Inspection on 15/11/07 for Edenmore Nursing Home

This inspection was carried out on 15th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Edenmore Nursing Home 18/10/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Edenmore Nursing Home 7 Hostle Park Ilfracombe Devon EX34 9HW Lead Inspector Vickie Stewart Key Unannounced Inspection 09:30 15 and 28th November 2007 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 DS0000066336.V345987.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. DS0000066336.V345987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Edenmore Nursing Home Address 7 Hostle Park Ilfracombe Devon EX34 9HW 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) 01271 865544 www.aalenhouse.com PSP Group Ltd Elizabeth Mary Thompson Care Home 48 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30), Mental disorder, excluding learning of places disability or dementia (30), Old age, not falling within any other category (30) DS0000066336.V345987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is permitted to admit up to three service users under the age of 65 at any one time The maximum number of persons accommodated at the home, including those under 65, will remain at 48. 9th November 2005 Date of last inspection Brief Description of the Service: Edenmore is a purpose built detached two-storey building in the Ilfracombe area of North Devon. The home is sited in a residential area, stands in its own grounds and has distant views over the nearby coastline. There are car park facilities for visitors. Private rooms (some with ensuite facilities) are situated on the ground floor and the first floor. Some shared rooms are available. There are two lounges, a dining room, conservatory and Snoezelan (stimulation therapy) room. The home has a large reception area and a keypad controlled entry/exit system for safety and security. The home has a wing named Bay Tree House. This is directly connected to the main building and accessed from the first floor. Bay Tree has two floors and is accessed by a modern lift. This extension has 4 ensuite single rooms with a lounge, kitchen area and assisted bathing facilities. The cost of care ranges from £507 to £600 per week depending on individual needs. Additional costs, not covered in the fees, include chiropody at £12 per session, hairdressing at cost, and personal items such as toiletries and newspapers at cost. Current information about the service, including CSCI reports, is available to prospective residents, relatives and others who may have an interest such as care managers. DS0000066336.V345987.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A total of 15 hours were spent at the home and the inspection was completed over two days. The last key inspection took place on 18 December, 2006 and a further random inspection was completed on 24 April, 2007. The purpose of this visit was to check on the home’s progress to meet the requirements highlighted following the key inspection. Several weeks before the inspection took place an Annual Quality Assurance Assessment (AQAA) document, which contains general information about the home and the people living there, was completed by the registered manager of the home and returned to the CSCI. From this information, survey forms were then sent out to residents, relatives and health/social care professionals. We also spoke with a further 4 relatives, 3 health/social care professionals and 13 members of staff during our visit to the home. Edenmore provides care predominantly for those people with a dementia related illness. Many of these people do not have the capacity to communicate fully or understand the inspection process. Therefore we spent a considerable amount of time observing the care and attention given to these people by staff. We also looked closely at the care given to three specific people living at the home, looked at a selection of records (including residents’ files, staff files, medication records, staff training records, quality assurance records, health and safety records) and undertook a tour of the premises. All of this evidence has been used and included in this report to help form the judgements and findings of this inspection. On the first day of inspection, the manager was on annual leave and a registered nurse was in charge of the home. The manager was present on the second day of inspection. The outcome of the inspection was discussed with both the registered nurse on the first day and the manager on the second day of inspection before we left the home. What the service does well: People who wish to live at Edenmore receive useful information about what the home offers. If they then decide they want to live at the home, a member of staff undertakes an assessment to ensure that the home can fully meet his/her needs. Peoples’ health care needs are met by the home developing good working relationships with other health and social care professionals. DS0000066336.V345987.R01.S.doc Version 5.2 Page 6 Visitors are welcome at any time and the home has a warm, open and homely atmosphere. Staff are friendly, The home has a good procedure in place to deal with complaints and no complaints have been received by the home or the CSCI since the last inspection. The home is well managed by a ‘hands-on’ manager who has worked at the home for many years. She is a qualified nurse with a management qualification. People were very complimentary of the staff with positive comments given. The home is clean and homely. Private rooms are individual and are personalised. People are encouraged to bring in their personal and sentimental items. Good systems are in place to ensure that residents’ financial interests are fully safeguarded. What has improved since the last inspection? What they could do better: Care plans had been redesigned and introduced since the last inspection. However, in order to ensure that people receive care in a consistent manner these need to be fully completed and reviewed regularly. Some improvement is still needed to ensure that medication administrations records are maintained appropriately. More consideration is needed to ensure that people receive stimulating and meaningful activities suitable to their individual needs and interests. The way in which some staff care for people must be reviewed to ensure that they are treated with respect at all times. Staff should ensure that meals are undertaken in a pleasant and unhurried manner and that individual needs and preferences are met. Staffing levels need to be monitored and increased where necessary during mealtimes. DS0000066336.V345987.R01.S.doc Version 5.2 Page 7 The home must ensure that proper recruitment procedures are being followed in order to protect people. 