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Inspection on 18/04/06 for Eastcotts Nursing Home

Also see our care home review for Eastcotts Nursing Home for more information

This inspection was carried out on 18th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

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

What the care home does well

This inspection found the quality of the personal and nursing care provided within the special needs unit was of a good standard. Observation of the unit revealed that members of staff were polite and responsive to residents, and their requests for assistance with care. Residents were noticeably well groomed, and staff encouraged drinks, and supported residents with their meals. Residents` care plans, risk assessments and professional assessments were very through, were up to date, and provided a detailed record of the care required. Falls were appropriately recorded, assessed, and monitored. Medication practises within Lavender were appropriate, and safe. The staff at Lavender spoken with provide person centred care. There appropriate care could be delivered. and had received good training from confirmed that all efforts were made to were sufficient levels of staff on duty, so Staff were experienced and skilled nurses, the home.Residents confirmed the care they received was good and were usually able to make choices about the daily care and support they received. Relatives commented that staff were helpful and caring towards residents. During the inspection staff were observed to be supportive and patient with residents who have special needs and their daily care. The home was mainly clean, warm and maintained. Staff employment and recruitment records were checked and appropriate documentation was found in place. Staff training and supervision continued. The management of the home continued to be responsive to the needs of residents.

What has improved since the last inspection?

This inspection demonstrated the home continued to improve the documentation of the care provided, which was essential for the appropriate management and provision of nursing care to residents with special needs. For example, pressure area care or falls risk assessments, weight and nutritional monitoring. Previous inspection shortfalls, around the early rising of residents, had been positively addressed by reorganisation of the rota. Morning staff now commenced at 6.45am, and care commenced from 7am ensuring that residents are able to rise when they chose.

What the care home could do better:

This inspection focused on Lavender, the special needs unit, and while the provision of care was to a good standard, the quality of life and signs of well being for special needs residents was lacking and in need of improvement. Residents observed lacked sufficient stimulation and lifestyle opportunities.Challenging behaviour must be more clearly identified and a plan implemented to assist vulnerable residents. This was discussed with the manager and an action plan will be devised and implemented to address this issue. Residents` dignity must always be maintained by the correct provision of screening. Food snack options must be provided at morning and afternoon teas, and where snacks must be limited for medical reasons, this must only be undertaken within a risk assessment framework, and with the resident`s agreement. Residents must be provided with their own personal chest of drawers, and shower hot water temperatures must only be delivered at around 43 Degrees Celsius, to avoid scalding. Unpleasant odours must be neutralised and a sealed floor covering must be provided for the laundry floor. Recommendations included the provision of additional cleaners, as hygiene standards have previously been higher, and the review of the activities programme to ensure that residents` lifestyle needs, are being met. More homely improvements to the lounge in Lavender should be considered, and additional special needs training be provided for staff. Quality assurance forms should be reviewed to ensure they capture the most relevant information to the home. Due to relative`s feedback comments, the home should ensure that there are sufficient staff numbers to meet residents` needs.

