Inspection on 18/10/06 for Edenmore Nursing Home

This inspection was carried out on 18th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 15/11/07

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 Dee McEvoy Key Unannounced Inspection 18th October 2006 08.45 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 Edenmore Nursing Home DS0000066336.V307286.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. Edenmore Nursing Home DS0000066336.V307286.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) Edenmore Nursing Home DS0000066336.V307286.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 Snoezelen (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. Since the last inspection a new provider has been registered with the Commission. The PSP Group Limited is an experienced provider and operates other registered care homes in the local area. The cost of care ranges from £500 to £800 per week depending on individual needs. Additional costs, not covered in the fees, include chiropody, hairdressing, and personal items such as toiletries and newspapers. 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. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors completed this unannounced inspection over a period of eight and a half hours. During the visit the inspectors case tracked 4 residents, which helps us to understand the experiences of people using the service. Most residents living at the home were seen or spoken with during the course of the day. The home provides care for people with a dementia related illness and the majority of residents do not have the capacity to communicate fully or understand the inspection process. The inspectors spent a considerable time observing the care and attention given to residents by staff. Prior to the inspection CSCI questionnaires were sent to six residents and five were returned. The majority of residents are unable to complete comment cards due to their communication difficulties. Questionnaires were also sent to seven relatives, two were returned. One relative was spoken with during the inspection. Staff surveys were sent to 19 members of staff and eight were returned. Seven staff were spoken with during the inspection, including the manager and deputy manager. Additional information was gained from a questionnaire completed by the home prior to the inspection. The inspectors toured the premises and a sample number of records were inspected which included care plans, medication records/procedures, staff recruitment files, service and maintenance certificates and fire safety records. The outcome of the inspection was discussed with the registered manager, Liz Thompson and the deputy. The manager is keen to work towards the improvements necessary to ensure that all residents receive the care they need. What the service does well: Good information about the home is available to prospective residents and their families to ensure an informed decision can be made before moving in. Assessments are completed prior to any resident moving into the home to ensure that their needs can be met. The home aims to find out about residents’ past lives and interests to give staff a better understanding of their experiences and needs. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 6 Residents’ health care needs are met by the home working closely with other health and social care professionals. Relatives said that they feel welcome at any time and that the home had a “friendly” and “homely” atmosphere. Residents and relatives felt that staff do a good job, comments included, “Staff are always welcoming, friendly and cheerful” and “The staff are excellent”. Residents able to communicate said that staff listen and act on what they say. The environment is good; the home is kept extremely clean, well maintained and furnished with quality fittings. Good systems are in place to ensure that residents’ financial interests are fully safeguarded. The management style is open and friendly ensuring that residents, relatives and staff can feel confident in the registered manager. What has improved since the last inspection? What they could do better: Care plans had improved since the last inspection however, in order to deliver more person centred care the home has been asked to develop care planning and risk assessments. The provider has specifically recruited a ‘specialist’ to develop a care planning and risk assessment system for the group of nursing homes and hope this will be implemented early in the New Year. Attention is needed to ensure that medication administrations records are maintained and that guidance is available to staff to ensure that occasional medicines are given appropriately. Particular consideration should be given to stimulating and meaningful occupation for residents with dementia to ensure that individual preferences can be met. Staff must always maintain residents’ dignity and privacy and do more to promote independence, individual choice and rights, particularly for those residents with a dementia type illness. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 7 Staff should ensure that mealtimes are a pleasant and sociable time for residents and that individual needs and preferences are met. Staffing levels need to be monitored and increased where necessary during mealtimes. The home must ensure that proper recruitment procedures are being followed in order to protect residents. Specialist staff training and practice needs to be addressed to ensure the home meets the needs of residents with a dementia type illness in a holistic way. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Edenmore Nursing Home DS0000066336.V307286.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 Edenmore Nursing Home DS0000066336.V307286.