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. DS0000066336.V345987.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 DS0000066336.V345987.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): 1, 3 &6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into Edenmore can be assured that they will receive full information about the home. Those choosing to live there will receive an assessment before they move in to make sure that the home can fully meet their individual needs. EVIDENCE: The majority of people living at Edenmore are unable to make a choice for themselves about whether they wish to live there or not. However, surveys from relatives acting on their behalf showed that they had received enough information about the home before choosing it as a place to live. One resident did say that she had chosen to live at Edenmore and, with support, was managing to lead as fulfilling and independent a life as possible in her choice of everyday living. The home has a good Statement of Purpose (SOP) which shows the services and facilities that Edenmore can provide. The home does also have a brochure but this is now an outdated one from the previous owner. The manager said DS0000066336.V345987.R01.S.doc Version 5.2 Page 10 that she is intending getting a new one ordered from Head Office to enable her to give them to people who make enquiries about the home. The AQAA states that the home has improved their assessment process and understands how important it is to complete this fully to ensure that the home can meet all their needs fully to prevent a wrong placement at the home. Since the last inspection, the home now uses a detailed assessment form which is completed before a person begins to live at Edenmore. This is used for both people receiving funding from Adult and Community Services and those people with private funding. The manager or senior nursing staff will visit people at his/her home or in the hospital in order to complete these assessments. We looked at the care files of three people living at Edenmore and each of these files had a comprehensive assessment form completed in their files, giving the necessary detail on which to begin an individualised plan of care. The home does acknowledge, however, that it is difficult at times when a Care Manager requires a person to be admitted to Edenmore in an emergency, to ensure that all the paperwork is completed appropriately. However, this is something they are aware of and try and eliminate as much as possible. Edenmore does not provide intermediate care but does offer respite care. DS0000066336.V345987.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 adequate. This judgement has been made using available evidence including a visit to this service. A new system of care planning has been introduced. Further development of these plans and other care records will ensure that all residents’ health and personal care needs are met in a consistent manner. Peoples’ health care needs are well met by good close working relationships with other professionals. There are some good systems for managing medication, but some areas of recording need improvement. People living at the home would benefit from staff having the correct skills to treat them with privacy and dignity at all times. EVIDENCE: Relatives responding to surveys felt that the home meets the needs of the people living there. Comments about the service included “they took excellent care of my XXXX and showed kindness and compassion” and “sees to XXXX needs very well”. We spoke with a further 4 relatives who said they were DS0000066336.V345987.R01.S.doc Version 5.2 Page 12 happy with the care provided. One relative said “I would definitely recommend the home to anyone who has an elderly relative requiring nursing care”. Health and social care professionals responding to surveys spoke positively about the home and comments included “generally provide excellent nursing care”, “the staff cope very well with the range of problems presented to them” and “relates well to Medical Services and can be trusted”. Two visiting General Practitioners and one specialist nurse visiting on the day of inspection spoke highly of the care provided at Edenmore and confirmed that the home has established good working relationships with health and social care teams. We looked at the care files of three people living at Edenmore and tracked their care carefully. This included a cross section of people who had differing care needs. The home has recently introduced a new care planning system which provides a thorough and comprehensive package of care records to be completed for each person living at the home. However, some staff reported that they felt the recording was taking too long and taking them away from caring for the people that they look after. They also felt that several areas of the files were repetitive, for example recording the visit of a visiting professional is recorded in 3-4 different places. One recently admitted person had a care plan which had been commenced but this plan did not fully reflect the person’s changing needs and how they these were going to be met. For example, he/she had come to live at the home some