Inspection on 13/03/08 for Eastfield House

This inspection was carried out on 13th March 2008.

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

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

Other inspections for this house

Eastfield House 17/08/06

Eastfield House 28/02/06

Eastfield House 21/10/05

Eastfield House 08/12/04

Eastfield House 12/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Eastfield House Eastfield Lane Whitchurch on Thames Oxfordshire RG8 7EJ Lead Inspector Delia Styles Unannounced Inspection 13th March 2008 11:00 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 Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eastfield House Address Eastfield Lane Whitchurch on Thames Oxfordshire RG8 7EJ 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) 01189 842586 01189 842179 eastfieldhouse@majesticare.co.uk Eastfield House Limited Mrs Mary Bayliss Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability (2) of places Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of persons that may be accommodated at any one time must not exceed 27 The PD category refers to one named resident under the age of 65. Date of last inspection 17th August 2006 Brief Description of the Service: Eastfield House is situated in the village of Whitchurch-on-Thames. The home is registered to provide personal care for 27 male and female service users aged 65 years and over. District nurses visit the home to provide nursing care. Communal space comprising two lounges and a separate dining room is located on the ground floor. Bedroom accommodation is situated on the ground and first floors and there are also five flats for independent living in the grounds of the home. Room sizes and amenities are listed in the home’s Statement of Purpose and Service User Guide. A good range of activities is provided and regular trips to places of interest are arranged. The gardens surrounding the home are well maintained and provide extremely pleasant outdoor amenities. The current fees for this home range from £646:87 to £785:67 per week. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection of the service was an unannounced ‘Key Inspection’ during which we assessed a number of the standards considered most important (‘key’) by the Commission out of the 38 standards set by the government for care homes for older people. The inspection visit took place over 6 hours and was a thorough look at how well the service is doing. We took into account detailed information provided by the homes manager in the form of the Annual Quality Assurance Assessment (AQAA) - a self-assessment and summary of services questionnaire that all registered homes and agencies must submit to the Commission each year; and any information that the Commission had received about Eastfield House since the last inspection. A tour of the building, and inspection of a sample of the records and documents about the care of the residents and the recruitment and training of staff, were part of the inspection. Talking with a number of residents and staff gave us information about the home and peoples’ opinions about what it is like to live here. Some of the Commission’s comment cards (surveys) were left at the home for residents, staff, relatives, and visiting health and social care workers to have an opportunity to have their say about the home. Completed surveys from 7 residents and 6 relatives/friends/advocates were received and taken into account when writing this report. At the end of the inspection, feedback about our findings was shared with the house manager and a senior manager from Majesticare who was also visiting the home on that day (the registered manager, Mary Bayliss, was on a day off). We would like to thank all the residents and staff for their welcome and the time taken to help us with the inspection process and to the residents and relatives who completed surveys. What the service does well: This home provides a comfortable, clean and homely environment for the people who live here. The gardens and grounds are well kept and offer an attractive outdoor space for residents to enjoy. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 6 People especially commented on the friendliness and ‘family atmosphere’ For example ‘[The staff] make the residents feel at home, part of a family’ ‘Visiting is at any time and our family always feel very welcome whenever we go’ ‘[Eastfield House is a] happy and comfortable home’. ‘Eastfield House is a small care home and extremely friendly. Because of its size it’s easy to get to know everyone and it seems like one big happy family’. Staff are kind, patient and attentive to residents: ‘the staff from the Manager down, all are very caring and attentive’. The food and menu choices are good and provide varied and nutritious meals that meet peoples’ needs. The Activities Coordinator makes sure that there is a good range of activities on offer for residents to be involved in as they wish. What has improved since the last inspection? What they could do better: Some staff use blood glucose meters to take ‘finger prick’ blood tests to measure the blood sugar levels of residents with diabetes, without having training in the correct use of the equipment. There is a risk that the test results may not be accurate and that the visiting doctor may alter peoples’ treatment on the basis of the results. All staff who use blood glucose meters must be trained in their use and there should be records to show that the staff are assessed as competent to do so. The system used to record peoples’ care – care plans – has been developed and improved since the last inspection. Though the care plans broadly describe the care and support needs of each resident, they should be further improved by making sure that the resident is involved in the drawing up of their care plan and any changes that are made. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 7 The home has been without a maintenance person (based at the home) for 3 months and some of the routine maintenance and safety checks have been undertaken by maintenance staff from another local home owned by Majesticare. The records of maintenance seen in the home on the day of the inspection were not up to date, so there was not evidence that repair work or safety checks had been undertaken (although managers confirmed that the work had been done and copies of routine maintenance records were sent to us later). It is important that accurate records are kept to show that any requests for repairs are followed up promptly and that everyone is confident that routine health and safety checks are taking place to protect the wellbeing of residents and staff living here, and visitors. We noticed that one person’s bedroom door was wedged open. Doors should not be held open because in the event of a fire they would not act as a barrier to the spread of smoke and flames. The fire officer must be consulted about fire protection measures in the home and fire safety guidance must be followed to minimise the risks to residents, staff and visitors. Because staff said they would do this as soon as possible, this has not been listed as a requirement on this occasion. Though it is good for people living here to have a regular staff team whom they know, and agency staff are not used, there is a potential for the permanent staff to work a lot of extra hours to cover for others’ absence. The home should review the number of staff employed to make sure that all aspects of care of the residents are met and to allow for staff training and cover for sickness and holidays. The homes AQAA gives only a brief picture of the current situation in the home with little supporting evidence or detail about how they have improved and intend to improve in the next year. The AQAA should be completed as fully as possible giving clear relevant information so that we know about the changes the home has made and showing that they are aware of where they still need to make improvements. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is good. Prospective residents’ care needs are assessed before they come into the home, so that they can be confident that the home will suit them and provide the level of care they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector looked at the pre-admission assessments for two recently admitted residents, and for one resident whose needs have changed substantially since their initial admission. The manager visits prospective residents in their homes or in hospital (if they have needed hospital treatment) to assess whether the home can meet their care needs. Information from other health and social care professionals is also taken into account. In the case of one assessment seen, it was evident that the individual had increasing physical care needs. The manager confirmed that it had been Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 10 agreed that the home can no longer provide the level of care and support needed and an alternative placement for this individual was being found with the help of a care manager. A relative who asked to speak to us said that they felt it would be good if the home’s staff asked about peoples’ life history and family networks and former social support, as part of their assessment when they came to live at the home so that staff would have better information about peoples’ interests and abilities. This would help new residents to settle in and staff to get to know them more quickly. According to information received after the inspection, life histories are undertaken by the activities organiser and carers and were available but not inspected. The comment cards received from residents showed that they felt they had had enough information about the home before admission to make an informed decision that it was likely to meet their expectations and care needs. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Overall the medical and personal care needs of the people who live here are satisfactorily met. Residents’ written plans of care do not consistently record their assessed care needs and preferences and the extent to which staff interventions have met their needs. The system for the management and administration of medicines is satisfactory though certain aspects of record keeping should be improved. Staff must have training and assessment of their competence if they use specialist equipment (blood glucose meters) in order that residents and visiting medical and nursing staff can be confident that test results give accurate information about the residents’ condition and can plan their medical and any nursing care accordingly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of three residents’ care records was examined. Each person has a set of care plans, risk assessments and a daily record of the care they have received. There was evidence that staff review the care plans at least monthly, but they do not consistently evaluate whether the care given has met the resident’s care needs or alter the care plans when there are changes in the Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 12 person’s care needs. For example, one person who was assessed as being ‘at risk’ of poor nutrition, had apparently lost 3 Kg in weight in a four week period. There was no indication that that staff had noted this or checked that weight recorded was accurate. Residents’ own opinions about their care needs are not included in the care plans; for example, one resident told us about particular difficulties they experience with walking but this was not reflected in their care records. The care plans and evaluation should be further developed to include more detail about what actions staff need to take to meet each residents care and support needs, and to what extent their actions have met the residents’ expectations. Daily record