Inspection on 10/01/08 for Ebberly House

This inspection was carried out on 10th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ebberly House 07/12/06

Ebberly House 30/11/05

Ebberly House 04/08/05

Ebberly House 11/01/05

Ebberly House 19/04/04

Ebberly House 14/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ebberly House 17/18 Ebberly Lawn Bear Street Barnstaple Devon EX32 7DJ Lead Inspector Adele Adams Unannounced Inspection 14:00 10 , 11 & 14 January 2008 th th th 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 Ebberly House DS0000022086.V348674.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. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ebberly House Address 17/18 Ebberly Lawn Bear Street Barnstaple Devon EX32 7DJ 01271 345684 01271 345684 ebberly@tiscali.co.uk 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) Mr Peter Frederick George Allen Mrs Beverly Judith Watton Care Home 19 Category(ies) of Dementia (3), Old age, not falling within any registration, with number other category (16) of places Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2006 Brief Description of the Service: Ebberly House is a large, adapted Victorian property, situated in a residential area close to the centre of Barnstaple. The home is sited on the corner of a private residential square, which provides an attractive outlook from the homes lounge. There is dedicated parking for visitors to Ebberly House in the square. Access to the house is on several levels, the main entrance being approached from Ebberly Lawn. Other entrances have ramped access for wheelchairs. There are stair lifts to facilitate access inside the home. Ebberly House provides long-term accommodation for up to 19 elderly people. There are 17 single bedrooms are of varying sizes and outlook and one double room, all are furnished individually. The communal rooms on the ground floor are spacious and comfortably furnished; the atmosphere is homely and relaxed. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission for Social Care Inspection has introduced “Key Standards “ to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some ‘non- key’ standards may not be inspected. This inspection was unannounced and took place over 3 weekdays in January 2008 and lasted for approximately 9 hours. The main focus of this inspection was to seek the views of people using the service; all people using the service were sent a survey prior to the inspection date. A total of 1 was returned; a relative had completed this. A tour of the home was completed and included visiting the bedrooms of most of the people using the service. We case tracked 2 people using the service, meaning that these people were spoken to about their experiences of living at the home, and their records of care and medications were also looked at. A total of 4 people using the service were spoken to during the day. 1visiting relative also spoke to us during the inspection and their comments have been included in the report. We also spent time talking with the provider (owner), the registered manager and care staff. 2 care staff were spoken with on a 1 to 1 basis. Staff were also asked to complete surveys prior to the inspection and 1 was returned. Some key documents were looked at, these included 2 people’s care plans, medication records, 2 staff files, and peoples finance records and some health and safety records. Information was also received from this service before the inspection as asked for by the Commission for Social Care Inspection. This was in the form of an Annual Quality Assurance Assessment (referred to as an AQAA) the assessment provided us with important information that supported this inspection and has been included in this inspection report. The fees for this service vary for each individual and can be obtained from the service on request. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? This key unannounced inspection found: Each person using the service now have contracts with the service in place – this is to make sure that people are informed about what the service provides and that people are aware of their rights while living at Ebberly House. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 7 The medication policy has been improved and changed to make sure staff watch people have taken their medicines before they leave the person and before signing the medication records, this is a good improvement that will make sure that people using the service do take the medicine prescribed for them. The service has had a new boiler installed since the last inspection; this improvement makes sure there is an efficient hot water and heating supply for people. Following a finding at the last inspection the service has taken positive action to improve how it stores cleaning products; this will reduce risks to people using the service. The provider (owner) and the registered manager told us that an electrical contractor has begun essential electrical testing; when complete this will mean the service can be confidant and show that the electricity supply in the home is safe. Following the previous inspection, receipts for people’s financial dealings such as chiropody and hairdressing are now kept, this is a good improvement as it means that people’s financial records can be clearly be audited and cross referenced, and reduces the risk of errors. What they could do better: This key unannounced inspection found that improvements are needed as outlined below. The service currently has a resident application form in place, this has to be updated to make sure that all people moving to the home receive the same level of assessment regardless of who is paying for their care. The