Inspection on 15/09/08 for Eastholme Nursing Home

This inspection was carried out on 15th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Eastholme Nursing Home 24/09/07

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Eastholme Nursing Home 74 - 75 South Park Lincoln Lincolnshire LN5 8ES     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: Elisabeth Pinder     Date: 1 5 0 9 2 0 0 8 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. the things that people have said are important to them: They reflect 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 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Eastholme Nursing Home 74 - 75 South Park Lincoln Lincolnshire LN5 8ES 01522 521956 01522 537371 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Mr Kanagasooriam Ravivaruman care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: People whose needs come within the category PD will be accommodated as single occupants in any one of the following identified bedrooms :- 1, 2, 7, 9, 12a, 14, 15, 16, 17 and 18 The maximum number of people who can be accommodated is 24 The registered person may provide the following category of service only: Care home with Nursing - Code N to people 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 Physical Disability - Code PD of the following age range: over 55 years - Maximum number of places 4 0 4 Over 65 24 0 Date of last inspection Brief description of the care home Eastholme Care Home is a large, detached, three-storey, Victorian building with a ground floor, purpose built extension. It is situated in a cul-de-sac in a residential area Care Homes for Older People Page 4 of 26 to the south of the city of Lincoln, overlooking the common. It is one of three homes in Lincolnshire owned by Mr. Ravivaruman. The accommodation has been substantially altered and refurbished to provide improved standards with some rooms now providing en-suite facilities. First floor rooms are accessible via stairs or a shaft lift. There is a small garden area to the rear of the property with car parking space and there is also car parking opposite the home next to the common. It is registered to provide personal and nursing care for a total of twenty-four people of both sexes over 65 years of age, up to four who may have a physical disability and who are aged over 55 years of age. Care Homes for Older People Page 5 of 26 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: The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms ‘we’ and ‘us’ refer to The Commission for Social Care Inspection (CSCI). The visit lasted approximately six hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Care Homes for Older People Page 6 of 26 The Commission are trying to improve the way that we engage with people who use services so that we gain a real understanding of their views and experiences of social care services. During this inspection we used a method of working where an ‘Expert by Experience’ visited the home as part of the inspection. An ‘Expert by Experience’ is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert met and talked to several people living at the home. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. However, the information in this document was brief and did not tell us all we needed to know about the service. We sent out surveys to people before we visited the service but to date none of these have been returned to us. The main method used to carry out the inspection is called ‘case tracking’, this includes following the care of a sample of four people through their records and assessing their care. We spoke to four people who use the service and saw rooms of those people who said we could and to one staff member. The ‘acting’ manager was present throughout the visit and the general outcomes of the visit were discussed with her. The current fees range from £398.00 - £540.80 per week, additional charges are made for chiropody, hairdressing, newspapers and personal toiletries. What the care home does well: What has improved since the last inspection? What they could do better: 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 8 of 26 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 9 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming into this service have access to information to help them make a decision about moving into the home and procedures are in place to ensure people are only admitted after a full needs assessment has been carried out. Evidence: Information about the home is available in the statement of purpose and service users’ guide, these tell people about the service and each person has a service user guide in their room. Both documents have been updated to include the changes in management and the change in address for reporting complaints to us. However, they do not tell people how to access our reports or include full details regarding fees. The service user guide is only available in a witten format and a discussion was held regarding this document being made available in different formats for example, audio, Care Homes for Older People Page 10 of 26 for people with sight disabilities and the acting manager agreed to look into this. Records of two people admitted since the previous inspection showed that a full needs assessment had been carried out prior to their admission. Generally, people said they were happy living in the home, one person told us ‘I love living here, I like to look at the open fields out of the window. Care Homes for Older People Page 11 of 26 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. Care plans do not detail how people are able to make choices and decisions about their daily life and there is a lack of information to show that peoples’ capacity to make decisions has been considered which has the potential to deprive people of their rights. Medication policies and procedures are detailed and safe procedures are being followed for the administration, recording and storage of medicines. Evidence: Three peoples’ records were checked and these gave clear information to enable staff to know about their individual needs and how to meet them. However, generic care plans are being used, peoples names are written into care plan templates which detail the same information for everyone and are not person centered. Care Homes for Older People Page 12 of 26 Care plans detail medical profiles including allergies and risks and each person has a record of activities of daily living. However, more detail needs to be included, for example, the religion of a person is recorded but no details are written as to whether they wish to practice and the action needed to ensure this would be met. No information was recorded as to the wishes of people concerning terminal care