entries written by care staff were not related to the listed care needs/plans and were repetitive indicating a lack of understanding by staff about the purpose of the care plans and evaluation of peoples’ care. By contrast, the social care plans and evaluation of people’s recreational and social time were very good. One of the three care records seen had an assessment of the person’s mental health and wellbeing. This assessment tool is a very useful way for staff to observe and assess peoples’ mood and emotional state, and is especially useful for residents who are not able to communicate very easily and at risk of being withdrawn and isolated. We note that the home operates a ‘key worker’ system whereby each resident has one member of staff with particular responsibility for monitoring their care and communicating with colleagues and other staff about any changes. In practice, care staff are allocated to different residents on a daily basis and may rely more on verbal handover reports than referring to the written care plans for up to date information. However, comments from the surveys we received from residents and that were made during the inspection showed that the majority feel that they ‘always’ receive the care and support they need from the homes’ staff, and ‘always’ receive good medical support (from GPs and local NHS clinics). They all said that staff listen to them and act on what they say. Written comments included: ‘My [relative] has superb care and her health has improved greatly since she has lived [at Eastfield House]’. ‘[The home is] very good at ensuring residents needs, personal and otherwise are catered for’ A sample of the medication administration records (MAR) were seen and were complete in terms of the date and time medicines are given to residents. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 13 Residents sign a self-medication form to indicate that they accept the responsibility for managing their own medication if they wish to, and have been assessed by the doctor as able to self-medicate. One individual who is self-medicating had not been reassessed since 2006. The deputy manager said that they would check that this person wanted to, and was capable of continuing to self-medicate. Another person has a medication that they take according to their need of the tablets during the day, so are given enough tablets in the morning to last the day. There should be a record kept of the number of doses actually taken by the resident and how any unused/unwanted tablets are accounted for. A risk assessment should be made and updated to ensure that the medication is not accessible to other residents, visitors or unauthorised people. Several residents are prescribed skin creams for relief of muscle or joint pain or skin soreness. Usually care staff when assisting residents with their personal care, apply these creams or lotions. There was no reference on the residents’ MAR charts to show that the prescribed products had been applied as directed and/or that all care staff are aware of the specific instructions about how to use them. It is important that where care staff apply creams and lotions that they know how to do this and to recognise and report any adverse reactions that the resident may have to their treatment to the doctor. There was evidence that the doctor reviews peoples prescribed medication regularly to make sure that their medication is appropriate for their condition and adjusted if necessary. Staff have training in safe administration of medicines, but it was not clear from the training records seen during the inspection whether the training is at the ‘accredited’ required standard set out in guidance produced by the pharmaceutical advisors to the Commission. The manager later confirmed that staff have attended a 12 week accredited course in a local college and have been assessed as up to date in their skills and competence. Some senior staff check the blood sugar levels of residents with diabetes by taking a finger prick blood test and using a blood glucose-monitoring device. Staff spoken with had not had training in the use of blood glucose meters and were not aware of the calibration checks that are needed to make sure the device is set correctly and will read the reagent strips accurately. Blood glucose testing is usually a task performed by a healthcare professional. If the doctor requires that residents need regular blood glucose tests the GP or community nurse should do this. If this is not possible, arrangements must be made for some of the homes staff to be training in the use of the test equipment and procedures and to be assessed as competent by an accredited trainer so that the test results and their significance can be relied on to inform Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 14 the doctor or specialist nurse about the management and treatment of the resident’s diabetes. The home manager has confirmed that she will contact the community nursing team about access to training for the homes staff. From observation during the inspection, conversation with residents and the written survey comments, it is clear that people living here feel that they are treated with respect and that staff listen to them and act upon what they say. Comments received included – ‘The staff from the Manager down, all are very caring and attentive’ ‘There is no discrimination with residents’ ‘I have never noticed anyone receive anything other than good service whoever they are’. We consider that the home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural backgrounds. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. There is a good range of activities within the home and community so that residents have the opportunities to join in social and recreational events that interest them. The residents enjoy meals and mealtimes and menus offer choice and variety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities organiser who works between 10 am and 4 pm each weekday. From conversations with the activities organiser, residents and other staff, it is clear that the social and recreational aspects of residents’ care are given high priority. There is a varied programme of activities and entertainments that appear to suit the needs of most residents. Five out of the 7 residents who completed a survey answered that there were ‘always’ activities arranged by the home that they can take part in; two people answered that this is ‘usually’ the case. However, one relative/friend/advocate’s survey comments indicated that they feel there is a need for more ‘stimulation and social interaction with staff …they do put on entertainment but it is the everyday, day to day [interaction] which needs attention’. This suggests that all care staff need to be aware of the Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 16 importance of taking time for conversation and ‘ad hoc’ activities with individual residents, so that the social and recreational aspects of care are not overlooked for those people who are mentally frail or have sight and hearing difficulties that may limit their ability to join in organised group activities and outings. The homes own survey results (as part of their Quality Assurance) about activities undertaken in October and December 2007, indicates that social care plans for residents are discussed during regular review meetings. A relative confirmed that this was their experience. The homes AQAA self-assessment shows that they are trying to expand the organised activities and to improve the access to the grounds and gardens so that more outside events can be available to residents. They have bought a marquee for use in the grounds and plan to build some raised flowerbeds and provide new outdoor furniture. Meetings are planned with other activities organisers to share ideas about activities and outings. Residents are also involved in suggesting things they would like to do – one suggestion has been to provide a temporary floor for dancing. The home has the use of a minibus (shared with two other homes owned by the same company, Majesticare) and residents have regular opportunities to go shopping and to visit local garden centres and places of interest. Responses to the CSCI surveys from relatives/friends/advocates, and the homes’ own survey (October/December 2007) show that visitors are made welcome in the home. Some of the comments we received included ‘Visiting is at any time and our family always feel very welcome whenever we go’ ‘Eastfield House is a small care home and extremely friendly. Because of its size it’s easy to get to know everyone and it seems like one big happy family’ The activities co-ordinator organises a small trolley shop stocked with items requested by residents (toiletries, sweets, etc) and bought and sold at cost price to residents. All of the current residents have a Christian faith background. Links with local churches and social events are advertised in the home. Residents, who wish to and are able, attend the local church services. Local clergy visit the home regularly and offer a regular service of Holy Communion for those (of any Christian denomination) who cannot go out to a place of worship. Conversation with residents, and their written responses to questions about meals in the residents’ comment cards, confirmed that the quality and variety of meals is good. Three of the 7 residents who completed a survey questionnaire stated that they ‘always’ like the meals and the remaining 4 that this is ‘usually’ the case. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 17 The standard of the environment in the dining room is also regularly checked as part of the home’s own quality audit. The dining room is attractively decorated and the dining tables (each seat up to four residents) are set with linen tablecloths and napkins, small flower vases, cruets and condiments. Residents are asked for their opinions and suggestions about menu choices. People spoken with during the inspection said that the manager and cooks do take note of their requests and change the menus. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Residents feel safe and listened to. There are safeguarding systems in place and staff understand and implement the homes procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ and relatives’ comment card responses showed that people know how to make a complaint and who to speak to if they are not happy – though no-one had had cause to complain: ‘the manager is very approachable and if I had reason to complain about anything I’m sure it would be sorted out quickly’. Several comments emphasised peoples’ satisfaction with their care and support and sense of safety that they have living here: ‘[the home/staff] make you feel ‘at home’ and safe’. ‘This is a happy and comfortable home’ ‘I will always be happy here’. The home’s complaints procedure was on display on the doors of most residents’ rooms, in the reception area, and is included in the Service User guide booklet (currently being revised and re-printed). No complaints have been received since the last inspection, either by the home or the Commission for Social Care Inspection. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 19 All staff have training in safeguarding of adults – signs and indications of suspected abuse and how to report any concerns. New care staff have training as part of their induction. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. The standard of décor and furnishings are good, providing residents with attractive and comfortable accommodation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is clean and smells fresh throughout. Residents’ rooms are well decorated and personalised with their own possessions and ornaments. Residents appreciate the good standard of cleanliness and the décor – all seven of the people who completed our survey said that the home is ‘always’ fresh and clean. One relative wrote ‘this is one of the better homes around – very comfortable, compares to a good class hotel’. Another person wrote that ‘the refurbishment has made it excellent’. A programme of refurbishment and redecoration continues to improve the environment. A new assisted Medic bath has been installed to replace an old, outdated bath in a first floor bathroom so that residents who need help to bath have a safe and accessible facility. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 21 A part-time gardener is employed and the gardens and grounds are very attractive. The home uses a commercial laundry service for bed linen and towels. There was an ample stock of good quality clean towels and linen in the store cupboards. Residents’ personal clothing is laundered in-house. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. The home has a consistent staff team and there is a good system of training in place, so that residents benefit from care and support by reliable and skilled staff. However, staffing numbers should be reviewed and improved to make sure that there are always enough staff to allow for the changing needs of the people who use the service, staff training, annual leave and rest days. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home benefits from having a low staff turnover so that residents and staff get to know each other well creating a relaxed and positive atmosphere in the home. Five of the current ten care staff have a National Vocational Qualification (NVQ) at Level 2 and two more are currently working towards this award; others are now working for Level 3. The home meets the recommended percentage (50 ) of care staff with a nationally recognised qualification in care. Examination of the staff rota for the week 10th to 16th March 2008 showed that there is consistently a senior carer (or the deputy manager) and three care staff on duty in the morning (from 8 am to 2pm) and a senior carer and 2 care staff in the afternoons (from 2 until 8 pm). One carer is on duty overnight, with another carer on call within the home. One of the managers or senior staff are also ‘on call’ overnight to respond to any emergencies in the home. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 23 Additionally, during the day, the registered manager is available (but supernumerary to the listed care staff) and the house manager works from 8 am to 4 pm on weekdays. Ancillary and support staff – chef manager, relief chef, kitchen assistant, domestic staff, laundry worker, and activities coordinator – complete the staff team. Residents’ survey responses indicate that they are satisfied with the care and support they receive – 6 out of 7 replies stated that they ‘always’ received the care they needed and the remaining person that this was ‘usually’ so. In answer to the question ‘are staff available when you need them?’ 4 out of 7 said ‘always’ and 3 out of 7 said ‘usually’. We noted from the sample duty rota, that staff work flexibly to cover other’s absence. For example, there were 4 separate occasions when care staff were allocated to escort residents to hospital or clinic appointments (one person came in on their day off to accompany someone to hospital). Three care staff were working a mixture of day and night duties in the same week. Four care staff were listed as ‘on call’ for night duty during their working week. Three care staff were rostered to work on days that had originally been marked as ‘A/L’ (annual leave) or ‘DO’ (day off) on the rota. At least 3 staff cover different work roles for example, relief cook, kitchen assistant. This indicates to us that the provider should review the numbers of staff employed to make sure that there are enough staff to provide for the direct care of residents and cover the additional time needed to replace staff who are on leave, providing escort duties, or attending training. There is a potential for staff who are working mixed day and night shifts in the same work period to have insufficient rest time. In the AQAA (completed 14/12/2007) the manager acknowledged the need to ‘increase the staff team to ensure continuity of care’ and states that their plans for improvement in the next 12 months are ‘to review staffing levels for holiday and training cover’ whilst ensuring ‘no agency use’. Staff induction and training records show that the home is committed to providing on-going training and development opportunities for all staff. Examination of two staff members’ files showed that they were well organised and that the home had received the necessary references and checks prior to appointing new staff to work in the home. There is evidence that staff have regular formal supervision meetings with senior managers to discuss their work and progress in the home. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. The management arrangements in the home are good and meet the needs of the residents. Residents’ views are valued and influence the running of the home. The home has effective quality assurance systems in place. The home must improve record keeping to show that routine repairs and fire safety checks have been undertaken and that residents live in a safe, well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager, Ms Mary Bayliss, was away on a day of annual leave when this inspection took place. She has extensive experience in her role and has achieved the Registered Managers Award and NVQ Level 4, the required formal qualifications for managers of registered care homes and agencies. Comment received from residents and relatives are very positive about her Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 25 abilities, describing her as ‘very approachable’ and very good at communicating with residents and their relatives. There are regular residents’ and relatives’ meetings held in the home – a list of dates for