Inspection on 11/10/07 for Eastfield Nursing & Residential Care Home

This inspection was carried out on 11th October 2007.

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 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 Nursing & Residential... 08/08/06

Eastfield Nursing & Residential... 08/02/06

Eastfield Nursing & Residential... 07/02/05

Eastfield Nursing & Residential... 27/10/04

Eastfield Nursing & Residential... 19/11/03

Eastfield Nursing & Residential... 08/06/03

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Eastfield Nursing & Residential Care Home Hillbrow Road Liss Hampshire GU33 7PB Lead Inspector Gina Pickering Unannounced Inspection 10:00 11 October 2007 th 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 Nursing & Residential Care Home DS0000011499.V347202.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 Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eastfield Nursing & Residential Care Home Address Hillbrow Road Liss Hampshire GU33 7PB 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) (01730) 892268 Wenham Holt Homes Limited Dr Dennis Anthony Greenwood Care Home 37 Category(ies) of Dementia (7), Dementia - over 65 years of age registration, with number (37), Old age, not falling within any other of places category (37), Physical disability (7), Physical disability over 65 years of age (14), Terminally ill (7), Terminally ill over 65 years of age (37) Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. All Service Users in the DE, TI and PD categories must be 55 years old and over. 8th August 2006 Date of last inspection Brief Description of the Service: Eastfield Nursing and Residential Home provides care, or care with nursing, for service users over fifty-five years, including those who are terminally ill, have a physical disability or dementia. The home has thirty-five bedrooms. Twenty-nine of these are single and four shared. Communal space comprises a lounge, a smaller conservatory type sitting area and dining room. The home has extensive landscaped gardens that service users are able to access. Eastfield is situated on a main road a short distance from Liss and is close to local amenities. The home is one of two family-run businesses. The manager informed the Commission that weekly charges at the home range form £550 - £625. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection considered information received by the Commission about the home since the last key inspection in August 2006. This includes information provided to the Commission in the form of the home’s Annual Quality Audit Assessment form in which the registered provider or manager tells the Commission how the service has developed over the past twelve months and how they propose to continue to improve the service. The Commission surveyed service users, relatives and staff; the information in these was used to inform the inspection. An unannounced visit was made to the home on 11th October. The inspector case tracked five service users, looking at documentation relating to them, and speaking with the service users. The inspector had conversations with a further four service users, three staff members, the registered manager, and one visitor as well as touring the home and looking at various documentation as part of the inspection process. Comments received from relatives were very positive about the care and support received from the staff at Eastfield. A sample of the comments include that the home has a ‘happy caring atmosphere,’ staff are ‘ always polite and cheerful’ and the home ‘makes residents feel ‘at home’ and among friends who know and care about them.’ One service users in the comment care expressed their thanks for all eastfield had done. Two care managers returned surveys to the Commission commenting that ‘this home cares for clients in a holistic manner. They support both client and families though what are difficult times and decisions. There is account taken of client’s wishes, choices and needs, entertainment, activities etc.,’ and ‘I have always been very pleased with the care clients receive, the concern and interest taken by the staff in individual’s circumstances. This home has always appeared to be effectively run. The staff are caring and professional. Comments from clients and relatives are very positive and uplifting.’ A GP commented that ‘ I think most individuals have their needs met. It is very well managed with experienced staff that seem happy and always helpful.’ As a result of this inspection one requirement has been. This is regarding the ordering of medications. The manager at the time of the inspector’s visit to the home said that the process for ordering medications would be reviewed promptly to ensure that a resident would not run out of their medications. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home now obtains care management assessments for all service users that are admitted under a care management process as well as assessing the person under their own admission procedures. Routines of care at the home have been revised to allow more time for one to one activities with service users. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 7 New laundry equipment has been installed and changes made to the laundry system; this means that all laundry can now be done on site and there is less lost laundry. Some building work has been completed. A new lounge area, toilets, shower room and hydrotherapy pool are now available for service users as well as improvements being made to the gardens to allow better access for persons with mobility problems. Recruitment procedures are followed, with two written references being obtained prior to a person commencing employment at the home. The home is already an approved centre for City & Guilds registered to offer both NVQ 2 & 3 and in September was accredited to offer NVQ 4 in Health and Wellbeing. Training has been provided from a specialist that now ensures there is a appointed first aider on duty at all times. What they could do better: 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 Nursing & Residential Care Home DS0000011499.V347202.