CARE HOMES FOR OLDER PEOPLE
Eastwood House Care Home 24 Church Street Eastwood Nottingham NG16 3HS Lead Inspector
Mary O`Loughlin Unannounced Inspection 31st May 2006 10:00 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 Eastwood House Care Home DS0000031673.V288276.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. Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Eastwood House Care Home Address 24 Church Street Eastwood Nottingham NG16 3HS 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) 01773 712003 01773 530386 Forthmeadow Ltd Manager post vacant Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The person accommodated under the age of 65 is a named individual Date of last inspection 04/04/06 Brief Description of the Service: Eastwood House provides care for up to 14 men and women over 65 years, with the exception of one named person under 65years. The entrance is accessible for wheelchairs. The accommodation is on two floors and there is a passenger lift. There are twelve single bedrooms, four of which have an ensuite facility and there is one double bedroom. There is a bathroom on each floor and toilet facilities are within easy access of the communal and private accommodation. There are car-parking facilities and a garden area with benches. The home is situated close to the facilities and amenities that Eastwood has to offer including a wide range of shops, public houses, a library and market place, churches and a community centre. The range of fees are: £309.00 to £379.00 Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was undertaken unannounced over 5hrs. Information was used from the last Random Visit to the service in April 2006. Key National Minimum Standards were assessed and this included the progress in meeting the requirements set at the random visit. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and tracking the care they receive through checking their records and discussion with them, in one case a relative was interviewed. Information was provided by the Environmental Health Officer following a visit to the home in April 2006 to examine the progress in meeting the requirements set by this department. The Environmental Health Report indicates compliance with the requirements made. The registered Provider of the home is currently submitting an application to vary the home’s registration to accommodate people with Dementia. Parts of the standards assessed include information that may be useful when considering this application. The home has been without a registered manager since 2005 and there has been some noticeable deterioration in the record keeping and environmental improvements. The Commission has confirmed at this visit the achievement in some areas of improvement, however there are some areas that require urgent attention to ensure the home is a safe and appropriate environment for the residents it accommodates. Five residents spoken with all said they were happy at the home and felt safe. What the service does well:
The care staff have been working at the home for long periods and are familiar with the residents and the aims and objectives of the home. Medicine administration is safely managed.
Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 6 Residents have opportunities to be involved in activities when they choose and they are encouraged to maintain their independence as long as possible. There is good support for residents to maintain their mobility and staff encourage them sensitively and safely. What has improved since the last inspection? What they could do better:
The registered person must ensure that when care plans are reviewed that residents or their representatives are involved in that review as far as possible, the plan should be agreed and signed by them and any changes to the residents condition must be included within the care plan. This will ensure that staff are aware of how problems are to be addressed and can measure actions necessary to bring about improvement in the person’s management of their condition. As the condition of the resident changes the review must consider external professional support and social work review to ensure the resident has access to any necessary treatment or provision of equipment. The registered person must have regard for the number and needs of the residents and ensure that the home is suitable for the purpose of meeting its aims and objectives.
Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 7 There must be a programme of routine maintenance and renewal for the building. This must be a written record and must be audited to ensure improvements are taking place. Equipment such as beds and commodes must be replaced and not allowed to fall into disrepair and present possible infection control problems. The Registered provider must also ensure that hot water does not exceed safe temperatures and provide risk assessments to determine the safety. Records of hot water temperature must be held. The open stairwell on the first floor could present a significant risk to residents that may wander at night, this must be considered for all those accommodated and especially if the home intends to register to accommodate people with deteriorating mental health such as Dementia. The management of the residents falls risk must be improved by proper research into how to manage the risks through evidence based practice and provision of items such as alarm mats or hip protectors. The starting point for assessing the residents’ nutritional status must be to have accurate weight records; the home must provide suitable scales to meet this need. The registered provider must continue to implement a system of quality assurance for the home to ensure it is meeting its stated objectives. The Fire department are planning a visit to the home in June 2006 and the registered person must act on any advice and requirement made to ensure that safe systems are in place to protect the residents. Cleaning schedules must include areas such as treatment rooms, cupboards and the medicines fridge to ensure safe control of infection. Residents would benefit from a written menu provided to them in large print. The policies of the home must be reviewed to ensure they are up to date and provide appropriate guidance. 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
Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 9 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 Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 1-3-6 Quality in this outcome area is good. This Judgement is made using available evidence including a visit to this service. Prospective residents have the information needed to choose a home, which will meet their needs. They have their needs assessed and are involved in a care plan that tells them what service they will receive. EVIDENCE: Residents and relatives are given the opportunity to visit the home and spend time there if they wish, this was confirmed by discussion with a newly admitted resident and their relative. Where admissions are arranged through care management arrangements the home now ensure they obtain a copy of that assessment prior to the admission taking place.
Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 11 There are policies and procedures in place for the admission of residents to the home. A statement of purpose has been developed which sets out the aims and objectives of the home, however this requires review to include changes in the home management arrangements. Intermediate care is not provided. Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 7-8-9-10 Quality in this outcome area is adequate. This Judgement is made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Three residents were case tracked. Each resident has a care plan, but practice of involving residents in the development and review of the plan is variable. The plan in most cases includes basic information necessary to plan the individuals care and includes risk assessment elements. The plan complies with relevant clinical and social care guidance.
Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 13 There was no evidence to suggest that care plans were updated as conditions changed. One resident exhibiting difficult behaviour had not been referred for external specialist support via the GP which is required and the plan of care did not reflect present problems.The staff new the resident well and were knowledgeable about the person’s present needs. The evidence within the care plans of the health care treatment was minimal and did not demonstrate that health care needs were managed well. The nutritional assessments were not up to date and there are no scales on which residents can be weighed. However staff said they were able to refer any problems to the GP and records of the residents nutritional intake was held. The staff are trained to administer medicines safely and the records show that medicines are recorded appropriately. The treatment room was dirty and the medicine fridge was frozen and dirty, there was no cleaning or maintenance schedule in place to ensure safe practice. The medicine policies require review and need to reflect current guidance. Residents confirmed that they were given their medicines by care staff and received analgesia as required for any pain they experienced. Staff were aware of how to treat residents with respect and to consider their dignity when delivering personal care. There are screens available in shared rooms. Residents spoke of being happy and feeling cared for by the staff team. Eastwood House Care Home DS0000031673.V288276.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-13-14-15 Quality in this outcome area is good. This Judgement is made using available evidence including a visit to this service. Social cultural and recreational activities are provided and meet the residents’ expectations. Residents receive a wholesome and nutritious diet. EVIDENCE: Residents are actively encouraged to keep contact with their families and friends. Visitors are welcome any time and residents can choose to see them in their room if they wish or in quiet areas. The staff attitude and systems in place promote the residents independence. They are encouraged to control their own money for as long as possible and one resident is able to collect her own pension and attend the local bank. Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 15 Residents are given the opportunity to take part in activities in the home and the local community. Staff are aware of individual needs and choices and try to be flexible when providing activities in the home. Residents are able to attend a service at the home that is periodically provided by the local minister. Staff said that they make every effort to assist anyone who wishes to attend local churches. Residents said they looked forward to mealtimes and enjoyed the food provided. Staff tell residents’ what is on the menu and they can have other options if they do not like the main meal. Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 16-18 Quality in this outcome area is good. This Judgement is made using available evidence including a visit to this service. Residents have access to a robust, effective complaints procedure, are protected from abuse and have their legal rights protected. EVIDENCE: The home has an appropriate complaints policy in place and this is displayed in the home. There have been no complaints against the service for the previous 6 months. Staff confirmed they had received training in adult protection and the home has a copy of the Local Adult Protection Policy. Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 19-22-24-25-26 Quality in this outcome area is poor. This Judgement is made using available evidence including a visit to this service. The service provides a homely environment but some areas may present a risk to the residents. There is poor provision of equipment that would ensure residents had access to aids and adaptations to meet their changing needs safely. Infection control does not safeguard the residents. EVIDENCE: Consultation with Fire Officer has been undertaken and visit planned in June 2006.
Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 18 The service provides a homely environment that is generally clean. Improvements have been made following requirements made at inspection to the home but there was slippage in meeting the timescales. There may be areas of potential risk to residents from excessively hot water at some wash hand basins and in baths. The records of the water temperature checks were not available at this inspection. The management does not appear to have recognised or responded to these areas of risk Each room has a list displayed indicating outstanding repairs. The last inspection required a replacement wash hand basin which has been replaced, however the broken vanity unit in which it stands has not been changed. Bed bases were old and worn. There were no adjustable height beds in place for those that could benefit. Alarm mats that could alert staff to a potential risk to residents from falling over during the night are not provided. There is an open stairwell on the first floor landing that is guarded by a child safety gate. This could be a potential risk to any resident who may wander during the night. One bedroom had a serious malodour that staff could not manage, the management of the home does not appear to be addressing this problem. Commodes seen in use in residents rooms were rusty and torn and could not be appropriately cleaned to control any outbreak of infection. Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This Judgement is made using available evidence including a visit to this service. There are sufficient numbers of skilled staff to meet the aims and objectives of the home and meet the changing needs of the residents. Robust recruitment practices safeguard residents’ from abuse. . EVIDENCE: The homes recruitment practice ensures that staff are appropriately checked prior to employment. Staff files were viewed and seen to be well maintained. A staff rota is held and shows the number and times of staff on duty to be appropriate to meet the numbers of residents at the home. There are no agency staff in use. The staff team have been working at the home for some years and know the aims and objectives of the home well. Residents were happy with the care they receive and did not express concerns about staff numbers.
Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 20 There is an induction and foundation training record file in place. Staff receive training and are working towards their NVQ in care. A new training programme has recently been put in place to ensure staff receive updates in mandatory training. There are job descriptions in place. Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33-35-38 Quality in this outcome area is poor. This Judgement is made using available evidence including a visit to this service. There has been a lack of a registered manager that has caused deterioration in the homes administration over recent months. There are no systems in place to monitor the quality of the service and ensure it is meeting its aims and objectives. Residents are protected from financial abuse. EVIDENCE: Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 22 There is no registered manager in post but a new manager has been appointed to commence June 2006. A senior member of the care staff has been providing continuity during this vacancy with the support of the registered person. The senior carer was on leave at the time of this inspection and the registered person was not at the home. Policies and procedures require review. The registered provider has confirmed in writing since the last random inspection visit in April 2006 that a quality assurance system is being devised and will be implemented. Residents personal monies are not managed by the home, small cash floats can be held in the homes safe and correct accounting procedures safeguard the resident. Records show that the home tests the fire system weekly and staff receive training in Fire prevention. Staff receive training in areas of health and safety. There was no evidence that up to date environmental risk assessments have been undertaken. Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 23 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 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 3 1 X X 2 X 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X 2 3 Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP8 Regulation 14 Requirement The registered person must ensure; 1. Care plans are reviewed with the resident wherever possible and signed by them. This will require the original plan to be rewritten where changes are indicated. 2. Risk assessments must be undertaken monthly or as conditions change to inform the plans. 3. The plans must contain evidence of how the person’s health care is managed. 4. The resident exhibiting mental health problems must be referred to the GP and to the social worker for assessment. The registered person must ensure that medicines are stored safely. The medicine fridge must be
DS0000031673.V288276.R01.S.doc Timescale for action 30/06/06 2 OP9 13 30/06/06 Eastwood House Care Home Version 5.2 Page 25 3 OP19 23 4 OP22 23 kept clean and frost free. The treatment area and equipment in use must have a cleaning and maintenance schedule in place. The registered person must ensure that a programme of routine maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept at the home. The registered person must ensure that residents receive referral for adaptations where these are required to ensure their safety and wellbeing. Residents who may be at risk of falling should be referred to the Community Occupational Therapist for guidance and provision of any necessary equipment. The registered person must ensure that equipment provided in the care home is kept in good working order; The broken vanity unit must be replaced. 30/06/06 30/06/06 5 OP24 23(2)(c) 30/06/06 6 OP25 23(5) The registered person must consult with the Environmental Health office for the management and safety of hot water at the home. The registered person must ensure that room 8 is appropriately cleaned and maintained to control the malodour and the risk of infection. The registered person must ensure that equipment is maintained in good working order The commodes in use where
DS0000031673.V288276.R01.S.doc 30/06/06 7. OP26 13 30/06/06 8. OP26 13 23(2)(c) 30/08/06 Eastwood House Care Home Version 5.2 Page 26 10. OP33 24(1) rusty and have ripped vinyl and do not ensure safe control of infection procedures and allow for cleaning. Establish and maintain a system for reviewing and improving the quality of care at the home, seeking views of service users and their representatives. This is outstanding until evidence is seen of the provider’s progress with the written response of planned action following the last visit to the home. Ensure the fire exit door satisfies fire safety regulations. This is outstanding awaiting the visit from the Fire Inspection in June 2006. 30/08/06 11. OP38 13(4) and 23 30/06/06 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 3 Refer to Standard OP1 OP15 OP37 Good Practice Recommendations Review the home’s statement of purpose ensuring that all the information is up to date and compliant with Schedule 1 of the Care Homes Regulations 2002. The registered person should provide a written menu that is available to the residents. The policies and procedures should be reviewed. Eastwood House Care Home DS0000031673.V288276.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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