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information about the home is available for prospective residents and their representative, which enable them and their families to make an informed choice before moving into the home. Residents benefit from a good admission and assessment process, which ensures that the home can meet their needs. EVIDENCE: All surveys from residents showed that they had received enough information about the home before moving in so they could decide if it was the right place for them. One relative said that they had chosen the home and had visited prior to the admission of their relative to ensure they were happy. The home’s statement of purpose is comprehensive and contains the necessary information about the service. It is freely available in the reception area of the home. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 10 One visitor said that their relative, admitted within the past few months, had been made very welcome and had settled well at the home. The inspector was told, “I am pleased with the standard of care”. Four resident files were looked at. The home had obtained comprehensive assessments completed by a health or social care professional, such as community psychiatric nurse, or care manager. Good evidence was seen to show that the home liaises with family and representatives during the assessment and care planning process. The manager or senior nursing staff will visit prospective residents at home or in hospital in order to complete assessments. Four assessments looked at were detailed and contained important information about health and personal care needs as well as individual preferences. All staff responding with surveys said they were not asked to care for people with needs outside of their experience. The Home does not provide intermediate care but does offer respite care. Edenmore Nursing Home DS0000066336.V307286.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. 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. There has been improvement to the care planning process and further development of these plans and other care records will ensure that all residents’ health and personal care needs continue to be met. Residents’ health care needs are generally well met by good monitoring and close working with other professionals. There are some good systems for managing medication, but other areas of poor practice may affect safety. On the whole residents’ privacy and dignity is met by staff but could be improved. EVIDENCE: Four residents responding to the CSCI survey said that they “always” receive the care and medical support they need; one resident felt that they “usually” Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 12 received the support they required. Most residents were unable to comment on the care they received due to communication difficulties. 3 relatives were satisfied with the overall care provided, one wrote the home provides the “finest” care. A visitor told the inspector that they were happy with the progress and improvement achieved for their relative. The care planning records and risk assessments of four residents were looked at. Social histories including important information about residents’ past lives and occupations are well documented in some residents’ care records, which gives a sense of who this person is. The manager is encouraging families to assist the home in gathering all relevant information about individuals to improve the planning and delivery of care. Care plans outlined residents’ general care needs, such as personal care but did not always provide enough detail about communication needs, mobility and certain behaviour. One resident case tracked had a specific method of mobilising but this was not mentioned in the care plan or manual-handling plan. Another resident was described as “aggressive” but no detail of whether verbal or physical aggression was present. Another care plan looked at suggested that staff use ‘sign language’ to communicate but staff spoken with were unaware of this and staff training files did not confirm that any staff could use this form of communication. Risk assessments had been completed in some care files and highlighted the risk of falls or a need to use bedrails. However, behavioural and situational risks had not been assessed and planned for. In one case a resident was identified in daily notes as posing harm to themselves but the risk assessment did not reflect certain behaviour or outline a strategy for managing this situation. Other behaviour such as wandering into other people’s bedrooms had not been risk assessed to ensure that hazards were minimised. One trained nurse told an inspector that they were “always working on the floor” and had little time to ensure that care plans and risk assessments were up to date. The majority of wheelchairs used within the home do not have footplates and staff were pulling residents backwards (which looked undignified) or tipping wheelchairs slightly when moving residents around. No risk assessments were found on the day to guide staff when using wheelchairs. The manager said they had been completed and the reason foot plates were not used was that residents would not recognise them and they may cause injury. An inspector witnessed one resident catching their feet on the floor under the wheelchair. One accident record for a resident using a wheelchair without footplates stated, “large bruise noticed on foot”, but no clear explanation was given as to the cause. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 13 Care records showed that the home works closely with other professionals in order to ensure that the residents’ health needs are met. For example, some residents have regular contact with mental health professionals such as psychiatrists, or specialist nurses such as the diabetes nurse. Diabetic care plans have been completed where necessary, as is good practice but should contain the agreed range of acceptable results for blood sugars to ensure staff know what to do should levels fall outside of the agreed range. Residents’ weights are monitored regularly and three of the four residents case tracked had either maintained or increased their weight. It was noted that one resident was consistently loosing weight. The care plan was not clear how staff should help this resident regarding their ongoing weight loss problem, although the manager said staff were aware of the individual’s needs. The home monitors residents’ dentist and optician checks and chiropodists are used according to residents’ needs. On the whole existing staff appeared to have an understanding of people’s needs but the lack of consistent information may affect continuity of care when relying on individual staff knowledge. The management of medication was looked at; trained nurses administer all medicines. Some good practice was evident, such as a record of specimen signatures to ensure accountability and comprehensive policies for staff to refer to. Appropriate records had been kept for controlled drugs, and stock held correlated with totals recorded. Unused or unwanted medicines are disposed of correctly. Medication reviews were seen for two residents. One visitor praised the home for the management of medication and described how the home had reduce the amount of sedatives given to their relative which had improved the general quality of their life. Medicines with a limited shelf life once open, such as insulin, had not been dated to ensure it was used within the appropriate timescale. The medicines fridge had been maintained at the necessary temperature to ensure that medication was safe and effective but was dirty and needed to be cleaned. Hand written entries were noted on four Medicine Administration Records (MAR) charts; these had not been signed or dated by two as is good practice to ensure accuracy. Gaps on the MAR charts were noticed and codes had not been used to indicate why medicines had not been given. It was noted that not all medicines are ‘signed in’ by the home to confirm the quantity received. No clear guidance was available for the use of medicines to be given “as needed”. Some privacy and dignity issues were managed extremely well, for example good consideration had been given to ensuring that important family relationships were maintained. Some staff, including the manager, are very competent when relating to residents and some positive interactions were seen. Some staff skilfully communicated with residents when delivering care and addressed them by their preferred name; other staff appeared less Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 14 competent. One inspector heard staff refer to residents as “love” or “darling” rather than using their name. Staff were also heard to discuss the care needs of a new resident in front of others. One staff member used some inappropriate language when it was assumed that a particular resident “was on their best behaviour”. One resident had a notice in their room to remind staff about extra precautions to take to maintain infection control; it was felt that this was unnecessary and could infringe the resident’s privacy. One communal bathroom/toilet did not have a suitable door-locking device, which may compromise privacy and dignity. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 is good provision for activities for people at the home and this would be further improved with meaningful care planning to ensure that residents’ individual preferences, potential and diverse needs are met. Residents benefit from the good relationships the home has developed with their relatives and representatives. A number of residents’ could be more enabled to make daily choices and retain some control over their lives. A balanced diet is provided, but efforts need to be made to try to ensure it meets individuals’ preferences and that mealtimes are a pleasant experience. EVIDENCE: Four of the five residents responding to CSCI surveys said there were activities arranged by the home that they could take part in. The home has a dedicated activities organiser for 20 hours a week; a member of the care staff provides a further 12 hours. Group and individual activities are organised but not on the day of the inspection. One staff member was seen to help a resident with a Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 16 puzzle for a short while and one carer tried to engage several residents in the ground floor lounge with music and general chat. Several female residents enjoy having their nails painted regularly; one relative commented on this attention to person care. One member of staff said, “We have time to sit and chat or play games with residents”. One relative wrote, “More stimulated here than in previous home”. Two staff members identified activities or “diversion” as an area for improvement. One wrote, “more staff to take residents out on trips would be good”. Residents’ hobbies and interests had been briefly explored but little detail of how to meet residents’ social needs was described in care plans. For example in one care plan it stated that the resident “likes to be doing” but no other information regarding what the resident would ‘like to be doing’. During the inspection this resident spent varying periods of time unoccupied apart from when receiving care. It was noted that the residents on the first floor spent long periods unoccupied during the inspection, with little social contact from staff. The home has established good relationships with the relative interviewed and those responding to the CSCI survey. Relatives confirmed that they were always welcome at the home and that they were always informed and consulted with regards to their relative. One relative wrote, “Staff are always welcoming, friendly and cheerful.” Residents’ preferences regarding daily routines and choices were not consistently recorded to identify what time people like to get up or go to bed or how and where they spend their day. It was noted that the majority of residents on the first floor were up for a communal breakfast on the day of the inspection. 