Inspection on 21/08/07 for Eardley House

This inspection was carried out on 21st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Eardley House 02/01/09

Eardley House 21/02/08

Eardley House 05/02/07

Eardley House 30/05/06

Eardley House 29/11/05

Eardley House 08/06/05

Eardley House 30/11/04

Eardley House 11/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Eardley House Moorland View Bradeley Stoke-on-Trent Staffordshire ST6 7NG Lead Inspector Wendy Jones Key Unannounced Inspection 10:00 21st and 23rd August 2007 and 14th 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 Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 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. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eardley House Address Moorland View Bradeley Stoke-on-Trent Staffordshire ST6 7NG 01782 234530 01782 234530 eardley.house@swann.stoke.gov.uk 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) Stoke on Trent City Council Mrs Susan Mountford Care Home 44 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (44), Mental disorder, excluding learning of places disability or dementia (6), Old age, not falling within any other category (44), Physical disability over 65 years of age (44) Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2007 Brief Description of the Service: Eardley House is a care home providing both long term and respite care for up to 46 older people with dementia. The home is owned by Stoke on Trent City Council, a unitary authority, and care is directly provided by the councils staff team from the social services department. The home is located on the outskirts of the City of Stoke on Trent, in the village of Bradeley. It has ready access to community facilities and, including shops, pubs, post office and public transport. The home was originally purpose built to the standards current at the time, and consists of two storeys. Because of its large size, and to meet up to date good practice in care provision, it is now divided into four group living arrangements. Each area has its own living/ dining area. Assisted bathing and toilet facilities are strategically provided throughout the home, and other facilities include a smoke room and separate quiet room with a pay phone. All bedrooms are single. None of the bedrooms have en suite facilities. Access to the enclosed rear garden is from two lounge areas with ramps and handrails provided for safety. The garden has a patio area with seating, flowers and a summerhouse. Overall the accommodation is generally comfortably appointed and welcoming, although there are still some areas of the home that need decorating. Current fees range from £89 to £328 per week and are reviewed annually. Additional charges are made for newspapers, chiropody, hairdressing, some outings, and personal toiletries. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key visit of the service undertaken by one inspector during the afternoon and evening of 21 /08/08 and the morning of 23/08/07. An additional visit was carried out by a pharmacy inspector on the 14/09/07 information from all visits have been included in this report. This report also includes information provided from pre visit, resident and relative surveys; from the services Annual Quality Assurance Audit; from discussion with staff, residents and relatives; from observation of interactions and practice and from inspection of care records, systems for the safe storage and administration of medication, staff records including training rota’s and recruitment files; evidence of staff, relative and resident meetings, observation of the environment and a mealtime and other documentation relevant to the inspection process. The pharmacy inspection looked at the effectiveness of the home’s arrangements for the receipt, recording, handling, storage, safekeeping, safe administration, and disposal of all medicines received into the home. The inspection included examining the medication storage area, examining the records kept and having discussions with both the care staff and residents. The findings of the inspection were then fed back to the manager at the end of the visit. Areas of most concern were discussed with the assistant manager. An immediate requirement notice was left for the service to act upon. In addition a letter of serious concern was sent to the provider for the service, which in this instance is Stoke-on-Trent City Council. A satisfactory response has been made to the serious concern letter and to requirements and timescale given in this report. What the service does well: Eardley House provides care and accommodation to residents who are described as older people and who may have dementia care needs or mental health problems. Staff have received training in Equality and Diversity and try routinely to ensure that all residents needs are met. Changes have been made to assessment records and care plans to ensure that they properly take into account the diverse needs of residents who may have dementia or mental health needs. Information about the service and it’s facilities is available in the home and is discussed with potential residents and their families. All residents have an assessment of need and care plans are in place to ensure that any identified care need is met. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 6 Residents receive a good quality diet, enjoy a comfortable life style and are asked to comment on the care they receive, and to meet to discuss things that are important to them. Relatives and residents made positive comments bout the service in pre inspection survey’s and in discussion during the site visit. The service confirmed that any concerns that resident have are taken seriously and properly looked into. Information about how to make a complaint is made available to resident and their supporters. Staffing levels are adequate and at least 50 of the care team have trained to National Vocational Qualification level 2, mandatory and supplementary training has taken place or is planned. Recruitment practice is good with evidence that the service takes it’s responsibilities seriously. Policies and procedures are in place to provide staff with a solid platform and framework from which to deliver care. Health and safety matters are known and risk assessments are in place to ensure levels of risk are minimised. The manager has a relevant qualification and regularly seeks the views of residents, relatives and others about the quality of care they receive. Equipment in the home is serviced regularly. Records corroborate this. What has improved since the last inspection? What they could do better: Information about the service should be up to date and every resident should have copy with the details of the terms and conditions of residency and the fees they have to pay. They should also be sure that the service can meet their needs and that any suspicion of abuse is promptly reported, and that they are listened to. Residents’ legal rights must be respected and they should receive Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 7 the support to pursue any area of conflict. If care plans are reviewed residents must be sure that they are consulted and involved in this process. The service must ensure that the systems for the storage, management and administration of medication are so robust that they protect and ensure the health and welfare of residents. The current arrangements fail to do this resulting in residents being at risk. The routines in the home should be re-evaluated to ensure that residents don’t go more than 12 hours without a meal. Menu’s should be displayed in a format that residents can easily understand and activities should be more varied and frequent to ensure resident are occupied and entertained. Development of the service should continue to ensure the environment is well maintained and comfortable throughout. Routines should be reviewed to ensure that resident have access to their own bedroom when they choose to. Staffing vacancies should be filled to reduce the number of casual and bank staff hours currently used and the frequency of staff supervision and meetings should be increased. The service must ensure that it acts promptly to report and protect vulnerable adults from the risk of abuse and also promote the legal rights of residents. The details of the certificate of registration for the service were not correct, the name of the nominated person to act as a responsible person on behalf of Stoke-on-Trent City Council should be sent to the CSCI. 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. The summary of this inspection report can be made available in other formats on request. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 8 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 Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is ( adequate ). This judgement has been made using available evidence including a visit to this service. People who use the service can be sure they have access to enough information about the service which provides them with the detail they require to make a decision about moving in although there is a need to ensure this information is up to date. People who use the service can be sure that their care needs are met if they are accepted into the home through the planned admission process, but those admitted on an emergency basis cannot be confident in all cases that the service is right for them. EVIDENCE: A resident guide is displayed in the home, this and the Statement of Purpose have been updated this month. Information in both documents requires further review to ensure that they present an accurate picture of the service, Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 10 the organisation. For example the current named Registered Provider in the Statement of Purpose no longer has responsibility for elderly care services in the city. The summary of the complaints procedure in the Statement of Purpose should contain up to date contact details for the Commission for Social Care Inspection (CSCI). The resident guide should contain information about the fees for the service and the terms and conditions of residency. Care records show that the residents guide has been discussed with the individual resident or their family member at the time of assessment/admission to the home. Residents can sign the pre assessment form to indicate that they had the opportunity to see or discuss the residents guide and confirm that the service has stated it can meet their needs. One relative said that she had been provided with information about the home. It was not evident though that all residents had been provided with a resident guide or a copy of their contract of terms and conditions. This should be addressed by the service. One relative stated that when she had asked for copies of the previous inspection reports, they were made available to her, and she had seen other relevant information about the service. In two survey’s, relatives said they were provided with enough information about the home, another said they were usually provided with enough information. In two surveys the relatives said, “the service always meets the needs of my relative,” in one survey the relative, said, “The service usually meets the needs of my relative.” One relative said, “ I had the chance to look around the home before deciding if it was suitable for my relative, and they came to visit too.” Since the last key inspection the service has changed it’s pre admission assessment tool, to ensure that it meets the needs of the service, the residents and reflects the National Minimum Standards (NMS) for older people. These standards are what the service is assessed against. The new tool is a simple one that ensures the assessor is prompted to seek all relevant information about the residents, physical, emotional/ psychological and social needs. In samples of the care records it is evident that those residents admitted as part of a recent planned admission had these assessments completed and, they and their relatives had been involved with them. Samples of other care records show that two residents have recently been admitted from home (on an emergency basis), and one had been admitted from hospital. Staff said that they had concerns