Inspection on 12/10/06 for Eastleigh Care Homes, South Molton

This inspection was carried out on 12th October 2006.

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

Eastleigh Care Homes, South... 06/12/07

Eastleigh Care Homes, South... 31/01/06

Eastleigh Care Homes, South... 07/07/05

Eastleigh Care Homes, South... 06/12/04

Eastleigh Care Homes, South... 08/06/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Eastleigh Care Homes, South Molton 90-91 East Street South Molton North Devon EX36 3DF Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 12th October 2006 09.40 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 Eastleigh Care Homes, South Molton DS0000026713.V310110.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. Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eastleigh Care Homes, South Molton Address 90-91 East Street South Molton North Devon EX36 3DF 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) 01769 572646 01769 579098 Mr Garry John Wilson Mrs Elizabeth Jane Knight Care Home with nursing 56 Category(ies) of Dementia - over 65 years of age (41), Old age, registration, with number not falling within any other category (56) of places Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Notice of Proposal to Grant Registration of staffing/environmental conditions of registration issued 18/8/2000 Up to 41 service users in the category DE[E] [Dementia over 65], not requiring nursing care, can be admitted 31st January 2006 Date of last inspection Brief Description of the Service: Eastleigh offers a total of 56 residential and nursing care places, for people over retirement age. The home can offer care for up to 41 people with dementia but whose needs do not require specialist nursing staff to supervise this care. They also offer care for up to 20 residents with nursing needs of a physical nature. Most residents with personal care requirements only are accommodated in the original building, which dates back to pre-1839. Residents requiring nursing care are mostly accommodated in newer extensions. Some staff work only in one of these two areas, whilst other staff are allocated on a shift-by-shift basis to either area. The home was awarded the TCB/Pinders Healthcare Design Award in 2003. It is in the market town of South Molton, local to shops and amenities, approximately 12 miles from Barnstaple, and in easy driving distance of the countryside. It has its own minibus, suitable for wheelchair users, which is used regularly for residents outings, etc. There are garden areas at the rear of the home, and some parking space near the home’s entrance. There are plans to refurbish the ground floor of the residential wing, to provide seven en-suite rooms (including two double rooms for couples) instead of the current 12 bedrooms. Weekly fees at the time of the inspection were £280 – £650. These did not include the costs of hairdressing (£3.50 - £ 20), chiropody (£7.50), toiletries, activities and newspapers/magazines - which are charged at cost price. Inspection reports produced by the Commission for Social Care Inspection (CSCI) about the home are kept in two locations at the home. These are available to read, on request through any staff member, for prospective residents and other interested parties. Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were 55 residents at the home on the day of this unannounced inspection, 20 of who needed nursing care. The inspection was carried out over two consecutive days. Liz Knight, the manager, had returned a CSCI preinspection questionnaire. Completed CSCI surveys or comment cards were also returned from ten residents or their relatives, seven care staff, and seven community-based health or social care professional. The inspector met 23 residents, in sitting areas or their bedrooms; although some were not able to give their views because of physical or mental frailty, 15 were able to answer questions or discuss the service they received. She also spoke with three visitors and ten staff as well as the manager during 15 hours spent at the home. The inspection included ‘case-tracking’ of six residents; the group included new residents, people who needed only residential care, people who needed nursing care, people who had no or few visitors, and people who had mental health disabilities such as confusion or dementia. This involved looking into their care in more detail by checking care records and other documentation relating to these residents (medication sheets, personal monies records, etc.), seeing their private accommodation, general observation of the care they received, and talking with staff about this. A tour of the home was also made, including the kitchen and laundry. Staff files, the home’s quality assurance surveys and some records relating to health and safety – such as accident records - were seen. The inspector ended the visit by discussing her findings with the manager, provider, and two other senior staff from the home. Information gained from all these sources and from communication with the service since the last inspection is included in this report. The Commission has not received any complaints about the home since the last inspection. What the service does well: There is a high level of ‘customer satisfaction’. Positive comments from residents or their relatives included, “My wife is wonderfully looked after”, “The care is excellent”, “This is a very happy home”, “Very comfortable and pleasant home.” One said the staff and owner were “Exceptionally caring, thoughtful and loving, and have a well-equipped and provided home.” Another said the home was a very happy place…friendly, bright, clean and caring, with wonderful individual care and attention”. Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 6 Prospective residents’ needs are assessed well, helping to promote success of any admission to the home. Residents enjoy a homely, very well maintained environment that promotes the quality of their daily lives. A majority are happy with the meals provided, regarding quality and choice. There are good opportunities for social fulfilment, helped by regular contact with residents’ families, friends and the community around the home, so residents can enjoy supportive or interesting relationships and experiences. There is generally good promotion of residents’ choice and control in their lives, to uphold their rights, with respect shown for their privacy and dignity. Staff numbers and the skill mix help to ensure residents’ needs can be met, with the care team having a good basic level of knowledge and skills to ensure residents’ safety. Residents benefit from good health and personal care, partly through input from community professionals. Various strategies help to ensure the home is run in the best interests of the residents. These include that the manager has skills to ensure the home is run well, residents feel they get an appropriate response to their concerns and complaints, and there are systems that protect residents’ financial affairs. Staff suggestions about what the home did well were that the home cared for residents well and did a lot with them; that the home had a lovely atmosphere; and there was good team working. What has improved since the last inspection? What they could do better: Whilst there are systems for informing staff about residents’ care needs, more detail must be added to some care plans to prevent inconsistencies in care given and ensure all residents receive the care they need. Whilst a range of policies and practices protect residents from abuse, use of potential restraints such as lapbelts must be considered better, to ensure residents’ needs are met appropriately and their rights are fully promoted. Some additional measures should be taken regarding other health and safety matters, to further protect residents and staff. Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 7 Dining arrangements could be further developed so that all residents can enjoy good quality facilities. Whilst care is taken when recruiting new staff, obtaining all required information before employing each staff in the home would help protect residents more fully from unsuitable staff. Staff have training and support, but some residents would benefit if all staff had updating on caring for people with mental disabilities and issues relating to use of potential restraints. Staff suggestions about what the home could do better were having more ‘quality’ time with residents, increasing the size of some bedrooms (although one knew changes were already being planned), and better team working. 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. Eastleigh Care Homes, South Molton DS0000026713.V310110.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 Eastleigh Care Homes, South Molton DS0000026713.V310110.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): 3 (The home does not offer intermediate care – Standard 6). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good systems are in place to ensure prospective residents’ needs are sufficiently assessed, to promote success of any admission to the home. EVIDENCE: The majority of surveys returned by residents or their relatives said they had enough information about the home before the resident moved in, to help them decide if it was the right home for them. One would have liked clearer information about outings and religious services, but found the rest of the information comprehensive. One said Matron had visited and given them lots of details. A visitor said the information given to them before their relative moved in had proved correct after their admission. Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 10 Pre-admission information gained about residents included a comprehensive assessment of abilities and needs by senior staff from the home, with details such as when the person had last seen their GP, their interests, etc. Some families had also completed forms given to them by the home, telling staff about prospective residents’ social history, hobbies, etc. Information from hospital staff was also seen, giving very up-to-date information about the person’s needs. Staff surveys said they were not asked to care for people with needs outside of their experience, and others said they felt people were admitted to the home appropriately in terms of their needs. Eastleigh Care Homes, South Molton DS0000026713.V310110.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 – 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are adequate systems in place for informing staff about residents’ care needs, although lack of detail in some care plans may lead to inconsistencies in care and a risk that some residents may not receive all the care they need. Multidisciplinary working ensures residents receive good health care. Management of medication is good, with practices in place that promote residents’ safety. There is good promotion of residents’ privacy, with respect shown for their dignity. EVIDENCE: There was a care plan file for each resident. The senior staff member for the residential wing had carried out an audit of these and was beginning to Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 12 address issues identified. There were some excellent examples of good information to guide staff. For example, guidance about someone at high risk of falling was very detailed, so it was clear how the risk could be reduced. Social histories were well documented in most residents’ care records, to give staff a picture of the whole person. A new staff member said they referred to care plans when writing up daily notes, and read residents’ social