Inspection on 21/06/05 for Eastcotts Nursing Home

This inspection was carried out on 21st June 2005.

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.

Other inspections for this house

Eastcotts Nursing Home 13/05/09

Eastcotts Nursing Home 18/04/06

Eastcotts Nursing Home 21/12/05

Eastcotts Nursing Home 03/11/04

Eastcotts Nursing Home 20/05/04

Eastcotts Nursing Home 11/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Eastcotts Nursing Home Calford Green Kedington Haverhill, Suffolk CB8 7UN Lead Inspector Kevin Dally Announced 21 June 2005 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 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. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Eastcotts Nursing Home Address Calford Green, Kedington, Haverhill, Suffolk, CB8 7UN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01440 703178 01440 763435 None Raveedha Care Ltd Application in progress Older People 59 Category(ies) of DE(E) Dementia over 65, (27) OP Old Age (59) registration, with number of places Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3 & 4 November 2004 Brief Description of the Service: Eastcotts is a Care Home with Nursing, 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 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. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 6 This announced inspection was undertaken over 2 days on the 21st and 23rd June 2005 between 9am to 4.30 pm on both days. This inspection found that of the 29 National Minimum Standards inspected, the home fully met 20 standards, with 9 being partially met. At the previous inspection undertaken on the 3rd and 4th of November 2004, a comprehensive audit had been undertaken of the service by the Commission. This was in response to a number of concerns that had been raised by relatives and staff at that time. Following these visits, a total of 32 requirements were made, and the home was asked to respond in writing to the Commission, to confirm what action they had taken to address this situation. From the response received, it was evident that the new owners, Raveedha Care Limited, were committed to addressing these concerns. This included the appointment of a new manager, Mrs Angelina Silva, Registered Nurse, and who has now taken up this post. Mrs Silva was present for both days of the inspection, and the owners were available at various times including the feedback session on the last day. Part of the inspection process was to check the progress that had been made since the last inspection in November 2004, in which 32 requirements had been identified. Very positively, this inspection found that of the 32 previous requirements made, 29 had been resolved by the home. Three key requirements which were still being addressed were as follows:- The provision of weighing scales, ensuring consistent levels of staff on each shift, and ensuring that the cleanness of the home was maintained, especially at weekends. These issues are fully discussed under the summary heading, “What the home could do better”. During the inspection process the management structure of the home was examined, and which revealed that the owners, the new manager, and staff were working together as a team to resolve the outstanding matters. This inspection demonstrated that positive and significant progress towards the improvement in the delivery of the care service, and the environment was being made. New staff had been recruited, staff meetings were now regularly scheduled, the supervision process was under way, and staff training was now a priority. The management team operated a quality assurance feedback system, in order to assess residents and relative’s views on their progress to date. The manager stated that she regularly visited residents in their rooms, and that she was also available to speak with relatives about any concerns they had. This was confirmed by a group of residents who stated, “She comes in [to the units] every day”. Specialised dementia training, including dementia mapping, had now commenced for 8 staff. The manager Mrs Silva, and the deputy manager, Mrs Flordelis have recently qualified as dementia care mappers with Bradford University. This was in order that the home could ensure that the staff group were properly trained and able to meet the needs of this specialised resident group. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 7 Nursing staff were observed to act in a professional, caring and responsive manner towards residents. A group of 5 registered nurses, including 1 night nurse were spoken with as a group. They agreed that the quality of care currently being offered by the home was good. This had been made possible with support from the new manager and the owners, and by the purchase of a number of important nursing equipment items, for example 9 hospital beds and 6 ripple mattresses. From residents spoken with, observation of care, and from records examined, found good evidence that holistic nursing care practises were in operation at the home. Resident’s views of the home were received from feedback via resident’s cards, by holding a residents meeting, and by speaking with individual residents in their room. Some comments received from residents included, “I am happy at the home”, or “staff do meet my needs, definitely”, or “the staff are wonderful. I couldn’t wish for better”. Alternatively one resident stated, “the food was good, I enjoy breakfast but dinners are not so good…Teas are unimaginative and are always sandwiches, and never cakes”. Additional feedback received from 14 completed resident’s cards included the following views. • 13 of 14 residents stated that they felt well cared at the home. One stated sometimes but did not clarify why. • 12 of 14 residents stated that they felt staff treated them well whilst two stated sometimes, but did not clarify why. • 14 of 14 residents stated that they felt safe at the home, and 13 of 14 residents stated that they knew who they could talk with, if unhappy. Relatives views of the home were gained from the 29 returned relative/visitors cards received and which included the following views. • • 26 relatives stated that they were satisfied with the level of service provided, 2 of which had additional comments stating that they were ‘very satisfied’. 