CARE HOMES FOR OLDER PEOPLE
Eastleigh Care Home 90-91 East Street South Molton North Devon EX36 3DF Lead Inspector
Rachel Fleet Announced 07 July 2005 10:00hrs 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 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 Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Eastleigh Care Home Address 90-91 East Street South Molton North Devon EX36 3DF 01769 572646 01769 579098 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Garry John Wilson Pauline Margaret Alford Care Home 56 Category(ies) of OP Old age (56) registration, with number of places Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Notice of Proposal to Grant Registration of staffing/environmental conditions of registration issued 18/8/2000 2 Authorised Person in Charge Mrs Pauline Alford RGN 3 The home is allowed to admit one named person, aged under 65 4 The maximum number of placements including that of the named service user will remain at 41. 5 On the termination of the placement of the named service user, the registered person will notify the Commission and the particulars and conditions of this registration will revert to those held on the 1st October 2003 Date of last inspection 6 December 2004 Brief Description of the Service: Eastleigh offers a total of 56 residential and nursing care places, providing some hotel style services with high quality care. The Home was awarded the TCB/Pinders Healthcare Design Award in 2003. The original building, dating back to pre 1839, accommodates service users with residential requirements. Extensions were added in 1999 and in 2000, accommodating up to 23 services users with nursing requirements. There are plans to refurbish the ground floor of the residential wing, to provide seven en-suite rooms (including 2 double rooms for couples) instead of the current occupancy of 12. The Home is situated 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. Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. There were 54 residents at the Home on the day of this inspection, almost half of who needed nursing care. Two inspectors visited for just over seven hours. This time was spent with 27 residents (some individually, some in groups), a visiting relative, four members of care staff, one member of domestic staff and the Training Officer, as well as looking at certain records and looking at the environment. The inspection ended with discussion of findings with senior staff and the Provider. Residents’ comments included ‘I can’t recommend the place enough’, and ‘I would recommend it to anybody’. What the service does well: What has improved since the last inspection?
Information for prospective residents now includes the waiting list fee. Care plans and other care documents can be stored securely. Records of drugs received into the home are kept; medicines requiring refrigeration are stored safely and securely; hand transcribing of medication and dosages is done appropriately, as is administration of medication. Advice has been sought and action subsequently taken to ensure safe practices, with regard to lack of handwashing facilities in the sluices. Induction and supervision for new staff is now in line with the regulations.
Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 6 The results of the Home’s latest six monthly Quality of Care survey are available. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3 Systems for assessment of needs and for providing information ensure that residents’ needs and preferences can be met, and that they can make fully informed choices about whether to live at the Home or not. EVIDENCE: Newly admitted residents said they met the manager prior to being admitted and understood that this was an information-sharing exercise. They said they were given useful information about the home and felt they could make an informed choice. Such information was very comprehensive, well presented, and now included the waiting list fee. Care plans show that comprehensive assessments are undertaken and that residents can be sure the home can meet their needs. Staff talked of how assessments take place in the setting from which the resident is coming, whether this is home or hospital. There was evidence that the manager travels some distances to ensure that assessments are undertaken face to face where possible.
Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 There is a clear care planning system in place. However, a lack of consistency in recording means that some residents’ needs may not always be met. The health needs of residents are well met, with evidence of good multidisciplinary working taking place. The systems for managing medications are compromised by one area of poor practice. Personal support is offered in such a way as to promote and protect residents’ privacy, dignity and independence. EVIDENCE: Residents said that they receive the care they want and need, and staff demonstrated an excellent knowledge of individual needs and preferences. Staff continue to work hard to improve care planning, and some good examples of detailed evaluations were seen. However, not all care plans contain the level of information required to ensure that consistent quality care is always given (- regarding residents with needs related to dementia, for example). Social histories were not seen in some.
Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 10 Many residents talked of how they and their health had improved since living at Eastleigh. For example, one resident said their niece said they had never looked better, one resident is putting on weight, and one resident’s mobility has improved so that they are able to walk short distances. Care plans showed that appropriate referrals to health specialists are made and that staff seek advice. On the day of inspection, the district nurse was visiting in response to an urgent referral made by staff. Residents said they always got their medication on time. Staff demonstrated a sound understanding of the medications in use and of the systems of management that should be in place. Ordering and receipt of new medication supplies is a shared responsibility, which is good practice. However, one box of some ‘prescription only’ medications is used for all residents who are prescribed this medication. This goes against good practice guidelines issued by the Royal Pharmaceutical Society. Since the last inspection, improvements have been made to ensure that medicines requiring refrigeration are stored safely and securely. Residents said staff always treated them with respect and as individuals. Residents looked comfortable in the presence of staff, who were cared them respectfully and with dignity: sensitive and discreet examples of how staff maintain privacy and dignity were seen throughout the inspection. Shared rooms are divided by curtains, and some single rooms have privacy curtains around the basin area where there is no en suite facility. Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Links with the local community and the range of activities on offer support and enrich residents’ social opportunities. The meals in the home are good, offering both choice and variety. EVIDENCE: Residents talked of the many activities they enjoy at Eastleigh. They go out in the homes minibus for picnics, for drives, for coffee and for visits to local attractions. Residents are invited to take part in activities such as bingo, word search and music sessions. Although residents said they have plenty to do, the owner feels that outings have decreased due to a lack of time. Residents have made friendships within the home, and visit other residents, able to use the many communal seating areas around the home if they wish. Residents go out, or are taken out by staff, into South Molton, with Thursday being a popular day when the local market is open. Each resident has a ‘special time’ when staff support residents to do something that the resident wants to do. All residents said that the food is good and that there is plenty of variety. A cook and a kitchen assistant are on duty daily. If residents don’t wish to choose from the given options, the cook is always willing to find an alternative. Food is well presented, and sensitive help is given to those who need it. Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Systems for listening to residents’ views and complaints are good. And residents are protected by the Home’s polices and procedures on the protection of vulnerable adults. Recording time limits in plans for use of equipment such as wheelchair lapbelts or bedrails would strengthen existing practices, further safeguarding residents’ welfare. EVIDENCE: Residents said they had no complaints about the home or the staff. One resident said ‘They have meetings which we can go to and make complaints, but I never go because I don’t have any complaints’. Another said that any grumbles are dealt with very quickly, and that staff, the owner and manager are always responsive. One staff said they would offer a Complaint form to anyone voicing a complaint and report the matter to a senior staff. CSCI has not received any complaints about the Home. Staff were observed being open to suggestions and comments, and quick to act positively. They demonstrated a good knowledge of issues relating to the abuse of vulnerable adults and were clear about the procedure which should be followed if an allegation is made. Training on protection of vulnerable adults is considered mandatory training for any employee at the Home. Risk assessments were completed for potentially restraining equipment such as wheelchair lap belts and bedrails. Such equipment was not in common use, but two risk assessments seen did not include how long these could be used without releasing them, as would be good practice. Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The standard of the environment within this home is very good providing residents with an attractive, clean, safe and homely place to live. EVIDENCE: Eastleigh is well maintained throughout. Residents were happy with their own accommodation, including attention to cleanliness. All areas are bright, and many areas have large displays of flowers. Residents say it is always like this, and describe it as ‘lovely’ and ‘very comfortable’. The redecoration programme is continuous. There are at least two cleaners on duty everyday. Procedures for dealing with soiled linen is good and well understood and followed by staff. Residents say their clothes are always well cared for. The laundry area was orderly, and had machines with programmes recommended for disinfection of washing. Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 There are sufficient staff, with an appropriate variety of skills, to meet residents’ needs. Recruitment procedures are not robust enough, potentially leaving residents at risk. EVIDENCE: Residents said staff came sufficiently quickly if they rang their call bell, and felt there were usually enough staff on duty. Senior staff said there were on the day of the inspection– for 54 residents - twelve care staff on duty at the Home during the morning, eight in the afternoon/evening, four staff overnight, including one nurse on duty at all times. Ancillary staff supported them during the day. Three staff files were inspected. All had proof of identity, a photograph and references. Two contained evidence that Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks had been undertaken. However, one staff had started work before completion of a CRB or POVA check. One staff confirmed new staff followed a written induction programme. The Training policy has been updated since the last inspection, to take into account new regulations relating to induction and supervision. The care staff’s training programme is comprehensive (including bereavement, skin care, self esteem, epilepsy). Link nurses take responsibility for developing aspects of care (related to diabetes, for example). Staff confirmed they had plenty of training opportunities, as well as undertaking NVQs in Care, and sometimes accompanied visiting health care professionals to learn from them about meeting residents’ needs. Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 37 & 38 Systems for obtaining residents’ views are good. Sharing action plans based on results of care surveys would show further how the Home is run in the residents’ best interests. Residents’ monies, possessions and personal information are protected by good systems of management and practices. Satisfactory systems are in place to ensure safe working practices and promote the safety and health of residents. However, all staff must receive fire safety training at intervals recommended by the local fire authority, to ensure all is done to protect residents’ wellbeing. EVIDENCE: Residents felt able to speak freely with staff. Results of a recent quality assurance survey were available in the entrance hall; residents and relatives/friends had been consulted. Inclusion of an action plan would further strengthen the Home’s Quality Assurance systems.
Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 16 The system for managing residents’ monies is safe and secure. It is easily auditable, and residents said the system is easy to use and suits them. Copies of the accounts are given to residents (or their representative) regularly. Storage of residents’ personal information has been made more secure since the last inspection, staff also showing awareness of the need for this. Residents and staff did not have concerns about their environment. Safe working practices, maintenance and checking systems are in operation and are sound. Records of fire checks and controls are satisfactory, but one staff’s file showed they had not had fire safety training for over 6 months. Checks for asbestos on the premises have been carried out. There is even a back-up generator should power cuts occur. Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x 3 x 3 2 Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 18 NO Are there any outstanding requirements from the last inspection? 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 29 Regulation 19(1)(b) Sched. 2. Timescale for action You must not employ a person to 31 07 05 work at the care home unless you have obtained the information & documents specified in Schedule 2. This is especially regarding awaited CRB disclosures and use of POVAFirst checks, as indicated in Department of Health POVA guidance issued 26 July 2004 (Paras.37-46, pg.13-15) You must, after consultation with 31 07 05 the local fire authority, make arrangements for persons working at the Home to receive suitable training in fire prevention. This is with regard to ensuring all staff receive fire safety training at recommended intervals. Requirement 2. 38 23(4)(d) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations You should ensure all health, personal & social care needs
D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 19 Eastleigh Care Home 2. 9 3. 4. 18 33 are included in each residents plan of care, based on comprehensive assessment (including social histories, for example), with detail of action to be taken to meet those needs. This was especially with regard to residents with dementia. You should ensure residents receive medication from their own prescribed supply, rather than a shared source, unless done so in compliance with Royal Pharmaceutical guidelines. You should include time limits, or related information, for use of potentially restraining equipment (such as wheelchair lap belts and bedrails) in risk assessments. You should include action plans with results of Quality of Care surveys made available to residents & CSCI. Eastleigh Care Home D54 D06_s26713_eastleigh_v228498 stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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