CARE HOME ADULTS 18-65
Eden Place 1 Vicarage Road Lillington Leamington Spa Warwickshire CV32 7RH Lead Inspector
Justine Poulton Announced Inspection 3rd November 2005 09:15 Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 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 Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Eden Place Address 1 Vicarage Road Lillington Leamington Spa Warwickshire CV32 7RH 01926 313227 01926 887333 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) Eden Place Limited Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (24) of places Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may provide care for one additional resident during the period 26 July 2005 to 31 October 2005 5th May 2005 Date of last inspection Brief Description of the Service: Eden Place is a spacious Edwardian Town House, situated in Lillington, Leamington Spa. The home accommodates 24 residents with enduring mental health problems. It is staffed 24 hours a day by a team of qualified nurses and nursing assistants. The home provides a service to residents aged 49 and over. Wheelchair access is from the car park. There are currently no lifts available within the home. The home is within easy reach of local amenities including shops, churches, libraries and the local bus route. The home was established in 1984 and is a building of three storeys, a basement and extension, known as `The Lodge`. There are 22 bedrooms including two double bedrooms. There is a medium sized, private, sheltered garden. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday and was carried out from 9:15am until 16:00pm. The manager, residents and staff co-operated fully with the inspection. A total of 31 standards were inspected on this occasion of which 13 had shortfalls. The majority of requirements from the previous report for this home have been actioned, with only two being carried forward as they were only partly met on this occasion. All of the residents were at home for all or part of the day. A number were spoken with informally throughout the day. Seven members of staff spoke to the inspector as a group. In addition to this records, files and policies and procedures were inspected, and a number of comment cards were received from residents of the home. The manager of the home has made an application to the Commission for Social Care Inspection for registration. This application is being processed at the time of writing this report. The inspector would like to thank the manager, residents and staff for their cooperation and hospitality during the inspection. What the service does well:
A considerable amount of work has been undertaken since the last inspection to meet the requirements made, all of which the inspector was easily able to identify within the home. When asked, the staff spoken with said that they felt motivated and enthusiastic about their roles, were very good at recognising the residents as individuals and treating them with respect and that they were very good at working together and supporting each other as a team amongst others. In addition it was felt that the manager was approachable and easy to talk to and the directors of the home had become a part of the wider team much more so than previously. The atmosphere within the home, demeanour of the residents and attitudes of the staff team in general presented a very positive approach which was reflective of the new management approach to supporting people with mental health needs. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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.
Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 Adequate information regarding the service provided by the home is available for prospective residents however the age range catered for is incorrect. Information concerning the assessed needs of residents is available to ensure staff are fully aware of their support role for each individual. Residents placements within the home are safeguarded by the provision of contracts detailing their terms and conditions of residency. EVIDENCE: Since the last inspection of this home which took place on 5th May 2005 the home has applied to the Commission for Social Care Inspection for a variation to its registration as a nursing home for adults aged 18 to 64. The home can now take residents aged 49 and over, with no upper age limit. This follows discussions with both commissioning agencies and the Commission for Social Care Inspection, and thus ensures that the requirement made at the last inspection regarding this has now been met. The home has a Statement of Purpose in place, however this does not now reflect the current registration status. Three residents have been admitted to the home since the last inspection. Pre admission documentation from various sources, including nursing reports and community care assessments were available within their care plan documentation. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 9 The homes own initial assessment documentation had also been completed, as had a ‘lifestyle assessment’, which detailed residents’ individual aspirations with regards to their leisure, occupation and educational needs. All residents have been provided with individual contracts that detail their terms and conditions of residency within the home including the method of payment of fees and any personal contribution necessary. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet residents needs. The people living in this home are supported to take responsible risks based on effective risk management strategies that are agreed and recorded on the individuals care plan. EVIDENCE: All residents have individual plans in place. Review documentation was in place in those looked at that included information on social and leisure needs. All review documentation was signed by the resident concerned as well as the healthcare professionals involved. Observations made during the inspection provided evidence of residents making decisions for themselves. This included activities such as what to have for their meal and how to spend their time. In discussions with staff and residents the inspector was informed that the residents are encouraged to make as many choices and decisions about their lives as they feel able. One example given was being able to choose where to visit in the homes newly acquired mini bus. Work has been undertaken on providing risk assessments for each resident.
Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 11 In the care plan files looked at, residents were found to have a ‘risk identity sheet’ which indicated whether an activity had a high, medium or low risk associated with it. All risks identified as medium or high had accompanying risk assessment documentation in place. This was dated and signed with planned review dates recorded. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 and 17 Opportunity for residents to participate in appropriate activities both in house and in the community to meet their needs and wishes is improving, however the level of recording regarding activities does not reflect this. Service users are supported to maintain family links and friendships. A varied selection of home cooked food is available that meets residents dietary needs. The lack of protective clothing work by staff when in the kitchen place residents at risk of infection via cross contamination. EVIDENCE: The home has a nursing assistant who holds responsibility for activities and entertainment in the home. In discussion staff members said that in house activities such as bingo and quizzes are arranged, however since the arrival of the new minibus, more activities away from the home are being arranged both by suggestion from staff, and by request from the residents. On the day of the inspection residents told the inspector that they were going to a coffee morning at a local drop in centre, and that they were looking forward to being able to get out and about in the new bus, much more than they were previously able.
Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 13 Although it was reported that activities are taking place on a daily basis, there was very little evidence in the way of recording available to demonstrate that this is the case. A number of residents have regular contact with their families through a variety of means, such as being visited, telephone contact and letters. Although the home is large, emphasis has recently been placed on individual care and support, with a move away from a more institutional way of living. The inspector ate lunch with a small group of residents in the ‘lodge’ dining room. This was tasty, plentiful and nutritious. The residents spoken with over lunch said that the food was always good and there was always lots of it. The menu is planned over a four week period that rolls over and over. The cook stated that it had not been revised since January 2005, however the local dietician service had been contacted and it was hoped that they would be able to give input into menu planning and nutrition. Upon inspection the kitchen was found to be old and worn, and in need of refurbishing. The manager and the cook both stated that this was scheduled to take place before Christmas. All of the necessary records such as fridge and freezer temperatures, food delivery temperatures and cleaning records were in place and up to date. Food was observed to be stored appropriately in various store rooms. It was noted during the inspection that a number of people access the kitchen throughout the day, not necessarily to prepare or serve food. It was also noted that no protective clothing such as aprons were worn other than by the cook when staff were in the kitchen area. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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, 20 and 21 The healthcare needs of the people living in this home are assessed and recognised, with most residents having routine and specialist appointments being arranged as necessary. Residents are protected by the homes policies, procedures and recording of medication, however the administration of homely remedies currently places the residents at risk. EVIDENCE: Information was available within residents files regarding their physical and emotional healthcare needs. Although residents are offered routine healthcare appointments such as dental or optical appointments, information available indicated that these were not at the recommended intervals for some residents. Records were in place that confirmed whether residents chose to accept these appointments, along with the outcome if attended and any future appointment dates. A policy for the use of and administration of homely remedies is now in place, however the safety of paracetomol when taken with other prescribed medications has not been sought for each individual. Residents wishes regarding aging, illness and death are recorded within their care plan files. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has a satisfactory complaints system in place that is accessible to residents. There are policies and procedures in place to ensure that residents are protected from harm. EVIDENCE: Work has been undertaken in the home to provide the residents with a complaints procedure that is understandable and easy to use. A copy has been given to each resident. A complaints record book is in place. Inspection of this confirmed that there have been no complaints since the last inspection. The home has a policy on the protection of vulnerable adults from abuse. In discussion the manger clearly demonstrated an understanding of abuse and how to deal with it should it be suspected. Training information available indicated that the staff team are scheduled to receive training in this area in December 2005. It was reported that there have been no allegations of abuse made in the home in the last twelve months. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27 and 30 Recent and continuing investment has significantly improved the appearance of this home creating a comfortable and homely environment for those living there. EVIDENCE: The home has started a major refurbishment programme, that will see all areas redecorated and where necessary refurnished. A programme of refurbishment has been provided to the commission. It was stated that work on all of the communal areas will be undertaken first, followed by residents individual bedrooms. At the time of the inspection the entrance hall and smoking lounge had been completed and work had commenced on the stairway to the first floor. A number of bedrooms and one bathroom had preciously been completed, before the major programme began. A new central heating system is to be installed, a passenger lift to the first and second floors is to be put in and a complete refit of the kitchen is also planned. Residents spoken with said that they liked the completed decoration as it made the home nicer and more homely. There was a noticeable difference in the cleanliness of the home. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 33, 34, 35 and 36 Staff morale is high resulting in an enthusiastic staff team that works positively with residents to improve their quality of life. The recruitment policy and procedure for this home ensures that residents are supported and protected from harm by the people caring for them. Further investment in staff supervision would ensure that residents are not placed at unnecessary risk. EVIDENCE: The home employs a mixture of qualified nurses, nursing assistants, housekeeping staff, cooks, maintenance staff and administration staff. It was a requirement of the last inspection that nursing assistants cease cleaning duties. This has been actioned, and the home now employs a head housekeeper and a cleaner on a full time basis. A further cleaner has been recruited, but has not started yet as all of the necessary recruitment checks had not been received. The manager stated that he feels that the staffing levels in the home are satisfactory, with 5 staff in the mornings and 3 staff in the afternoons as a minimum, along with 3 staff over night, as the ability to increase staffing levels should the need arise for specific activities is available. The management of staff recruitment files has been taken over by the recently appointed administrator. A sample of files were looked at, and found to contain all relevant documentation, thus confirming that the home operates a safe and robust recruitment procedure.
Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 18 A training audit has been undertaken since the last inspection. This clearly identifies which staff have had what training and when. Dates for refresher training for mandatory subjects are also included within this audit. A training evidence file has been started, with contains the certificates issued to all of the staff for any training undertaken. This is in alphabetical order, and is easy to use. As recorded previously, training on the protection of vulnerable adults is planned for December. The manager said that more specialised training around the needs of the resident group will be looked at in the spring of 2006. A requirement of the last inspection was for staff to be provided with supervision in line with national minimum standards. Evidence was available to confirm that this has been commenced, but remains an ongoing requirement. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 and 39 Leadership, guidance and direction to staff ensures that residents receive consistent good care. This has resulted in care practices that promote and safeguard the health, safety and welfare of the people living in this home. Strategies for enabling residents, staff and associated stakeholders to raise their views and concerns about the way the service is delivered are not in place. EVIDENCE: At the time of writing this report the manager has made application to the Commission for Social Care Inspection for registration. This is currently being processed. Staff spoken with made very positive comments about the manager which indicated that morale is high, communication has improved and the service is moving forwards for the first time in a very long time. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 20 Comment was made about the investment in the building, which reflects that the residents are valued, and about how job roles have been clarified which ensures that the service runs in a much smoother manner. Comment was also made by the staff team spoken with the residents appear to appreciate the investment being made in the service, and are generally happier, more talkative and involved that previously. A blank copy of a relative’s satisfaction questionnaire was provided during the inspection. It was stated that this has been used previously to find out relatives views about the service being provided to their relatives. This alone is not sufficient to form a valued judgement about the quality of the service, and does not meet the requirements of standard 39 of the National Minimum Standards. Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 x 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 2 2 2 x x 3 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 x 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Eden Place Score x 2 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x x x DS0000004306.V255219.R01.S.doc Version 5.0 Page 22 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 YA1 Regulation 4 Requirement The homes Statement of Purpose must be updated to reflect the recent variation that has been approved by the commission. Activities undertaken by residents must be recorded individually, and separate to nursing records. Staff must wear personal, protective clothing at all times when in the kitchen. Evidence must be available to confirm that all residents are offered routine healthcare appointments at the recommended intervals. (08/07/05 – not met) Confirmation must be sought from all residents GP’s that it is safe for them to take paracetomol as a safe homely remedy. Timescale for action 31/01/06 2 YA11YA12YA13 17 31/12/05 3 YA17 13(3)(4) 31/12/05 4 YA19 13(1)(b) 31/01/06 5 YA20 13(1)(b) 31/01/06 Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 23 6 7 YA24YA25YA26YA27 23(2)(c) YA36 18(2) 8 YA39 24 The planned refurbishment of the home must continue. Staff must be provided with formal, recorded supervision a minimum of 6 times per year. (31/07/05 – part actioned) A means of auditing the quality of the service provided by the home that seeks the views of residents, relatives and other stakeholders must be implemented. 28/02/06 31/01/06 28/02/06 Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 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. Refer to Standard Good Practice Recommendations Eden Place DS0000004306.V255219.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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