that, they did not always receive sufficient information about the needs of residents admitted in an emergency. This procedure should be reviewed to ensure that the safety and welfare of residents admitted under these circumstances. During discussions one resident stated “ I wasn’t told I was coming into this place, I was told I was going home when I was discharged from hospital.” They also said, “ I shouldn’t be here and I want to go home.” Staff said that the resident had been consistently saying this since admission. The care records for the resident confirmed this to be the case. The deputy manager was asked to make a Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 11 referral to the local authority to request an urgent review, it is suggested that an advocate may be of benefit in this instance to support the resident. In addition we have made contact with the placing social work department to make a request for an urgent review, this matter was also raised with the service development manager for the home in a phone call to them, and in a letter of concern to the provider. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is ( poor). This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that their care plans reflect their assessed needs, but cannot always be sure that they are involved in the monthly reviews of the plans. People who use the service cannot be confident that their medication is managed, stored or administered safely or that staff have the skills to do this. This leaves them vulnerable. EVIDENCE: Care records show that a new care planning and assessment format recently introduced, has been specifically designed for residents with dementia care needs and ensures that staff gather all relevant information regarding the individual including social, family, occupational histories, hobbies interests etc. Not all files have been transferred on to this new format yet but this is planned. In addition a new care plan has been introduced for short stay residents. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 13 There is evidence of a monthly review of the needs of residents, but not necessarily a formal review of care plans with the individual on a monthly basis. Staff said that they do discuss care with residents and one resident said “staff talk to me about my care,” two relatives stated in pre inspection survey’s, “We are kept up to date with the care needs of our relative,” and one relative said “the service keeps me informed of any issues or changes I need to be aware of.” Some resident records did not include evidence that they had been involved in care reviews it is accepted that some residents would have difficulty understanding the information, but they should not be excluded from this. Throughout this visit there was evidence from observing practice and overhearing interactions of the sensitive management of some potentially difficult situations, by a staff team who are professional but warm and empathetic in their approach to residents. There was an impression of good relationships between residents and staff and a relative said, “all staff treat my relative with respect and consideration,” another said, “ I feel that the staff are very caring towards my relative.” A resident said, “the staff are really good, they will always help out if they are asked to.” Health care needs are recorded in each care file and a separate record of health related appointments and intervention is maintained, providing evidence that residents have regular check up’s with the GP, chiropody and other health services. District nurses visit the home as required and some residents have regular in put from Community Psychiatric nurses. Medication was looked at during the visit of 21 and 23 August 07 and a number of areas of concern were identified, an immediate requirement form was left at the end of the site visit and a letter of concern sent to the provider. The CSCI regional pharmacy inspector was also asked to undertake a visit, this was carried out on 14 September 2007. The outcome is as follows: The quantities of medication were not being recorded upon receipt and any medication carried over from the previous month was not being consolidated on the new MAR charts. This meant that the home could not perform any audits to evidence that the residents were receiving their medication as their doctor wished. An examination of the Medicines Administration Record (MAR) charts found there to be no gaps in the recording. However the integrity of the MAR charts was brought into question when it was discovered that some members of staff had signed the MAR charts but had not administered the medication. Where medication had not been administered and a generic abbreviation had been used there was no definition of the abbreviation and therefore the reason for the non-administration was not evident. The handwritten entries on the MAR charts were also poorly written and were not being checked for accuracy by Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 14 other suitably trained members of staff. There was also no additional information in place for the administration of “when required” medicines and therefore the staff did not know at what point the medication was to be administered, at what intervals the doses should be and what the total daily dose was. The Controlled Drugs cabinet found within the medication room was not rag bolted to the wall and therefore was not meeting the standard expected in Standard 9.5 of the National Minimum Standards for Care Homes with Older People. The records pertaining to the receipt, administration and disposal of the Controlled Drugs appeared to be satisfactory. However the records did show that one of the residents had not received their Controlled Drug medication for a period of six days because the home had no stock available. It is likely that having not received the Controlled Drugs for this period of time the resident would have suffered withdrawal symptoms. This particular resident had also not received other prescribed medicines at the same time. The resident had also received a 10-fold increase in the amount of