CARE HOMES FOR OLDER PEOPLE
Eaton Court Eaton Court Grimsby DN34 4UD Lead Inspector
Jane Lyons Unannounced 23 May 2005 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. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Eaton Court Address Eaton Court, Eaton Court, Grimsby, DN34 4UD 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) 01474 341846 01472 346185 Winnie Care (Eaton Court) Ltd Mrs Beverley Snape CRH 45 Category(ies) of OP 45 registration, with number of places Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: NONE Date of last inspection 13th October 2004 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 withy residential care needs.The home consists of two floorsserviced 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 p[arking 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 complany. The responsible person is Mr Paul Hulbert and the registered manager is Mrs Beverly Snape. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day in May 2005. During the visit the inspector spoke to the manager, four staff, one visiting health care professional, seven residents and two 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, complaints, 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:
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; one visitor said that she was always made very welcome and another had completed a comment card which detailed that “the home was very friendly”. It was good to see that relatives had brought in their mother’s dog during the visit; staff confirmed that she had been so pleased to see it. All the residents spoken to during the visit said how satisfied they were with the staff and the care provided; one person commented that” the staff were excellent and always had enough time for you” whilst another said that” the staff were brilliant and he couldn’t praise them enough”. There was always enough staff in the home; many of them have worked there for a long time and have built up good relations with the residents and their families. The nursing staff at the home work hard to keep themselves up to date with all the current practices; one of the nurses represents the home at the specialist support group link nurse meetings which are held monthly. The comment card completed by the Heath and Social Care Co-ordinator detailed that” I have a good relationship with the staff and clients; relatives speak highly of the staff too. They are willing to embrace good practice ideas to meet the care needs of their clients. I enjoy my visits to Eaton Court.”
Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 6 The majority of comments about the meals in the home were very positive; one resident said “they were superb” and another said that “the food was excellent- I can have what I like, when I like, if I like”; he went on to say that earlier in the week he hadn’t liked any of the meal choices and wanted some kippers which had been provided. Two of the residents commented that the meals were satisfactory yet could not tell the inspector how improvements could be made. What has improved since the last inspection? What they could do better:
The manager must make sure that she has all the correct documents in place before new staff start working in the home to ensure the safety of all the residents. 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 some gaps on the charts and it was not clear if some of the residents had had their medication. The staff do not have regular individual meetings with the senior staff which is important for them to talk about their work and the training they need. The manager has not fully put in place a quality assurance system which would provide a better picture of all the checks and questionnaires that are carried out. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 7 Regular reviews of aspects of the “homes” performance through a good programme of self review and consultations , which includes the views of residents, staff, relatives and others must be fully completed. 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 J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 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 standard(s) 2,3,4 and 5 The service users were provided with detailed information regarding the home and always met a senior member of staff prior to admission. Clear written contracts were provided to each resident, which detailed appropriate contractual arrangements and top up charges. Staff were informed of the care needs of residents prior to admission; the admission process was thorough with staff ensuring that new residents felt welcome and secure. EVIDENCE: Prospective service users and relatives/ friends have the opportunity to visit the home prior to admission, but not all take the opportunity to do so. The majority of service users spoken to confirmed that the choice of home had been made by their families, which they were satisfied with. All service users have a trial period. Thorough assessments were completed by the manager/ deputy manager prior to admission and these were seen by the inspector.
Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 10 The manager had provided all service users with a contract/ statement of terms and conditions, which included their bedroom number, fees and top up charges. Staff at interview confirmed the admission process; there was clear evidence that they were well informed of service users needs on admission and all specialist equipment was in place if required. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 Service user’s health, personal and social care needs were fully met. Service user’s health needs were monitored and reviewed appropriately. Staff were knowledgeable about the needs of the service users and provided support in a manner which respected their privacy and dignity. The staff communicated well with the team, service users, relatives, visitors and other health care professionals. Deficiencies in the recording of medication administered, although minor, 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: Case tracking of three service users was completed, which included examination of care records and discussions with service users and staff. The care programmes were well developed and maintained; clear plans of care were in place to support all identified needs on assessment. 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.
Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 12 Medication storage and recording was checked. Storage of medications was satisfactory. The home utilised the Nomad monitored dosage system; printed administration charts were provided by the pharmacy; these records when checked revealed a significant number of gaps where the staff had not signed or used a code to account for the omission. Controlled medication storage and administration was checked and found to be satisfactory. One service user stated that the staff were not giving him the correct Warfarin medication which was looked into during the visit; records of administration were maintained and satisfactory. From discussions with the nursing staff it was clear that the service user did not fully understand the changing dose and different coloured tablets he was receiving; the staff confirmed that they would provide more support to ensure a clearer understanding. Service users stated that their care needs were met and described how care was provided in a way that respected their privacy and dignity. They described the staff as excellent and confirmed that they always had enough time to provide support. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 13 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, 14 and 15 The service users daily routines were flexible and enabled service users to exercise choice. Service users are able to take full advantage of activities and interests, and to participate in community and family life. Staff were very polite and made visitors welcome. The meals provided in the home were of very good quality offering choice and variety. EVIDENCE: Service users stated that they were able to exercise choice in relation to routines of daily living, leisure/ social activities and meals/ mealtimes. Visitors to the home confirmed they were made to feel very welcome; the staff were pleasant and friendly. There were numerous visitors to the home during the visit; one family was accompanied by the service user’s dog which she had missed during her stay in the home. The home employed an activity co-ordinator for three days per week; a weekly activity programme supported the entertainments programme. Service users
Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 14 stated that they enjoyed participating in the bingo, quizzes, dominoes, manicures, music etc. The activity co-ordinator also provided one-to- one support for service users. A number of service users chose to spend time in their rooms; watching the TV, listening to music or “watching the world go by”. The majority of service users spoke very positively about the meals provided; describing the choice and quality of the meals as excellent. Two of the service users described the meals as satisfactory however they could not identify any deficiencies and stated that they did not want any changes made to the menus. Discussion about the menus was always on the agenda for the residents meetings. The menus were drawn up on a weekly basis, daily menus were posted on the notice board. The staff confirmed that the service users often made individual requests which were accommodated. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 15 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 and 18 The relationship between the manager, staff and service users enabled the service users to feel confident in making a complaint if it was necessary. A satisfactory complaints procedure was in place. Recruitment and selection practices do not protect service users from abuse; CRB checks or POVA First checks must be in place prior to new staff commencing work. Staff had been provided with adult abuse training and appropriate vulnerable adult procedures were in place. EVIDENCE: A complaints procedure was displayed in the entrance hall. Service users and staff reported understanding of the procedure. Service users stated they felt confident raising issues with the staff and management; one service user reported that the shrubs growing outside his window were affecting the lighting in his room and he had requested that they be cut down which the manager had actioned. The manager stated that the home had not received any complaints since the last inspection. A procedure for responding to allegations of abuse was available and training records showed staff had been provided with adult abuse training. Staff spoken to all reported that they would feel confident about reporting bad practice and who to report concerns to.
Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 16 There have been no allegations or incidents of abuse made at the home since the last inspection. The homes policies and procedures regarding service users monies ensured that the financial affairs of service users were safeguarded. Recruitment and selection practices do not protect service users from the risk of abuse. All existing staff have CRB checks in place; however the home had recruited a kitchen assistant in April 2005 and there were no police checks in place. All CRB/ POVA First checks were managed by the staff at head office; this information must be in place at the home prior to employment commencing. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 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 standard(s) 19 and 26 Service users live in a very safe, clean, comfortable and homely environment. 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 J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 18 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 and 30 The staffing levels were appropriate for the current dependency of the service users. Staff were undertaking training to ensure they were competent to carry out their work. The recruitment practises in the home had not been adequately implemented in all cases to ensure sufficient protection for the service users. EVIDENCE: Staff confirmed that the staffing levels in the home were consistently maintained. Examination of the rotas identified that there was always one qualified member of staff on each shift; seven care staff in the a.m., six care staff in the p.m. and three care staff on the night shift. The workforce has continued to be very stable; this has supported positive moral amongst staff and provided continuity of care for the service users. Service users confirmed that the staff were excellent; they reported that the staff always answered the call bells promptly. The staff interviewed were very experienced carers and had received a variety of training. The manager had obtained more video training packages to support the external training programme. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 19 The manager had an overview of the training completed by the staff and a current staff training and development programme in place. The four staff files evidenced that the training records were up to date. There was a comprehensive induction programme in place and new staff accessed external induction training to TOPPS standard via Learn Direct. Advice was given to review this provision to ensure that the external training programme provided new staff with the detailed training required for all the induction standards. Of the four staff files examined all recruitment records were satisfactory with the exception of a CRB check for the kitchen assistant recruited in April 2005.The manager confirmed that the processing of CRB checks was managed through head office and she had received verbal confirmation that the CRB check had been received and had not identified any concerns. It is vital that the Registered Provider reviews the system for confirming police checks to ensure that the written information is held in the home prior to new staff commencing work. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 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 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) 33,35,36 and 38 The home was generally well managed and run efficiently; a structured quality assurance programme was not in place and staff were not in receipt of regular formal staff supervision. The arrangements for the management of service users finances were satisfactory. The manager was proactive in ensuring that the health and safety of staff and service users was promoted and protected however the delay in securing the portable appliance annual check provided a potential risk. EVIDENCE: The manager is experienced; staff and service users reported that she is very professional and caring with a management style that is open and approachable.
Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 21 Staff confirmed that moral was very good and there was an excellent team approach promoted within the home. Staff and service user meetings were held regularly. A formal staff supervision programme had been implemented although records evidenced that care staff had not accessed the required number of sessions. The manager has developed and implemented satisfaction questionnaires and audits however this now needs to be structured and supported by an annual development plan. 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. The maintenance man carried out monthly equipment checks including hot water temperatures and bed rails; records evidenced that these were up to date and satisfactory- eight sets of bed rails were currently in use. Risk assessments were in place for all safe working practices. Records evidenced that service checks had been completed for all installations and equipment with the exception of the portable electrical appliances; the last check had been completed in December 2003. The Registered Provider had been providing regular reports to support formal visits to the home under Regulation 26. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4
COMPLAINTS AND PROTECTION 4 x x x x x x 4 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 2 x 2 Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 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 9 Regulation 13(2) Requirement The registered person must ensure that staff complete the medication administration charts in accordance with NMC and CSCI guidance. 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. The registered person must ensure that CRB checks and POVA list checks are obtained prior to employment The registered person must ensure that the portable electrical appliances are checked annually. The registered person must ensure that care staff receive formal documented supervision six times per year. Timescale for action With immediate effect 31st August 2005 2. 33 24 3. 29 18 and 19 With immediate effect 31st July 2005 31st August 2005 4. 38 13(4) 5. 36 18(2) Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 28 30 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. Eaton Court J54 2783 Eaton Court V228715 23 May 05 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Unit 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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