Inspection on 27/02/09 for Eastgate House Residential Home

This inspection was carried out on 27th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Eastgate House Residential Home 17 Littleport Street Kings Lynn Norfolk PE30 1PP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Maggie Prettyman     Date: 2 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Eastgate House Residential Home 17 Littleport Street Kings Lynn Norfolk PE30 1PP 01553691054 01553691054 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Integrated Nursing Homes Ltd care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 22 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Eastgate House is a residential home for 19 older people. It is situated in a large historic 17th Century detached house which is situated close to the town centre of Kings Lynn. All local ameneties are close by. The Home was opened in 1987, and changed providers in 2008. The accomodation is on the ground floor and first floors. Some stair lifts are in place to enable people with less mobility to access their rooms upstairs. Accomodation takes the form of single and double rooms. The current charges at the home range from £370 - £520 per week according to size of room. Care Homes for Older People Page 4 of 28 Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers, the residents and their visitors as well as others who work in or visit the home. This report gives a brief overview of the service and current judgments for each outcome group assessed. This was a key unannounced inspection which took place over 7.5 hours on Friday 27th February 2009 and was carried out as part of a routine inspection plan. There were 19 people living in the Home on that day. The Manager and her deputy were present during the inspection. Care Homes for Older People Page 6 of 28 We undertook a tour of the premises, examined care plans, staff files and other records. There were private individual and group discussions with most of the residents and staff on duty that day. What the care home does well: What has improved since the last inspection? What they could do better: The home has not yet produced up to date written information about its services for people to consider before they come to live there. Needs assessment documentation needs to be expanded so that all aspects of peoples needs are checked before they move in. Peoples care plans need to be improved in terms of outcomes of risk assessments. The medication system at the Home is poorly run, and needs to be urgently improved. Although the home is clean and tidy, some areas are in need of redecoration and a number of Health and Safety issues have been identified in this report as needing urgent action. Some of the Staffing and Management levels at the Home have been reduced under the new owners. Care needs to be taken that this does not affect the safety and welfare of residents. The Home has yet to implement a comprehensive system of quality assurance, and some aspects of record keeping could be better organised.. Care Homes for Older People Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Homes written information and contracts need to be fully updated and the form for Needs Assessment needs to be expanded so that people coming to live at the Home understand its services and have every potential aspect of their needs assessed. Evidence: The Home has recently changed ownership, and the new owners have not yet completed an up to date Service User Guide and Statement of Purpose. This means that people who are considering moving into the Home do not have up to date written information about its services to assist them in making an informed choice. While some contracts are in place, the new owners have yet to fully update the contracts for some residents of the Home. This means that residents may not always be clear about the financial and practical arrangements for their residence Care Homes for Older People Page 11 of 28 Evidence: Evidence of pre admission needs assessment was seen in residents personal files. The new owners have a pre admission assessment form. This is very basic and does not cover all aspects of peoples needs as described by the standards. This means that it is possible that not all aspects of peoples needs would be considered before they came to live at the Home The Home does not provide intermediate care Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care support that people receive is based on their individual need and people are treated with dignity and respect. The medication system at the Home is unsafe and needs urgent review and improvement. Evidence: Up to date and reviewed service user plans were found in place for all residents. These included risk assessments, but there was not always instructions to staff about how risks identified could be reduced or prevented. Examination of residents personal files demonstrated that people are accessing the services of a range of external health care professionals and that their health care needs are being promoted and maintained. A visiting Health Care professional confirmed that the Home always implements the health care guidance that is given to them. A medication round was observed and a short audit of medication within the Home was Care Homes for Older People Page 13 of 28 Evidence: undertaken. These observations demonstrated that the system of medication at the Home is not properly audited, and that errors and omissions are occurring in the recording and administration process. In addition the person responsible for the round was subject to distraction and interruption which could cause errors to be made. The outcome for residents is that the medication system at the Home is potentially unsafe and this needs to be urgently addressed. Residents interviewed confirmed that they feel treated with privacy and dignity by staff at the Home. They said that their clothes and personal possessions are safe and well cared for. Post is handed to people unopened and their name of choice is used when they are spoken to. Some areas of improvement were identified as care plans were found in the dining room and one person was seen having medical treatment in a public area. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle and are supported to develop their life skills. Social, cultural and recreational activities meet individuals expectations. Evidence: Residents at the Home confirmed that their routines are flexible and that they have choice in all aspects of their lives. They get up and go to bed when they wish, and they spend their days in their room or the lounge according to choice. Special days and celebrations are marked. One person had recently enjoyed a birthday party organised by the home . Two people commented that the number of activities seems less since the new owners took over. However overall the Home is providing an excellent range of activities and occupation. People said that their family and friends can visit whenever and as often as they like. They confirmed that their visitors are warmly greeted by staff and are offered refreshment during their visit. The manager and her team are committed to involving families and have set up resident and family evening meetings and activities. The town is near at hand and people enjoy going out shopping and to other local attractions. Care Homes for Older People Page 15 of 28 Evidence: People living at the Home said that they feel in control of their lives and that they exert choice in their day to day life. One person was spending her day in her room, but said that at other times she chooses to sit in the lounge. Everyones room was filled with personal possessions which are well cared for and kept safe by the Home. A tour of the kitchen was undertaken It was clean, well organised and the food was being prepared from scratch with minimal use of packet ingredients. There is a rolling programme of menus, but this is under review to incorporate more resident involvement. A list of likes and dislikes and dietary requirements is kept in the kitchen. The cook sometimes has baking sessions with residents in the afternoon. Luncheon was observed and proved to be a pleasant social event. People sat around afterward having a chat before going back to the lounge or their rooms. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure. The staff at the Home are trained know how to protect people from abuse. Evidence: The Home has a good complaints policy and procedure. All residents spoken to said that their occasional grumbles or requests are listened to and that action is taken. There has been one formal complaint dealt with by the Home since the last inspection. This demonstrated that the complaint was taken seriously and appropriate notifying action was taken by the Home. A review of staff training records demonstrated that people are trained in safeguarding as part of their induction, and that this training is regularly updated. The investigation of the complaint noted above demonstrated that the Home is aware of its responsibilities to ensure that people are properly safeguarded. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean pleasant and comfortable Home. Some aspects of the Homes flooring and maintenance could be improved so that the Home is safer and more accessible. Evidence: The Home has a homely atmosphere and is a pleasant environment, although some aspects of its decor could do with being refreshed.. During the inspection it became apparent that some residents may have difficulties in negotiating some changes in level on the ground floor, and that this prevented them from moving from room to room without assistance. Some aspects of monitoring and maintenance such as the electrical wiring certificate, call bell system checks and high water temperatures in taps have not been addressed. The Home is clean, pleasant, hygienic and odour free. Several hand soaps were found in toilet areas, but these were removed by the manager who undertook to ensure that this practice will not continue. Inspection of the laundry found it to be tidy and well oganised with effective laundry sorting methods to ensure that clothes and bedlinen are washed separately. Care Homes for Older People Page 18 of 28 Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the Home are trained and skilled to support the people who live there. Staffing numbers at weekends may need to be increased to ensure that peoples personal and health care needs are fully met at these times. Evidence: Staff were observed working hard during the inspection. They were consistently polite, friendly and warm with residents. Residents confirmed that this is always the case, and that they feel well treated. Since the new owners took over, staffing levels have been reduced in the mornings at weekends. This may need to be reviewed, especially as the person giving out medication must not be distracted by other tasks during their work. The Homes records demonstrated that a high level of NVQ 2 qualification has been attained, and new staff are encouraged to commence this training. A selection of staff files were checked and mostly found to be complete. One had a reference missing. The Homes manager was sure that this had been gained, but had been mislaid. The files themselves lacked organisation and this has hampered proper audit of their contents. The new owners have upgraded the type of induction and ongoing training given by Care Homes for Older People Page 20 of 28 Evidence: the Home. The Deputy manager has completed a detailed record of staff training and is to be commended for the detailed and up to date information compiled. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Homes management team treat residents with care and respect. Unfortunately poor health and safety standards and other shortfalls mean that the Home does not always fully protect people from potential harm. Evidence: The Homes manager and her deputy are clearly both professional people who are concerned and interested in the welfare of the residents of the Home. The new owners have applied for the Home to be amalgamated with an adjacent home for registration purposes, and the current management team will be responsible for managing both sites. Senior carers are used at the Home to enable the manager and deputy to work from next door. Bearing in mind the number of Health and Safety and medication shortfalls that were found during this inspection, the Home may wish to consider strengthening the day to day management presence in the Home until such matters are fully resolved. Care Homes for Older People Page 22 of 28 Evidence: The new owners are implementing a new quality assurance system for the Home . Residents confirmed that they are consulted about how the Home is run. The Home does not manage money on behalf of residents. During the inspection the Handover book was examined and found to contain notes and instructions relating to peoples individual and personal care needs. These records should only be kept in peoples individual care plans, as people have a right to know all that is written about them and omissions from care plan records could undermine effective review. The home should devise a handover system that enables effective handover without compromising consistent of recording and the privacy of residents. During the inspection some serious shortfalls were noted in relation to Health and Safety issues. In addition to those recorded in the rest of this report cleaning products were left unattended, a wheelchair was seen without footrests, used soaps and unmarked personal toiletries were left in communal bathing areas, falls are not audited to ascertain underlying patterns and trends and the Home has had a recent Health and Safety inspection following two accidents involving staff. It is essential that the Home address its practice in theses areas so that the Home is a Safe as well as a pleasant place to live and work. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 A fully up to date Statement of Purpose and Service user Guide must be completed This is so that prospective and current residents know what services the Home offers 10/06/2009 2 2 17 An up to date contract must be issued to all residents. This is so that residents know what services they are to be charged for 10/06/2009 3 7 13 All risk assessments must give staff guidance about how to reduce or prevent the risk identified This is so that the health and safety of residents is promoted. 10/04/2009 4 9 13 The medication administration system must be thoroughly reviewed and improved This is so that a safe system 10/04/2009 Care Homes for Older People Page 25 of 28 of medication administration is in place for residents to protect them from potential harm 5 19 13 The aspects of environmental health and safety identified during the inspection must be urgently addressed. This is so that residents are protected from potential harm. 6 31 9 The Registered person must 10/04/2009 consider the effectiveness of current management arrangements at the Home This is so that the Home is properly managed during the current period of change. 7 38 13 The Serious Health and Safety issues identified during this inspection must be addressed This is to ensure that people living and working at the Home enjoy a safe environment. 10/05/2009 10/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The Needs Assessment form should be expanded so that all potential aspects of peoples needs are considered before they move in, this will ensure that the Home is the right one for them. All personal information about residents should be kept Page 26 of 28 2 10 Care Homes for Older People securely and confidentially in an area that is not publicly available. 3 10 Medical treatment should be given in private unless the person concerned and other residents are consulted and are happy for this to happen. The Home should consider rationalising the different floor levels found on the ground floor so that residents can move around more safely and without assistance. The Home should implement a system of handover that does not involve records being kept in a general handover book, so that residents privacy is protected and records in care plans are consistent and complete. 4 19 5 37 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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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