two months before and at this time the person’s care needs were identified as ‘neglect, confusion and frailty’. However, this had not been reviewed since he/she had settled into the home. Staff gave a clear history of how this person was when he/she was first admitted to the home and how, after two weeks of living there, he/she’s care needs have now changed significantly, for example not sleeping at night, being aggressive, becoming incontinent, taking clothes off inappropriately and not eating and requiring feeding. These details, and how staff should deal with them, were not recorded in the care plan. This person was also identified as being at risk of ‘wandering, aggressive and frequent mood changes’. However, although this risk had been identified, no appropriate action to instruct staff the best way to deal with this behaviour was recorded in the care plan. We spent some time with this person to whom this care file related to and felt that care records did not represent their care needs fully. One other care file described a person who was seen to be constantly ‘wandering, unsteady on his/her feet, very poor communication and poor appetite’. No risk assessments relating to these care needs had been completed. This person was also constantly wandering around all the time, at mealtimes and going up and downstairs, but no suitable risk management strategy for staff to take had been recorded. It was clear that staff were very inconsistent in their approach on how to deal with this person during the inspection. DS0000066336.V345987.R01.S.doc Version 5.2 Page 13 These two care files gave no feel or identity of who the person was and whilst some contained a very brief history of their personal life and previous interests/hobbies etc, these were scanty. However, we were shown the history sheet that relatives/friends are asked to complete to help the staff know the individual person but the manager said that this information was proving very difficult to obtain. However, without this information, introducing meaningful social/recreational interests is difficult to do (see NMS 12). One other care file was completed on the ‘old type’ of care documentation and this file contained lots of useful information and appropriately completed risk assessments relating to that individual person. We looked at the management of residents’ medication. Trained nurses administer all the medication. We looked at the Medication Administration Record (MAR) and saw when some dosages of medication had been amended/altered, the reasons why, when or on who’s directions this had happened were not documented. The home has a designated drugs fridge to store unopened medication in, such as insulin. It was noted that most of the monthly medicines are ‘signed in’ by the home but extra supplies such as antibiotics are not routinely checked to confirm the quantity received. The home uses controlled drugs, which are managed satisfactorily, and a random check was undertaken. Unused or unwanted medicines are disposed off correctly. One visiting General Practitioner commented that he carries out regular reviews on people’s medications and is alerted to any problems regarding medication by the nursing staff. He/she also said that the home asks for advice when necessary and they hold good professional discussions with the home. Medicines with a limited shelf life once open, such as insulin, had been dated to ensure it was used within the appropriate timescale. Staff managed some aspects of people’s privacy and dignity needs - with the exception of mealtimes (see NMS 15), how to approach people and how to communicate well. Staff’s approach was inconsistent and some staff clearly had more skills than others in how to treat people with respect. For example, one member of staff stood over the person whilst they were assisting them to eat, staff were seen talking amongst themselves over the people and some members of staff did not address people appropriately. DS0000066336.V345987.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. There are some activities and social interests for people living at the home, but these could be improved upon to make them more meaningful and individual. People benefit from the welcoming and friendly approach when relatives and friends visit. People living at the home are offered a nutritious and balanced diet. However, the way in which the food is served to them needs reviewing to make mealtimes a pleasant and enjoyable experience. EVIDENCE: Since the last inspection, the home no longer has a designated activities coordinator. Two of the ancillary staff are currently covering this shortfall and arranging for some activities to be undertaken in the afternoons. The manager told us that this mainly consists of doing jigsaws, painting, knitting, reading and some one to one activities. The home does have a budget for activities and some of this is spent on bring in outside entertainers which the people enjoy listening to and taking part in, for example one entertainer who uses a guitar, one uses a musical organ and one who predominantly sings. The home regularly has activities to fit in with the changing seasons, for example they held a strawberry tea in summer, a recent Halloween party, visits to the DS0000066336.V345987.R01.S.doc Version 5.2 Page 15 garden centre and are currently looking forward to the planned Christmas activities. Many of the people are going to see the local pantomime and people’s relatives and friends have been invited to spend Christmas lunch at Edenmore. Two Father Christmas visits on two separate days have been organised, together with Santa’s elf (carried out by the staff of the home dressing up for the occasion). Photographs are taken of these events and the home is thinking about setting up individual albums/photographs for relatives to have as a keepsake. The manager is aware that regular activities are limited at the home at the moment, but has extensively advertised for the post