Haloperidol when changing from 0.5mg capsules to 5mg/5ml liquid. Looking at the information available it was seen that there were some external contributing factors, which had an effect on this situation, but also it highlighted a number of failings in the homes systems. With respect to the out of stock medication the records did not show that staff had relayed to the resident’s GP the sense of urgency required to resolve the situation. In the absence of the manager it did not appear that one member of staff took on the responsibility to resolve the situation and it relied on messages being received by different members of staff from the GP. The system for checking in medication did not appear to emphasise the importance of checking the new medication against the previous MAR charts. Also overall the home’s systems relied on the pharmacy to order, collect and dispense the residents’ prescriptions. As a consequence the home did not know what medication was arriving until it was received on to the premises. The home also did not know whether the information on the prescriptions were correct until they examined the labels on the bottles by which time it was too late to sort out before the next monthly cycle was due to start. The home had a fridge dedicated to the storage of residents’ medication. The home did not have a maximum and minimum thermometer instead they had an ambient fridge thermometer and appeared to be using it to measure the ambient temperature of the fridge on a weekly basis. The home was therefore failing to measure and record the maximum and minimum temperatures of the fridge on a daily basis. It was also discovered in the fridge that a bottle of an antipsychotic medicines had gone out of date and the resident, it had been prescribed for, had been receiving out of date medication for eleven days. It was also seen that a bottle of Xalatan eye drops, which were required to be stored in the fridge were being stored in the excess stock cupboard. The home was not always dating the eye drops upon opening and therefore the home could not guarantee that the eye drops were in date upon administration. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 15 The staff responsible for administering medication appeared to have undertaken a number of courses in the safe management of medication. Information about the course’s content was not evident and therefore it could not be determined whether the courses undertaken met with the Skills for Care learning sets and outcomes. In light of some of the issues identified during the inspection the home should arrange for a retraining programme to be put into place with some urgency and ensure that the contents meet the Skills for Care criteria. On the subject of monitoring the competency of the staff to manage medicines safely and correctly the manager informed the inspector that she did monitor the staff from time to time but there was no a formal programme in place to evidence what was being examined and what the outcomes were for each member of staff. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that they will be supported to keep in contact with families and friends and can be visited at any reasonable time. They cannot always be sure that the service provides sufficient activity or entertainment to prevent boredom. People who use the service cannot always be sure that they know what the meal choices are before they are served, this means that they may feel that their choice is restricted. They also cannot be sure that they will not have to wait for extended periods of time before being offered food and drinks. EVIDENCE: In pre inspection information the manager said that the service provides various activities appropriate for residents, but could provide more, particularly for those resident who may have dementia care needs. This visit did not include an in depth look at the range of activities provided, but concentrated on the thoughts of residents and their relatives. Residents said, “ it can be boring sometimes, all I seem to do is watch the television,” another said “ I keep my self occupied I like to keep busy,” another said “ we talk among Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 17 ourselves, we’re a happy bunch the staff do their best.” A relative said “ when I visit I don’t always tell the staff I’m coming, so have been here at different times of the day, staff do try to arrange things for residents to do but they are not always interested. I like to ensure that my relative keeps mentally alert and will discuss things with her.” A hairdresser visits the home regularly, a religious service is held in the home monthly and felt to be sufficient to meet the spiritual needs of the current resident group. None of the residents at the home, during this visit were from an ethnic minority group or had differing cultural or religious needs from the rest of the resident population. One relative said “ the home meets my relatives’ needs, keeps me up to date about their welfare and well being. When ever I phone the staff always ensure that my relative is bought to the phone or I talk to her on the home’s mobile.” Another relative said “I am made very welcome when I visit,” a third relative said “staff are welcoming and do not appear to object whatever time I visit”. A notice is posted at the main entrance to the home asking visitors to refrain from visiting at mealtimes. This appears to be the only restriction. Resident meetings are planned but their frequency can be variable, the manager has identified the need to ensure that they take place more regularly. Carers meeting are also planned with the intention of holding these at least 3 times per year, one relative said, “ I am informed if there is going to be a meeting although I am not always able to attend, but I am told what was discussed in any meeting.” She also confirmed that questionnaires are circulated periodically. Staff said that meal times are arranged around 9am onwards for breakfast, 1212:30 for lunch, 4pm for the evening meal and 6pm for supper, the night staff also ensure that residents have a hot drink if they want one. It was of concern that