CARE HOMES FOR OLDER PEOPLE Eastcotts Nursing Home Eastcotts Nursing Home Calford Green Kedington Haverhill Suffolk CB8 7UN Lead Inspector Kevin Dally Announced Inspection 18th & 19th April 2006 09:15 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 DS0000055177.V288137.R01.S.doc Version 5.1 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. DS0000055177.V288137.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Eastcotts Nursing Home Address Eastcotts Nursing Home Calford Green Kedington Haverhill Suffolk CB8 7UN 01440 703178 01440 763435 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) Raveedha Care Ltd Mrs Olive Angelina Silva Care Home 59 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (59) of places DS0000055177.V288137.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st December 2005 Brief Description of the Service: Eastcotts is a Care Home with Nursing, is registered to care for a total of 59 older persons in the categories of dementia and older persons not falling into any other category. Located in a small rural hamlet near Haverhill, Eastcotts is set in its own grounds with car parking. The home is a converted three-story period property, with a single storey extension. The home is divided into 3 areas, Main home, Jasmine and Lavender Unit, each with their own lounge and dining room. There are 33 single and 13 double bedrooms, with some of the newer rooms having en-suite toilets and showers. DS0000055177.V288137.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Eastcotts is a care home offering nursing care for 59 older people, of which 27 places are registered for dementia care. This announced inspection was undertaken on the 18th and 19th April 2006, between 9am and 5pm on both days. This was a key inspection that assessed the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. This inspection focused on the outcomes provided for residents mainly in Lavender, the special needs/dementia unit, and most of the first day was spent within this area. Residents and staff provided feedback about the service provision, including how they managed and worked with special needs clients. Care plans, risk assessments, accident records, lifestyle plans, observation and specialised assessment records were assessed. Two staff members’ records, and some policy documents were checked, and an environmental tour of Lavender was completed. Mrs Angelina Silva, the manager, was present throughout both days, and contributed to the inspection process. Nine comment cards were received from residents and relatives in response to a survey of the care and support received at the home. This inspection revealed that of the 28 standards inspected, 19 were assessed as fully met with 9 standards as almost met. What the service does well: DS0000055177.V288137.R01.S.doc Version 5.1 Page 6 This inspection found the quality of the personal and nursing care provided within the special needs unit was of a good standard. Observation of the unit revealed that members of staff were polite and responsive to residents, and their requests for assistance with care. Residents were noticeably well groomed, and staff encouraged drinks, and supported residents with their meals. Residents’ care plans, risk assessments and professional assessments were very through, were up to date, and provided a detailed record of the care required. Falls were appropriately recorded, assessed, and monitored. Medication practises within Lavender were appropriate, and safe. The staff at Lavender spoken with provide person centred care. There appropriate care could be delivered. and had received good training from confirmed that all efforts were made to were sufficient levels of staff on duty, so Staff were experienced and skilled nurses, the home. Residents confirmed the care they received was good and were usually able to make choices about the daily care and support they received. Relatives commented that staff were helpful and caring towards residents. During the inspection staff were observed to be supportive and patient with residents who have special needs and their daily care. The home was mainly clean, warm and maintained. Staff employment and recruitment records were checked and appropriate documentation was found in place. Staff training and supervision continued. The management of the home continued to be responsive to the needs of residents. What has improved since the last inspection? What they could do better: This inspection focused on Lavender, the special needs unit, and while the provision of care was to a good standard, the quality of life and signs of well being for special needs residents was lacking and in need of improvement. Residents observed lacked sufficient stimulation and lifestyle opportunities. DS0000055177.V288137.R01.S.doc Version 5.1 Page 7 Challenging behaviour must be more clearly identified and a plan implemented to assist vulnerable residents. This was discussed with the manager and an action plan will be devised and implemented to address this issue. Residents’ dignity must always be maintained by the correct provision of screening. Food snack options must be provided at morning and afternoon teas, and where snacks must be limited for medical reasons, this must only be undertaken within a risk assessment framework, and with the resident’s agreement. Residents must be provided with their own personal chest of drawers, and shower hot water temperatures must only be delivered at around 43 Degrees Celsius, to avoid scalding. Unpleasant odours must be neutralised and a sealed floor covering must be provided for the laundry floor. Recommendations included the provision of additional cleaners, as hygiene standards have previously been higher, and the review of the activities programme to ensure that residents’ lifestyle needs, are being met. More homely improvements to the lounge in Lavender should be considered, and additional special needs training be provided for staff. Quality assurance forms should be reviewed to ensure they capture the most relevant information to the home. Due to relative’s feedback comments, the home should ensure that there are sufficient staff numbers to meet residents’ needs. 