of activities co-ordinator. She is looking forward to employing the right person to improve the recreational/social interests within the home. However, peoples’ preferences and expectations must be included in the care planning to ensure that they are meaningful and individual. Some residents spent long periods wandering around the home with little input from staff. On the day of inspection, one person was doing a jigsaw puzzle on his/her own but this was child-orientated in nature. One person was knitting. Others seem to sit for long periods in front of the television. One person was left sitting in the upstairs Snoezelan room, amongst the stored equipment, with little contact from staff. During the first day of inspection, radios with pop music were heard in several of the people’s empty bedrooms and the radio and television constantly played pop music during the lunchtime meal. This did not happen on the second day of inspection and songs from the ‘olden days’ were playing, which some residents clearly liked listening to. The home has a welcoming and friendly atmosphere and good interaction and relationships were seen with the way relatives spoke at ease with the management and the staff of the home. Residents’ preferences regarding daily routines and choices were not always recorded to identify what time people like to get up or go to bed or how and where they spend their day. Where residents lack capacity and have difficulty expressing their wishes clearly agreed routines and preferences would be useful to guide staff. During observation it was evident that not all staff have the same skills to support residents to make choices. On several occasions we saw staff telling people to ‘sit down’, with little effort made to find out why the resident wanted to move or what they wanted to do. However, we also saw some good practice from other staff who did assist some people expertly and tried hard to find out what the resident wanted when they were agitated or confused, with a genuine warmth and interest. The manager felt that the quality of meals had improved at the home. The cook uses a 6-week menu but this will soon be changing. The cook is assisted DS0000066336.V345987.R01.S.doc Version 5.2 Page 16 by kitchen porters who ensure that the preparation and cleaning of the kitchen is undertaken. However, the kitchen have recently had problems with staffing levels which has meant that some areas of the kitchen have not been cleaned as well as they should have been. A new kitchen porter has just been recruited to fill this gap. The home uses a mixture of fresh and frozen vegetables and provides an appetising soft diet for those people that require it. Other specialised diets are provided for, for example those people with diabetes. On the first day of inspection people ate faggots with carrots, sweet corn and croquette potatoes for lunch. On the second day of inspection, cottage pie with broccoli and sprouts was served for lunch. Those people that did not appear to like the food that was served were offered an alternative such as soup or a sandwich. Meal times continue to present a challenge at the home with most of the people requiring some level of assistance. We saw lunch on both days, but with more in-depth observation was carried out on the first day. Mealtimes appeared hurried and very task orientated. Some staff were very skilled and interacted well with residents during meal times, for example offering choice, explaining what they were doing and sitting with the resident while assisting them, particularly in the upstairs dining room. Other staff in the downstairs dining room and lounge area were less skilled and we saw poor communication, staff not assisting people to eat their meals and staff not giving a consistent approach to residents, for example one person was wandering around and different staff kept giving him/her differing advice. One person was given their meal and cutlery but did not start to eat. No help or assistance was given to this person who sat for 15 minutes before starting to eat their food with their fingers. With assistance from the inspector, this person managed to eat with cutlery. Another resident in the communal lounge needed assistance and encouragement at lunchtime but was left to manage which resulted in their food being very cold and uneaten. It was then reheated and given to the person again but staff gave no help or assistance again. DS0000066336.V345987.R01.S.doc Version 5.2 Page 17 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 a good complaints procedure which ensures that peoples’ concerns of any type are listened to. Residents’ are protected from staff who have a good knowledge of adult protection issues. EVIDENCE: The AQAA states that the home aims to deal with complaints before they become a problem and that the positive attitude and better communication within the home prevents complaints occurring. There is a complaints system in place and all complaints are taken seriously. We saw that the home had not received any complaints since the last inspection. Relative and health/social care professional surveys stated that they knew how to make a complaint. Staff surveys and conversations showed that the majority of staff are aware of adult protection procedures. The AQAA and staff training files confirmed that Protection of Vulnerable Adult training takes place regularly and is on going with one trained nurse who takes responsibility for this training. DS0000066336.V345987.