3 relatives stated that they were not satisfied with the level of service provided. Comments made to support this, included concerns about lack of staffing and the cleanliness of the home. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 8 A sample of some relative’s positive comments of the home included, “I am extremely pleased with the care my [relative] receives from all the staff at Eastcotts and since new owners have taken over it is even better.”. Or, “ I cannot fault the kindness and care shown to [my relative] Their every need and comfort was more than accommodated. The staff were kind, loving, considerate and sympathetic”. Or ,“I think the staff do a wonderful job and my friend is looked after very well”. Alternatively some relatives concerns were raised as follows. “Care staff are always happy, pleasant, willing, and helpful but they struggle as only basic levels of staff are in place. Cleaners are helpful and willing but struggle to cover their areas sufficiently, and there are no cleaning staff on duty at weekends…”. Or “There never seems to be enough staff on duty…. overall the staff are very caring but there does always seem to be a shortage of staff.” Or, “The cleaning of rooms is well below an acceptable standard”. This inspection concluded that positive progress was being made by the home in order to address the previous concerns that had been raised around the care provided, and the quality of the home environment. It was also concluded that as a priority, in order to continue positive progress and effect change, optimum staffing levels must be maintained on all shifts. Further, that the cleanliness of the home must be improved, particularly on weekends; therefore more cleaning staff would need to be recruited, to ensure that this is fully addressed. What the service does well: What has improved since the last inspection? There have been many significant improvements since the last inspection, the majority of improvements, which can be attributed to the work of the owners, the manager and the staff group. These are summarised under the following headings. 1. The Care practice • Care plans in place which reflected the resident’s needs • Needs assessments which reflected residents assessed needs • Moving and handling assessments and specialised assessments • Medication policy has been updated • Improvements in medication handling, recording and storage • Improved training for staff including core and specialised training • More input from clinician specialists etc tissue viability nurses 2. The service Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 9 • • • • • • • • • • • • Statement of Purpose and Service User Guide, which reflected the service offered. A Social/leisure programme now in place and overseen by an appointed activities officer. More leisure opportunities and outings for residents Relatives and residents meetings, so improved feedback More staff recruited and levels of staff attempting to be increased A registered nurse to take charge of Lavender Unit Improvements in the organisation of meals to residents. Residents clothing better laundered Laundry staff now appointed and systems in place Improvement in recruitment procedures Quality assurance programme in operation and quality assurance officer appointed English classes for overseas staff 3. The environment • Pathways and garden benches repaired • Rolling cyclical maintenance programme established • Hoists maintained • Windows were cleaned • Water temperatures checked regularly to ensure safety • Redecorations, carpet cleaning and new equipment What they could do better: Part of the inspection process was to check the progress that had been made since the last inspection in November 2004, and very positively, found that of the 32 previous requirements made 29 had been resolved by the home. Three requirements that still required addressing were as follows:• • Weighing scales, which must be provided in order that the home can appropriately monitor any resident’s weight. Staffing levels. Whilst the home could positively demonstrate that every effort had been made to recruit new staff (eight new employees had been recruited), restructured the staff team, and increased staff numbers, there were still staff shortages, especially during the holiday period, or when staff were on sick leave. These concerns were confirmed by residents, relatives and staff feedback, and the home was required to continue to actively address this matter. Cleaning. Whilst the home could demonstrate that improvements had been made to the cleanliness of the home, it was identified that there were still shortfalls in the overall cleanliness of the home, especially at weekends, when no cleaning staff were on duty. More cleaning staff must be provided which the home was required to address. • Today’s inspection required that the home also address the following matters. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 10 • • • • • • All moving and handling risk assessments must be periodically reviewed to ensure that they are current. Jasmine lounge must be repainted Door frames in main, upstairs require repair and re-varnishing Windows must be regularly cleaned An oxygen cyclinder must be fastened to the wall All staff must receive moving and handling training, fire training, food hygiene, and abuse training 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. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 11 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 Standards Statutory Requirements Identified During the Inspection Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 12 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 standard(s) 1,2,3,4,5,6 People can expect that they will receive informative and helpful information about the service provided, and will have their care needs assessed. EVIDENCE: Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 13 In response to the previous inspection, which had outlined a number of shortfalls in the home’s Statement of Purpose and Service User Guide, these documents had been completely rewritten. These now described for residents the various services that could be offered, and outlined how to make a complaint. The Service User Guide also included a copy of the home’s Terms and Conditions document, which would be offered to residents after admission to the Home. This was presented in an informative and easy to read style, and included all the information, as required by the regulations. Prospective residents and/or their relatives would be encouraged to visit the home, before accepting a placement, and the manager would undertake a nursing assessment of a residents care needs. This allowed the home to assess the potential service users needs, whether the home could adequately meet these needs, and if a place was available. Four residents records were checked, and detailed “needs assessments”, referred to by the home as “activities of daily living lifestyles assessments”, had been undertaken. These were found to be detailed and included appropriate nursing assessments, which related to each service user, and the care that they required. Additional assessments included nutritional risk screening, and general risk assessments. 7 residents spoken with and 13 of 14 questionnaires received from residents confirmed that the home met their personal care needs. 1 residents questionnaire stated that the home met their care needs sometimes but did not clarify further. 26 relatives questionnaires received stated that they were satisfied with the level of service provided, 2 of which had additional comments stating that they were ‘very satisfied’. 3 relatives questionnaire stated that they were not satisfied with the level of service provided. Comments made to support this, included concerns about lack of staffing and the cleanliness of the home. The manager stated that the home no longer accepted residents for intermediate care, therefore this was not assessed. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 14 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 standard(s) 7,8,9,10 People could expect to receive professionally planned care and have their nursing healthcare needs met by nursing staff, and could expect that regular reviews would be maintained of their care assessments. People could expect that they will be treated with respect and dignity by staff. EVIDENCE: Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 15 4 residents care plans were checked and tracked. Care records included an “activities of daily living, lifestyles assessment”, which assessed 13 areas of personal need, in summary form. Care plans would be produced from this assessment. The 4 care plans checked included very detailed assessment of each resident’s care needs, and how care should be delivered. These were current and daily progress records had been maintained. In addition to this, professional nursing assessments including personal, environmental, and moving and handling risk assessments, nutritional risk assessments, falls risk assessments, and weight charts were found to be in operation. These had been mostly reviewed on a monthly basis. Some risk assessments, including moving and handling assessments were found not have been reviewed within the last year and which were required to be updated. From records examined, residents and staff spoken with, it was confirmed that Eastcotts promoted a good standard of nursing care for its residents. This may however be affected by available staffing levels, (refer to standard 27) and when short staffed, personal care and time available to meet the health care needs of some of the residents, could be limited or hurried. One resident stated that they had once missed their bath when staff had been short handed. However the resident confirmed that they not gone without daily care and washes. Positively, a registered nurse had been recruited for the Lavender unit, which until recently had had no registered nurse cover during the day period. This meant that the unit could now be properly organised and managed. The manager confirmed that the home was supported nursing and care staff to attend more training courses, in order for staff to be updated with the latest trends in care. The accident log was examined and found to contain 40 recorded accidents /falls within the last 6 month period. During this period 9 residents had been taken to hospital for further investigations. Falls monitoring was not checked on this occasion. The manager stated that 3 residents currently had been identified as having pressure ulcers. The records of 1 of these residents was examined and tracked. Nursing staff had appropriately undertaken a “Waterlow” Pressure Area Assessment, which identified the resident’s vulnerability to pressure sores, as “35 or at very high risk”. The care plan included individual assessment details of the pressure area; a professional wound care assessment form, a body chart, a weight chart, and a photographic record. Assessment in addition to the pressure area assessment charts included nutritional assessments, risk of trapping, and full care assessments. The resident had been nursed on one of the homes new hospital beds and ripple mattresses. Daily fluids and a specialised diet had been encouraged. The records checked showed that the pressure ulcer, which had originally been a grade 5 ulcer, had now sufficiently healed and was considered a grade 3. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 16 The records for two residents living within the dementia unit were checked and the level of record keeping was found to be very good. Assessments appropriate to the needs of these residents had been implemented and a professional approach had been maintained around their nursing care. These had been regularly updated. The manager stated that 8 staff were now attending a dementia course at Cambridge College with the intension that person centred care approach would be professional, current, and consistent. Further, dementia care mapping had taken place in Lavender and Main units and will be updated at regular intervals. Time spent in this unit found it to be a very calm and relaxed area, with staff busy at their work without unduly disturbing residents. Staff were seen to be polite and kind with residents, offered encouragement and appropriate support. An agency staff member on duty in the unit commented that they liked working at the unit and had been several times before. Further that staff were, “very friendly and supportive”. 7 residents spoken with and 13 of 14 questionnaires received from residents confirmed that the home met their personal care needs. 1 resident’s questionnaire stated that the home met their care needs sometimes but did not clarify this point further. Nursing staff were observed to act in a professional, caring and responsive manner towards residents. A group of 5 registered nurses, including 1 night nurse were spoken with as a group. They agreed that the quality of care currently being offered by the home was good. This had been made possible with support from the new manager and the owners, and by the purchase of a number of important nursing equipment items, for example 9 hospital beds and 6 ripple mattresses. From residents spoken with, observation of care, and from records examined, found good evidence that holistic nursing care practises were in operation at the home. After discussion with the owners it was agreed that weighing scales must be purchased within the next three months to ensure that all residents can be weighed where this was considered necessary. Medication records were briefly checked but will be examined in more detail at a later inspection. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 17 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 standard(s) 12,13,14,15 With staff support, residents were enabled to be involved in meaningful recreational activities, exercise choice, and make decisions about the lifestyle that they wished to pursue. Contact with relatives, friends, and family was encouraged, and there were also some limited opportunities to go into the community. Residents can therefore expect a balanced and interesting lifestyle at the home. Residents were provided with a good diet, however some concerns remained about the teatime menu. EVIDENCE: Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 18 At the previous inspection concerns had been raised about the home being task orientated, and not based on residents individual needs and preferences. 7 residents, staff and the activities coordinator spoken with confirmed that the home was making every effort to provide a revitalised programme of activities for residents. Resident’s questionnaires asked if the home provided suitable activities. Responses received stated that 6 agreed, 5 stated sometimes and 1 no. 26 questionnaires received from the relatives did not raise any areas for concern about residents activities. There was therefore good evidence of improvement. An activities co-ordinator was now employed to encourage and promote personal pursuits and leisure opportunities. Her rota included Monday and Thursday, 10:30am to 2:30pm, and three afternoons from 1:30pm to 5:30pm. This allowed for the planning of activities, and she confirmed that she was never involved with care, so was quite focused on the programme for residents. The programme varied considerably and included • • • Individual programmes for residents, for example personal crafts Group activities for residents, for example live entertainment A Home activity for staff and residents for example a summer fate was planned. Residents could join any of these activities, should they so wish to. A group of residents confirmed that they had access to interesting and enjoyable activities and described a number of their favourite sessions. One resident confirmed that they preferred their own company and did not enjoy group entertainment. This wish was respected. The activities list was available with upcoming events. Residents were seen enjoying various activities during the afternoon, which was being run by the activities co-ordinator and included a walk for two residents. Communion could be arranged where required. Residents confirmed that they could receive visits from friends or family and that there were no restrictions placed on visiting times. Discussion with a group of residents confirmed that they were able to rise and settle when they so chose. Residents stated, “no one tells you when to rise or go to bed”. Some preferred an early start whilst others preferred a sleep in. Throughout the visit residents were found to congregate in the lounges or would remain within their room. One resident stated that they had requested to remain in their room. Discussions with staff identified that current workloads and staffing levels did not always enable staff to spend sufficient time with residents, particularly on weekends. However, it was noted on some units, that time was allocated but would depend of staffing levels. This raised the importance of consistent numbers of staff to ensure adequate time can be spent with residents. (Refer to standard 27.). Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 19 At the previous inspection concerns had been raised about the home’s meals, especially the quality of the teatime meal, and the ‘haphazard fashion’ in which the lunchtime meal had been served to residents. This was discussed with the manager who stated that the meal delivery system had been completely reorganised. As Jasmine was the greatest distance from the kitchen, meals were now served and placed in the hot plate, which was then transported to the unit’s kitchen, ready for serving hot to residents. The kitchen staff would then serve up the remaining residents meals, which were then plated and served directly to residents. The home’s three week rolling menu plan was checked and this was found to provide a balanced, wholesome and varied menu with two hot meal choices at lunch time. 7 residents were spoken with about the meals, and who confirmed that these were very good, there was a choice, and that these were served in sufficient quantities. Further, they stated that they we happy with the evening meals and that there was a reasonable variety of food. Examples given were sandwiches, cheese and crackers, selection of yoghurts and cake. The midday meal observed was found to be wholesome, served hot, smelt and looked appetising. Tables had been set with table cloths, napkins, condiments, flowers, and a basket of fruit was visible and within reach of residents. Residents requiring blended meals had had the various components separated. The main meal on the first day was sausages and gravy, or omelette, tomatoes, beans and mashed potato. One resident confirmed that the meal was “nice and tasty”. Observation of the meal time in all units evidenced a very calm and relaxed environment, with sufficient numbers of staff to assist the more disabled residents. The lunch was unhurried and staff and residents could be heard talking about the day’s events. Resident’s questionnaires asked if they liked the food provided by the home. Responses received from residents stated that 9 confirmed they did, 3 stated sometimes and 1 not. The 26 relatives questionnaires received raised no areas of concern about the food. Whilst the kitchen was not checked on this occasion, an environmental report was examined dated the 6th April 2005, which identified a number of requirements that needed attention. The manager was able to confirm that these matters had now been attended to, including that kitchen staff would attend relevant courses. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 20 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 standard(s) 16,18 The home had a complaint system in operation, and abuse procedures were appropriately in place. Residents could expect to be safe, and that any complaints would be taken seriously and acted upon. EVIDENCE: Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 21 In the previous 12 month period the home had received 4 complaints, which had been investigated. The complainants had been responded to and a record maintained about the outcome. However, from the records it was not possible to determine if each complainant had been satisfied with the final outcome of any investigation, from the home. It was therefore recommended that the home should consider the use of a complaints satisfaction letter to confirm this with any complainant. Since April 2005, the Commission had received two complaints with respect to the home, both of which are still pending an outcome. The complaints procedure was provided within the Statement of Purpose and was adequate and informative. This included the name and address of the Commission for Social Care Inspection, which was required, should a service user wish to contact the CSCI directly. The policy also stated that a complaint would be investigated within 28 days. The Home had suitable Adult Protection policies and procedures in place and were aware of their obligation in the reporting of any allegations of abuse to Social Services, the police and/or 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 CRB disclosures, references and identity checks for all staff. A sample of staff records checked found these records in place. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 22 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 standard(s) 19, 20,22,23,24,25,26 Whilst people could expect a reasonably clean home, they may not be able to expect this at all times, especially weekends. This would be due to lack of cleaning staff. The environment would be maintained and had adequate communal provision. The bedroom sizes and facilities were adequate, with sufficient toilets and hand washing facilities. People could mostly expect a safe environment. EVIDENCE: Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 23 Eastcotts Nursing Home is a privately owned care home allowing for up to 59 residents to be accommodated, in the categories of dementia and older persons. 