forthcoming meetings is displayed in the entrance hall. Conversation with residents, and their comment cards, confirm that people feel that their opinions are listened to and acted upon by the staff and managers. The home undertakes regular quality reviews covering ‘Living at the Home’, ‘Catering’, ‘Activities’ and ‘Care Delivery’. This involves sending out surveys questionnaires to residents and their relatives (for ‘Visitors Views’) every three months. The results of the surveys are fed back as part of the agenda at Residents’ meetings. Residents meetings are held approximately 6 weekly. The home also produces a quarterly newsletter that contains news of past and forthcoming events and entertainments, birthday wishes and welcomes to new residents. The Annual Quality Assurance Assessment (AQAA) was completed by the manager and returned to us by the date requested in December 2007. It gave a brief account of the home - what it does well and future plans for improvement. The AQAA is intended to give the opportunity for the home to provide us with information about how they are meeting outcomes for the people using their service and helps us to develop an accurate picture of how well it is achieving this. It would be helpful to provide more evidence to support the comments made to illustrate what the home has done in the last year or how it is planning to improve. The home undertakes to look after small amounts of residents’ personal allowances (‘pocket money’) when they are unable or prefer not to do this for themselves. The procedures for keeping a check on the money received and spent by residents are good. The home’s accident records, fire safety log book and maintenance/repair request books were looked at. The home’s house manager oversees the maintenance and domestic work in the home. The home has been without a maintenance person on site for three months but is hoping to employ someone shortly. Meanwhile, staff from another local Majesticare home undertake routine repairs and maintenance jobs in Eastfield House. The fire logbook records were not up to date, for example the last recorded fire alarm tests were in November 2007. Staff on duty, when asked, were not aware of who was responsible for routine fire alarm and lighting tests in the absence of a maintenance person on site. Hot water temperatures are normally routinely checked on a monthly basis but had last been recorded in January 2008. However, there was evidence that Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 26 care staff check and record the hot water temperature before residents are bathed – these checks were up to date. The requests for repairs, entered in a notebook at the staff workstation, were not signed as having been attended to. The house manager said she was sure that the visiting maintenance person had done all the required tests and work, and had recorded them elsewhere. She said she would follow this up with the staff member and makes sure that the records were updated in the home. The homes records should show that the required safety checks and repair work have been undertaken to protect the safety and wellbeing of residents and staff. It was noted that a resident’s ground floor bedroom door was wedged open. Doors should not be held or propped open because, in the event of a fire, the open doors will not provide the intended barrier to slow the spread of smoke and flames and residents, staff and visitors are put at avoidable risk. The fire officer should be consulted and his/her approval sought about the fire precautions in the home, and prior to fitting suitable automatic door closers. The deputy manager said that this would be done. An external specialist company oversees the Health & Safety policies and procedures in the home. There was evidence that staff have attended training in health and safety topics, such as First Aid, care of Substances Hazardous to Health (COSHH), infection control and safe food handling. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP37 OP30 Regulation 17; Schedule 4 (14) 18 (1)(c)i Requirement Records required by regulation must be maintained, up to date and accurate. Where clinical interventions are delegated to care staff, the staff must have training in the delegated intervention and be assessed as competent to do so by a suitably qualified health care professional Timescale for action 01/06/08 01/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Improve the care plans by * Including sufficient detail about the action that needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the residents are met * Reviewing and updating the plans with the involvement of the resident and/or their representative * Including information (with the individual’s consent) DS0000037997.V359320.R01.S.doc Version 5.2 Page 29 Eastfield House 2. OP9 3. OP27 about peoples’ past and current hobbies and interests, and family and social networks to assist staff to plan and provide ‘person-centred’ care and support. * Including evaluation of care interventions * Care staff who are delegated to apply residents’ prescribed skin creams and lotions should be assessed to ensure that they follow the instructions for the application of the product and know how to report any adverse reactions. * A record of topical prescribed medications should be maintained to show that they have been applied as directed. * Risk assessments should be in place and written records updated for residents who wish to keep and administer all or some of their prescribed medicines. Carry out the planned review of staffing numbers and skill mix and ensure that staffing levels are sufficient to allow for changing care and support needs of residents, staff training, annual leave and sick leave. Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Eastfield House DS0000037997.V359320.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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