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 support residents to make choices. Although some residents were seen to move freely around the ground floor, choosing where to sit and who to speak with, others who were totally dependant sat in their “usual” chairs according to staff. Another resident attempted to get out of their chair and was told by a carer to “sit there”. No effort was made to find out why the resident wanted to move or what they wanted to do. The resident was left agitated and confused. When serving food staff handed sandwiches or biscuits to the residents rather than letting them choose. Mixed comments were received from residents regarding the meals at the home. Two residents said they “always” like the meals and two said they “sometimes” enjoy the meals. One resident said if they didn’t like something they were always offered an alternative. The chef told an inspector that menus had recently been reviewed with nursing and care staff to see which meals were preferred by the majority of residents who lack capacity. The kitchen has Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 17 some information about residents’ individual needs and likes and dislikes. The chef said the kitchen had the resources and support to provide a “good diet” and that things were “improving all the time”. Meal times present a challenge at the home with 35 of the 41 residents requiring some level of assistance. The inspectors observed breakfast and lunchtime. 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. Other staff were less skilled and the inspectors saw poor communication and staff reluctant to encourage independence at mealtimes. For example, one resident was attempting to feed himself but was told by the carer “I’ll do it”. Another resident in the communal lounge needed assistance and encouragement at lunchtime but was left to manage which resulted in little food being eaten. Other residents in the first floor sitting room were assisted with their meals by care staff in silence or with the carer standing over them. One staff member was heard to comment, “Finished her” when assisting one resident. Some breakfast food, such as porridge, was left for up to 20 or 30 minutes before being given to residents. Staff said this was to make sure it wasn’t too hot but couldn’t confirm that it wasn’t too cold after 30 minutes. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure and there are systems in place to ensure that investigations are undertaken, which means that people can be confident that their complaints will be listened to. Staff have a good understanding of what to do to protect residents from abuse, however additional guidance and care planning will protect residents further. EVIDENCE: All residents responding with surveys knew how to make a complaint and who to speak with if they were not happy, one wrote, “Never had to make a complaint”. All residents responding with surveys felt that staff listen and act on what they say. One complaint has been received by the home since the last inspection but a record of the complaint is held at “head office” and the inspectors were not able to see the nature of the concerns or how they were dealt with. The manager said that issues related to the supply of toilet paper, wheelchair storage and the effect of another residents behaviour. The inspectors were told that the complainant was happy with the outcome. Due to their condition some residents do not have an understanding of personal boundaries and space. Two residents particularly were seen to encroach on others in the ground floor lounge. One visitor said their only concern was the level of staff supervision in the lounge, the inspector was told, “I have seen fisty cuffs in here before”. The visitor was worried that some Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 19 residents may inadvertently hurt others and had discussed these concerns with the manager when bruises were noticed on their relative. Care plans and risk assessments did not give clear guidance with regards to the strategy for managing residents who may pose a risk to others, for example residents who wander into other resident’s rooms or who may be aggressive towards others. The inspectors discussed this with the manager during the inspection. The majority of staff responding with CSCI surveys were aware of procedures to protect residents from harm, two said they were not familiar with the procedures. Training records showed that not all staff had undertaken training but staff spoken with had received training in relation to adult protection issues and had a good understanding of their responsibilities. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 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 the home is good providing residents with a safe, attractive and homely place to live. The cleanliness and standard of hygiene is good. EVIDENCE: The home is extremely clean and well maintained both inside and outside of the building. One relative wrote, “The environment is inviting, pleasant and well maintained”. The home has an open, welcoming reception area. Décor is of a good standard, and refurbishment is on-going with six carpets due to be replaced to ensure the home remains comfortable and homely. 