in effect residents may go without a drink or food for a 15 hour period, it is recommended that the service reviews it’s meal times to ensure that residents meal times are more evenly divided throughout the waking day and do not have an extended period of time without something to eat or drink. This visit did not include an inspection of the kitchen, but residents were spoken to about the food choices available to them and said “the food is lovely here, I have no complaints,” “you always get a well cooked meal and you can have something else if you want to.” When asked what the main meal choices for the evening meal where residents were not able to say, “We never know until the staff come round with the meal,” “ staff ask us what we want, but I’m not sure what I’ve ordered.” Records in the home show that staff had done this. It is suggested that a menu should be made available, or be on display in the dining room, to ensure that residents are aware of the choices available to them. As recommended at previous inspection visits, pictorial formats should also be considered. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 18 One of the other areas of discussion during this visit was the time that residents were gathering in the dining room for their meals, some 50 minutes and more before the meal was due to be served, when discussed with them, residents said, “ I like to get here early so I can be sure I sit in the seat I want to,” “ I like to be sure I’m sitting where I want to be.” Other residents were bought into the dining room by staff and left to sit at the table. It was suggested that the rationale for this was linked to staff routines, and recommended that this routine be looked at to ensure that residents are not left to sit at the table for prolonged periods prior to their meals being served. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is (poor ). This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that if they or their relatives have any concerns that they will be looked into and properly investigated. They can also be sure that if staff do suspect that any resident is suffering from abuse, appropriate action will usually be taken to safeguard them but not necessarily reported promptly and they cannot always be confident that their legal rights will be promoted. EVIDENCE: The service has a complaints procedure that is on display in the home and is included in the services Statement of Purpose and Resident Guide. As discussed in previous text the service needs to make some changes to ensure that any complainant can contact the CSCI, and ensure that correct contact details are provided. No complaints have been received by the CSCI regarding this service. The manager states in the pre inspection information, that the service has a complaints booklet that is readily available at the main entrance to the home. This is confirmed. A notice board also displays notes and cards of compliments from the families of residents. The manager also said that she operates an “open door” policy for staff, residents and relatives to ensure that they feel able to approach her should they have any concerns. She also commented that Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 20 the service could improve by ensuring that all complaints, concerns, grumbles and compliments are recorded. Residents said, “ if need to talk to staff about any problems they always listen to me,” “ I feel that I can talk to staff if something isn’t quite right,” “ I’ve told staff I’m not happy, but I’m not sure that they have done anything about it.” One resident is currently in the home and subject to a Guardianship order, this means that they have been placed at the home to ensure their safety and well being following discharge from hospital, as they have been assessed as too vulnerable to return to their home. During the site visit, staff said that the resident was not happy living at the home. The resident said, “ I don’t want to live here and thought I was going home from Hospital.” In the records of events it was clear that staff had tried to contact relevant people to highlight the residents’ position but had not been effective in promoting her rights. A serious concern letter was sent to the provider about this matter, following this visit. In pre inspection information the manager said all staff have attended a Vulnerable Adults Course and are aware of the policy, and there is a heightened awareness of Vulnerable Adults Issues. Three referrals under the Vulnerable Adults Procedures have been made since the last inspection; all matters have been satisfactorily resolved. During discussion with staff they reported some concerns about the behaviour of a resident towards others that could be considered to be abusive. This was confirmed from the records seen, but there did not appear to be any evidence that the matters had been referred via Vulnerable Adults procedures, it was recommended that this should happen. It was accepted that the events were historical and the behaviour no longer presented a problem. But was of concern that residents could have been vulnerable and staff did not appear to have acted promptly to ensure that they were properly protected. The service must also inform the CSCI of any event in the home that effects the well being and welfare of residents. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 25 and 26. Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that the environment in which they live is well maintained and comfortably furnished, with sufficient communal and personal space to meet their needs. EVIDENCE: Since the last key inspection visit the service has improved by having new fire doors installed and a new fire alarm system; has improved the fire safety signage that is displayed in the home; has had new flooring fitted in some bedrooms and names of residents have been fixed to bedroom doors. Hand alcohol dispensers have been located around the home and new patio furniture has been purchased. Plans for the immediate future include replacement of all carpets in the communal areas of the home and general refurbishment and decoration. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 22 The home has no smoking policy and adheres to recent laws regards smoking. A separate smoking room is provided for those residents who continue to choose to smoke. The service provides two lounge dining rooms on the first floor of the home each have it own kitchenette area. The ground floor also contains two living areas each with additional dining space; the main kitchen is also located on this floor. Since the last key inspection the service has had new bedroom door locks fitted following advice from fire safety officers. Staff reported that there had been some difficulty with them and they had problems unlocking some of the doors when residents locked them from the inside. This problem had been reported and had been investigated but due to the intermittent nature of the problem it had proved difficult to resolve. Clearly the service must ensure that they can access residents bedrooms when needed to, it is understood that since this inspection visit action has been taken and all bedroom door locks have been replaced. Residents said, “ I have my own bedroom and I keep it how I like it,” another said “ I have my own key so I can lock my bedroom door when I leave it.” This site visit did not include a thorough inspection of the unit; observations included an environment that is adequately maintained, communal areas comfortably furnished, clean and tidy. A sample of bedrooms showed that residents are able to personalise their rooms to make them more homely and welcoming. Bathrooms are functional and generally well maintained and equipped, a range of assisted facilities is available, such as bath hoists. All areas are fitted with an emergency call system. In the management communication book a note said that “you have to be rough with the shaft lift,” this related to the push buttons controlling the lifts movement. It was established that there is a need to push the buttons in the lift firmly to progress to another floor. It’s recommended that a notice be displayed in the shaft lift to this effect. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is ( good ). This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that staff are provided in sufficient numbers to met their needs, but because of the high use of casual and bank staff cannot be confident that the care is consistently of good quality. EVIDENCE: A sample of staff rota’s showed that staffing levels included at least one assistant manager throughout the waking day, sometimes there are two during the morning shift. A manager also does a sleeping in shift each night. 5 care staff are usually deployed during the morning shift and 4 during the afternoon and evening. There is evidence of a reliance on bank and casual staff to maintain staffing levels and reported that staff recruitment has been frozen by the organisation. It is not acceptable that the service has to use bank and casual staff on a regular basis, even though some were reported to have been to the home on a number of occasions. The potential affect of continued use of casual/bank staff and none recruitment for permanent positions is to disrupt the continuity and delivery of effective care to residents. It is hoped that this matter is addressed in a timely manner. The manager reported that bank/casual staff has filled 631 care shifts in the 3 months prior to the site visit. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 24 3 waking night staff are deployed from 10pm-8am. Cooks hours are 38.5 per week, staff usually work from 7.45am-16.15 or 8am-16.30, in addition the service has a kitchen domestic for 16 hours per week usually for between 8am17.00. Overtime and agency staff is used to cover holidays and sickness. Domestic staff hours are 150.30 per week and a handy person is deployed for 37 hours per week. Staff communicate information from one shift to the next via a “handover” and via communication records in books for this purpose or in residents individual care records. A handover was observed and listened to during this visit information appeared to be given in sufficient detail to ensure that staff on the late shift knew what residents needs were. The manager said in pre inspection information that staff have received all training that must be provided and that 50 of care staff have trained to at least National Vocational Qualification (NVQ). She indicated that she hopes more staff will achieve the qualification in the next 12 months. Records of staff recruitment showed that appropriate recruitment procedures are followed. There is also evidence that staff have attended various training courses, including First Aid, fire safety, manual handling, medication and Vulnerable Adults awareness. Good practice guidance in terms of the management of difficult behaviour has also been provided. A Code of Conduct produced by the General Social Care Council have also been provided, and all new staff have completed an induction programme. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is ( good). This judgement has been made using available evidence including a visit to this service. Residents can be confident that the service takes it responsibilities under Health and Safety legislation seriously and has completed health and safety and fire safety checks regularly and ensured that equipment is in good working order. But although there are meetings with residents, relatives and staff these could be more frequent to ensure that their views are obtained on the quality of service delivered and received. EVIDENCE: Pre inspection information showed that the care manager has trained to NVQ level 4, one of the assistant managers has trained to level 3 and two others are undertaking the level 3 training. The monitoring and frequency of staff supervision and personal development reviews could be improved to ensure Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 26 that the service is meetings it’s targets and more regular staff meetings should be considered. The manager said in the pre inspection information that further efforts would be to do this and also said that she felt that staff should receive