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 Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good assessment processes and the provision of good information about the home from several sources ensures that service users move into the home with the knowledge that their needs will be met at the home and with an understanding about the running of the home. The ethos of care and support provided by staff at the home ensures that those service users that are admitted for short-term convalescence and rehabilitation have their needs met and achieve their optimum independence. EVIDENCE: The AQAA states that all prospective service users have their needs assessed by the registered manager or one of the nurses to ensure the home can care and support that person. This is in conflict with information in the statement of purpose; this states that assessments are done only for people who have Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 10 complex needs and where there is some uncertainty as to whether the home will be able to meet their needs. Discussion with the manager confirmed that all prospective service users are assessed and he agreed to amend the details in the statement of purpose. Of the four care plans that the inspector looked at all had details of the pre assessment process. Information provided by the persons previous care home or the hospital from which they are discharged supplements the information obtained during the home’s assessment of that person’s needs. The manager confirmed that copies of care management assessments are obtained for all service users funded by social services complying with a requirement made at the last inspection. The inspector saw in service user files care management assessments. Staff that the inspector spoke with during the visit to the home confirmed that the information they have when a person moves into the home is of sufficient detail to enable them to support and care for that person. Prospective service users and their representatives are supplied with information about the home in the form of the home’s brochure that incorporates the statement of purpose along with a copy of the Agreement of Residence (The contract between the nursing home and the resident). There is also a copy of the statement of purpose in the nursing office, so that anyone can examine the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the nursing home. As stated above the statement of purpose is going to be revised to ensure it accurately describes the pre admission assessment process. This information is also available on the company website. The information being accessible to the public by various methods evidences the service’s commitment to ensuring prospective service users have good information about the home before they make the decision to move into the home. Service users surveys told us that they had all received sufficient information to make a decision about moving into the home and that they all have a contract between the home and themselves. The home will provide intermediate care in the form of rehabilitation. The manager told us that if there is a room available the home will admit a person for a short term stay after illness for a period of convalescence and gentle rehabilitation to enable that person to return to their own home. He explained that as the ethos of the home is to maintain and strive to improve the abilities of all service users the care and support for service users admitted for a shortterm period is no different from that of persons permanently living at the home. For this reason no separate facilities or care procedures are in place for short-term service users. At the time of our visit to the home there was no such service users at the home. But one service who had been at the home for a period of time was able to discuss how the care and support provided by the home had resulted in his physical wellbeing improving to such an extent that he is now in the process of looking for accommodation so he can move out of the care home into more independent living. Eastfield Nursing & Residential Care Home DS0000011499.V347202.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, 10 & 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good care planning and assessment processes ensure that service users receive individualised support and care that actively promotes their wellbeing in a manner that protects their privacy and dignity. Some shortcomings in medication procedures do not always ensure that service users have the medications they need. The use of recognised care practices for service users that are in the end stages of their life ensure that carer and support are provided to the service and their family EVIDENCE: Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 12 As part of the case tracking process five care plans were viewed for a group of service users with differing needs. The home has developed a system of core care plans that can be personalised to detail the unique needs of the individual service user. The AQAA informed us that the service plans to further encourage staff to personalise the core care plans to ensure all service users receive individualised care at the home. Care plans detail the action to be taken by care and nursing staff to care or support the service user to meet their needs with regard to personal, health and social care. Detailed assessments are made of specific health needs and a comprehensive moving and handling assessment is reviewed monthly. As part of this assessment detailed information is documented about how to assist the individual to move in a variety of settings for example moving from bed to chair, moving from chair to chair, and walking. The comprehensive details in these assessments are likely to be a contributory factor to the fact that accident records indicate that service users have few falls. Staff that the inspector had conversations with expressed that care plans are always accessible and are used to inform the care and support they are providing to the people living at the home. Care plans detail that reviews are made monthly to ensure the plan is current; changes to the plans are made at that stage or when a service user’s need changes. Care plan documents detail services users contacts with health care professionals. Service user surveys received by us indicate that they believe their health care needs are met. No concern has been raised from relatives about the health care provided by the home. One survey commented about their relative living at the home, ‘Good health care, her health has improved since she has been in the home.’ Medications are administered by the nurses employed at the home. Staff have access to a relevant procedure about the safe handling of medications. As part of the case tracking process five medication administration charts were looked at. These clearly indicated the amount of medication administered and at what time the time the medications were administered. But one chart detailed that medication had been out of stock for over a week for a particular service user. This service user had recently been admitted; staff spoke about difficulties that are sometimes encountered around ordering medications for new service users. Procedures must be made robust to ensure this does not happen and that there is a sufficient supply of medications for each service user. Service users told us that staff at the home treat them as individuals. Observations throughout out the visit evidence that staff respect the privacy and dignity of service users. All personal care is delivered in the person’s bedroom or in the bathrooms. No concerns were raised in surveys received by us about the maintaining the privacy and dignity of service users. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 13 The home provides care for those in the final stages of their life. For this purpose the service follows a recognised care pathway known as the Liverpool Care Pathway. At the time of the our visit to the home there were no service users needing the Liverpool Care Pathway but comments received from care managers indicate that the care of service users in the end stage of their life is of a high standard; the home caring for not only the service user but the relatives and friends of that individual as well. Comments included ‘they support both client and families though what are difficult times & decisions.’ Training records indicate that all staff have undertaken training about various aspects of care of the dying person. The manager discussed plans for the next twelve months to consolidate staff knowledge and skills with regard to this subject with further training about the care of some one in the end stages of their life and pain control methods. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home listens to the views of the service users and considers their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Routines, activities and plans are service user focused, regularly reviewed, and can be changed to meet individuals changing needs, choices and wishes. The service is committed to enabling service users to make their own decisions and choices regarding all aspects pf their lifestyle. Mealtimes are considered important; service users are able to chose from a varied and nutritious diet and are able to take eat their meals in the surroundings they wish to. EVIDENCE: Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 15 The home offers a large choice of activities for service users to partake in. Activities are listed in the statement of purpose and the newsletter published monthly and distributed to all service users. Activities listed in October’s newsletter include music afternoons consisting of vocal and harp performances, minibus trips, art and craft activities, multi sensory therapy, fitness and fun classes, and sessions in the hydrotherapy pool. Service users told us that they enjoy joining in activities, but they do not have to join in the activities if they do not wish. They particularly commented that they enjoy the music activities. Several service users spoke of how they enjoy being able to use the hydrotherapy pool, being able to move more freely in the water and being able to take part in an activity that they used to enjoy when they were younger. A relative commented in a survey that the home provides ‘afternoon entertainment for these that want to join in.’ A member of staff told the inspector that some activities now take place during the morning rather than activities only happening in the afternoon. This has been done in response to requests by service users and their representatives and enables service users that prefer to have a snooze in the afternoon to join in activities at other times of the day. The service told us that changes have been made to the caring routine to provide more emphasis to personal contact and interaction with residents. This addresses the recommendation made following the previous inspection that the social needs of individual residents for ‘face to face’ contact with staff should be assessed and planned for. It was observed during the visit to home that staff have time to sit and talk with service users; this was confirmed in conversations the inspector had with service users. The spiritual needs of service users living at the home are met with regular communion services being held at the home as well as service users being able to receive visits from clergy whenever they wish. Visitors are welcome at any time to the home as stated on the statement of purpose. Service users are able to receive their visitors in any of the communal places or in the privacy of their bedrooms. The service has identified a need to provide a more private facility for relatives to meet the residents. Plans have been made to open up a small lounge bar area in the home for this purpose. A