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 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, and is neutral in colour and was provided with fixtures, fittings, pictures and carpets. The gardens were maintained, and accessible to service users. At this inspection three residents’ rooms were visited and were found to be clean and tidy, warm and properly maintained. Residents were enabled to bring some of their own personal furniture, if they so wished. One resident stated that, “My room is kept clean all the time and the ensuite is cleaned every day”. A domestic spoken with confirmed that there were usually 3 cleaning staff on each day, Monday to Friday, one per unit, and that they worked very hard to maintain the Home’s cleaning standards. There were no cleaners on duty at the weekend. A carpet cleaning machine had now been purchased, and this was routinely used to clean rooms and corridors. Over the two day inspection, odours could be detected at various times. However these were attended to during the course of the duty. From feedback received from residents, relatives and staff it was confirmed that whilst the home could demonstrate that some improvements had been made to the cleanliness of the home, it was identified that there were still significant shortfalls in the number of cleaning staff available. Whilst the 3 existing staff did their best to maintain a very large building, the overall cleanliness of the home, especially at weekends, could be improved. One relative commented that, “The cleaning of rooms is well below an acceptable standard”. This concern was discussed with the management who agreed that more staff would be employed, particularly to cover the weekend periods, and so address these concerns. The Home was found to be accessible to residents. The owners had made significant purchases of equipment and plant to ensure that staff could meet residents assessed needs. These purchases included aids, 9 medical beds, 6 ripple mattresses, adaptations, bedsides and bumpers, moving and handling equipment, 3 vacuum cleaners, a carpet shampoo machine, new bed linen for 59 beds, quilt, covers and pillow cases. Importantly, the equipment purchased was considered vital to provide a quality care service, and meet residents identified needs. The management provided a copy of the homes cyclical maintenance programme, which would ensure that routine maintenance would be scheduled through out the year. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 24 At the previous inspection, a significant number of maintenance matters were found requiring attention, and these matters had now been resolved. A number of windows were observed to be in need of cleaning, the Jasmine lounge required repainting, and a number of damaged door frames in Main required re-varnishing. At this inspection a number of resident’s hand washbasin’s hot water tap temperatures were checked and these remained at an acceptable level. A large oxygen bottle located within one resident’s room was required to be immediately fastened securely to the wall to avoid injury to the resident Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 25 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Residents could not expect that the Home would always have consistent levels of staff, especially during holiday periods, weekends, at night, and when staff were sick. People could expect that most staff have had some training, and that this will improve as the training plan continues. People could expect that trained nursing staff would be able to support and meet their nursing care needs. EVIDENCE: Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 26 The previous inspection identified serious shortfalls around the number of staff available to provide care and support services to residents. The new manager began the recruitment of new staff, and since January has employed 8 staff members. Some staff had also left in the interim period but recruitment continues. Staff recruitment and retention was seen as essential to the redevelopment and improvement of the home. Whilst the home can positively demonstrate that every effort has been made to recruit more staff, restructure the staff team, and increased staff numbers, there still remain some staff shortages, especially during the holiday period, or when staff were on sick leave. This situation continues to leave the home vulnerable to shortages on nights and weekends, which then affects other areas of the home. These concerns were fully confirmed by residents, relatives and staff feedback. In discussion with the management team it was confirmed that the levels of care staff numbers that must be maintained were as follows. Agreed minimum staffing levels for each of the 3 units, Main, Jasmine and Lavender, AM Shift (7:45 to 2pm) 1 Registered Nurse 3 Care staff PM Shift (1.45 to 8pm) 1 Registered Nurse 2 Care staff Agreed minimum staffing levels for the whole home on night shift Night Shift 1 Registered Nurse 4 Care Staff The staff rota was viewed and this demonstrated that staff numbers fluctuated and were not yet consistent. The home did make every effort to employ agency staff when they were available. It was a requirement of this inspection that the home ensure that appropriate numbers of care staff are constantly maintained in order to meet the needs of the residents. More cleaning staff were required, and which is fully discussed under standard 26. Since the previous inspection the manager has re-established the staff training and development programme for all staff, to ensure that staff are able to meet the needs of the resident group. Induction training for new staff now includes 5 days TOPPS training including moving and handling training, abuse and food hygiene. Core training for staff that is planned throughout the year and will also include moving and handling, food hygiene, first aid, fire training and infection control. Specific training planned will include record keeping, risk Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 27 assessments, dementia training and an English course for overseas staff where English is a second language. Staff management records evidenced that most staff had now received moving and handling training, abuse training and fire safety training. Further that they were progressing with food hygiene, first aid, and dementia training. Nursing staff were attending courses relevant to their professional nursing developmental needs. Three care staff had gained an NVQ 3 in care whilst 5 had gained their NVQ 2 in care. This inspection evidenced that some staff had