Inspection on 07/02/07 for Eastbury House

This inspection was carried out on 7th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Eastbury House 12/08/08

Eastbury House 30/07/07

Eastbury House 31/07/06

Eastbury House 06/01/06

Eastbury House 14/09/05

Eastbury House 11/01/05

Eastbury House 01/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Eastbury House Long Street Sherborne Dorset DT9 3BZ Lead Inspector Alison Stone Unannounced Inspection 7th February 2007 10:30 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 Eastbury House DS0000048854.V321113.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. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eastbury House Address Long Street Sherborne Dorset DT9 3BZ 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) 01935 812132 01935 814164 eastburyhouse@btinternet.com Eastbury House (Sherborne) Ltd Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2006 Brief Description of the Service: Eastbury House is situated close to the centre of Sherborne within easy level walking distance of the town amenities. The home is registered to provide care and accommodation to a maximum of 19 people over the age of 65 and offers long and short-term places. Mrs Appleyard is the previously registered owner of the home and the responsible individual on behalf of the limited company: Eastbury House (Sherborne) Ltd. The home is at present without a registered manager and is being managed by Mrs Appleyard and acting manager Miss Witt. Parts of the building date back to the 17th century, in particular the hallway and main staircase, dining room and front lounge. These areas retain many of the original features such as oak wood panelling, stonework and leaded lights. The accommodation for service users is arranged over the ground and first floor of the home. Due to the age of the building and extensions to the house made many years ago there are a number of internal stairs and steps and changes of level, therefore some parts of the accommodation cannot be easily accessed by people who experience severe mobility problems. A stair-lift fitted to the back staircase provides access to bedrooms situated on the first floor. Nine bedrooms are situated on the ground floor: two bed/sitting rooms are in a building close to, but separate from the main house. In addition to personal care and support the services provided include all meals, laundering and housekeeping. The home has mature private gardens where residents can sit and relax in the warmer weather. There is a small parking area to the side of the house and a public car park is also situated a short walk from the home and close to the town centre. Arrangements can be made for a hairdresser, chiropodists, opticians and other health and social care professionals to visit individual residents. Fees range from £440 to £660 per week. This information was given on the 7th of February 2007. Readers of this report may find it helpful if they have any queries about fees to contact the Office of Fair Trading WWW.oft.gov.uk. The acting manager had copies of the last report available within the office. The report of this inspection is available from enquires@csci.gsi.gov.uk. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection of this care home by the Commission for Social Care inspection this year, the inspection year runs from 1 April 06 to 31 March 2007. This was a key inspection. The key standards are identified in the main body of report in each outcome area. In order to obtain a fuller picture of the home the reader should refer to the earlier inspection report dated 31 July 2006. The inspector arrived at 10.30 am and left at 4.00pm the visit lasted five and a half hours. The inspector spoke with four service users, one relative, the responsible individual, the acting manager and the deputy manager. The inspector also undertook a tour of the premises, observed practice and looked at medication supplies. She inspected records relating to service users’ care, staffing and other documentation relating to the running of the home. Preparation work included, reading the previous report and analysis of notifiable incidents reported to the Commission for Social Care Inspection, the body that regulates services like Eastbury House. Of the 38 National Minimum Standards, all 22 Key Standards and eight of the remaining 16 Standards were assessed. The responsible individual and acting manager were present during the inspection. The acting manager provided the inspector with all the relevant information relating to the inspection and any necessary background information. Feedback was given to the acting manager at the end of the inspection. This inspection found that substantial improvements have been made since the last inspection in all aspects of management of the home. Improvements were noted to improve the quality of outcomes for service users living at Eastbury House. The inspector would like to thank everybody who contributed towards the inspection process. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The acting manager has worked hard to meet the requirements and recommendations left at the inspections of 31 July 2006. There were eight requirements and twelve recommendations made at the last inspection. Six requirements and seven recommendations have been met, a further two requirements have been partially met since the last inspection. A further seven requirements were made at this inspection. The home has improved in most of the areas identified in the last inspection, the areas that the inspector found improvements in are summarised in this section of the report. It was noted that improvements in service users medication administration have been made addressing some of the requirements made in this area at the last inspection. Service users are supported with a risk assessment in the area of selfadministration of medication. Staff record in ink, the reasons why service users medication is omitted. More work is required to make sure each time a new medicine is prescribed or changed by a GP, a record of this is made in the person’s care notes as well as their medication administration chart. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 7 The acting manager ensures the homes pets are no longer able to access the kitchen area. The glass panel which was stored on the first floor landing at the last inspection, presenting a potential risk to service users was removed during the last inspection of the 31 July 2006. Staff were noted to have had the appropriate recruitment checks, these had been undertaken prior to employing staff. Staff have attended training in the area of Adult Protection. The acting manager will be applying to the Commission for Social Care Inspection to become the registered manager of the service. What they could do better: Care plans need to be developed to detail the objectives staff are supporting service users to achieve and must include the action staff should take to meet service users needs. Care plans should also express service users preferences. Service user’s weight needs to be regularly monitored, this should be checked at least monthly. Service users need to be supported with nutritional and skin assessments to ensure their health needs in these areas are identified and then care planned for. Some areas in relation to medication administration remain outstanding from the last inspection. Individual risk assessments need to be developed to support service users accessing excursions. The homes own Adult Protection policy needs further amendments, to bring it in line with the Social Care and Health’s Multi-agency guidelines. Risk assessments relating to the home environment need further development with regard to scald/burn risks. This refers to issues around hot water outlets that are not protected by a water temperature control valve and the open fire in the sitting room. Whilst the acting manager has undertaken a lot of work in developing policies and procedures, further work is still required to ensure the home has adequate policies and procedures in place to support the running of the home. This includes further development of the excursions policy. The home needs to develop a quality assurance system that ascertains the opinions of the service provided at Eastbury House, this process needs to involve all stakeholders. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 8 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. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 9 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 Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 10 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): 2, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the home can meet their care needs prior to them moving in, because the home undertakes assessments of people needs. Service users and their families/representatives are actively encouraged to visit the home and spend time assessing the quality and suitability of the home’s facilities, before making a decision about whether they would want to live there. The home does not provide any intermediate care. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three service users records were reviewed as part of the inspection. The majority of service users who live at Eastbury House are private and therefore do not have a social services users assessment. When a service user is referred to the home the acting manager/responsible individual visits that person in their own home to carry out their own assessment of a service users need. The review of these documents indicated that there were assessments in place that included basic information such as information about the person’s next of kin and GP. The review of the home’s assessment pro-forma demonstrated it included sections to complete about a person’s needs including their health needs. Service users said that they had been supported with visits to the home before having to make a choice about moving in. Eastbury House DS0000048854.V321113.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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally service users needs are detailed in their care plans. However care plans need further development to ensure all service users health needs are identified. Service users best interests are generally protected by the homes policies and practices in relation to medication. Service users can be confident that they will be treated with respect and the staff will uphold their right to privacy. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 13 EVIDENCE: As part of the inspection three service users records were looked at. These were found to be generally detailed. However care plans did not describe the action staff are to take to meet individual’s needs. Nor were service user’s preferences and the objectives staff were supporting service users to achieve included in their individual care plans. Care plans had been regularly reviewed. However information relating to service users reviews was limited and did not provide any information about whether the service user and/or their family were involved. Care plans did not demonstrate what changes if any had been made following the review. However one family spoken to during the inspection said staff kept them informed about any changes in their relatives care. However despite the issues around care plans it was noted that service users spoken to felt very well cared for. Service users felt that everything about the home was positive, including the care they received from the staff. One service user said, “They couldn’t do more for you.” The relative involved in the inspection process said lots of positive things about standards of personal care their family member received at the home. Some of the comments included “they care for mum very well” and “I am very happy with the care staff give mum”. Service users files demonstrated that they saw their GPs regularly and were supported to see the optician, chiropodist, and the dentist as required. Service users spoken to supported the fact that they regularly saw their GP and other health professionals when they were unwell. The acting manger said service user’s had the choice of accessing these services at the home or in their local community. Service users files did not demonstrate people were weighed regularly nor had individual nutritional and skin assessments been undertaken. The homes medication management was reviewed as part of the inspection. It was noted that recommendations made at the last inspection had been taken on board and there were improvements. All staff who administer medication are trained in this area. The deputy manager is in overall charge of medication. She is a qualified nurse, although does not practice as such in her role as part time deputy at Eastbury House, because the home is a care home. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 14 Further improvements need to be made in the area of medication. These improvements include regular medication audits, service user assessment forms need to be amended to demonstrate that service users were asked if they want to self medicate. The home’s current system for administering medication, which includes “potting up” medication and then care staff taking the medication to the individual service user, is far from ideal. However given the practicalities of the home’s physical environment, it was acknowledged there are few options available to the home in this area. The deputy manager has put in place a system from the advice given at the last inspection to make this process as safe and free from errors as possible. However CSCI has arranged for the specialist pharmacy inspector to visit the home to look at ways to support staff with good practices in relation to service user medication. Observations made by the inspector during the visit noted that staff were very polite, kind and respectful to service users needs. Staff appeared helpful, patient and considerate towards service users at all times and were seen to offer people choices about the care they received. Care offered by the staff at the home was noted to be unobtrusive. Service users were observed to be well dressed and were smartly presented. People were noted to be wearing jewellery and dressed in clothes that reflected their individuality. It was noted service users had nicely styled hair and were noted to be wearing their glasses and hearing aids. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 15 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to have access to a lifestyle in the home that meets their interests and preferences. The home encourages people’s social, religious and recreational interests, which promotes and encourages people’s individuality. Service users are supported to maintain contact with family and friends and be part of the local community. Encouraging service users to feel socially included preventing feelings of social isolation. Service users are supported to have choice and control over their lives, promoting people’s sense of independence. Service users receive a choice of appealing, nutritional meals in pleasant surroundings. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 16 EVIDENCE: It was noted that more detailed information should be obtained during the assessment process to inform staff about service users individual cultural, social and leisure interests. The home encourages service users family and friends to regularly visit them at the home. During the inspection it was observed that service users were encouraged to entertain their friends and relatives in the communal areas of the home and their own bedrooms. Service users bedrooms were noted to be pleasant, providing a comfortable, nicely furnished space to receive guests. The responsible individual has made links with the local community; a local school visits the service users at the home regularly. She also encourages local youngsters to do weekend work at the home, whilst they don’t undertake personal care work, they are involved in some cleaning, helping with meals, chatting with service users and supporting excursions out into the local area. Service users spoken to said that they enjoyed having visitors to the home, particularly young people from the schools. The home places a lot of emphasis on activities for service users, organising regular excursions such as going out to the coast, out for meals at the pub, shopping trips and trips to the theatre and pantomime. Since the last inspection the acting manager has developed a policy and procedure in relation to supporting service users going out. However this still requires further development to ensure there are individual service user risk assessments for all activities. Staff and service users spoken to agreed that there were regular service user meetings at the home. The acting manager said that they operate a system similar to a key worker system. Senior staff are responsible for a number of service users and take a lead in planning their care. One mealtime was observed during the inspection these were noted to be very pleasant social experience, where service users were supported by staff to enjoy their meal times. Staff spent time encouraging service users to make choices for themselves and were seen to offer service users discreet support where required. Mealtimes were noted to be pleasant and unhurried. Service users have a choice of where to eat, there is a formal dining room, a large kitchen area Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 17 provides a further area to eat in and service users can also have meals in their bedrooms. Menu charts indicated service users are offered a choice of meals, including main courses and deserts, meals were noted to be well balanced and nicely presented. All the service users spoken to were complimentary about the meals offered at Eastbury House. One relative said she and her family often eat with her mother at the home and the meals were “lovely”. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 18 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their relatives can be confident that their complaints will be listened to and taken seriously. The home has a complaints process in place that supports the management of any complaints. The homes own policy needs further development before it can be said service users are protected from abuse and neglect. Staff are supported with training in the area of Adult Protection to ensure they are vigilant in this area. EVIDENCE: The review of complaints file kept in the home demonstrated that all complaints were appropriately managed in accordance with the homes procedure. The home keeps records of all complaints received and investigated. Since the last inspection no complaints against the home have been received. The home has a complaints procedure in place, which is made available to all service users in the Service User Guide. There haven’t been any complaints made to the Commission for Social Care Inspection in relation to the service the home provides. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 19 Services users spoken to during the inspection said that they would feel confident to make a complaint to Mrs Appleyard or the acting manager. They said they felt the management supportive and interested in their suggestions, concerns and/or complaints. Three staff records were reviewed as part of the inspection. These indicated staff had been supported to undertake training in the areas of Protection of Vulnerable adults. It was identified on the last inspection that there was a need for the home to develop their own Adult Protection Policy. This has now been completed and was reviewed as part of the inspection. However this policy needs further amendments to bring it in line with the Social Care and Health’s Local Policy in this area. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 20 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, 20, 21, 23, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortably and nicely decorated home. More work is required in the area of risk assessments before the home could be described as providing a safe environment. Service users bedrooms are pleasantly decorated and furnished reflecting their personal tastes. The home provides service users with a clean, tidy and hygienic environment to live in. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 21 EVIDENCE: During the inspection a tour of the premises was undertaken. This included looking around all the communal areas including the dining room, lounge, bathrooms and toilets. The homes medication room, kitchen, pantry area and laundry room were also looked at. With the permission of the service users, three occupied bedrooms were looked at and a further two empty bedrooms were also seen. The responsible individual said that hot water outlets are not all controlled by a temperature thermostat. This is because service users said that they want to be able to access hot water. However this has not been documented as a choice people have made. The baths have controlling valves in place but communal toilet sinks and individual sinks in service users rooms do not. The acting manager has ensured a generic risk assessment is carried out in relation to the risks of possible scalds from the hot water taps in sinks, and there are also clear hot water signs up in each sink area where this is the case. However risks presented to people by very hot water are very individual dependant on people’s comprehension and ability. Therefore individual risk assessments would further support safeguarding service users needs in this area. The home has a large open fireplace in the sitting room, there is a risk assessments in place, which states a fireguard must be used at all times. However the fireguard was not in place during the inspection. The acting manager said that this is often removed for aesthetic reasons. This practice places service users at risk. The home is very old and is a listed building, which creates issues around making changes to the physical environment of the home. Consideration has been given to service users mobility needs by providing equipment like a stair lift. However the home has many sets of little steps on the ground and first floor, that would pose problems to service users with high mobility needs. The home is unsuitable for service users who need a wheelchair to mobilise. At the time of the inspection there was only one service user who used a wheelchair. It was noted that they have to leave the building and come in at another part of the building to access meal times in the dining room. The acting manager said that the accessibility issues are made clear in the Service Users Guide, which is given to all service users. Currently there are Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 22 two service users whose mobility needs seriously restrict access around the home. The acting manager said that these have been discussed with the service users and their representatives and despite the problems they are more than happy to remain where they have lived for a long period of time. The inspector spoke to one service user and their family who agreed that although she was unable to leave her room because of her mobility needs she would rather remain at the home than move anywhere else. The acting manager said that mobility issues were always an on-going challenge, as often service users needs change and their mobility needs increase whilst living at the home. Because of this the acting manager said that they kept service users mobility needs under constant review. In circumstances where staff notice difficulties a review is called with the service user and their representatives to look at ways of supporting people’s individual needs. The acting manager said options include offering people the option of moving to another home if they wanted to. Service users bedrooms were nicely decorated each room reflected a different style of décor. The manager said that the staff work with service users and their relatives to find out people’s preferences and tastes to make sure rooms reflected a person’s individuality. Service users were able to bring items of furniture from their own homes. It was noted that there were many personal effects around people’s bedrooms. Service users are able to have a television and/or telephone in their own bedrooms if they wanted. Service users have access to lockable facilities in their own bedrooms if they require. Each person has a key to their bedroom door that they can lock from the inside for privacy. Staff are able to unlock the doors in the case of an emergency. During the inspection the home was noted to be clean and tidy and free from any unpleasant odours. The responsible individual said that she employs one domestic assistant four days a week it is her responsibility to ensure the home remains well maintained. Further domestic work is undertaken by care staff to ensure the home remains clean and hygienic at all times. The responsible individual and the acting manager are keen to promote good practices in relation to cleanliness and hygiene. They have supplied antibacterial hand wash for visitors to use when entering the home. Bathroom/toilets were noted to have anti bacterial hand wash available at all times. However it was noted that the toilets have communal towels in place. This is not does not promote good hygiene practices. Hand dryers and/or disposable paper towels would better support infection control practices. Eastbury House DS0000048854.V321113.