comment in a relatives survey sent to the Commission states that ‘we can visit at any time’. Visitors were observed being welcomed into the home. A visitor that the inspector had a conversation with confirmed that she is welcome at the home at any time and her relative can chose where to receive her visitors. The ethos of care at the home promotes the dignity and autonomy of service uses. The home has told us that it is putting training and support in place for Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 16 staff to reduce incidents of staff being over protective towards service users and allow service users to make their own decisions. Service users said they are able to make decisions about their daily life and are able to influence the running of the home by discussing issues with the manager. During the inspector’s visit to the home it was observed that service users are able to choose how to spend their time; whether they take part in organised activities, sit in other communal areas of the home chatting with friends or spend time on their own participating in their own interests such as reading, listening to radio or television or knitting. Discussion with staff and residents also evidenced that service users are able to make individual choices as to rising, retiring times and there is flexibility within the routines of the home regarding assistance with baths and showers. The service told us that improvements have been made to the provision of meals to service users in respect of the choice of meals. This includes the menu plan being provided with the monthly newsletter and during mealtimes resident’s having the opportunity to choose from the main dish being cooked or a selection of alternatives. Service users said they enjoy the meals at the home and that there is a choice of meals. The home has no service user requiring special diets on account of the cultural beliefs, however it is detailed in the statement of purpose that such diets will be catered for if the need arises. Comments received in a survey from one of the catering staff included, ‘My department is catering. I am always informed if a resident has to have change of diet, or does not like the food, or just dislikes carrots for example. An alternative is always given’ and about undertaking NVQ training ‘the course will help me design and cook a more varied diet for the residents’. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are confident that complaints raised will be dealt with effectively. Service users are protected from the effects of abuse by a work force that has a good understanding about safeguarding adults. EVIDENCE: The complaints procedure is displayed in the home for all to view. A summary of the complaints procedure is detailed in the statement pf purpose. The service told us they have received no complaints about the service in the past 12 months. There is no record of any complaints received in the complaint logbook for the past twelve months. Discussions with service users evidenced that they are confident to raise any concerns with staff at the home and these concerns are dealt with immediately. Monthly resident meetings and three monthly relative meetings provide a forum for both service users and relatives to raise any concerns. The manager feels that these practices result in concerns being addressed promptly reducing the likelihood of complaints about the service being made. Policies and procedures are in place about the safeguarding of adults and their protection from abuse. This was reviewed in August 2007 to ensure it is in line with local guidelines for the reporting of abuse. Staff training records evidence that all staff have received training about the protection of vulnerable adults. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 18 Discussion with staff members’ evidenced that they have a good understanding of the effects of abuse and the action to take should they suspect an act of abuse has occurred. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence including a visit to this service. The service spends money on the environment in the best possible way so that outcomes are improved as much as possible for the people using the service. There is a selection of communal areas both inside and outside of the home, this means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The home is well lit, clean and tidy and smells fresh. EVIDENCE: Since the last key inspection in June 2006 building work has been completed. Service users now benefit from the addition of a further lounge, change in dining area, toilet and showering facilities, as well as a hydrotherapy pool. Plans are in place to further develop the home by building more bedrooms with en suite facilities and provide a bar area that can be accessed by all Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 20 service users. Comments in relative survey forms indicated some concerns with the quality of the furnishings in service users bedrooms. The AQAA has told us that in the past twelve months the service has been purchasing new furniture for the bedrooms as consequence of comments made on the feedback forms. Relative surveys also suggested that the positioning of furniture in the large lounge could be reorganised. Discussion with the manager evidenced that he is aware if these concerns and new furniture is going to be purchased to allow the room to be rearranged. The lounges was viewed, it is large room with at the moment a circle of chairs around it making it look un- homely and to some extent ‘institutionalised’. However improvements are planned with the proposed purchasing of new furniture that will allow grouping of chairs so service users can sit in small groups. As a further part of the building work a new kitchen area is in the process of being furnished and new bedrooms with en suite facilities are being made. The home will apply to the Commission to increase the service numbers it is registered for once these bedrooms have been completed. Service users