yet to moving and handling training, fire training, food hygiene, and abuse training, and was now required. Resident’s views of the staff group were received from feedback via resident’s cards, by holding a residents meeting, and by speaking with individual residents in their room. Some comments received from residents included, “I am happy at the home”, or “staff do meet my needs, definitely”, or “the staff are wonderful. I couldn’t wish for better”. Additional feedback received from 14 completed resident’s cards included the following views. • 13 of 14 residents stated that they felt well cared at the home. One stated sometimes but did not clarify why. • 12 of 14 residents stated that they felt staff treated them well whilst two stated sometimes, but did not clarify why. • 14 of 14 residents stated that they felt safe at the home, and 13 of 14 residents stated that they knew who they could talk with, if unhappy. Three staff member’s records checked evidenced that training had been received. Further that the Home had undertaken appropriate recruitment and employment checks, which included Criminal Bureau Checks (CRB), references, identity checks and a medical declaration of health status. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 28 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,38 People could expect the Home to be well managed and would take account of resident’s views. They could mostly expect the environment to be safely maintained. Staff had received appropriate health and safety training for the protection of residents. EVIDENCE: The new manager, Mrs Angelina Silva, is a Registered Nurse who has had a career in care since 1981. This includes work as a carer, registered nurse in a variety of hospital settings, a clinical trial nurse, a senior sister of a day hospital, and 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). Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 29 From comments received from residents, relatives and staff, confirmed that the Home was making every attempt to be open and transparent, and be responsive to the concerns of residents or relatives. A residents and relatives meeting had been called twice by the new manager since January, and a third was due shortly. Minutes checked evidenced good consultation with residents and relatives, and a willingness by the manager to address any of their concerns. During the inspection process the management structure of the home was examined, and which revealed that the owners, the new manager, and staff were working together as a team to resolve the outstanding matters of concern. This inspection demonstrated that positive and significant progress towards the improvement in the delivery of the care service, and the environment was being made. New staff had been recruited, staff meetings were now regularly scheduled, the supervision process was under way, and staff training was a priority. The management team operated a quality assurance feedback system, in order to assess residents and relative’s views on their progress to date. The manager stated that she regularly visited residents in their rooms, and that she was also available to speak with relatives about any concerns they had. This was confirmed by a group of residents who stated, “She comes in [to the units] every day”. Specialised dementia training, including dementia mapping which had commenced for 8 staff. This was in order that the home could ensure that the staff group were properly trained and able to meet the needs of this specialised resident group. Staff spoken with, and records examined, confirmed that staff were receiving health and safety training including moving and handling, fire training, first aid, infection control and food hygiene. This inspection confirmed that the Home undertake routine and maintenance tasks to maintain a safe environment, although an oxygen cylinder was required to be secured to the wall. (Refer to standard 26) Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 x 3 3 2 2 2 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x x x 2 Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 31 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 13(5)(6) Requirement Timescale for action 9.08.05 2. 3. 4. 5. 6. 7. 8. 8 19 19 19 24 29 29 9. 29 Moving and handling risk assessments must be periodically reviewed to ensure that they are current 12(1b), Weighing scales must be 13(6) purchased to ensure that any resident can be weighed 23(2d) Jasmine lounge must be repainted 23(2b) Door frames in main, upstairs require repair and re-varnishing 23(2d) Windows must be regularly cleaned 23(4)(a,d) An oxygen cyclinder must be fastened to the wall 18(1)(a) More cleaning staff must be recruited, especially on the weekends. 18(1)(a) Care staff numbers must be constantly maintained to ensure that residents needs are able to be fully met. 13(6)18(1 All staff must receive moving c)(i)23(4d and handling training, fire ) training, food hygiene, and abuse training 09.10.05 09.10.05 09.10.05 09.08.05 20/06/05 09.08.05 09.08.05 09.09.05 Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 32 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. Refer to Standard 16 Good Practice Recommendations A complaints satisfaction letter should be sent to any complainant to determine their satisfaction with the outcome of any complaint. Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 Page 33 Commission for Social Care Inspection 5th Floor, St Vincent House Cutler Street IPSWICH 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. Extracts may not be used or reproduced without the express permission of CSCI Eastcotts Nursing Home v218500 i54-i04 s55177 eastcotts v218500 050620 stage 4.doc Version 1.30 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. 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