service does not always clearly identify people’s health and social care needs in the correct areas of the care plan, for example a need identified in a person’s assessment was not included in the written care plan. This must be improved so that there are no gaps in care records that could have a negative effect on a person’s care and will make sure people have their assessed needs met in full. The service should improve it’s recording of contact with other agencies. This will make sure that all staff are aware of exactly what communication has taken place so that people using the service are given correct consistent information. The Registered Manager must make sure that the correct type of record is in place to record the receipt, administration, stock level and disposal of any Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 8 controlled drugs that may be used by people using the service. This is so a clear and appropriate audit trail and record are in place in line with recognised guidelines. The Registered Manager should keep a record of the monitoring of staff when they give people their medicines. This will clearly show that monitoring which is good practice takes place and will provide a useful record that can be audited and discussed with care staff as part of their development. The Registered Manager must make sure that the correct cold storage is used for medicines that need cold storage. This is so that medicines are stored safely at the correct temperature and cannot be contaminated or contaminate food. The Registered Manager must provide facilities for recreation for people using the service. Including, activities in relation to recreation, fitness and training and must make sure that people using the service are involved in making decisions about the programme of activities arranged by or on behalf of the care home. This is to make sure that the people using the service have enjoyable and fulfilling days. The Registered Manager should make sure that people using the service are not limited from making choices because of staffing levels or routines that are in place to suit the service. The Registered Manager should make sure that the Complaints Procedure is easily accessible to all. This will show the homes openness and willingness to improve the service. The Registered Manager must make sure that all fire exits at the home are safe to use at all times. This is to ensure a quick safe exit from the home in the event of a fire. An Immediate Requirement was issued in relation to this at this inspection. The Registered Manager should make sure that there is a programme of routine maintenance and renewal of the fabric and decoration of the home in place and records of this should be kept. This is to make sure there is a regular planned approach to maintaining the premises that can be audited. The Registered Manager should make sure that there is enough appropriate equipment available so that staff can move people using the service safely; this was identified for improvement at the previous inspection. The Registered Manager should make sure that all people using the service’ bedrooms are fitted with a lock that is easily accessible to staff in an emergency. This is so that all people are enabled to choose to remain as independent and private as they wish. This was identified for improvement at the previous inspection. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 9 The Registered Manager must make sure that suitable furniture and furnishings are provided for people, this is to so that people are comfortable and provided with privacy. An Immediate Requirement was issued in relation to this. The Registered Manager must make sure that people are not at risk from the large amount of uncovered radiators and pipe work in the building and that there are regularly reviewed risk assessments in place in respect of risks from hot surfaces, and where significant risks are identified that solutions are put in place to reduce or eliminate risks. This is to make sure that vulnerable people using the service have their safety needs considered and met and that a record of this information is available. This requirement was made at the previous inspection and the timescale for action has not been met. The Registered Manager must make sure that the home is kept free of offensive odours, this will help to make sure that the environment is pleasant for people using the service. The Registered Manager must make sure that there are facilities in place for staff to wash and dry their hands and that the laundry is kept in an orderly manner. This is to reduce the risk of cross infection and to make sure that good infection control practices are maintained, this will be positive for people using the service. The Registered Manager must make sure that there are always enough staff on duty to ensure that people using the service have their health and social care needs met. This is to ensure that people are cared for in a timely unhurried manner, that call bells are answered in a timely manner, that activities can be enjoyed by people, that bedtimes can be more flexible and that the home is kept clean and odour free at all times. The Registered Manager should enable staff to increase their skills and knowledge of caring for people using the service who have dementia type illnesses as this will benefit those people and increase staff confidence in how they work with people. The Registered Manager should make sure that results of any surveys are brought together and made available to people using the service and a copy sent to CSCI. This will show that the service makes changes based on people’s views. This was identified for improvement at the previous inspection. The Registered Manager should make sure that all staff receive supervision regularly. This is so that staff have the opportunity for dedicated 1- 1 time with the Registered Manager to plan and receive feedback about their performance and development. The Registered Manager must make sure that the routine essential fire safety checks are carried out correctly and any identified hazards reported and acted upon immediately. This is to make sure that the risk of injury from fire to people using the service is minimised. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 10 The Registered Manager must ensure that the electrical testing that has begun is been completed. This requirement was made at the previous inspections of 30/09/05, 31/12/05 and 28/02/07 and the timescale for action has not been met. 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. The summary of this inspection report can be made available in other formats on request. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 11 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 Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The service’s performance was assessed against Key standard 3 and Standard 2. Standard 6 does not apply to this service. People who may wish to use the service provided at Ebberly House have undergone an assessment process to determine whether their needs can be met by the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which told us that all people that are new to the service are Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 13 given documentation and that new people have had an assessment. It also stated that all people using the service now have contracts in place. The Statement of Purpose was read and advises people that a pre admission assessment will be undertaken to assist the service in identifying whether they can meet the persons care needs. On this occasion we spoke with 4 people using the service, 2 were unable to tell us about their own pre admission assessment experience. One person spoken with was able to tell us that they visited Ebberly House and two other homes before deciding that they wished to move into Ebberly House. Another person told us that their daughter visited the home on their behalf and made the decision that this would be the best home for their parent. We read 2 people’s care records and this included assessment information. The Registered Manager told us that all residents now have contracts in place and we saw 2 people’s contracts. 1 of the 4 people we spoke with told us that they did not know about their contract and that their social worker dealt with things on their behalf, another person told us that their family looked after that side of things for them. The Registered Manager informed us that there have been no changes to the information provided to people using the home known as the Statement of Purpose, the Service User Guide and the Complaints procedure. We were provided with copies of these. Our findings confirmed what had been stated in the AQAA. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The service’s performance was assessed against Key standards 7,8,9 and 10. The health and personal care that people receive at Ebberly is based on their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which told us that people have care plans that are well laid out and regularly reviewed. We spoke with 4 people using the service, each person told us in their own way about the care they receive and the way in which they receive care. People told us that they know that the home has records for each of them but these are not of interest to them. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 15 People told us that they can see a doctor if they need to and that nurses visit the home sometimes, we were also told that people can go to hospital appointments if they need to and that a chiropodist visits the home to attend to those people who want treatment – one person told us that they were able to continue with the chiropodist they had been seeing before they had moved into the home. We read 2 people’s care records and these show that people do receive visits from health professionals and that treatment outside the home is supported. There were good records of a person’s admission and discharge from hospital and good information showing that changes in care were needed on return from hospital. The care records also show that people’s care records are regularly reviewed and updated. We found that some information about a person’s social care could not be case tracked as it had not been entered into their care records – this was brought to the attention of the Registered Manager. We also pointed out to the Registered Manager that useful information held in a person’s assessment showing that they have a health care need had not been transferred to the health care needs section of the care records. People told us that staff although very busy are polite. We observed and listened to staff working with people using the service and they appeared polite and respectful in their manner. A relative confirmed that they have observed that staff are professional with people using the service. People told us that they are supported by the service with their medication needs and prescriptions and that the care staff give them their medicines. We looked at medication procedures and records in the home. We found that the medication administration records were completed to a good standard. We found that a controlled drug record is kept up to date, however the service did not have the correct type of record in place; the Registered Manager was informed of this. Medicines are delivered on a