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. DS0000055177.V288137.R01.S.doc Version 5.1 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 DS0000055177.V288137.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5 People can expect to have their care needs assessed, and have their nursing and personal care needs meet. The home may not be able to promote the well being of residents with special needs. EVIDENCE: Nursing needs assessments were undertaken by the manager or an appointed member of the nursing staff. Two residents’ records checked at Lavender confirmed that an assessment of each resident’s needs were undertaken before admission. The assessment included a summary of 7 areas of assessed need, and a further document referred to by the home as “activities of daily living lifestyles assessments”, had also been undertaken. The assessment was found to be adequate and included 13 areas of assessed needs. Additional nursing assessments included care dependency, falls risk assessment, pressure area risk assessment, nutritional risk screening, and general risk assessments were available. DS0000055177.V288137.R01.S.doc Version 5.1 Page 10 Feedback received from residents, and staff, records checked and observation, confirmed that staff at the dementia unit provided good quality nursing and personal care residents with special needs. Significant personal care improvements were noted by the way in which care was delivered, and documented. Documentation was to a good standard, was regularly updated, and provided sound evidence of good care practices. (Refer to standard 8) However, the quality of life and signs of well being for residents with special needs was lacking and in need of addressing. Residents observed lacked sufficient stimulation and lifestyle opportunities. For example a confused resident was observed frequently standing, who was then repeatedly asked by staff to sit down, due to concerns about them falling. This behaviour was not positively channelled into a supervised walk or planned activities etc. Another example noted was two service users slept most of the morning in the day room, awoken only by staff when regular drinks were being offered. These issues were discussed with the manager and it was agreed that special needs residents required a personal strategy to improve and encourage positive well being. Residents spoken with in other areas of the home confirmed that they were happy living in the home. Comments included, “there are nice people here”, and “I am okay”, and “whatever you ask for you get it” and “I am quite happy” and “staff are marvellous and work hard”. Of the seven relatives’ comment cards received, 5 stated they were satisfied with the overall care received at the home, 1 stated undecided, and 1 stated yes and no. DS0000055177.V288137.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People can expect to receive professionally planned care and have their nursing healthcare needs met by nursing staff. People can expect that regular reviews would be maintained of their care assessment. While people could expect to be treated with respect, they may not always be treated with dignity by staff. EVIDENCE: DS0000055177.V288137.R01.S.doc Version 5.1 Page 12 Care records checked at Lavender included an “activities of daily living, lifestyles assessment”, which assessed 13 areas of personal need, in a summary form. Care plans would be produced from this assessment. The care received by two residents with dementia and who were prone to falls were tracked. Each care plan included 14 points of very detailed assessment of each resident’s care needs, and how care should be delivered. These were individually signed and updated monthly, and daily progress records had been maintained. In addition, nursing assessments were in place and included moving and handling and nutritional risk assessments, pressure area and fall risk assessments, bedrail/bedsides risk assessments, a body chart, a turn chart and fluid balance charts were found to be in operation. These were reviewed monthly, which demonstrated a high level of nursing care monitoring and interventions. The accident log for Lavender was checked and found to contain 72 recorded accidents /falls within the last 12 month period. One resident at risk of falling was tracked. Detailed records of each fall had been maintained for the previous 5 months, and were closely monitored. A falls risk assessment had been completed, and information was included within their care plan. The manager monitored all falls each week, and particularly those identified as more prone to falls. Strategies to reduce the incidence of falls included risk