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Inspection on 25/02/09 for Ealing House Residential Home

Also see our care home review for Ealing House Residential Home for more information

This inspection was carried out on 25th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Several users spoken to confirmed that they had enough information about the home to make the decision of moving in here. One of the comments in surveys stated: We received very helpful information and were able to ask questions and got plenty of very useful answers. The AQAA, self assessment, explained what the home does well: "We provide excellent personal care for our residents which are individually cared for in an environment that is well maintained and mostly been refurbished over the last three years. We have always put the needs of our residents first and their care is of utmost importance. We are a family run home who have obviously invested financially as well as emotionally into this home and maintaining and improving our high standards." In a survey a visiting professional, a GP, commented: The home provides a personal care service in the atmosphere more like a home than an institution." A service user filled in a survey and stated: "Always a home from home". The other responses also were very positive. The environment, although disturbed due to refurbishment at the time of the site visit, was very nice and comfortable. The new kitchen was assessed by the environmental health as a five stars facility. records kept in the home were up to date and regularly reviewed. Service users were protected by the measures in place, not only to satisfy their expectations in the home, but also to protect their basic rights and to promote their dignity.

What has improved since the last inspection?

The home conducted their own quality assurance survey to identify areas for improvement and the manager, also the owner, analysed results and listened to suggestions. Reviewing the satisfaction of residents constantly does not always mean changing something, but the following example shows what also counts as improvement: "As we have people with and without dementia it was discussed with those without dementia whether or not they wanted separate lunch times so that they did not have their meals with those that need assistance. They decided they wanted to stay together." The home met all previously addressed requirements. Separate risk assessment to cover hazards during refurbishment had been carried out with the help of the insurance company and protected users better. The kitchen was inspected in January and was granted a 5 star rating, as food records were now up to date. medication training was organised and well attended by staff. Now, a pharmacy also inspects the standards related to medication, thus helping the home protect service users much better.

What the care home could do better:

There were no issues that needed addressing through regulatory requirements, as the home was capable and successfully was addressing and improving things that they jointly identified with with the users and their relatives, and with staff. The site visit only provided the recommendation that a field on the care plan form is added for service users and their relatives to sign this document.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ealing House Residential Home 86 Repps Road Martham Great Yarmouth Norfolk NR29 4QZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dragan Cvejic     Date: 2 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Ealing House Residential Home 86 Repps Road Martham Great Yarmouth Norfolk NR29 4QZ 01493740227 01493740227 ealinghouse@mac.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Sally Watson care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Dementia, over 65 years (DE) (17) Maximum Number Registered 17 Old age, not falling within any other category (OP)(17) Date of last inspection Brief description of the care home Ealing House is a care home providing personal care and accommodation for 17 older people some of whom have dementia. It is owned and managed by Mrs Sally Watson. Ealing House is located in the centre of the village of Martham close to shops, pub and local amenities. It is a short car ride to the coastal town of Great Yarmouth. The home consists of a detached two-storey house, with a variety of communal space. The Care Homes for Older People Page 4 of 26 Over 65 0 17 17 0 Brief description of the care home building is situated within its own grounds, with an enclosed garden at the rear. There are currently major alterations taking place inside and outside the building, which will enhance the lives of those living in the home. There will also be 13 en-suite single bedrooms and 2 double bedrooms. The inspection reports are available in the hallway at the home. Information regarding the cost of a bed in the home is available on request. 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. After revieving the service through annual service review on 31/10/07, the home continued to provide very good service for people that were cared for and supported in Ealing House. At the time of the site visit there were 17 people living in the home. Building work was in progress at the time we visited the home and caused a slight disturbance to service users and staff, but the management and even workmen, well known to users, tried everything possible to reduce discomfort and disturb service users. We monitored service through reporting activities. We asked users of the service, the professionals visiting the service and staff to fill in questionnaires about the quality of service and received a good response, one staff, 4 external professionals involved in Care Homes for Older People Page 6 of 26 users care, and 9 users returned their comments. We asked the home to provide self assessment using AQAA (Annual Quality Assurance Assessment) form that they returned as requested. We visited the home on 25/02/09 and spoke to 5 people living there, the deputy manager and the manager. We also spoke to workmen: the managers husband and another workman. We case tracked three people who were users of the service. This means we checked the information about them contained in records, care for them at the time of visit was oserved and we collected comments from staff. We checked two staff files. We also observed care practices in the home, checked the environment by walking through the home. We checked how the home met requirements from the previous inspection. What the care home does well: What has improved since the last inspection? What they could do better: There were no issues that needed addressing through regulatory requirements, as the home was capable and successfully was addressing and improving things that they jointly identified with with the users and their relatives, and with staff. The site visit only provided the recommendation that a field on the care plan form is added for service users and their relatives to sign this document. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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. The home provided good and updated information to service users allowing them to choose the home after being fully aware of what to expect. Good assessment of needs on admission allowed the home to organise care and meet the needs of people admitted to live in the home. Evidence: The statement of purpose was reviewed in December/January and updated, so that anyone was able to get a picture of what the home offered. Comments from users and their relatives confirmed that they had enough information to make an informed choice. Three checked files showed that the manager carried out a full assessment of service users prior to admission. She addressed all necessary details. She also introduced the collection of information from relatives, especially for users with dementia, to make sure that all resources were used in obtaining intitial information about each individual. Care Homes for Older People Page 11 of 26 Evidence: Service users responded in 9 returned surveys that their needs were met in the home. Three users that spoke to us, also confirmed that the home met their needs. On the question: what could we ask staff to do better for you, a user responded during the site visit: I dont think you would need to say anything to them, I get all I need. 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. Well written, detailed care plans and risk assessments helped the home plan and deliver care as service users wanted and ensured that their needs were met. Evidence: Three case tracked service users documents were checked. Care plans were clear and contained sufficient details to plan and organize care. The home collected information about users backgrounds, their likes and dislikes and planned care how they wanted. Two users spoken to confirmed that they knew about care plans. However, the format set to record care plans did not have a designated space for users to sign it. In spite of this, one of the files was signed and the comments from the relative of another user showed that she agreed with care plans. this demonstrated that both users and their relatives were included in care planning. Reviews seen and checked showed that care plans were reviewed monthly. Daily records and the handover book demonstrated that health care needs were well addressed and monitored, thus ensuring that users were cared for appropriately. Health care professionals responding to the surveys also demonstrated that the home was regularly visited and any health problem was addressed on time. In their AQAA, Care Homes for Older People Page 13 of 26 Evidence: self assessment, the manager stated: All residents have dental input, teeth are thoroughly cleaned. Pressure area risk is assessed and recorded and acted on accordingly, pressure relieving aids are used. All residents are assessed via the Continence team and appropriate toileting regimes are put in place with use of allocated individual named pads. We are constantly looking at the individuals needs both psychologically as well as physically. The AQAA also stated: Generally all residents are transferred to the local GP surgery as this is a policy from the PCT. Ealing House has the input of CPNs (community psychiatric nurses), district nurses, dentists, chiropodist, Speech Therapy, GPs, Continence nurses. Opticians visit regulary and hearing referral would be made as required,this would require the resident to travel to the local hospital. Medication and records for 5 users were checked and were in order, without gaps in records or discrepancies in amounts of medication. The deputy manager was observed administering medication and the procedure was safe and appropriate. Privacy and dignity were respected. Surveys showed that there were no single negative comments related to respect for individuals. A user stated: All staff are wonderful. They try and make life more bearable knowing about all my problems. Staff were observed helping users find the way around the building work, when one of the doors was closed and another created, on the day of the inspection. The home also addressed issues related to dementia. The manager attended Assistive Technologies Training and introduced some measures enabling users to orientate better around the home: using different colours, marking the doors and using large clocks helped users be better orientated regarding not only the environment, but also the time and dates. 