and arrangements after death. Risk assessments have been written where risks have been identified and these show peoples’ agreement. Regular care plan reviews are carried out and residents have signed them where able. There was no reference to whether peoples’ capacity to make decisions has been considered when drawing up care plans, this is important in view of recent legislation which came into force in October 2007. The member of staff spoken to had no knowledge of the Mental Capacity Act, although had a good knowledge of the needs of the people currently using the service. The acting manager told us that she has just received training and has a copy of the Mental Capacity Act code of Practice, but to date staff have not received training. Information provided prior to the visit told us that there is currently only one male staff working in the home and care plans looked at did not show that people are given the choice as to whether they wish to have a male or female caring for them and the acting manager is asked to address this. There is a ‘key worker’ system giving staff some responsibilities for specific people who use the service, however, people spoken to did not know who their key worker was. People told us they are able to make their own decsions regarding what time to get up/go to bed and felt their current needs were being met. They said they were really happy living here and they feel well cared for. Care Homes for Older People Page 13 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported to have control of their daily lives within their capabilities. Activity arrangements are limited and may not always meet individual recreational interests and wishes of people who use the service. The meals provided are well balanced and cater for peoples’ individual preferences and specific dietary needs. Evidence: Comments from people who use the service and observation during the visit showed that people have limited opportunity to participate in activities. The activity coordinator who commenced employment in July of this year was not on duty, however, the acting manager told us that she is currently planning activities. Records showed that these have focused on general activities such as painting, drawing, bingo and dominoes and the individual needs of people have not been considered. The Expert by Experience reported that people seemed to be sitting around with nothing to do. People told her they were happy, one person said they were able to go out shopping Care Homes for Older People Page 14 of 26 and others said they get taken to hospital for appointments. There was no mention of religious activities, for example visiting clergy or church attendance. One person uses a mobility scooter and regularly goes out in the local area. People said they were able to keep in touch with family and friends and have visitors and this was evident throughout our visit. One person told us they couldnt improve on what I have. People told us that the food is ‘very good’ and menus looked at showed that a varied nutritious diet is offered and people are able to choose each day what they want. The menu of the day was displayed and showed a choice of main dish. One person told us they have a vegetarian diet and staff know what they can eat and their preferences. Tables were nicely laid with cloths, napkins and condiments. The cook was not on duty and catering was being carried out by one of the domestic staff, however, this person was wearing a lot of jewellery and this was brought to the attention of the acting manager who agreed to discuss this with the provider. The Expert by Experience reported that when she enquired about the menu for the day she was informed the choice was fish or pork casserole, most people opted for fish, however, she noticed one person with sausages. One person said they loved teacakes and were very happy when they received one with their tea. Care Homes for Older People Page 15 of 26 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 using this service are protected by the procedures in place for handling complaints and allegations of abuse. Evidence: Information in the AQAA tells us that the home has an in-depth policy in place. This was seen during the visit and is included in the service user guide. People living in the home told us they know how to make a complaint or raise a concern if they need to and they feel safe living here. They feel staff listen to what they have to say and take any necessary action. Other policies and procedures are in place, for example, whistle blowing and safeguarding adults and staff spoken to had a good knowledge of abuse. They knew what to do should they need to report an allegation and confirmed that they had received training. Records show that two complaints made about the home since the last inspection had both been referred to the safeguarding adults team and have subsequently been investigated by social services. Care Homes for Older People Page 16 of 26 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 good 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 safe and comfortable home, which meets their needs. Evidence: People said they found their rooms to be comfortable and were able to arrange them to their liking and make them more personal with items of their own choice and this was evident in the three rooms looked at. Some windows on the first floor opened very wide and this was brought to the attention of the acting manager who immediately asked the handyman to secure them to a safe opening. Information provided in the AQAA told us that within the last twelve months refurbishement has continued and bedrooms are being redecorated and refitted as they become vacant. The service was visited by the Environmental Health Officer in August 08 and no recommendations were made. Staff told us they feel they work in a safe environment and protective aprons and gloves are always available to use when needed. Care Homes for Older People Page 17 of 26 Care Homes for Older People Page 18 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers are in sufficient quantity for them to be able to care for people currently living in this home, however, they must be regualrly reviewed to ensure peoples needs are being met. There is a lack of induction training which has the potential to put people at risk. Evidence: There are currently fifteen people living in the home and three members of staff are on duty between the hours of 07:30 and 20:30, two carers and one qualified member of staff. The acting manager works three shifts each week as a qualified nurse and she told us she finds it difficult to fulfill her management responsibilities due to the lack of specific management time. There are two wakeful night staff. Within the