CARE HOMES FOR OLDER PEOPLE
Eaton Court Care Home Eaton Court Grimsby North East Lincs DN34 4UD Lead Inspector
Mrs Jane Lyons Unannounced Inspection 10th November 2005 09:30 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 Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 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. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Eaton Court Care Home Address Eaton Court Grimsby North East Lincs DN34 4UD 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) 01472 341846 01472 346185 Winnie Care (Eaton Court) Ltd Mrs Beverley Snape Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd May 2005 Brief Description of the Service: Eaton Court is a purpose built care home that is situated in a quiet residential area of Grimsby. It is within walking distance of shops and is also on a public transport route. The home is able to support and care for up to forty -five people over the age of sixty five; the home is registered for the care of people with nursing care needs and up to seventeen places are reserved for people with residential care needs. The home consists of two floors serviced by a passenger lift. There are forty one single rooms and two shared rooms, and all have the benefit of en-suite facilities. There are six bathrooms, four of these are assisted and two have a jacuzzi facility. The home has two lounges and a large dining room downstairs; there is a further lounge upstairs. There are also easy chairs and occasional tables in the large reception area where people tend to congregate. The home has a pleasant atrium with patio tables and chairs. There are mature gardens to the rear of the building and ample car parking to the front. The whole feel of the home is one of comfort with pleasant, clean and homely surroundings. The home is part of a small group, Winnie Care which in turn is owned by a larger company. The responsible person is Mr Paul Hulbert and the registered manager is Mrs Beverly Snape. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over two days in November 2005. During the visit the inspector spoke to the manager, six staff, one visiting health care professional, seven residents and four relatives to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector looked at a number of bedrooms, bathrooms and communal rooms such as the dining room and lounge areas during the visit. Paper work relating to staff recruitment, staff training, activities, care plans and health / safety checks were looked at to make sure it was all in place and up to date. What the service does well:
Service users looked clean and well cared for; they were smart in appearance and informed the inspector that they were very happy in the home and felt that they were well cared for. One service user said that he had nothing but praise for the home and a relative wrote in a comment card that “the staff are very friendly and attentive, the food is lovely and her mother-in-law had settled into the home very well.” The home provided very good facilities; all areas were decorated and maintained to a high standard. The home was very clean and tidy. There was a very relaxed and homely atmosphere in the home, residents were very settled and comfortable in their surroundings. There was a good staff team, many of them have worked there for a long time and have built up good relations with the residents and their families. When the inspector spoke to them they said that they enjoyed working at Eaton Court, the atmosphere was very friendly, there was a good team approach and the residents always came first. A card written by a staff member who had left to further her career detailed that she had “felt honoured to work with such a fantastic team.” The home provided well-balanced meals of very good quality. Most of the residents took their meals in the dining room; the meals were served promptly and staff demonstrated a good understanding of the resident’s individual food choices and support needed. All the comments about the meals were very positive; one resident told the inspector that she was on a very restricted diet
Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 6 but the cook was very good and tried her best to provide variety. Other residents commented that the meals were excellent. What has improved since the last inspection? What they could do better:
The staff must make sure they sign for all the medications they have given or use a code to detail why the medication has not been given; there were a significant number of gaps on the charts, although from checking it was clear that the medication had been given for regular prescriptions. This requirement was identified in the last report and the manager must take more robust action to ensure that correct procedures are followed. Although the majority of care staff have received formal supervision over the last six weeks, the staff do not access the required number of sessions which is important for them to talk about their work and the training they need. This requirement was identified in the last report and the manager must take more robust action to ensure that the programme is fully implemented. The manager has improved the programme of audits which supports the quality assurance system; however now needs to complete the cycle of developing and implementing action plans to support the deficiencies identified and also to provide an annual development plan. This requirement has been outstanding since the introduction of the National Minimum Standards and
Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 7 efforts must be made to prioritise the full implementation of a formal programme. 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. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 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 Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The home does not provide intermediate care. Standards 2,3,4 and 5 were assessed at the previous inspection with no deficiencies identified. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 10 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 and 9 There is a clear and consistent care planning system in place that provides staff with the information they need to satisfactorily meet the service user’s needs. Little improvements had been made towards addressing the deficiencies in the recording of medication administered, although minor, this could put service users at risk of being administered the incorrect dose of medication and potentially cause delay in accessing support for non- compliance. EVIDENCE: Care plans inspected were detailed, covering all aspects of service user’s assessed needs and stated clearly where support was required and where that support was to be provided. There were risk assessment tools for mobility, falls, tissue viability, bed rail provision and nutrition. There was evidence that service users were involved in developing their plans of care. All care plans had been reviewed regularly. The format was user- friendly with all information easily accessible. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 11 Medication storage and recording was checked. Storage of general medications was satisfactory. The home utilised the Nomad monitored dosage system; printed administration charts were provided by the pharmacy; these records when checked still revealed a significant number of gaps where the staff had not signed or used a code to account for the omission. Controlled medication storage was checked; a service user recently admitted had brought with her a large amount of controlled medications and a number of the boxes did not fit in the cupboard; the registered manager should review this provision if the amount of controlled medications regularly exceeds the storage capacity. Controlled medication administration records were checked and found to be satisfactory. Standard 10 was assessed at the previous inspection. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 12 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 The recent loss of the activity co-ordinator has impacted somewhat on the activity provision in the home although there was good evidence that the care staff are working hard to continue to provide a varied programme. EVIDENCE: Standards 13,14 and 15 were assessed at the previous inspection. The activity co-ordinator resigned in September and the care staff have been trying hard to maintain the activity programme until a new co-ordinator is recruited. The majority of service users interviewed commented that the current programme was sufficient and enjoyed the regular bingo, dominoes, exercise and manicure sessions. Two service users who had indicated that they weren’t satisfied with the current provision on their surveys told the inspector that they would like more trips out; from discussions with the manager and staff it was clear that there had been a number of organised outings recently and this would increase when the new co-ordinator was in post. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 13 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): 18 Staff recruitment procedures have been reviewed and now better protect service users from abuse. EVIDENCE: Standard 16 was assessed at the previous inspection. Recruitment records were examined for two recently recruited staff members which evidenced that the manager had revised the procedures and now obtained a CRB/ Pova First check prior to employment. Other records such as two written references, health declaration and identification documents were also in place. Staff interviewed all reported that they would feel confident about reporting bad practice and who to report concerns to. Procedures were in place, staff had accessed protection of vulnerable adult training via the local authority. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 14 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 and 26 The standard of the environment is high, providing service user’s with a safe, attractive and homely place to live. EVIDENCE: All areas of the home accessed by the inspector were found to be very clean, tidy and free from offensive odours. The home was decorated and maintained to a high standard. Redecoration of individual service user rooms was part of an ongoing programme. There were few changes in the home since the last inspection. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 15 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 and 30 At this home there is a good match of well qualified staff offering consistency of care to service users. Improved recruitment practices now afford sufficient protection for service users. EVIDENCE: The staff rota was viewed and showed adequate numbers of staff on duty day and night; the occupancy in the home had increased in recent times and the manager was deploying more staff to meet this. The workforce has continued to be very stable; this has supported positive moral amongst staff and provided continuity of care for the service users. All service users spoken to commented very positively about the staff; specifically about how kind, patient, obliging and helpful they all were. The home provides a varied training programme for staff; the manager had an overview of the training completed by the staff and a current staff training and development programme in place. Mandatory courses in moving/ handling, fire prevention, food hygiene and first aid were seen to be up to date. The NVQ training programme continues; currently eight staff have gained qualification at level 2 and a further twelve staff have been registered to commence the course in January which is very positive. The manager was currently reviewing the induction programme for new staff to provide more detailed training around the TOPSS induction standards. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 16 The manager had reviewed the recruitment procedures and now obtained records of CRB /Pova First check prior to employment. Two records of staff recently recruited were examined and found to contain all the required documentation. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 17 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): 33, 36 and 38 The manager is well supported by the senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities however limited progress has been made towards fully implementing a regular staff supervision programme and quality assurance programme. EVIDENCE: Records of staff supervision sessions were examined which evidenced that although there the majority of the care staff had accessed formal supervision meetings within the last six weeks, this was not consistent and would not meet the annual target of six sessions per year. The manager had developed and implemented a more thorough programme of audits for the home which covered areas such as accidents, complaints, care
Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 18 programmes and facilities; action plans now need to be developed and implemented for all deficiencies identified. The inspector advised the inclusion of staff supervision and medication management in the audit process. Surveys are completed by service users and relatives these now need to be extended to cover other stakeholders to the home. There was good evidence that the staff continue to review and develop the management systems in the home; the qualified staff are now reviewing the care plan format. Following the last inspection the manager had ensured that the portable electrical appliances had been checked; all other checks/ certificates on systems and equipment were in place. Records showed that staff were up to date with mandatory training in fire safety, basic food hygiene, moving/ handling, first aid, infection control and health / safety. The fire safety equipment and checks were all in place and up to date. Fire drills were carried out monthly. Risk assessments were undertaken for all safe working practices. Accident reports were maintained, the manager audited the incidence monthly; advice was given to provide more detailed records of all further action taken especially with regard to falls. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 2 X 3 Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 20 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 OP9 Regulation 13(2) Requirement The registered person must ensure that staff complete the medication administration charts in accordance with NMC and CSCI guidance. Previous timescale 23/5/05 not met. The registered person must implement a structured formal quality assurance programme based on a systematic cycle of planning- action- review; which is supported by an annual development plan. Previous timescale 31/08/05 not met The registered person must implement a programme to ensure that care staff receive formal documented supervision six times per year. Previous timescale 31/08/05 not met. Timescale for action 10/11/05 2. OP33 24 28/02/05 3. OP36 18(2) 31/12/05 Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 21 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 OP28 OP30 OP38 Good Practice Recommendations The home should continue to work towards 50 staff qualified to level 2 by 2005. The registered person should review the TOPPS induction training provision to ensure that the quality of training is satisfactory. The registered manager should review the accident audit records to include details of staff action to further reduce risk, especially with regard to falls. Eaton Court Care Home DS0000002783.V266552.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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