CARE HOMES FOR OLDER PEOPLE
Eastwood House Care Home 24 Church Street Eastwood Nottingham NG16 3HS Lead Inspector
Mary O`Loughlin Unannounced Inspection 9th August 2006 09:00 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.V307166.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.V307166.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 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.V307166.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 31/05/06 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.V307166.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was conducted unannounced over 4.5hrs. There have been two previous inspections during this inspection year, a random inspection in April 2006 and a key inspection in May 2006, which found some of the outcome areas had significant weakness and important elements of the National Minimum Standards were not met. A range of information was used to determine the process of this inspection and the report, these included the previous judgements and findings, the information received from residents in response to the Commission for Social Care Inspection questionnaires in June 2006 and the pre-inspection information provided by the registered provider in June 2006. Improvement plans were received following the last key inspection and these were also used to inform the report. 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. The acting manager and one member of staff were spoken with. Areas of the environment were inspected to determine the progress in meeting the previous requirements. There was evidence of good progress in some outcome areas and a programme of improvement for areas that involved the environmental improvements required. There remain some potential risks to the residents but when balanced with an overview of the planned and achieved improvements the service is developing and improving the outcomes for the residents. Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
A maintenance programme has commenced that records all the required improvements in the service with a timescale for completion. Important improvements in the Fire proofing and replacement of a fire door have been undertaken. There has been a major improvement in the provision of care planning, which involves the residents in the planning of their care and demonstrates good practice in timely responses to any changes in the residents’ condition. Progress has been made on developing a quality assurance system that seeks the views of the residents and provides feedback to them. The open stairwell on the first floor that posed a potential risk to residents has been filled in and made safe. The cured walls in the kitchen area have now been retiled. Locks have now been fitted to all cupboard doors. Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 7 What they could do better:
This inspection has extended the timescales for compliance for three requirements. The service has prepared a programme of required improvements regarding the decoration and refurbishment within the home that will include the replacement of worn commode seats, the broken vanity unit and the redecoration of the treatment area. These areas of improvement must be undertaken to ensure best practice in controlling infection in the home. The registered provider must inform the Commission if there are any circumstances that will prevent them putting these things right within the revised timescales. Further recommendations for good practice have been made; The new acting manager should apply to register with the Commission for Social Care Inspection. Once the training matrix has been completed the acting manager should ensure that any training needs identified for staff are facilitated to ensure the staff team have the required skills and competencies to undertake their role. There is no sluice area in the home and the acting manager should consult with the environmental health department to identify best practice within the home with regard to the washing of urinals and commodes. Hot water is not regulated and could present a risk to the residents, the acting manager should complete risk assessments for the residents to as far as possible eliminate the risks to their safety from hot water. Consultation with the environmental health office on the management of hot water is also recommended. There is a programme of improvement in place however areas of stained and malodorous carpets should be addressed quickly to provide a cleaner more pleasant environment. The treatment room and laundry room are not well maintained, areas of peeling paintwork and a build up of dirt could compromise the control of infection and pose a risk to the residents. The registered person should also ensure that any incident that affects the wellbeing of residents is reported to the Commission for Social Care Inspection as required. The registered person should ensure that there is recording of medicines into the home to provide an appropriate audit trail.
Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 8 There must also be appropriate safeguards in place when hand writing prescriptions. Guidance can be sought on best practice from the Royal Pharmaceutical Society on the management of medicines in care homes. 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. Eastwood House Care Home DS0000031673.V307166.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.V307166.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 they need to choose a home, which meets their needs. They have their needs assessed and a contract which tells them about the service they will receive. Intermediate care is not provided. EVIDENCE: Prospective residents are given the opportunity to spend time in the home. Staff are made aware and give the resident special attention, helping them to feel comfortable with their surroundings before they make a decision. There is a statement of purpose in place that is up to date and contains information of the registered providers intention to accommodate people with
Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 11 Dementia, should the application to register be granted by the Commission for Social Care Inspection. The resident is not admitted to the home until an assessment of their needs has been undertaken through care management arrangements, which is then provided to the acting home manager who also undertakes a full assessment prior to agreeing admission. Eastwood House Care Home DS0000031673.V307166.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 good. This Judgement is made using available evidence including a visit to this service. The health and personal care, which the resident receives, is based on their individual needs. The principles of respect, privacy and dignity are put into practice. Medicines are managed safely but within an environment that has poor infection control procedures in place. EVIDENCE: The new acting manager has completed a review of all care plans in the home since the last inspection. Three care plans viewed show that the acting manager has involved the resident when writing up the plans. The care plans are used as a working tool by the staff and are type written in clear language enabling people not familiar with the content, to understand them.
Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 13 The plans are reviewed monthly and as the resident’s condition changes. Records indicate that residents have access to health and remedial services they need. The acting manager is making appropriate referrals to dieticians and occupational therapists as required. There are now excellent records of the nutritional needs of each resident including their monthly weight. Each resident is assessed for their risk of developing pressure sores and referred if required to the District Nurse for the provision of any specialist equipment required. Residents spoke of being happy at the home, being able to see the doctor if they needed and feeling safe and cared for by the staff team. 100 of the responses received by the Commission for Social Care Inspection survey’s to the resident’s said that staff listened and acted on what they say, and that they received the care and support they needed. Comments such as “staff having a consistent gentleness, being approachable and understanding and referring any changes in the residents health very promptly.” The medicines are administered by staff trained to do so. The records of three residents medication administration show they receive medicines as per the prescription. The present arrangements for the supplying pharmacist has not provided the home with any pharmacy audit service or training provision, the acting manager reported that she is looking into changing the supplying pharmacist presently. Not all medicines received into the home are recorded and as such there is no audit trail of medicines available. The treatment room has not improved since the last inspection. The cleaning and maintenance of the room must now be a priority to ensure good infection control procedures. Eastwood House Care Home DS0000031673.V307166.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. Residents are able to choose their lifestyle, social activity and keep in contact with family and friends. Residents receive a varied diet according to their assessed need. EVIDENCE: Responses received June 2006 from the Commission for Social Care Inspection survey suggest that all residents are generally happy with the activities provision at the home. The new care planning shows that staff focus on residents being able to participate in activities of their choice and are supported to maintain relationships with families and friends. The acting manager spoke of looking at improving upon the present available activities as she develops the service. There is now a regular visiting minister who has conducted services at the home for anyone wishing to attend.
Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 15 The acting manager has also acted upon the previous recommendation to provide a written menu for residents, following consultation with the residents a menu is in place and daily printed menus are to be provided shortly. Written responses received generally show that residents are happy with the food provided. Those residents spoken to during the inspection said they were happy with the meals provided. Residents with dietary problems are referred to the Dietician for assessment and provision of treatment as required, staff record the actions necessary within the residents care plan. Eastwood House Care Home DS0000031673.V307166.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 complaints procedure and are protected from abuse. EVIDENCE: This inspection found evidence of very good practice by the acting manager when dealing with concerns from one relative. The actions taken had ensured that relatives were fully informed in a short timescale, and the problem dealt with sensitively and effectively. The acting manager is completing a training matrix, which was seen to determine which staff require training in adult protection. Over 50 of the staff team have completed training to level 2 NVQ that includes elements of Adult protection. The last key inspection found the homes policies and procedures regarding the protection of vulnerable adults to be of good quality. 100 of the responses received from residents show that they know who to speak to if they have concerns or complaints. Eastwood House Care Home DS0000031673.V307166.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): 19-26 Quality in this outcome area is adequate. This Judgement is made using available evidence including a visit to this service. Residents live in a homely environment that has some potential risks to their safety. EVIDENCE: The service provides a homely environment. There is now a programme in place for the renewal of the fabric and decoration of the building. Following the last inspection the old stairwell on the first floor has been filled in and made safe. Areas of fireproofing and general maintenance have commenced. There is now a maintenance person employed 12hrs each week.
Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 18 Residents say they are comfortable; the home is warm and generally clean. There has been one outbreak of infection, which was not reported to Commission for Social Care Inspection, however appropriate action was taken. The acting manager was advised to contact the infection control about audit of the home’s practices. There may be areas of potential risk to residents; for example, water may be very hot coming from the taps in the resident’s rooms and bathrooms due to the lack of hot water regulator valves. The acting manager reported that this has been discussed with the registered provider but as yet no action has been taken. There are no risk assessments completed for these areas of risk. The treatment room and laundry room walls require attention to ensure the surfaces can be readily cleaned. The carpets in some areas have stains and malodour. Commodes have ripped vinyl that do not allow for appropriate cleaning to control cross infection, these are included on the renewal programme. There is no sluice provision, urinal bottles and commode bowls are washed and left to soak within baths. There was no evidence of procedural guidance to control the risk of cross infection in these circumstances. When balancing these pieces of evidence against other more positive parts of this outcome group an overview of the environment may be seen as adequate. Eastwood House Care Home DS0000031673.V307166.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): 27-28-29-30 Quality in this outcome area is good. This Judgement is made using available evidence including a visit to this service. The staff in the home are trained and sufficient in numbers to meet the aims and objectives of the home. However practices may not be up to date in mandatory areas of training. EVIDENCE: There were 9 residents accommodated at this time. Staffing levels were above average with dedicated management hours. The staff recruitment procedures remain compliant, showing that robust procedures are followed to ensure the protection of the residents. The acting manager has commenced a training matrix to highlight areas of staff training needs and shortfalls were evident, although not all the required information has been obtained to provide a clear picture of any shortfalls. All staff are presently undertaking training in Dementia Care. Over 50 of the staff team are qualified to level 2 NVQ in care which ensures that staff receive training relevant to the work they are to perform.
Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This Judgement is made using available evidence including a visit to this service. The home has an acting manager in place that is not yet registered with Commission for Social Care Inspection. Immediate improvements in the service since the appointment of the acting manager show that she is working to ensure the health and wellbeing of the residents and developing a quality assurance system. Slippages in ensuring staff are trained in all areas of health and safety may not ensure safe practice but the present audit of required training will determine the training provision to ensure staff are up to date and skilled in all areas of health and safety. EVIDENCE: Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 21 There is now an acting manager in place who is required to submit an application to the Commission for Social Care Inspection to register. The acting manager has worked continuously since her appointment in June 2006, to improve the service. There is good evidence of improvement in care planning and care delivery. She is also reviewing all the homes policies and procedures, and has commenced staff supervision and training records. Systems are now in place to quality assure the service provided through questionnaires, newsletters and resident meetings. The acting manager is regarded by staff as a good leader. Residents are encouraged to manage their own monies and only small cash floats are managed by the home, with appropriate records in place. There are shortfalls in the management of health and safety training, which is being audited and provision of trainers accessed by the manager. Weekly fire tests are recorded but there are some gaps when this has not been undertaken. Staff require refresher training in Fire safety procedures. The home has requested a fire safety officer visit and is still waiting a date for this, however the faulty emergency door on the first floor has been replaced and areas of fire retardant safety have been dealt with. Areas of risk such as hot water have not been risk assessed. Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 22 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 23 YES 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 OP9 Regulation 23 Requirement The registered person must ensure that all parts of the treatment room are kept clean and reasonably decorated. This requirement is outstanding from 30/06/06. 2. OP24 23(2)(c) 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. This requirement is outstanding from 30/06/06. 3. OP26 23(2)(c) The registered person must ensure that equipment is maintained in good working order The commodes in use where rusty and have ripped vinyl and do not ensure safe control of infection procedures and allow for cleaning. This requirement is
Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 24 Timescale for action 30/10/06 30/10/06 30/10/06 outstanding from 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. Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that there is an audit trail for all medicines received into the home and that appropriate safeguards are in place when hand writing prescriptions. The registered person should ensure that staff are trained in adult protection. The registered person should consult with the Environmental Health office regarding the management of hot water safety in the home The registered person should ensure that the carpets are suitably maintained to control malodour. The registered person should ensure that the walls of the laundry room provide a suitable surface that can be cleaned. The registered person should, following consultation with the environmental health office provide evidence of the management of the control of infection risk with the present arrangements for the cleaning of urinals and commodes. The registered person should ensure that the identified staff training needs are appropriately managed and resourced. The registered person should ensure that any person appointed to manage the care home applies for registration with the Commission for Social Care Inspection. The registered person should ensure that all events that adversely affect the wellbeing of safety of any resident is reported to the Commission for Social Care Inspection The registered person should ensure that risk assessments are completed on all hot water outlets. The registered person should ensure that all mandatory
DS0000031673.V307166.R01.S.doc Version 5.2 Page 25 2 3 4 5 6 OP19 OP25 OP26 OP26 OP26 7 8 OP30 OP31 9 OP31 10. 11. OP38 OP38 Eastwood House Care Home areas of training are included within the training plans for the home. Eastwood House Care Home DS0000031673.V307166.R01.S.doc Version 5.2 Page 26 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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