monthly basis and when possible medicines are packaged in blister packs. We were told by the Registered Manager and we observed that following the last inspection staff now stay with people until they have taken their medicine – the manager told us that the medicine policy had been changed to make sure this happens and that she informally monitors staff to ensure correct practice takes place – there is no written record to support this. We read the updated medication policy. Two care staff told us that they have received medication training; we read 2 staff training records that also confirmed this. The home does have a dedicated medication fridge we were told by the Registered Manager that the fridge was broken – we found that some Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 16 medication that need cold storage were being stored in the kitchen fridge – we informed the Registered Manager that this is not acceptable. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The service’s performance was assessed against Key standards 12,13,14 and 15. Some people who use the service provided at Ebberly are able to make choices about their life style. The home struggles to provide activities or a stimulating environment, people’s nutritional needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which told us that people at the home have choice over how and where they spend their day and that they have identified that activities need to be increased. The service does an annual quality review and staff communicate regularly with people particularly at the 4 weekly care review. We spoke with 4 people about the daily life and social activities provided by the service. One person told us they were able to go out independently, this was observed by us, they also told us that their family visited them and that there is not much to do in the home. Another person told us that they occasionally Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 18 have visitors, that they chose to eat and spend time in their room or one of the homes 2 lounges and can go out if there is enough staff to take them. One person told us that they go out to church another told us that not much happens in the home. The people we spoke with gave the overall impression that they fit in with the routines within the home – for example some people that need help to go to bed have to go to bed before eight o’clock – we were told that these people seem happy with this but that if an additional member of staff was available between eight o’clock and ten o’clock ay night then people would probably be able to stay up later. We did not see activities taking place when we visited the service and there was no information available or on display informing people about activities. There was minimal information in the care records we read about activities and choice. We read a quality questionnaire that did identify that a religious service takes place on Sundays at the home – the Registered Service confirmed this and explained that they were not always weekly now. The four people we spoke with said that on the whole the food was good and that they had enough to eat and drink. We looked at the kitchen, the menus and the fridges and freezers. The kitchen was showing signs of wear – the last environmental health inspection report was read and we were informed that the action identified at that inspection had been carried out. There was a supply of fresh, frozen and dried foods and the opened food was stored correctly in the kitchen fridge. We saw the records showing that the fridge and freezer temperatures are regularly recorded. We observed people eating in the dining room and in their own rooms. The 2 care records read by us showed that people’s weight is monitored regularly. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The service’s performance was assessed against Key standards 16 and 18. A complaints procedure is in place, and people using the service are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which told us that the service has a complaints procedure that all new residents receive a copy of, that there have been no complaints received by the home in the 12 months before this inspection and that all staff have attended training in the Protection of Vulnerable Adults. We were provided with a copy of the service’s complaints procedure, the complaints procedure is clear and provides all necessary information, however a copy of this is not on display in the home so is not accessible to all. This was brought to the manager’s attention. We spoke with four people using the service who were unclear about how to make a complaint and those with family said they would go to their family in Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 20 the first instance. The four people we spoke with said that staff treated them well. We spoke with 2 care staff who told us that they had had training in the protection of vulnerable adults and they were able to explain what abuse is and what action they would take if they suspected or witnessed abuse. We read 2 care staff training records and saw that they had attended Ault Protection training. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. The service’s performance was assessed against Key standards 19 and 26 and standards 22, 24 and 25. Improvements are needed to make sure that the environment is clean, well maintained and safe and that furniture provided for people is of an acceptable standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which told us that equipment is regularly serviced, that staff strive to keep the home clean, tidy and odour free and that each time a new resident moves in if appropriate the bedroom to be occupied is decorated. We were also told that a new boiler and call bell has been installed, locks have been fitted to store room doors and that electrical testing has begun. The Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 22 service identified that they could make improvements by completing more risk assessments in relation to uncovered radiators and that they plan to make improvements over the next 12 months by completing the electrical testing, to commence the fitting of radiator covers and to ask all new people moving to the home if they would like a lock fitted to their bedroom door. We carried out a tour of the home and visited almost every person’s individual room. We also looked at maintenance records spoke with 4 people using the service, the Registered Manager, Provider and staff. We also considered the results contained in the surveys we received and read 2 people’s care records. During a tour of the home we found that the communal areas are well furnished and provide a homely environment for residents to enjoy. We found that a fire exit was hazardous as the non-slip surface had become detached and had rolled over – this was brought to the attention of the Registered Manager and provider for action. We were surprised to find on a return visit 2 days later this had not been corrected. We issued an Immediate Requirement and the Provider removed the trip hazard when we were there. We found that there is not a programme of routine maintenance and renewal of the fabric and decoration of the home however, we read records and saw contractors’ certificates that showed equipment is regularly maintained. We found that call bells are accessible in every room and that there are stair lifts to assist people when needed, in addition we saw grab rails and other equipment to assist people. The home only has one hoist – we were told that it is not in use and that it is housed on the basement floor – there is no hoisting equipment available on other floors of the home. This was discussed with the Registered Manager. We saw that following the previous inspection findings that storage cupboards are now fitted with locks. We visited most people’s rooms and found that most had the minimum recommended furnishings, however much of the furniture is looking tired – several chairs were scuffed and had well worn seat pads that provided little cushioning, the curtains in some rooms were old and unlined and when drawn and lights are on do not provide much privacy. We saw that doors to people’s rooms are not fitted with locks – this was identified at the previous inspection and there was no information in the 2 care records that we read to show that this had been offered or discussed with people. This was raised with the Registered Manager who advised that this is to be included in people’s risk assessments. A bed in use in a person’s bedroom was found to be unfit for use. An immediate requirement was issued and a new bed was delivered and put into use the following day. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 23 We found that rooms are centrally heated; the 4 people we spoke with told us that the temperature is always comfortable. The provider and Registered Manager informed us that a new boiler has been installed; we read records to show that the hot water temperatures are monitored in relation to preventing Legionella. We found as identified at the previous inspection that not all radiators are covered – and we found that risk assessments in respect of this were not in place in the 2 care records we read – the Registered Manager was informed of this and acknowledged this. We found that some of the rooms had an odour of urine – in some instances carpets were stained, in one instance it was because a commode had been emptied but not cleaned. We also found that 3 commodes were rusting in areas that come into contact with peoples skin – the Registered Manager was informed of this and asked to take action to resolve this. We were told the home does not have a dedicated cleaner and that care staff in addition to their caring duties also do the cleaning and laundry, we saw the cleaning rota on display in the kitchen. On our third brief visit as part of this inspection the provider was seen shampooing carpets. We found that there are plenty of sinks with a supply of liquid soap but no paper hand towels were provided for hand drying. We saw a member of staff working in the kitchen was drying their hands on a tea towel The home does have a laundry and action has been taken following the previous inspection to safely store hazardous liquids safely. The laundry has a washable floor and cleanable walls - we found the laundry to have dirty linen on the floor and to be generally untidy. Our findings on this occasion do not support all of the information provided in the AQAA. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The service’s performance was assessed against Key standards 27,28,29 and 30. Staffing numbers do not currently seem to be sufficient to support the people living at Ebberly House, and support the smooth running of the service. The service does recruit staff properly and staff do attend training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which told us that staff have regular training including Adult Protection training and receive certificates for courses they do. The AQAA also told us that staff undertake NVQ qualifications in care and receive regular supervision. We spoke with four people that use the service and a visitor, we also read the staff rota, and observed staff, and we also read 2 staff records and spoke with 2 care staff and the Registered Manager. The people we spoke with told us that staff