CARE HOMES FOR OLDER PEOPLE
Echelforde Resource Centre Echelforde College Way Ashford Middlesex TW15 2XG Lead Inspector
Pauline Long Unannounced Inspection 12th June 2006 09.15 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 Echelforde Resource Centre DS0000013890.V299326.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. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Echelforde Resource Centre Address Echelforde College Way Ashford Middlesex TW15 2XG 01784 255225 0178 442 3243 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) manager.burroughs@careuk.com Care UK Community Partnerships Limited Mr Edwin Phillip Steyn Care Home 50 Category(ies) of Dementia - over 65 years of age (50), Old age, registration, with number not falling within any other category (50), of places Sensory impairment (3) Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Not exceeding 50 persons within the categories OP, DE(E) and MD(E). Of the registered Service Users, 3 (three) named service users may be within the category SI. 20th September 2005 Date of last inspection Brief Description of the Service: Echelforde Resource centre is a purpose built single storey home for older people with dementia and is conveniently located for all the local shops and community facilities. The home is organised in five units each with ten bedrooms. All accommodation is offered in single rooms. Each unit has its own lounge dining area and small auxiliary kitchen. The home is situated in its good-sized grounds with safe and well-maintained gardens. There is ample car parking facilities to the front and side of the home. The fees at the home range from £388.00 to £710.00 per week Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first site visit of the CSCI key inspection year and was unannounced. The inspection was carried out by one inspector and lasted for six hours. Discussions were held with the residents, relatives, visitors, manager and care staff. Documents sampled, included service users files, care plans, staff records, service files and the pre-inspection questionnaire. A full tour of the home and gardens took place. Verbal feedback from the resident’s at home on the day was limited, in view of their communication difficulties. However facial expressions and body laungage gave an indication of general well-being. CSCI would like to thank the residents, manager and staff for their hospitality and co-operation during the inspection. What the service does well:
The manager and care staff demonstrate an open and inclusive approach. They have a good understanding of the residents needs, which enables them to provide a consistent standard and level of care to the residents. Relatives commented that the staff were always respectful and mindful of the resident’s dignity. The staff on duty on the day had a good understanding of the resident’s personal care needs. This was evident from the positive interactions and relationships observed. Relatives commented that they were encouraged to become involved in developing their relatives care plan. The home promotes and encourages contact with family/friends and the local community. Relatives commented that the manager has a high profile in the home and since his appointment the home has changed for the better. Care needs assessments and care plan documentation is comprehensive and of a good standard providing staff with all of the relevant information required on a resident. Residents bedrooms are well equipped and decorated to reflect that of any other domestic setting. The home is in the process of adapting one of the storage rooms to provide a multi sensory room, which would be good for those residents with communication difficulties. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Incidents and accidents are routinely notified by the home. However it was of concern to note that there had been many unobserved falls reported at the home. To ensure that all steps are taken to minimise the risk of falls, a falls audit must be carried out at the home to include a further review of staffing levels. A lunch time activity was observed, and whilst on the whole care staff provided support in a sensitive way, it was noted that one member of staff raised her voice to an inappropriate level, which startled several residents and a visitor., Guidance must be given to the member of staff involved to ensure that in the future challenging behaviours can be managed in an appropriate manner. The overall environment has improved, however attention must be paid to the water supplies in a residents bedroom. The hot water tap must be repaired to ensure an adequate supply of hot water. Comment books are provided for the residents and staff to give feed back to the chef. It was noted that some of the entries were written in an inappropriate way, it was not clear as to which resident had a particular dislike of a certain food. It would be good practice for care staff to indicate an
Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 7 individual resident’s dislikes, in order that the chef could have a discussion with the individual concerned. The kitchen is well equipped in respect of crockery, cutlery etc, however it was noted that the thermos jugs will require replacement as all of the lids have been scorched and melted in such a way as to pose potential risk in respect of food hygiene regulations. Discussions were had with the chef about the importance of her spending some time with the residents at meal time, this would provide her with instant feed back about the food. The site visit was carried out on a very hot day. The majority of the homes exit doors were open and residents were observed going in and out of the garden. It was a concern that there were no shaded areas in one of the homes courtyards, and there was limited furniture for residents to sit and enjoy the sunshine. Requirements and recommendations have been made in these areas. Please refer to page 23 of this report 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. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 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 Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 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): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive needs assessments are completed prior to a resident being admitted to the home. The home does not provide for an intermediate care service. EVIDENCE: The home has admitted several residents since the last inspection. The manager stated that a community care needs assessments would be requested from the social and health care management teams. Once in receipt of these assessments the manager/ team leader would visit the prospective resident either at their home or in hospital, in order to carry out their initial needs assessment. The manager stated that if appropriate, prospective residents would be encouraged to visit the home prior to admission, in order to further assess their needs and to provide an opportunity for the resident and their relatives to become familiar with the home.
Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 10 The homes care needs assessment is comprehensive and would provide the reader with a good insight into a residents holistic needs and any potential risks they may face. The manager commented that, once a resident was admitted to the home the needs assessments would be on-going. The home provides a respite service for residents referred through the local authority social care teams, however they do not provide for an intermediate care service. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive holistic care plans are in place for the residents. The staff had a good understanding of the resident’s needs and choices. Residents were treated with dignity and respect and were encouraged and supported to help in decision making at the home. Improvements were needed in respect of staff service user interactions in respect of managing challenging behaviours. EVIDENCE: The staff on duty on the day had a good understanding of the resident’s personal care needs. This was evident from the positive interactions and relationships observed. Relatives commented that they were encouraged to become involved in developing their relatives care plan. Care plans were sampled, and were found to be well written, to include all daily living activities. The care plans gave clear instructions and guidelines to the reader about a residents care needs, demonstrating that the care staff would be aware of these needs. Relatives commented that their relatives needs were well met. Risk assessments were clearly documented and guidelines in
Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 12 place to minimise the risks. All care plans and risk assessments had been regularly reviewed. The homes medication practices were not inspected during this visit. However it was noted that the medication systems and practices were being audited by the local Community Pharmacist. Discussions were had with her in this respect and she indicated that the homes medication procedures and practices were much improved. Staff were observed supporting the residents in a respectful manner. Bedroom and bathroom doors were not left open whilst they were attending to a residents personal care needs. Doors were always knocked prior to a member of staff entering a room. Overall support was offered in a respectful and unhurried manner. However, whilst this lunch time activity was observed, it must be noted that on the whole care staff provided support in a sensitive way. Before the lunch was served one resident became distressed and was displaying challenging behaviour. Care staff responded, however it was concerning to note that one member of staff raised her voice to an inappropriate level to deal with the situation, which startled several residents and a visitor. This situation was discussed with the manager, who stated that guidance would be given to the member of staff involved, to ensure that in the future, episodes of challenging behaviours would be managed in an appropriate manner. Relatives commented that the staff were always respectful and mindful of the resident’s dignity. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are encouraged and enabled to maintain fulfilling lifestyles in and outside the home. The home promotes contact with family, friends and the local community. The meals offered in the home are good. EVIDENCE: The routines in the home are determined only by the timings of the visits to and from other appointments. On the day, the inspection started at 09.15 it was positive to note that some residents were still in their night attire, indicating a relaxed homely atmosphere. Some residents wished to remain in their bedrooms and had their breakfast brought to them. The home is committed to ensuring that the residents maintain their relationships with their family and friends and the local community. The manager discussed various activities for example: aromatherapy, visits to the shops and to the local pub, garden parties. Photographs were displayed in the front hall of various outings and evidenced many smiling faces. The manager commented that one of the storage rooms was going to be adapted as a multi sensory room in order to provide a quiet restful place for residents to spend time. Those residents who wish to practice their faith are encouraged and
Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 14 enabled to do so. Families and friends are encouraged to visit the home, some are regular visitors and visit their relative on a daily basis. Relatives commented that the home would always go out of their way to ensure arrangements are in place for visits to visit the home. One visitor commented that she would like to have her name added to the homes waiting list, as the home was so nice. The majority of the meals at the home are prepared off site and are delivered as a “ cook chill” method. The menus were good and provided reasonable choices. The manager commented that, following feed back from the residents some adjustments had been made to the original menus, for example: more salads, jacket potatoes, less spicy foods, more traditional cooking. The home provides the residents with a cooked breakfast three days a week, which would be cooked by the chef at the home. The meals served on the day looked appetizing and appealing. Residents commented that that the meal was nice and they appeared to be enjoying it. Staff were observed supporting those residents who required help with their food. Recommendations were made in respect of these standards. Please refer to pages 23 of this report. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 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 the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory policies and procedures in place for dealing with concerns, complaints and the protection of the residents. EVIDENCE: The CSCI have received no complaints about this home since the last inspection. Relatives commented that they were aware of the complaints procedures and if complaints are made they are dealt with in a timely manner. Two referrals have been made under the Surrey Multi Agency Safeguarding Adults procedures. Meetings have been held in this respect and the issues have yet to be satisfactorily resolved. All staff have undertaken training in respect of the safeguarding adults procedures. Discussions were had with all of the staff on duty in respect of abuse and abusive situations and it was positive to note they demonstrated a good understanding of the current policies and procedures. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 16 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): 19,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good and meets the needs of the residents providing a clean, pleasant and homely place to live. However consideration should be given to the provision of garden furniture. EVIDENCE: Considerable improvements have been made in respect of the overall environment and the furnishing and fabrics in the home. All of the communal areas of the home have been re-decorated. All of the residents beds have been renewed, new curtains and bed covers have been bought. The communal areas have been enhanced by the purchase of new arm chairs and curtains. The inside of the property provides a safe, homely and comfortable environment for the residents, with grab rails and adaptations in place to support residents to maintain their independence.
Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 17 On the whole the grounds are well kept, with many attractive places for residents to spend time. As discussed earlier in this report, the inspection was carried out on a very warm day and several residents were observed going outside. It was noted that there was a lack of appropriate safe seating and shaded areas for those residents who wished to spend time outside. A recommendation was made in respect of these standards. Please refer to page 24 of this report. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment practices in this home are good. The home employs an efficient, appropriately trained and supervised staff team. Staffing levels on the day were adequate, however they should be reviewed in respect of the number of unobserved falls reported at the home and the feedback received from relatives and residents. EVIDENCE: The home has clear policies and procedures for staff recruitment. Several new members of staff have been recruited since the last inspection. These recruitment records were sampled and demonstrated thorough recruitment and selection practices. There have been changes in the staff group at the home over the past few months. However the manager stated that the changes were necessary and was confident that the changes would prove to be a positive move for the home. The home no longer has to use agency staff. On the day of the site visit staffing levels were adequate and consisted of, the manager, two team leaders 8 care staff, two cleaners, one chef and one maintenance man. However one relative commented that at times there are not enough staff at the home, particularly when a resident has a fall, he recalled a few occasions when he had to leave his relative to fetch help for another resident who had fallen. Discussions were had with some of the staff on duty. They demonstrated that they had an awareness of their individual roles and responsibilities. Work
Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 19 based observations evidenced competent and confident staff carrying out their various tasks. Staff training is given a high priority in this home, and training records demonstrated many statutory and current good practice training had been undertaken since the last inspection and further planned throughout the year. Several staff are undertaking National Vocation Qualifications, 6 are already registered and a further 12 being registered on the 13th June. Staff commented that the opportunities for training were good. One relative commented that the staff appeared to be well trained and that they knew what they were doing. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is experienced and competent. Residents and staff benefit from his management approach, their views are listened to and acted upon. The health, safety and welfare of the residents is promoted and protected. However consideration should be given to the provision of safe seating and the provision of shaded areas in the gardens. EVIDENCE: At present the registered manager is undertaking the Registered Managers. On the day he demonstrated an open and inclusive approach and management style. From observation of his interactions with the residents and staff it was clear that there was an atmosphere of openness, understanding and respect. The home holds monthly resident’s meetings in which the care staff support the residents to express their views. Records are kept in this respect. The
Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 21 organisation issues service users with a yearly questionnaire in order to gain their views as to how the service is performing. The manager commented that he hopes to develop a service user questionnaire specifically for Echelford. The organisation’s questionnaires were not sampled on this occasion. Health and safety checks are routinely carried out at the home. All equipment in use on the day of inspection was properly maintained. Records evidenced that water temperatures, fire drills and fire bells were regularly checked. Kitchen records in respect of fridge, freezer and food temperatures were well kept. However as mentioned earlier in this report there are health and safety shortfalls in the provision of garden furniture and sun shade. There is a formal one to one staff supervision programme in the home. The manager commented, that he was striving to meet the required number of formal one to one supervision meetings. Records were sampled and demonstrated that one to one supervision meetings had been held. Group supervision meeting are held on a monthly basis and minutes kept. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X X 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 23 No 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 OP38 OP27 Regulation 12(1)(a) 13(4)(c ) Requirement The registered person(s) must ensure that all steps are taken to minimise the risk of falls, a falls audit must be carried out at the home. When completed a copy of this audit must be sent to the CSCI. Timescale for action 12/08/06 2. OP27 12(1)(a) 13(4)(c ) 18(1)(a) 12(1)(a) 23(2)(j) 2. OP25 The registered person(s) must 12/08/06 ensure that a review of staffing levels is undertaken and when completed a copy must be submitted to the CSCI. The registered person(s) must 12/07/06 ensure that all areas in the home have adequate supplies of hot running water. The tap in a residents bedroom must be repaired. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000013890.V299326.R01.S.doc Version 5.2 Page 24 Echelforde Resource Centre 1 2 3 4 Standard OP18 OP38 OP15 OP33 OP38 It is strongly recommended that all staff are provided with guidance as to how they might respond to challenging behaviours in a sensitive and appropriate manner. It is strongly recommended that home provide appropriate garden seating and safe shaded areas for the residents to spend time. The chef should consider spending time each day observing meal times and speaking with the residents about their food likes and dislikes. It is strongly recommended that consideration is given to the replacement of the thermos jugs used at the home. Echelforde Resource Centre DS0000013890.V299326.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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