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. The home was a part of the community, not only by its location but with the interactions that included local staffing, entertainers and activities. Evidence: The manager ensured that the background of service users was carefully considered when activites were planned and organised. Although some users did not want to take part, like the one who spoke to us, she continued stating that she had had the same hairdresser for the last 20 years. In their AQAA, the manager reported: Leisure activities are offered to the residents and they choose what they participate in or if they participate. We have a dedicated Activities Co-ordinator who has a variety of pastimes on offer. Residents have set mealtimes for lunch and tea, but breakfast is served either in their bedroom or in the dining room as preferred. We can offer more flexibilty with this. There is an over 60s club available in the village which is offerred to residents. Some residents have gone for a short time and transport is provided for this, continued the manager in their self assessment. The manager repeatedly reported: We could attend to peoples spiritual needs by having the vicar come in to provide a religious service, but have had problems getting someone to do this; we have tried and cannot get anyone to come in. However, she Care Homes for Older People Page 15 of 26 Evidence: showed that she was fully aware of and continued searching for a solution to this planned activity to meet the users needs. Residents were encouraged to manage their finances when they were able to. For those that could not, money in a cash tin was kept and administered to by a few senior staff. The records related to case tracked users were accurate. The new kitchen and new arrangement in the kitchen made food safer and resulted in the 5 stars achievement on the recent kitchen inspection. Service users were generally happy with food choice and quality. However, based on their suggestion, the manager arranged for the cook to have training on cooking for a larger number of people and the trainer came on the day of this site visit. 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. Service users were protected by clear policies and procedures and by an open and trustworthy atmosphere. Evidence: The statement of purpose and other information documents provided a clear and well explained complaints procedure. The notice board also had a procedure displayed. However, possibly due to dementia, some users spoken to were not sure how to complain. This was discussed with the manager who would introduce regular reminders of the procedure through the homes newsletter recently introduced and through residents meetings. She also suggested to ask staff to mention the procedure on their one to one meetings with service users. The manager reported in their AQAA: There is an Adult Protection Policy in place which has been approved by the Lead for NCC (Norwich County Council) in Adult Protection. All staff are trained in Awareness sessions through NCC or in house. Any allegations would be put through the Joint Protocol for Abuse. Policies are in place regarding service users money. Money is only handled by designated staff. The fact that the only POVA (Protection of Vulnerable Adults) investigation related to a person not directly involved in care in the home showed that the home was fully aware of protection responsibilities and procedures in case issues arose. Care Homes for Older People Page 17 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. The very comfortable and much improved building already created a homely environment for service users. However, the work was in progress during the site visit and determined only a good scoring regarding environmental standards, although there was a potential for possible excellent rating in the near future. Evidence: The location of the home enabled the home to be a part of the local community. Service users benefited from the well maintained building and garden, designed to a high standard. Comments from service users included: I have all I need in my room., This is a really nice, clean and fresh place., but the best description came from the surveys filled by a GP: Good quality accommodation, always bright and clean and by a relative helping a user to respond: Its just like walking into someones home, always spotless, never any smell like you would get in some other care homes. This was the reason why we chose this home. Recent review of the kitchen included addressing infection control measures. The manager reviewed the status, organised improvements and reviewed related policies to ensure not only comfort but also to improve safety for service users. The manager stated that she would inform regulators when all building work is completed. Meanwhile she kept us informed, and stated in their self assessment: Ealing House is an exceptionally well maintained home with many areas of the home Care Homes for Older People Page 18 of 26 Evidence: already refurbished to a high standard.The remainder is scheduled to be completed within the next 6 months. Facilities are being improved in all communal areas. Our new building and upgrading of existing areas exceeds what the Fire Service requires. All areas are decorated to be homely and domestic in appearance. New laundry facilites have been created with investment in new washing and drying facilites which are compliant with the sluicing facilities required and water regulations. We have installed an Inco pad macerator for the hygienic disposal of inco pads, washcloths and wash mitts. Environmental health recently inspected the kitchen and granted them a 5 stars rating. 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. The local and stable staff team was a real asset to the home, showing respect and meeting users needs as they wanted. Good training and atmosphere in the home also ensured good protection of service users. Evidence: Two staff files were checked and contained all relevant check and documents. Most comments in surveys started by praising the well organised and committed staff. Speaking to service users, they all confirmed that they felt that there were enough staff on duty to meet their needs. The AQAA provided details of the staff training: 73 of carers are trained to NVQ level 2 or above (3 of which are qualified nurses, not including manager) Many of the remainder are highly experienced with up to 21 years experience. One carer about to commence NVQ level 2 and care administaitor nearing completion of NVQ level 3. Observing the staff while they worked with service users confirmed the statement provided in self assessment. All new staff were inducted into the work place and had supernumery status for up to three weeks. The induction day programme was in place coving the statutory requirements. The training plan was in place for next 12 months and staff achievements were seen in their files. Staff spoken to also stated that they felt supported and encouraged to work with Care Homes for Older People Page 20 of 26 Evidence: passion. The manager explained the current process of preparing previous care co-ordinator to become a deputy manager and progress from her role to this newly created position that would further strengthen the management of the home. 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. Good management and leadership of the home ensured satisfaction both of staff and service users and also compliance with relevant legislations and regulations. Evidence: The manager described herself in AQAA: I have been running the home since 2001, prior to that I was a Senior Nurse in the Health Service. During that time I undertook the Certificate in Management. I am a NVQ Assessor. I keep up to date professsionally by reading Journals and attending relevant training sessions. More training planned for Jan 2009. I am a qualified Manual Handling Trainer. Update training booked for 13th and 22nd Feb 2009 for all the staff. I am only responsible for Ealing House. I am also the Registered Provider. The results of the quality assurance surveys were displayed in the home showing that the management used them effectively to improve services and conditions for service users. Service users money is kept safely locked and only handled by designated people. Care Homes for Older People Page 22 of 26 Evidence: This is periodically checked to ensure all as it should be, stated the manager in their self assessment. Being aware of Mental Capacity Act and rights of service users according to this act was another example of good management, but also of staff determination to ensure full protecton of service users. Safe working practices were in place and were confirmed through surveys filled in by external professionals, service users and also appropriately addressed in AQAA: There are scheduled training session which cover all aspects of this standard. This is covered with new staff by use of training DVDs, these days are run by the Care Administrator. Have worked on health and hygiene and now have 5 Stars (have I mentioned I am pleased about this), commented the manager and the propriator of the home. 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 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 7 The form for care plans should contain a designated space for service users or their representatives to sign the document. This would further confirm involvement of service users in care planning process. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!