assessments, the use of hip protectors, nurses meetings to discuss preventative measures, and staff training. The NHS falls coordinator had visited the home and had reviewed the home’s falls strategy with the manager. Additional resident’s records checked revealed that staff had undertaken a falls risk assessment for these residents and was updated on a monthly basis. The falls monitoring records for the past 15 months indicated the number of falls in Lavender was reducing. Pressure area care risk assessments and nutritional screening documentation was found in place. Photographs were taken of wounds or bruising that required close monitoring. Moving and handling risk assessments were undertaken and integrated within residents’ care plans. Daily fluid balance and weight charts revealed that former underweight residents on admission had gained weight. Residents spoken with, observation of care and records checked revealed that holistic nursing care practises were in operation at the home. DS0000055177.V288137.R01.S.doc Version 5.1 Page 13 The home uses the Monitored Dosage System (MDS), which is provided by the local pharmacy. Stocks are ordered each 28 days and supplied to the home in pre-dispensed packs. This makes the administration of medication effective and safe for residents. The deputy manager was responsible to undertake monthly unannounced checks and audits of each unit’s medications and any problems are identified and rectified. The medication and systems provided within Lavender were checked and included observing staff administering medication, checking the storage cupboard, the Controlled Drug (CD) cupboard and a sample of medication records. Records were found dated, signed and appropriately maintained. Staff were observed to act in a caring and responsive manner towards the provision of residents personal care, were polite and helpful towards residents. The residents spoken with confirmed that members of staff were courteous. As part of the inspection an environmental tour of Lavender unit was undertaken, and some care practice observed. Eight double rooms were checked and screening was still found inadequate due to inadequate curtain sizes, which prevent total screening of residents. This was an outstanding requirement from the previous inspection and was required to be immediately addressed to ensure the privacy and dignity for each resident was maintained. Positively by the second morning of the inspection the owners had provided extra appropriate curtain cover. While touring the premises, one resident on bed rest was observed to have lost their covering sheets which had exposed their incontinent pads, so their personal dignity had not been maintained. Staff did attend to this quickly, and the home was required to ensure that all residents’ dignity was always maintained. DS0000055177.V288137.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 With staff support residents are able to be involved in limited recreational activities, mostly exercising personal choice, and usually making decisions about the lifestyle they wished to pursue. People could not expect the wellbeing and lifestyle needs of residents with special needs to be properly met. Residents could expect the provision of a good diet. EVIDENCE: Residents, relatives and staff spoken with stated that residents were provided with some leisure opportunities to pursue. This included the provision of a programme of activities during the week, which was organised by the home’s activities co-ordinator. However even though activities were provided, residents did not always choose to join in. Residents spoken with stated they enjoyed various opportunities including a summer fete last year and musicians who were really good. However, the musicians had not been for some time. The activities co-ordinator stated that residents were provided with various activities including passive exercises, painting, paper activities and board games including bingo and cards. Interest had fallen recently and it was difficult to encourage people to be involved. The home should review the activities programme to ensure that it meets the needs of residents. DS0000055177.V288137.R01.S.doc Version 5.1 Page 15 Special needs residents in Lavender lacked signs of well-being and stimulation. On the day of the inspection there were limited meaningful activities for Lavender residents to participate in, which may increase some residents’ anxiety. (Please refer to standard 4) The activities co-ordinator was seen positively working with two residents, and encouraging their participation in a morning discussion. Further, she confirmed that two days each week were spent at Lavender unit with special needs residents, and revealed this was mostly very successful. Unit staff were polite and responsive, and always met physical needs, but did not always have quality time to spend with residents and lifestyle pursuits. For example taking them for a walk outside. This situation was discussed with the manager and owners and it was agreed that a total review of the special needs unit would be undertaken, to determine how best to improve this aspect of the service. The review must include ensuring there are daily meaningful activities and opportunities for residents, as part of a lifestyle plan, with preferences and choices and weekly plans being identified. The home must also ensure that Social Assessment forms are further developed