are able to give the care that is needed but that staff are busy and do not have time to talk, we were also told that it is sometimes a problem to respond to call bells in a timely way. We read Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 25 the staff rota that confirmed what we were told by care staff and people that use the service that there are normally three carers on during the morning shift – this includes the Registered Manager. There are 2 care staff on duty during the afternoon and one waking night care staff and one sleep in staff during the night and early morning, other findings mentioned in this report highlight where the service falls down and could probably be improved by more staff being available. The Registered Manager told us that 2 staff had recently left and that the service is advertising for staff – we were told it is an aim of the service to employ more staff and also enable the Registered Manager to focus on the managerial responsibilities. We read staff records and spoke with staff and found that over 50 of staff that have achieved a National Vocational Qualification level 2 or above. Staff told us what training they had completed and we read 2 staff records that showed staff do access training. It was identified that care staff would benefit from additional training in dementia care – this was discussed with the manager. A member of staff was very positive about the work they had done as part of a course on Parkinson’s disease. The 2 care staff and Registered Manager all described the recruitment process at the home and 2 staff records showed us that all relevant checks and references are followed up. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. The service’s performance was assessed against Key standards 31,33,35 and 38. A Registered Manager manages the service, people’s views are sought but it is not known if they are acted upon, health and safety practices need to be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided a completed AQAA (Annual Quality Assurance Assessment), which told us that they complete and collate an Annual Quality Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 27 Survey with people using the service and that electrical testing has begun and is to be completed, we are also advised that a health and safety inspection has been undertaken. The AQAA also provided information about what health and safety checks are routinely carried out and when equipment is checked and serviced. The registered manager is qualified and experienced. Staff said that they could talk to her and that their opinion was listened to. A visiting relative said that they felt that the manager is approachable. The registered manager sends out surveys to residents once a year as part of their quality assurance programme and this information is collated, however this still needs to be made available to residents and a copy sent to CSCI as identified at the previous inspection. We saw some of the surveys that had been returned and read some of the comments on them. The 2 care staff we spoke with told us that they do meet for supervision with the Registered Manager – we saw 2 staff records that showed that staff supervision meetings had taken place but not as regularly as they should be recently. The four people we spoke with told us how they manage their finances and this is different for each person, some manage themselves, some have the support of their family. We read the details of 3 peoples financial transactions and also saw that following the previous inspection that receipts for all transactions are now kept and can be audited and cross referenced with records. We read a variety of certificates and health and safety checks that had been carried out for and by the service – an area of concern is that the checks detailed in the Fire Log were not being carried out weekly as they should be. Another area of concern is that it is recorded that the fire exits/ escapes are checked weekly however we found a fire escape to be hazardous due to the lifting and folding back of a non slip surface – this had not been identified as part of the weekly checks. We could not see the certificate to demonstrate the electrical testing of the home had been carried out but were informed by the Registered Manager and the provider that this had begun – the name of the contractor was given to us. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 28 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 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X X 2 X 1 1 1 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 1 Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15(1) Requirement The Registered Manager must make sure that people’s health and social care are clearly identified and planned for. This is to make sure that all people have their health and social care needs identified, planned for and met. The Registered Manager must make sure that the correct cold storage is used for medicines that need cold storage. This is so that medicines are stored safely at the correct temperature and cannot be contaminated or contaminate food. The Registered Manager must make sure that the correct type of record is in place to record the receipt, administration, stock level and disposal of any controlled drugs that may be used by people using the service. This is so a clear and appropriate audit trail and record are in place in line with recognised guidelines. The Registered Manager must provide facilities for recreation DS0000022086.V348674.R01.S.doc Timescale for action 31/03/08 2. OP9 13(2) 31/03/08 3. OP9 13(2) 31/03/08 4. OP12 16.2 (n) 31/03/08 Ebberly House Version 5.2 Page 30 5. OP19 13.4(a) 6. OP24 16.2(c) 