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a home that is safe, well maintained and clean. EVIDENCE: The home is clean and but some areas are now looking tired and in need of some redecoration. The manager told us that quotes were being obtained for some repainting and decorating of communal rooms, which should be taking place shortly. Two of the carpets in peoples’ private rooms were stretched and ruffled which posed a risk of falling to those people. These rooms have had new carpets ordered but the old ones were made safe until these are fitted. Some chairs were now dirty and would benefit from a good clean. The home has had some problems with the shortfall in numbers of the housekeeping staff and felt that this could have caused the problems to occur. The home has an open, welcoming reception area. On the ground floor there is a large lounge and adjoining conservatory (with views towards the sea). A separate dining room can accommodate most residents. There are also several areas for residents to sit in the ground floor corridor recesses. On the DS0000066336.V345987.R01.S.doc Version 5.2 Page 19 first floor there is a lounge/dining room and a Snoezelan room, which should offer a quiet relaxation area but on the days of inspection this room was being used as a storage area for wheelchairs and hoists etc so was not very welcoming. The manager said that storage areas in the home are limited and equipment tends to be placed in here. In this room is a baby grand piano, which belongs to one of the people who live there and who, from time to time, like to play on it. All bedrooms visited had been personalised with items such as pictures, photographs and various pieces of furniture. All areas of the home can be accessed by a passenger lift. The home is secure with key coded entry. This allows residents to freely wander around the home in a safe way. The home has a nice, attractive garden area and employs a gardener to keep these areas enjoyable and tidy for people to sit in and enjoy. The laundry is well equipped and well organised with dedicated housekeeping staff to ensure peoples’ laundry is handled effectively. The sluice areas were clean and the home was generally hygienic, with the exception of one or two private rooms. The home uses a disposable bag system for infected laundry/linen to prevent cross infection. Antibacterial hand wash is available throughout the home for staff and visitors. DS0000066336.V345987.R01.S.doc Version 5.2 Page 20 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. Staffing numbers are generally sufficient to ensure that residents’ general care needs can be met, with the exception of mealtimes. The home must ensure that all staff employed undergo a thorough recruitment process in order to protect the people who live there. Staff undergo the necessary training, but would benefit from more specialised training to ensure that they have the right skills to look after the people living at the home. EVIDENCE: Health and social care professionals were very complimentary of the staff of Edenmore. Comments included “staff are pleasant”, “well staffed”, they (the staff) “are very approachable and helpful” and staff are “competent”. Relatives also spoke highly of the staff and comments included “I have nothing but praise for the staff at Edenmore” and they (the staff) “provide a warm and friendly atmosphere”. Mealtimes continue to present a challenge due to the high numbers of people who require some level of assistance from staff to help them eat. During the lunchtime meal in the dining room, two extra members of staff from the housekeeping side are available to assist. However, no member of staff appeared to be in charge of organising the meal serving and we felt that the DS0000066336.V345987.R01.S.doc Version 5.2 Page 21 meals were hurried and staff were under pressure to ensure all residents’ meals were given out as quickly as possible (see NMS 15). The home has had some shortfalls in staffing recently and is in the process of recruiting a new trained nurse and several care assistants. We looked at five staff recruitment files of recently recruited staff. These were generally satisfactory with some of the correct information held on file. However, the home must not accept “To whom it may concern” references in the future. Two members of staff had recently been appointed - one kitchen member of staff and one housekeeping member of staff. These members of staff had a Protection of Vulnerable Adult (POVA) check but no Criminal Record Bureau (CRB) check had been obtained yet. Due to the short staffing of the home, the manager told us that she had allowed these people to commence work under supervision until these documents had been obtained. Police checks from overseas staff’s country of origin had been obtained. Two staff files did not contain a photograph of identity and one did not have up to date confirmation of registration with the NMC (which is the professional body for trained nurses). All files contained an application form but, apart from scores, no interview notes were held. This was particular relevant for one member of staff who had disclosed some information which should have been recorded. Currently almost 60 of staff have either achieved or working towards a nationally recognised qualification in care (NVQ 2 or 3). Two members of staff are undertaking NVQ 4. All new staff undergo an induction programme based on the nationally recognised Skills for Care training. This ensures that all staff achieve the training to do their jobs properly. Staff spoken with said they had not received any training on working with people with a dementia related illness and would find this useful. However, three members of trained staff have recently undergone advanced training in dementia care and intend to roll this out to all of the staff in the home to give them the skills and improve their care practice. The home has a low staff turnover and some staff go on to undertake qualified nurse training. The manager told us that there is a comprehensive training schedule which highlights the training needs of the staff and is updated regularly. This includes all the mandatory training as well as specialised training. However, this was not available to look at. Staff were undertaking wound care training on the days of inspection. However, staff reported that training such as this was not planned properly - staff were expected to do the training whilst