with appropriate lifestyle background information which is integrated into a daily plan for each resident. Any challenging behaviour and possible triggers must be recorded and a strategy provided as to how this should be managed. Residents in Main and Jasmine units confirmed they could receive visits from friends or family and no restrictions were placed on visiting times. Relative comment cards received confirmed they were welcomed at the home and could visit their relative in private. The local vicar was seen visiting residents. Five residents spoken with confirmed they were able to rise in the morning at times that suited them. A sample of care records checked had been updated as to the normal rising and settling times for special needs residents. The home’s three-week rolling menu plan was checked and was found to continue to provide a balanced and varied diet with two hot meal choices at lunchtime, and a lighter hot meal choice at tea. Breakfast could include a cooked meal. Residents spoken with about the meals commented they were “satisfactory”, and “excellent”, and “were happy with the meals and options offered”. Four of 5 residents stated they thought the meals were “above average, while 1 stated, “average”. The lunchtime meal seen was a choice of pork steak and stuffing or Quorn (meat substitute) and was served with roast or mashed potatoes, cabbage and mixed vegetables. Dessert was jam pudding sponge and custard or ice cream. Puréed meal components were found separated and very tastefully presented to encourage more poorly or residents’ with special needs appetites. Meals looked and smelt appetising, were in sufficient quantities and were delivered hot to residents. Staff were also seen assisting some residents to feed. DS0000055177.V288137.R01.S.doc Version 5.1 Page 16 Five service users spoken with stated that morning and afternoon tea was not always served with snacks or biscuits and requested this be re-instated. In discussion with the manager, snacks had been omitted, as some residents had not been eating their main meal. However, it was agreed that this was each resident’s choice, and particular health problem must be agreed and managed separately, within a risk assessment framework, and with the agreement of the resident. DS0000055177.V288137.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People could expect that complaints would be dealt with and the home would ensure the safety and protection of residents against abuse. Residents’ personal money records would be appropriately maintained. EVIDENCE: Since the previous inspection, the home and the CSCI had not received any complaints. The complaints procedure was provided in the Statement of Purpose and was adequate and informative. This included relevant information including how to make a complaint to the home, and also stated that a complaint would be investigated within 28 days. Two Protection Of Vulnerable Adult alerts had been received about the home, and these are still ongoing with outcomes pending. The home had suitable Adult Protection policies and procedures in place and were aware of their obligation to report any allegations of abuse to Social Services, the police and to notify the CSCI. The manager had undertaken a detailed risk assessment to ensure that risks to vulnerable residents had been considered. The home’s recruitment procedures included Criminal Record Bureau (CRB) disclosures, references and identity checks for all staff. A sample of staff records checked found these records to be in place. The finance records checked with respect to the personal money held for two residents were checked and these were found in order and correct. DS0000055177.V288137.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24, 25,26 People can mostly expect adequate communal provision, but cannot always expect a safely maintained home. People can expect a mostly clean and hygienic home, but some odours may be detectable. EVIDENCE: Eastcotts Nursing Home is a privately owned care home for up to 59 residents in the categories of dementia and older people. The home is divided into 3 main areas, Main Home, Jasmine and Lavender Unit, each with their own lounge and dining room. There are 33 single and 13 double bedrooms, with some of the newer rooms having en-suite toilets and showers. The décor and characteristics of each day room is different, mainly neutral in colour and each provided with fixtures, fittings, pictures and carpets. The gardens were maintained and accessible to service users. DS0000055177.V288137.R01.S.doc Version 5.1 Page 19 At this inspection eight double bedrooms in Lavender were inspected and found to be clean and tidy, warm and mostly maintained. Residents could bring some of their own personal furniture if they so wished. These rooms were checked and screening was still found inadequate due to inadequate curtain sizes. (Please refer to standard 10) Positively, by the end of the inspection, the owners had provided extra appropriate curtain cover. In one double room, two residents’ shared a chest of drawers, and the separate provision of drawers was required for each resident. One drawer handle was found broken and required replacement. Five residents spoken with confirmed that their rooms and the home were maintained in a clean and hygienic state. The lounge and dining room in Lavender were adequate, clean and tidy, but further improvements could be made. For