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are generally supported by skilled and trained staff, who are encouraged by the organisation to undertake regular training. Service users can be confident there is regularly enough staff on duty to meet their needs. Service users can be confident that the home’s recruitment practices are generally robust, ensuring staff are suitability to work with vulnerable adults. EVIDENCE: Three staff files were reviewed as part of the inspection along with staff rotas. Staff files indicated staff were supported with mandatory training in areas like, infection control, health and safety, protection of vulnerable adults, fire, food hygiene, first aid and manual handling and medication training where appropriate Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 24 The acting manager said staff have an induction in line with the nationally recognised “Skills for Care” induction programme before commencing work with service users. The acting manager recognised the importance of providing the staff team with regular training, supervision and staff meetings. The management of staff training needs would be further enhanced through the introduction of a training matrix, which would enable the manager to have an overview of all staff’s statutory training and would flag up when refresher courses were due. The acting manger and deputy manager are currently undertaking their NVQ 4. Staff are also encouraged to undertake their NVQ to support them in their roles. Staff are also supported to access specialist training as required in areas such as dementia and diabetes. Service users say that they felt staff were knowledgeable about their needs and they had confidence in the care provided to them. Service users said they felt there were enough staff on duty to meet their needs and they didn’t feel they had to wait long periods of time for help or that they were rushed during personal care. The review of rotas indicated that there were adequate staffing levels in place on a daily basis to meet the needs of the service users, in all areas of the home including domestic support, service users activities, maintenance and catering staff. The acting manager is on duty throughout the week and often works as part of the care team. The responsible individual also works full time in the home supporting the acting manager with the day to day running of the home. The review of staff recruitment records demonstrated these are generally robust with all the necessary checks in relation to pre employment being undertaken. Including Criminal Records Bureau Disclosures, checks are made against the Protection of Vulnerable Adult (POVA) lists prior to employment and staff files had two written references in place. Eastbury House DS0000048854.V321113.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, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users benefit from having an experienced acting manager who is committed to improving their quality of life, who runs the home efficiently and in the best interests of the people who live there. The management style enables service users and their family and/or friends to feel confident about raising issues. Service users would benefit from the development of a quality assurance system, to inform them about the quality of care they can expect to receive living at Eastbury House. Service users can be confident that staff are regularly supervised in relation to the work they carry out in the home. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 26 More work is required in the area of policies and procedures to ensure robust systems are in place to protect service users and staff. The home has the necessary arrangements in place to safeguard service users financial interests. EVIDENCE: The acting manager has been effective in her role over the previous seven months and has made good progress towards meeting the requirements and recommendations made at the last inspection on the 31 July 06. She has been in post over 18 months and has worked in the home since she was 15 years old. Mrs Appleyard, who is the responsible individual and was the previous manager, supports the acting manager in her role. An application has not been received by CSCI, to register the existing manager. This was due to the acting manager misunderstanding the process. Now the acting manager is aware of the correct information relating to registering with CSCI as the manager she will be submitting her application to CSCI in the next few weeks. Service users said they felt confident about being cared for by a management team that they have known for a long time and liked the consistency of a stable management team. Service users spoken to say that they felt they could approach the acting manager with any concerns. The home has yet to develop a quality assurance system. The home has polices and procedures that relate to the management of service users’ finances. The acting manager said small amounts of cash and/or valuables can be kept in a secure place for service users. Records are kept of all transactions and receipts are retained. The home does not act as an appointee on behalf of any of the service users. Staff records indicated staff were supervised on a regular basis. The acting manager also had a policy and procedure in place to support staff supervision. Staff records indicated that supervisions were detailed and demonstrated that any issues with staff performance were discussed at these sessions. The acting manager was able to demonstrate that there was an effective policy and procedure relating to staff supervision and appraisals in place. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 27 Accident forms were in place for staff and service users, these were properly completed and were regularly audited by the acting manager to look at ways of preventing slips, trips and falls. To comply with data protection legislation accident forms should be kept in locked facilities and correctly indexed to prevent loss. The inspection of fire records showed regular tests of the fire equipment take place. Regular fire evacuation drills are undertaken, however the record of fire drills should include the names of staff and service users who took part. Staff records demonstrated that staff have received fire training. Generic risk assessments are in place for many aspects of the home including staff, the premises and food safety. These need to be further development to ensure there are risk assessments in place for every all aspect of the management of the home. These need to be reviewed and updated annually. The home has regular visits from the environmental health officer. It was noted that there was an up to date portable appliance testing certificate in place, along with the appropriate five-year hard wiring check. An up to date gas landlord certificate was seen. Regular service checks where made on the stair lifts and mobility hoists. The home still needs to develop further polices and procedures to support the safe management of the home. Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 28 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 3 2 2 Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 29 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 12(3) Requirement Timescale for action 07/04/07 2. OP8 12 (1)(a) 3. OP8 12 (1)(a) The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practical ascertain and take into account their wishes and feelings. (This relates to ensuring service users wishes and preferences are recorded in their care plans.) The registered person shall 07/03/07 ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users. (This relates to ensuring service users weight is regularly monitored, at least monthly.) The registered person shall 07/04/07 ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users. (This relates to ensuring service users assessments are carried out in relation to service users nutritional and skin care needs.) Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 30 4. OP9 13 5. OP18 13(4)(c ) 6. OP25 13(4)(a) (b)(c) 7. OP25 13(4)(a) (b)(c) When a medicine is prescribed for administration as required the reason for such administration must be recorded in the directions. Unmet at this inspection time scale extended. The registered person shall ensure that-(c) unnecessary risks to the health or safety of service users are identified and as far as possible eliminated. (This relates to ensuring the home’s own Adult Protection Policy is further amended to ensure the guidance is in line with the SSD policy in Adult Protection) The registered person shall ensure that(a) all parts of the home to which service users have access are so far as reasonably practical free form hazards to their safety; (b) any activities in which service users participate are so far as reasonably practical free form any avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (This relates to ensuring service users have individual risk assessments in place, relating to the risks presented by hot water outlets.) Outstanding from the last inspection 31 July 2006. Amended to take account of the progress made.) The registered person shall ensure that(a) all parts of the home to which service users have access are so far as reasonably practical free form hazards to their safety; (b) any activities in which service users participate are so DS0000048854.V321113.R01.S.doc 07/04/07 07/04/07 28/02/07 14/02/07 Eastbury House Version 5.2 Page 31 8. OP33 24(1)(a) (b)(2)(1) (3) 9. OP37 17(1)(a) & (b) Sch 3&4 far as reasonably practical free form any avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (This relates to ensuring that risk assessment for the open fire in the sitting room is followed at all times.) Outstanding from the last inspection 31 July 2006. Amended to take account of the progress made. (1) The registered person shall 07/08/07 establish and maintain a system for- (a) reviewing at appropriate intervals; and (b) improving, the quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home. (2) The registered person shall supply to the commission a report in any respect of any review conducted by him for the purposes of paragraph (1), and make a copy of the report available to service users. (3) The system referred to in paragraph (1) shall provide for consultation with service users and their representatives. (This refers to developing a quality assurance system for the home, that involves all stake holders) The registered person shall- (a) 07/03/07 maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user; (b) ensure that the record referred to in sub-paragraph (a) is kept securely in the care home the records specified in Schedule 4 (This relates to ensuring service users accident forms are kept DS0000048854.V321113.R01.S.doc Version 5.2 Page 32 Eastbury House according to date protection legislation.) 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 OP8 Good Practice Recommendations It is recommended that an accident policy and procedure with particular regard to falls management be developed and implemented. This recommendation is made for the second time. It is recommended that a list of all prescribed medicines be recorded for each resident, together with the reason for prescription. This recommendation is made for the second time. It is recommended that systems for obtaining the opinions of residents and other service users be improved. This recommendation is made for the second time. It is recommended that to ensure the safety of passengers the designated car drivers should receive associated training and work in association with a specific policy/procedure giving guidance on accompanying residents on excursions. This recommendation is made for the second time. It is recommended that at the earliest opportunity written policies and procedures be developed and implemented for all subjects referred to by the Commission in the preinspection questionnaire. This recommendation is made for the second time. 2. OP9 3. 4. OP33 OP38 5. OP38 Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Eastbury House DS0000048854.V321113.R01.S.doc Version 5.2 Page 34 - 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. 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