histories so they knew what to talk to them about. However, whilst there were care plans for meeting what were considered ‘acute’ or short-term needs, care plans were not available for longer term needs (such as nutrition, mobility and dementia), and how they should be met. For example, what might cause unsettled behaviour in residents with confusion or dementia, so that these triggers might be minimised, or a change in behaviour anticipated; also, how they might be meaningfully occupied, which could increase their wellbeing and slow the progression of their mental disability. Some evaluations simply stated ‘No change’, so it would then be difficult to measure if a problem got better or worse, when the original problem was not well described. A care plan for a confused, socially isolated resident had not been reviewed for some months, until they had a fall; and without regular reviews, changing needs may not be identified. A community-based professional did not feel specialist advice was always included in residents’ care plans. It was seen in one case that a consultant’s written advice about caring for an agitated resident was in the resident’s file but not reflected fully in care plans; different staff described different strategies for helping the resident, suggesting there may have been inconsistent responses to the resident. However, a relative felt the resident had improved in the time since being seen by the consultant. Staff suggested different possible triggers for unsettled behaviour in residents with confusion, but these were not included in written care plans seen; if this information was used to inform care planning, staff might prevent restlessness occurring or care consistently for the resident if they were restless. Comment cards from residents or their relatives said the resident usually or always received care and support they needed; one added there was good cooperation between their GP and the staff – reflected in most professionals’ comment cards. Care records showed residents had input from a variety of community-based professionals - an occupational therapist where someone had had falls, a physiotherapist employed by the home, continence advisors, opticians, etc. Weights were recorded, and staff had informed the GP of one resident who had lost weight in recent months. Residents asked were satisfied with how staff gave them their medication, receiving it on time, etc. The manager said general practitioners carried out annual medication reviews for each resident, to ensure they were on medication appropriately. A self-medicating resident confirmed staff had Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 13 assessed their ability to do this, promoting their independence but with safety. Staff asked described appropriate procedures for administration and disposal of medication. Some medication issues identified at the last inspection had been addressed for example, drug fridge temperatures were monitored daily, to ensure safe storage conditions. And records were kept of medicines disposed of, so that all medication received into the home can be accounted for. Two staff usually signed records to confirm appropriate disposal, as is good practice, although sometimes only one signature was found; the manager said she would ensure in future that two staff signatures were kept. Two residents’ allergies were noted in their care notes, but not on their medication chart - unlike for other residents; some staff were aware of the allergies. Listing allergies on administration sheets helps avoid prescribing errors. Staff said they would add the details where missing. Residents said staff respected their privacy as much as possible when they were bathing, etc., and knocked before entering their room. Shared bathrooms and toilets have privacy locks. Surveys from community-based professionals confirmed residents could see them in private. A visitor noted that staff always maintained residents’ appearance. Staff were pleasant with residents during the inspection, offering assistance respectfully. A shared room had curtains between the beds for privacy, but the shared sink was one side of this curtain, so one resident could only use it in private if the other resident left their side of the room; the resident concerned confirmed this is what happened. Possibility of fitting a privacy curtain around the sink area itself was discussed with senior staff; the room was in an area to be refurbished, partly to improve private facilities. Eastleigh Care Homes, South Molton DS0000026713.V310110.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 – 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good provision for social fulfilment, with recent developments improving individual residents’ quality of life. There are good links with residents’ families, friends and the community around the home, helping to ensure residents benefit from supportive and interesting relationships. There are good practices to promote residents’ choice and control in their lives where possible, to uphold their rights. Most residents enjoy a healthy, varied diet, but catering arrangements could be further improved by addressing the adequacy of dining arrangements for frailer residents, to ensure all residents get the same service. Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 15 EVIDENCE: Residents’ surveys said there were usually or always activities arranged that they could take part in; one said they usually did not wish to take part in arranged activities. One especially enjoyed the sing-alongs, minibus outings and craft sessions. A resident said the activities were always improving. Two residents with mental disabilities had only an average of two to three social events per month (over recent months) noted on the activities sheet in their records, although frequency had increased recently. Activities more suitable for people with dementia – such as a ‘rummage box’, of familiar items – had been introduced since the last inspection. One of the senior staff said there were now some extra staff hours at weekends, for one-to-one outings or other activities. A communion service was taking place at the home the day after the inspection. One staff said they tried to sit people together, at mealtimes, who would enjoy talking to each other. A visitor said, “The staff are brilliant. I feel so comfortable and happy when I am there.” A resident said families visited, including with children. Residents said they took it in turns to go on the minibus outings, as well as staff taking them individually to the town centre – to places they used to frequent before admission. A visitor said their relative couldn’t do much for themselves but had been on coach trips, which they really enjoyed. Residents’ surveys said staff listened and acted on what they said. A resident said they were able to have a shower whenever they wished. One staff member, when asked how they promoted choices for people with dementia, said at meals they would take the resident a meal they were known to enjoy (from their social history, etc.) and if they didn’t eat it, would offer them something else. Or they would show a resident a choice of three outfits and let them select one, if the resident says, “You choose” when getting dressed. The majority of residents’ surveys said they usually or always enjoyed the meals provided, reflected by most of those spoken with. Comments about the food included, “Excellent”, a visitor saying the meals were “first class”. A resident with diabetes said, “Staff make sure I eat the right things. Their kitchen is excellent.” Information about residents’ special dietary needs and preferences was seen in the kitchen. A resident said the food had improved since they made a complaint about it. Another said staff always fetched something else if the resident didn’t like what they were brought. Hot drinks and home-made cakes were taken on bus trips, for residents to enjoy while out - as arranged during the inspection – with a choice of three types of homemade cake offered at mid-afternoon tea. One respondent enjoyed breakfasts because there was a good choice, but felt other meals were of “poor quality”; one person spoken with was not positive Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 16 about the food, but said they were currently discussing this with staff. One said service at mealtimes was very noisy; staff said this might be the case occasionally, depending on whether any residents were unsettled during the meal. Of areas being used for dining at lunchtime, it was noted that two particularly accommodated residents who needed help to eat. These had different facilities to areas used by more independent residents – tables weren’t set with mats, cutlery, etc. Provision of equal facilities was discussed with senior staff. Eastleigh Care Homes, South Molton DS0000026713.V310110.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good relationships between residents and staff are such as to ensure that residents feel they get an appropriate response to their concerns and complaints. There is an adequate range of safeguarding policies and practices in use, to try to residents from abuse. However, one improvement is needed to fully protect residents’ rights. EVIDENCE: A resident commented, “When problems arise, they do listen and deal with them.” Surveys said most residents knew whom they could speak to if not happy or how to make a complaint, with three adding they had not needed to make any complaints. Those spoken with felt able to complain to care staff, senior staff or the owner – and that appropriate action would be taken. One said, “You just ask – there’s no problem. And I’m a paying guest - if we don’t like it, we complain”. Complaint forms were available in a corridor display on the residential wing, for anyone to use. The home’s complaint record had one recorded, which was not upheld. The Commission has not received any complaints about the home since the last inspection, and none were voiced during the inspection. A community-based professional said they had had Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 18 some issues with the home, but these had been resolved after talking with staff about the problem. The majority of staff surveys said respondents were aware of adult protection procedures. Those spoken with either knew procedures or said they would refer to information available to them if wanting to report a concern. Training records showed half of the staff had had recent updates; one who had not knew what constituted abusive practice (including using force or control, and not giving choice), and was clear about who they could contact to report concerns. A new staff said abuse awareness was part of their induction programme, and was aware of action to take about any concerns. Records did not show multidisciplinary review and decision-making before potential restraints such as lapbelts or bedrails were used. Senior staff were asked to address this urgently, especially regarding a confused resident who had a lapbelt put on whenever they were seated - intended to stop the resident getting up unaided and falling over. Three staff asked were not aware that there were risks associated with use of lapbelts. The resident’s care records indicated they had not had a recent review by mental health specialists such as a psychiatric nurse, and had had few positive social experiences in recent months (recreational activities, etc.). Thus it was not clear that the reasons why the resident might try to stand up had been fully considered, which might suggest different strategies for ensuring their safety. Eastleigh Care Homes, South Molton DS0000026713.V310110.