example additional pictures could be added. However an unpleasant odour could be detected. This was discussed with the owners, who considered this to be a stale milk smell. The owners confirmed that carpet cleaners were contracted to clean these areas about twice a week. Further consideration must to be given to manage unpleasant odours, for example additional cleaning hours, alternative floor covering in the dining area, or different strategies for residents with special needs. The shower units in rooms 1 to 8 in Lavender were checked and could deliver hot water temperatures up to 59 degrees Celsius. This was excessive and could scald residents. The home must ensure that hot water temperatures are maintained at around 43 degrees Celsius, and ensure that appropriate safety mechanisms are in place to prevent excessive temperatures. These changes must be undertaken within a risk assessment framework. During the inspection the laundry was checked. The owners had lined the ceiling, painted the walls and removed unsightly pipes. The floor lining was quite worn, and required replacement to a semi permeable floor covering. The general cleaning and hygiene of the home was found to be adequate although the home was short of one domestic. Normally there are three home domestics and additional contract cleaners for carpet cleaning. One new domestic was commencing the following week. Some unpleasant odours were noticed in Lavender, which required neutralising. The home should review numbers of cleaning staff to ensure adequate cleaning staff available. DS0000055177.V288137.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Residents can expect the home would have adequate staff levels. People can expect that most staff will have received training and nursing staff would be able to support and meet residents nursing care needs. EVIDENCE: Concerns at the previous inspection about possible early rising of residents had been addressed by the home by a change in the rota. Where day staff previously commenced work at 8am, staff now arrived at 6.45am thus allowing day staff to begin assisting residents from 7am, to prepare for the day. The rota for Main, Jasmine and Lavender were checked and revealed the following minimum staff levels, for each area. Early Shift (6:45 to 1pm) 1 Registered Nurse and 3 Care staff. PM Shift (12.45 to 7pm) 1 Registered Nurse and 2 Care staff. Night shift. (6.45 to 7pm) 1 Registered Nurse and 5 Care Staff. DS0000055177.V288137.R01.S.doc Version 5.1 Page 21 Observation of Lavender unit revealed that the number of staff on duty during the morning shift was 1 Registered Nurse, and 3 care staff, and 1RN and 2 care staff in the afternoon. This provided a 1:4 ratio in Lavender during the morning and a 1:6 ratio in the pm, which was acceptable. At the previous inspection concerns were raised about the daily redeployment of staff from Lavender to other areas and it was revealed this no longer happens. Additional staff working at the home included the manager, an administrator, a handyman, the cook and two kitchen assistants. Two domestics were working at the home, with a third position about to be filled. During this inspection concerns were raised about some aspects of the cleanliness of the home, and it was recommended the owners consider employment of additional domestic staff. Residents and relative’s views of the staff group were received from direct feedback and discussion throughout the inspection and comments included the following. “Staff are marvellous” and, “staff work hard”, and “I feel they need more of them”, and “at times they are very short staffed”. Of the 7 relative comment cards received, 4 stated that more staff were needed, while 3 stated they were not. It was therefore recommended that the home review staffing levels to ensure that sufficient numbers are available to meet residents needs. Two staff member’s records were checked 1 Registered Nurse (RN) and 1 care staff revealed the home continued to undertake appropriate recruitment and employment checks, which included Criminal Bureau Checks (CRB), 2 references, an identity check and a medical declaration of health status. The home also checked the RN’s Professional Identification Number (PIN) to ensure they were currently registered with the Nursing and Midwifery Council (NMC). Records of the nurses’ professional background were checked and revealed they had considerable experience and appropriate skills to provide nursing care to elderly patients. Both staff members’ records revealed they had received good training relating to their various responsibilities. This included specialist training around dementia care, and basic training including moving and handling, food hygiene, fire, infection control and health and safety. Skills for living induction training was completed for all new staff, and NVQ in care qualifications were offered. It was a recommendation of this inspection that all staff working within the dementia unit receive further training in the care of people with special needs. (Please refer to standard 3, DS0000055177.V288137.