us they are happy with the furnishings and decor of the home and that the home is kept clean and free of odours at all times. The home was clean and free from offensive odours during the course of the visit. A tour was made of the home viewing communal areas, toilet and bathing areas, the garden, and the laundry and kitchen areas. A team of cleaning staff are responsible for the cleaning of the home. Service users clothes, bedding and other items laundering are done in the homes own laundry. The provision of new equipment in the last 12 months has helped to improve the laundry service by ensuring that laundry is washed at the correct temperature and enabling all laundry to be done at the home rather than the bedding having to be sent to a professional laundry. Comments in relative surveys include that the home could improve by ensuring ‘that each resident gets his or her own laundry back, things get ‘lost’’, and ‘the service ‘could improve the ironing.’ Information within the AQAA informs us the service is aware that there are sometimes problems relating to the laundry service being provided to the residents and states that the service will continually be scrutinised and that in the next 12 months they intend to improve the efficiency of the laundry service. The manager said that already the routine for doing the laundry had been changed to attempt to ensure that service users get their laundry back and that the ironing is of a good standard. The AQAA states that staff undertake training about the control of infection and all catering staff have undertaken food hygiene training as well as 37 of the care staff having had food hygiene training. Training records evidence that this fact is correct. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 21 Eastfield Nursing & Residential Care Home DS0000011499.V347202.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 & 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staffing levels reflect the needs of the people using the service, and rotas are flexible to fit around the lifestyles and needs of individuals. The home ensures that all staff working at the home receives relevant training that is targeted and focused on improving outcomes for people who use services Robust recruitment practices ensure that people living at the home have their wellbeing protected. EVIDENCE: The AQAA tells us that the nursing home has a good skill mix of staff with an experienced group of registered nurses managing the nursing needs of residents and that the staff duty rota is developed following the managers assessment of how many care hours are required to meet the care needs of service users. This means if there are periods when service users needs are intense sufficient staff will be rostered to ensure all service users have their personal, health and social needs met. Information received from service Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 23 user, relative and staff surveys detail that there is usually enough staff to meet the needs of the service users. We have received no concerns or complaints about staffing numbers or skill mix. The AQAA tells us that out of 19 care staff employed 8 have NVQ level 2 or above in care and a further 5 others are studying for this qualification. This means that the home will have met the National Minimum Standards for 50 of care staff to have NVQ qualifications once the five members of staff have completed the course. The home is an approved centre for City & Guilds registered to offer both NVQ 2 & 3 and in September NVQ 4 in Health and Wellbeing. Training records evidence that staff have received training about communication, care planning, pressure sores, health and safety, moving and handling, strokes, oral care, promoting choice, bereavement care for the person at the end of life. Much of the training makes use of recent articles in professional publications. In this way staff are kept informed about recent research ensuring that the care provided by the home is based on best practice guidance. A requirement was made at the last inspection that two references must be obtained, one of which must be from the most recent previous employer, prior to the a member of staff commencing work. The AQAA, staff surveys and viewing a sample of staff files evidence that this is now happening. No member of staff commences work until two satisfactory written references, CRB and POVA clearances have been obtained. Staff indicate in returned surveys that they receive training to meet the needs of the service users living at the home. The AQAA states that all new care staff complete an induction programme within their first 6 weeks of employment. A member of staff in their survey said that the induction programme covered everything she needed to know to care for the service users. we looked at the programme noting that it meets Skills for Care Common induction guidelines. The extensive training programme in place for all staff members equips them with the skills and knowledge to care and support service users living at the home as well as supporting the relatives and friends of service users through what can be distressing times. Training records detail each staff members training. Training over the past year includes topics such as communication, care planning, strokes, and oral care, promoting choice and bereavement care for the person at the end of life. Much of the training makes use of recent articles in professional publications. In this way staff are kept informed about recent research ensuring that the care provided by the home is based on best practice guidance. One staff member told the Commission that ‘my employer is sending me to college once a week to do my NVQ 2 in professional cooking paying for my time and travel costs and all equipment.’ The service recognises the importance of providing excellent care for a person and their family in the end stages of life. For this purpose the home follows the Liverpool Care Pathway. The AQAA states that training continues to be Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 24 given to all staff members in respect of end of life care to ensure that that all staff understand the importance and principles of end of life care and that registered nurses are confident in pain management techniques is one of the areas of improvement for the next 12 months. Comments received from care managers include ‘This home cares for clients in a holistic manner’, ‘The staff are caring and professional’, and ‘Eastfield and their staff are able to manage the needs of service users who have complex needs and behavioural difficulties’. From these statements it can be concluded that there are no concerns about the skills and abilities of the staff at the home to care and support the service user group living at the home. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a home that is managed by a resourceful and competent manager who is committed to improving outcomes for those living at the home. Service users views are an integral part of the development of the service with service users and stakeholder’s views being sought inn a variety of methods. Procedures are in place protecting the financial wellbeing of service users. Good health and safety practices protect all people at the home. EVIDENCE: The registered manager has been managing the home since 1983. He is a Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 26 registered first level nurse and has a wide range of relevant qualifications that ensure that he is able to meet the requirements of the position. During the course of the visit to the home it was observed that staff and service users are able to approach him with any concerns or issues. Staff comments about the manager received in surveys include ‘The manager is a very hard working man who cares for his staff and residents’ and from a care manager ‘This home has always appeared to be effectively run’. Throughout the inspection process the manager demonstrated his ability to discharge his responsibilities fully and his commitment to develop the service to improve the outcomes for those living there. This includes the development of the environment, excellent training for staff members, effective care planning systems that support service users to receive individualised care and support and the act of listening to what service users and their representatives tell him and using that information to run and develop the home. Information in the AQAA, surveys and observation at the home evidence that the home is managed in a manner that is in the best interests of the service users. The home’s philosophy of care is based around the relationship of service users, their relatives and friends and staff. Meetings are held between the management, residents and relatives. Feedback from residents/ relatives and healthcare professionals in the form of questionnaires are obtained twice yearly. Meetings are held with residents monthly and with relatives three monthly. The results from these meetings and surveys feed into the yearly planning of the home. Examples of how the running of the home has been influenced by the wishes of service users have been included throughout this report. Some of them have included commencement of group reminiscent/conversational therapy, changes to the laundry system, the purchasing of new furniture for bedrooms, changes to the menus and additional staff training to improve quality of the catering provision, changes to the caring routine to provide more emphasis to personal contact and interaction with residents, employing someone to provide hand massage and focus on interaction with residents that are not that involved with the existing nursing home activities and providing activities during the morning as well as the afternoon. Improvement s planned for the next twelve months as a response to service users requests and wishes include the provision of a small bar area, the continued development of the new lounge area to allow for smaller seating areas. Service user surveys indicate that staff usually listen to what they say and act on their wishes. The home operates a policy of not handling service users monies; bills for sundries are invoiced to the responsible person handling the service user’s money. The service told us that improvements have been made in risk assessment documentation in the last 12 months along with staff having training about risk assessments. Risk assessments were seen for the environment, working Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 27 practices and the fire risk assessment. Concerns had been noted in the previous inspection about the safety of service users who have fire escapes located in their bedrooms. Risk assessments are in place for the relevant rooms and service users. However the inspector noticed that a fire escape in one service users room was partially blocked. The manager rectified this immediately. Training records indicate that all staff receives the relevant training about health and safety issues including fire safety, moving and handling and COSHH. Service certificates were seen evidencing that all services and equipment are maintained at the recommended intervals to ensure safety of all at the home. A requirement was made at the last inspection that there should a member of staff trained in first aid on duty each shift. Training has been provided from a professional company for staff that now ensures that there is at least one appointed first aider on duty each shift. Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement A procedure must be in place and complied with to ensure that service users never run out of medications. Timescale for action 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Eastfield Nursing & Residential Care Home DS0000011499.V347202.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Nursing & Residential Care Home DS0000011499.V347202.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. 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