they were on shift, thereby leaving the remaining numbers of staff to look after the people diminished. DS0000066336.V345987.R01.S.doc Version 5.2 Page 22 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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems in place to ensure the health, safety and finances of the people who live at Edenmore are protected. Informal systems are in place for people and their relatives to be involved in the running of the home, but this needs to be formalised and the quality of care, services and facilities evaluated. EVIDENCE: The registered manager is a Registered Nurse, specialising in people with a mental illness. She has completed the Registered Manager’s Award which is a recognised management qualification. She has many years experience in caring for older people and has worked at the home for many years before becoming the registered manager. She has a ‘hands-on’ approach and staff, DS0000066336.V345987.R01.S.doc Version 5.2 Page 23 relatives and other health/social care professionals felt that the manager had an open management style. Staff surveys and interviews indicated that staff generally felt well supported but that they felt that the manager was not as accessible as she had been in the past due to the recent pressures of work. Due to the shortfalls in staff, the manager undertakes several shifts a week covering the home, working ‘on the floor’ in the trained nurse numbers. This reduces her management hours and adds pressure to this role. However, a new trained nurse is due to start very shortly which will help the staffing levels. The home is keen to ensure the quality of the service is monitored but no recent review of this had taken place. The manager thought that the questionnaires to review the facilities and services of the home had been sent out to relatives/friends by Head Office but unfortunately these had not yet been done. These are to be sent out soon, with the Christmas cards. Regular relative/resident meetings are not held and therefore their views on the running of the home are not obtained. The home encourages family or advocates to assist residents manage their finances. The manager is currently assisting some residents with finances. Good systems are in place to ensure that peoples’ monies are held safely and Head Office manages these. Staff files indicated that formal supervision had now been introduced by Head Office with a supervision matrix identifying which staff require supervision on a two monthly basis. Staff felt that supervision was useful. Staff also undergo a yearly formal appraisal which looks at their developmental and learning needs. The home has a recent fire risk assessment. The AQAA confirms that fire safety is appropriately managed and that equipment is serviced regularly. The last environmental health inspection identified work to be undertaken in the kitchen, including the replacement of some tiles. The kitchen is due to be to be refurbished and some new equipment provided. The kitchen was generally clean and well organised. All the necessary temperatures of both food and kitchen equipment are recorded and held in one file. The AQAA showed that the maintenance of equipment and water, gas and electrical systems is undertaken appropriately. Window restrictors have been fitted to first floor windows to reduce the risk of falls, radiators were covered and taps have safety valves, which reduces the risk of scalding to residents. DS0000066336.V345987.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 DS0000066336.V345987.R01.S.doc Version 5.2 Page 25 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) (2) Timescale for action All people living in the home 18/12/07 must have a plan of care as to how their needs are to be fully met and this must be regularly reviewed. This is to ensure consistency of care. When medications is brought 18/12/07 into the home it must clearly checked into stock. All handwritten entries on the Medication Administration Record (MAR) and any changes in the dosage of medication must be signed, dated and then checked. This is to ensure people get the correct medicines prescribed to them. (Previous requirement of 01/01/06 and 29/11/06 not met). 18/12/07 No member of staff must be employed to work at the home without first obtaining all the necessary information required in this case proof of identity and not accepting “to whom it may concern” references. This will ensure that residents are not put at unnecessary risk of harm. (Previous timescales of DS0000066336.V345987.R01.S.doc Version 5.2 Page 26 Requirement 2. OP9 13(2) 3. OP29 19 (1) (a)(b)(c) Schedule 2 1-7 4. OP33 24 (1) (2) 01/01/06 and 29/11/06 not met). The home’s must review its facilities, services and care regularly. A copy of this report must be supplied to the Commission and a copy made available to interested parties. This will ensure that the home is meeting the needs of the people living at the home fully. 18/01/08 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 OP7 Good Practice Recommendations It is recommended that all care plans include preferences with regards to social & personal care needs. Care plans and associated records should contain adequate detail to ensure that staff know what action to take to meet residents’ needs. It is recommended that further staff training and support be available to ensure that residents’ dignity is maintained at all times. It is recommended that more meaningful and individualised activities take place in the home. It is recommended that staff ensure that mealtimes are a pleasant and unhurried experience, and that all residents get the assistance they require. 2. 3. 4. OP10 OP12 OP15 DS0000066336.V345987.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon 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 DS0000066336.V345987.R01.S.doc Version 5.2 Page 28 - 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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