7. OP25 13(4)(a)( b)(c) 8. OP26 16.2 (k) including, activities in relation to recreation, fitness and training and must make sure that people using the service are involved in making decisions about the programme of activities arranged by or on behalf of the care home. This is so people using the service have enjoyable and fulfilling days. The Registered Manager must make sure that all fire exits at the home are safe to use. This is to ensure a quick safe exit from the home in the event of a fire. An Immediate Requirement was issued in relation to this. The Registered Manager must make sure that suitable furniture and furnishings are provided for people, for example appropriate seating, floor covering, commodes, beds and curtains. This is to make sure that people are comfortable and provided with privacy. The Registered Manager must make sure that risk assessments are reviewed in respect of risks form hot surfaces, and where significant risks are identified solutions put in place to reduce or eliminate risks. This is to make sure that vulnerable people using the service have their safety needs considered and met and that a record of this information is available. This requirement was made at the previous inspection and the timescale for action has not been met. The Registered Manager must make sure that the home is kept free of offensive odours, this will help to provide a pleasant environment for people using the service. DS0000022086.V348674.R01.S.doc 31/03/08 30/04/08 30/04/08 29/02/08 Ebberly House Version 5.2 Page 31 9. OP26 16.2 (k) 10. OP27 18.1(a) 11. OP38 13(4)(a) 12. OP38 13(4)(a) The Registered Manager must make sure that there are facilities in place for staff to wash and dry their hands and so that the laundry is kept in an orderly manner. This is to reduce the risk of cross infection and to maintain good infection control practices, which will be beneficial for people using the service. The Registered Manager must make sure that there are always enough staff on duty to ensure that people using the service have their health and social care needs met. This is to ensure that people are cared for in a timely unhurried manner, that call bells are answered in a timely manner, that activities can be enjoyed by people, that bedtimes can be more flexible and that the home is kept clean and odour free at all times. The Registered Manager must make sure that the routine essential fire safety checks are carried out correctly and any identified hazards reported and acted upon immediately. This is to make sure that the risk of injury from fire to people using the service is minimised. The Registered Manager must make sure that the electrical testing that has been taking place for sometime is completed as soon as possible. This is to make sure that the risk to people using the service is minimised and so far as possible eliminated. This requirement was made at the previous inspections of 30/09/05, 31/12/05 and 28/02/07 and the timescale for action has not been met. 29/02/08 31/03/08 31/03/08 31/03/08 Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 32 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 OP3 Good Practice Recommendations The Registered Manager should make sure that the resident application is updated; this will make sure that all people moving to the home receive the same level of assessment regardless of who is paying for their care. The Registered Manager should keep a record of their monitoring of staff when they give people their medicines, this will demonstrate that staff monitoring has taken place and provide a useful record that can be audited. The Registered Manager should make sure that people using the service are not restricted from making choices because of staffing levels or routines that have been imposed to suit the service. The Registered Manager should make sure that the Complaints Procedure is easily accessible to all. This will show the homes openness and willingness to improve the service. The Registered Manager should make sure that there is a programme of routine maintenance and renewal of the fabric and decoration of the home in place and records of this should be kept. This is to make sure there is a consistent planned approach to maintaining the premises that can be audited. The Registered Manager should make sure that there is sufficient equipment to enable staff to move people using the service safely. The Registered Manager should make sure that all people using the service’ bedrooms are fitted with a lock that is easily accessible to staff in an emergency. This is so that all people are enabled to choose to remain as independent and private as they wish. The Registered Manager should enable staff to increase their skills and knowledge of caring for people using the service who have dementia type illnesses as this will DS0000022086.V348674.R01.S.doc Version 5.2 Page 33 2. OP9 3. OP14 4. OP16 5. OP19 6. 7. OP22 OP24 8. OP30 Ebberly House 9. OP33 10. OP36 benefit those people and increase staff confidence in how they work with people. The Registered Manager should make sure that results of any surveys are collated and made available to people using the service and a copy sent to CSCI. This will show that the service makes changes based on people’s views. The Registered Manager should make sure that all staff receive regular supervision, this is so that staff have the opportunity for dedicated 1- 1 time with the Registered Manager to plan and receive feedback about their performance and development. Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Ebberly House DS0000022086.V348674.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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