last twelve months there has been a large turnover of staff with fourteen staff leaving their employment. The acting manager told us that these members of staff left before her employment in May 08 and she was unaware of the reasons. The records of two people who have commenced employment since the last inspection were looked at and these showed that they had been recruited using safe, robust Care Homes for Older People Page 19 of 26 procedures. New staff are given copies of the General Social Care Council Code of Practice, setting out their responsibilties as care workers looking after vulnerable adults when they sign their contracts of employment. Currently eight people living in the home need two members of staff to hoist them and staff spoken to said they were often very busy but felt there are normally enough staff on duty to meet needs. Comments from people living in the home about the staff were all positive, they told us the staff are excellent and very kind and caring. Staff were seen to be polite and respectful when speaking to residents and although they were observed to be very busy in the morning they were seen to have time to sit and chat to people in the afternoon. The Expert by Experience reported that in her opinion when she arrived staff seemed to be unaware of where or what they should be doing, there were only two main staff for the residents, another member of staff came over from another of the providers homes. Their report reads this person was very good but had little knowledge on residents whereabouts, for example room numbers. The Expert by Experience, said she asked twice to see some bedrooms and was only able to see two. Staff spoken to said, and training records confirmed, they had partipated in training such as basic food hygiene, manual handling, health and safety, safeguarding adults and fire training. Records also showed that over 40 of staff have achieved or are undertaking a nationally recognised vocational award in care. Although the service has registered with Skills for Care Council for induction training, it has been registered in the name of a previous acting manager and induction training packs are not being sent to the home for new staff to complete. The records of two new staff members showed that their induction has been to shadow an existing worker for a couple of shifts before commencement and this was raised with the acting manager who agreed to discuss this with the provider and ensure new workers complete an approriate induction programme. One new carer on duty did not have a designated staff member to supervise her and we were told it would be the senior on duty that day. Care Homes for Older People Page 20 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service is being well managed and there are opportunities to ensure peoples’ views about the service are sought in order to monitor and develop the quality of the care provided. Evidence: Since the previous inspection a new manager has been appointed and she is in the process of applying to be registered with us. She is a registered nurse and as previously highlighted works three shifts each week as a nurse. This is having an impact on her responsibilities as a manager and her tasks regarding record Care Homes for Older People Page 21 of 26 management. For example, quality audit questionnaires were sent to residents and their relatives at the beginning of August and although they have been returned she has not had time to collate these and write a report. Staff told us they find the acting manager to be approachable, available and she will listen to their opinions, and offer support to do their job. One member of staff spoken to confirmed she had regular supervision and appraisal with the acting manager. Minutes of resident and relative meetings were seen the last meeting was held on 28/08/08 and focused on activities. The last staff meeting was held on 24/06/08 and covered general topics. Although quality assurance questionnaires have been sent to residents and relatives a discussion was held regarding sending these to other stakeholders including district nurses, social workers General Pratitioners and chirpodist. The service uses the Department of Health guide ‘Essential Steps’ to access the current infection control management and health and safety policies are in place. Records showed that fire equipment checks and fire tests are carried out regularly and information received prior to the visit told us that equipment and appliances are regularly serviced. Accident/incident records are in place and we are informed of any incidents that require reporting. Up to date and accurate records are kept of residents’ finances. Records of visits made to the service on behalf of the provider were seen, the last visit being undertaken on 17/07/08. Care Homes for Older People Page 22 of 26 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 23 of 26 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 7 15 Care plans must be person centred, written in more detail and take into consideration the Mental Capacity Act 2007. To ensure peoples needs are met. 16/10/2009 2 12 16 Appropriate activities and leisure opportunities for residents must be provided. To meet individual needs. 16/10/2008 3 15 16 Staff preparing and cooking food must ensure satisfactory standards of hygiene are maintained in the kitchen. This will ensure unnecessary risks to the health or safetly of residents is so far as possible eliminated. 30/09/2008 4 30 18 All new staff must complete approriate induction training. 21/10/2008 Care Homes for Older People Page 24 of 26 To ensure they have the knowledge and skills to carry out their role. 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 10 1 The statement of purpose and service user guide should include details of fees and any additional costs for the service and also tell people how to access our reports. Care records should include the persons wishes concerning terminal care and arrangements after death. Regular reviews of staffing numbers should be carried out to ensure peoples needs are being met. A designated member of staff who is appropriately qualified and experienced should be appointed to supervise a new worker during their induction. Where possible this person should be on duty at the same time as the new worker. Results of any quality monitoring surveys should be collated and a report written detailing how the quality of care provided can be improved 11 12 13 7 27 28 14 33 Care Homes for Older People Page 25 of 26 Helpline: 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 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 © (2008) 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 26 of 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!