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. Residents enjoy a good, homely, well-maintained environment that promotes the quality of their daily lives. EVIDENCE: Bedrooms were personalised with residents’ own possessions. Shared bathrooms and toilets were decorated to the same standard as the rest of the home, with use of various colours around the home making the environment very homely. Grab rails, raised toilet seats and specialist baths were seen, to assist people with disabilities to use the facilities. Some bedrooms in the residential area of the home are relatively small, as raised by one resident and one staff member. The owner is considering how this area can best be redeveloped to increase room sizes. A ‘minor repairs’ list – including nightEastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 20 lights and automatic-release holders for fire doors - showed repairs had been done up-to-date; residents confirmed repairs were done promptly, even at weekends by the owner. All surveys from residents said the home was always fresh and clean, as seen during the inspection. One resident said they especially liked “The many vases of fresh flowers around the home.” Wheelchairs were clean, attended to regularly according to a cleaning rota seen. Staff used plate covers when taking meals to residents around the home. Disposable gloves and aprons were readily available, with staff describing other measures also used to reduce cross-infection. Washing machines had recommended programmes for thorough cleaning of laundry. Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 21 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 – 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers, the skill mix and basic level of knowledge and skills are good, helping to ensure residents’ needs can be met safely. Recruitment practices are adequate, although all required information must be obtained before employing staff in the home, to help ensure residents are protected from unsuitable staff. The adequacy of the comprehensive training and support available for staff would be improved by further training on dementia and on matters relating to potential restraints, to ensure all residents’ needs are met appropriately. EVIDENCE: Comments from residents or relatives included, “Very friendly staff”, “They are very caring”. Their surveys said staff were always or usually available when needed, one commenting there are lots of staff. A resident said they couldn’t fault the staff, adding they used their call bell a lot so were always calling on them. Another said there were quite a lot of staff around, that night staff checked them on regularly, and that call bells were answered quickly. Staff generally felt staffing levels were adequate. They were occupied throughout the inspection, but with time to respond to residents and visitors in Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 22 an unhurried manner. Rotas showed one nurse with ten carers in mornings, one nurse with a minimum of six carers the rest of the day, one nurse with three carers overnight usually - throughout the whole home, but working in two teams, looking after 56 residents. One carer said the adequacy of staffing varied, because occasionally a confused resident might need someone to sit with them, and the time this required could not be anticipated; it was positive to hear that staff considered spending time with residents in this way. Care staff were supported by housekeeping staff, kitchen staff and a part-time activities staff. A poorly-sighted resident said staff were mindful of their disability, with regard to minimising what might be hazards around them. A visitor said staff always greeted them and knew where the resident was that they’d come to visit. Rotas confirmed there is always a nurse on duty, to supervise care of those needing nursing care. Nearly half of the care assistants have a recognised care qualification, providing a care team with a good basic level of skill. Staff surveys indicated appropriate recruitment procedures were used, and four staff files seen generally contained required information, to help ensure residents were protected from unsuitable staff. No references were available for one staff recruited through an agency – evidence was seen that these had been requested. And there was lack of clarity as to whether initial police checks (‘POVAFirst’ checks) were obtained before staff started work at the home. The owner was sure they had been obtained before care shifts were worked, and will ensure there is clearer evidence that required procedures have been followed, regarding police checks. Residents asked said staff knew their needs and what help they needed. Training records showed that half of the care staff had attended updates on wound care and on dementia care, with a third attending a session on ‘valuing difference’. Induction programmes seen were comprehensive, including confidentiality and personal care; a new staff member added their induction included dementia care, sensory impairments, health and safety, and residents’ rights. Staff had found the recent training on dementia care very interesting and useful; one carer felt more would be beneficial for all staff. Staff recognised how dementia affected some of their residents (-affecting their usual ability to eat, for example). But one staff, asked how the social needs of residents with dementia were met, said activities staff were responsible for this – whereas it is good practice if all staff play a part, especially when caring for people with dementia. Regular supervision sessions have begun, so all staff will have been seen at least once by the end of the year. Issues relating to use of potential restraint (see Standard 8 & 18) suggest some staff would benefit from more knowledge about this aspect of their roles. Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has a good level of knowledge, skills and experience, which ensures the home is generally run well. There are good strategies in place to help ensure the home is adequately run in the best interests of the residents. Good practices used by the home protect residents’ financial affairs. There is adequate attention to health and safety matters, but additional measures should be taken to further protect all at the home. Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager was registered with the Commission earlier this year, and is undertaking a course relevant to her position, to develop her managerial skills. She has also attended updating in topics relevant to residents’ needs (dementia care and wound care), as well a training day on safeguarding vulnerable adults. A quality of care survey was distributed by the home in January 2006. A relative of a resident admitted since then said they had completed one recently. Records showed that action has been taken to address issues raised by individuals, but an overall analysis is still to be compiled and shared with residents. A resident said there was no need to wait for the next residents’ meeting to discuss any issues, but that problems were dealt with between meetings. Requirements from the last inspection have been addressed. The home is not appointee for any residents, leaving residents free to choose who assists them with their financial affairs. Personal monies are held by the home for some residents who have requested this be done, although lockable facilities are provided in bedrooms; the home gives receipts for money deposited. Records of individual accounts are computerised, with printouts given to the resident or their next-of-kin regularly, for their perusal. Auditing of individual accounts was not possible in the time available during the inspection (receipts were held by various staff, and cash balances were all kept together, so could not easily be verified against individuals’ records). Two signatures were not always obtained to verify transactions, but staff said this could be rectified to strengthen systems. The owner said accounts had been audited by another administrator, to try to ensure procedures safeguarded residents’ interests. Accident records were well completed, and GPs are notified. Auditing of these was discussed with the manager, it being noted that relatively more accidents were reported by one area of the home than the other. Kitchen staff on duty were aware of new food legislation; implementation was still to be addressed fully. Upper windows checked had restrictors in place, to prevent falls from open windows. Several radiators - including in bedrooms - did not have low temperature surfaces or radiator guards, to reduce risks of burns should someone fall against one; one in a relatively small bedroom (- thus increased risk of contact should someone fall) felt very hot. The owner confirmed all radiators have been risk-assessed, and guards fitted where found necessary. A wedge was holding one resident’s door open, whilst the resident was in the room, which would affect the resident’s safety in the event of fire; automatic door holders were used elsewhere. The fire log showed fire equipment had been tested at recommended intervals. Fire safety training sessions have taken place since the last inspection, with the owner and manager confirming all staff have now had a recent update. Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(1) Timescale for action Unless it is impracticable to carry 31/01/07 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. This is regarding preparing care plans for longer term needs. The registered person shall maintain in respect of each service user: (p) A record of any physical restraint used on the service user. This should include time limits, & evidence regular review, with multidisciplinary input, so as to avoid risks to residents’ physical & mental health & welfare. 30/11/06 Requirement 2 OP18 17(1)(a) Sched.3 (p) Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 27 3 OP18 13(7) The registered person shall ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. This is regarding evidencing there is appropriate multidisciplinary review of residents’ needs with multidisciplinary decision-making prior to use of potential restraints, to ensure residents’ rights are upheld & they receive the most appropriate care. (1) The registered person shall not employ a person to work at the care home unless (a) the person is fit to work at the care home; (b) subject to paragraphs (6), (8) and (9), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2; (c) he is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person. 30/11/06 4 OP29 19 30/11/06 Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP15 OP30 Good Practice Recommendations It is recommended that dining arrangements be further developed so that all residents have an equal opportunity to enjoy the quality facilities currently provided to some. It is recommended that all staff have ongoing training on dementia care & on residents’ freedom of choice, liberty of movement and power to make decisions, with particular regard to decision-making about the use of potential restraints. It is recommended that a) Appropriate covers be fitted to all radiators & other hot surfaces, to eliminate the risk of burns; b) All fire doors are held open by devices appropriate to fire safety, to safeguard the room occupant in the event of fire. 3. OP38 Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Devon Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Eastleigh Care Homes, South Molton DS0000026713.V310110.R01.S.doc Version 5.2 Page 30 - 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!