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 People can expect the home to be well managed and would take account of resident’s views. They could not always expect the environment to be safely maintained. Staff had received appropriate health and safety training for the protection of residents. People could expect that residents’ personal money would be correctly handled. EVIDENCE: The manager, Mrs Angelina Silva, is a Registered Nurse (RN) who has had a career in care since 1981. This includes work as a carer and RN in a variety of hospital settings, a clinical trial nurse, a senior sister of a day hospital and a lecturer and NVQ assessor. More recently she has managed two nursing homes including Eastcotts. Further, Mrs Silva has a National Business Certificate in Business Studies, with honours, the Registered Managers Award Level 4, and is also qualified in teaching and assessing of nursing staff (ENB 998). DS0000055177.V288137.R01.S.doc Version 5.1 Page 23 Comments received from residents, relatives and staff, confirmed the home continued to operate in an open and transparent way, and continued to improve services for residents. Records revealed that residents, relatives and staff meetings were held on a regular basis so provided an opportunity for direct feedback to the management team. Minutes were kept to record the matters raised. Two of the owners were available at the home most days so were aware of any day-to-day problems. Quality assurance is undertaken by the home and includes annual surveys, residents’ placement reviews, or direct feedback from residents and relatives. Comments checked from feedback forms included “I was most impressed by the friendly welcome I received from you and your staff”, and “your staff member showed initiative, thoughtfulness and very good patient care” and “my impression of Eastcotts was a comfortable country guest house. We were welcomed with smiles and a cup of tea. Once I had met your staff I knew I had left them in good hands”. The quality assurance form was discussed with the management team, and the importance of gathering regular feedback from service users. Further, that the right questions were being asked in the survey. For example, the quality of the food at the home, or the responsiveness of staff etc. Suggestions were made around how the survey form might be further developed. Staff records checked confirmed that regular supervision for staff continued which allowed feedback to management, and the opportunity for staff to discuss work related issues. For example, training needs. The personal finance records for two residents were checked and were completed and recorded. The cash in hand balanced with the money records. This inspection confirmed the home continued to undertake routine and maintenance tasks to maintain a safe environment, although the shower units in rooms 1 to 8 in Lavender were checked and could deliver excessive hot water that could scald residents. (Please refer to standard 25) Staff records checked revealed that staff receive regular health and safety training including moving and handling, first aid, food hygiene, and infection control training. The COSHH (Control of Substances Hazardous to Health) cupboard in Lavender was checked and substances were secured. DS0000055177.V288137.R01.S.doc Version 5.1 Page 24 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 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 x x x 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 2 DS0000055177.V288137.R01.S.doc Version 5.1 Page 25 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 OP4 Regulation 12(1)(a) Timescale for action A strategy must be produced to 20/05/06 improve the well being of special needs residents. Review must include ensuring there are daily meaningful activities and opportunities for residents, as part of a lifestyle plan, with preferences and choices and weekly plans being identified. Staff must always maintain 10/05/06 residents’ dignity. Social assessment forms must 20/05/06 be further developed to record appropriate lifestyle background information of residents, for staff information. Challenging behaviour and 20/05/06 possible triggers must be identified and recorded, and a strategy provided as to how staff will manage these. Morning and afternoon tea must 10/05/06 be served with snack options. A separate chest of drawers 20/06/06 must be provided for each resident. Requirement 2. 3. OP10 OP12 12(4)(a) 12(1)(a) (2) 4. OP12 12,1,a 17,1,a Sch3,3,m 16(2)(i) 23(2)(m) 5. 6. OP15 OP19 DS0000055177.V288137.R01.S.doc Version 5.1 Page 26 7. OP19 23(2)(c) One drawer handle was found broken and required replacement. Shower hot water delivery temperatures must be maintained at around 43 Degrees Celsius. Unpleasant odours must be neutralised. The laundry floor cover must be replaced, and sealed. This is an outstanding requirement from the previous inspection. 20/06/06 8. OP25 23(4)(a) (c) 16(2)(k) 23(2)(b) 10/05/06 9. 10. OP26 OP26 10/05/06 20/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP12 OP19 OP27 OP27 OP30 OP33 Good Practice Recommendations The home should review the activities programme to ensure that it meets the needs of residents. More homely improvements to Lavender lounge should be considered. For example additional wall pictures, etc. The home should consider recruitment of additional cleaning staff. Staffing levels should be reviewed to ensure sufficient staff at all times. Special needs staff should receive additional training in the care of people with dementia. Quality assurance survey forms should be reviewed. DS0000055177.V288137.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 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. 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