year for day staff Every three months for night staff.
DS0000046580.V254893.R01.S.doc Timescale for action 28/02/06 2 OP7 15 08/12/05 3 OP18 13(6) 27/02/06 4 5 OP21 OP31 23 8 19/01/06 31/01/06 6 OP38 23(4)(d) 28/02/06 Eagle View Care Home Ltd Version 5.0 Page 20 37 All accidents recorded must include the service users full name and the full name of any witnesses. Accidents that involve any of the emergency services or a medical visit must be reported to the Commission for Social Care Inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP33 OP28 Good Practice Recommendations A record of activities provided in each of the lounges should be kept. The manager should look to extent the quality assurance system to include stakeholders and relatives of the service users. All new staff should have their induction within 6 weeks and their foundation training within 6 months of the commencement of their employment. Eagle View Care Home Ltd DS0000046580.V254893.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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