further training in working on and with computers. Residents each have a financial care plan in place that they or their representative agree to. The service manages some monies for individuals. The organisation employs an administrator for this purpose that visits the home on a weekly basis to check that the individual accounts are up to date. The manager also said in the pre inspection information that the assistant managers will be supported to review the financial care plans of residents. A check of individuals account did not take place during this visit. Quality assurance systems are in place, and there is evidence that the service development manager visits the home at least monthly to monitor the conduct of the service and produces a report as evidence of this. Relative and resident questionnaires are sent out periodically and residents and relative meetings have been arranged in the past, again it is suggested that the frequency of these meetings should be increased. It wasn’t established during this visit if the outcome of any review of the feedback received is circulated to relatives, residents or other interested parties. This should be considered. The manager said that it has all relevant policies and procedures and the majority have been reviewed. Pre inspection information also states that regular tests and servicing of equipment tests has been carried out. A sample of records confirmed this. To ensure that the policy on Infection control is effective the manager should ensure that all staff have received training and should consider the most recent Department of Health guidance when producing action plans for the management of infection control. The fire records show that regular fire drills and testing takes place. A fire risk assessment for the home, and for each individual resident is also in place. It is recommended that all casual and bank staff have the opportunity to be involved with a fire drill. Records show that all fire safety checks have been carried out at regular intervals. A review of the certificate of registration was undertaken at the time of the site visit, it was found to be inaccurate and action must be taken by the service to inform the CSCI of the named nominated person, to act as the responsible person on behalf of Stoke-on-Trent City Council. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 27 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 3 2 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 1 18 2 3 x x x 2 x 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 3 3 Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 OP4 Regulation 12(3) Requirement Timescale for action 24/08/07 2. OP9 13(2) 3. OP9 13(2) 4. OP9 13(2) The provider must ensure the welfare of residents at the home and take action to promptly act if the needs, wishes and feeling of a resident are not being met. The ordering of the residents 30/10/07 medication must be co-ordinated and checked for accuracy at each stage by the home so that residents can receive their medication as prescribed. Accurate, complete and up to 30/10/07 date records must be kept of all medication received, administered, taken out of the home when residents are on leave and disposed of to ensure that medication is accounted for, is available and is given as prescribed. Appropriate information relating 30/10/07 to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including “when required” and “as directed” medication to ensure that all medication is DS0000028913.V338819.R01.S.doc Version 5.2 Eardley House Page 29 5. OP9 13(2) 6. OP9 13(2) 7. 8. OP18 OP17 37 12(3) administered safely, correctly and as intended by the prescriber to meet individual health needs. Staff who administer medication must be trained and competent and their practice must follow written policy and procedures to ensure that residents receive their medication safely and correctly. Medication must be stored within the temperature range recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. Any suspected abuse must be reported promptly. The service must ensure that resident legal rights are promoted and the service acts to ensure that residents wishes and feelings are not ignored. 30/10/07 30/10/07 24/08/07 24/08/07 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. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose for the home should be provide an up to date account of the service and the named responsible person on behalf of the organisation. The resident guide should contain up to date contact details for the CSCI in the summary of it’s complaints procedure. The resident guide should contain the terms and conditions of residency and the level of fees to be paid. The service should ensure that all residents have a copy of the resident guide. DS0000028913.V338819.R01.S.doc Version 5.2 Page 30 2. 3. 4. OP1 OP1 OP1 Eardley House 5. 6. 7. OP3 OP15 OP15 8. 9. 10. 11. 12 OP23 OP15 OP15 OP37 OP27 Undertake a review of the admissions procedure for person referred to the service in an emergency. A review of the mealtimes should be undertaken to ensure that residents don’t’ have extended periods of time without food or drink. A review of the routine that means residents who can not exercise an informed choice are sitting at the dining table for extended periods prior to the meal being served, should be undertaken Display a notice in the lift to ensure all users know to press the buttons firmly. The Controlled Drugs cabinet is securely fixed to the wall as specified in the Misuse of Drugs (Safe Custody) Regulation 1973. The date of opening of all eye drops and short dated medicines is recorded so that the home is aware of when they need to be discarded. The service should notify the CSCI of the named person to be included on the certificate of registration, as a representative of the provider. The service should actively recruit staff to ensure the vacancies at the home are filled. Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Eardley House DS0000028913.V338819.R01.S.doc Version 5.2 Page 32 - 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. 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