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 Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 21 several areas for residents to sit in the ground floor corridor recesses. On the first floor there is a lounge/dining room and a Snoezelen room, which offers a relaxation area for residents. The home has an adjoining “unit” with 4 en suite bedrooms called “Bay Tree House”. This has a small kitchen and lounge area. The home is considering using the communal lounge space in this unit as another bedroom and is putting their intentions in writing to the Commission. All bedrooms visited had been personalised with items such as pictures, photographs and various pieces of furniture. The front of the property has a well-maintained garden with seats and lovely views for residents to enjoy. The home is secure with key coded entry. This allows residents to freely wander around the home in a safe way. A passenger lift and stair lift ensure that all areas of the home are accessible to residents. Currently kitchen staff are using a storeroom in the kitchen as a changing room, this is not ideal and needs to be addressed. All residents responding with surveys said that the home was “Always” clean and fresh. One relative felt that it was a “great achievement” for the home to be free of unpleasant odours considering the dependency of the majority of residents, comments included, “The home is very clean and never smells”. Staff had knowledge of infection control issues such as MRSA and there was evidence of good practice, for example the manager will liaise with other health professionals to ensure that practice is up to date. There are gloves, paper towels and liquid soap around the home, to promote good basic hygiene. The laundry is well equipped and appeared to be well organised. The sluice areas were clean and the home was generally hygienic. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. 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. Residents are not protected by the home’s recruitment practice, which is poor. Staff have not received the training to ensure they can meet the specialist needs of the residents at this home. EVIDENCE: Three residents responding with surveys said that staff were “always” available when needed, two felt that staff were “usually” available when needed. Two relatives said that in their opinion there were sufficient numbers of staff on duty. Another relative felt that more staff supervision was needed in communal areas to ensure all residents were safe (refer to standard 18). The inspectors noted that during the day there were periods (up to 20 or 30 minutes) when residents in the ground and first floor lounge were unsupervised. Mealtimes continue to present a challenge due to the high numbers of residents who require some level of assistance. Lunchtime has been organised in two sittings and one extra member of staff is available to assist during this meal. The inspectors felt that both breakfast and lunch appeared to be hurried Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 23 and staff appeared to be a little under pressure to ensure all residents’ needs were met in a timely way (Refer to standard 15). The manager and deputy were happy with the current staffing levels and said the team were “working well together”. Residents spoken with during the inspection said that staff were “kind” and “lovely”. One relative wrote, “Staff excel at their job” and “No problem too big”. Four staff recruitment files were looked at. The home had not received Protection of Vulnerable Adult (POVA) checks or Criminal Record Bureau (CRB) checks for these people prior to them starting work at the home. Police checks from overseas staff’s country of origin had been obtained. Currently 32 of staff have achieved a nationally recognised qualification in care (NVQ 2 or above), which falls short of the expected standard. The new training programme will encourage and support staff to attain these qualifications. Seven of the eight staff responding felt that the home provided funding and time for staff to receive relevant training. The home is currently implementing a new training programme, which will include an induction to meet nationally recognised standards. Other areas of staff training require consideration and planning in order to continue to meet the changing and challenging needs of the residents. Staff spoken with had not received specific training in relation to dementia but expressed enthusiasm for training and felt that it would improve their skills and the general care of the residents. The manager told the inspectors that one session of in-house training for dementia had been organised last year. The home did not have a clear ‘overview’ of training, which would ensure that staff training needs were identified and updated when necessary. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Residents, relatives and staff benefit from the friendly and open management at the home. There are arrangements in place to involve residents and their representatives in the running of the home, with evidence that their views are sought. However, formal review of the quality of care is less well addressed. Systems are in place to ensure that residents’ personal monies are correctly managed. Formal supervision for all staff will improve care practice. Health and safety of the building is good, but some practices do not promote good health, safety and welfare for residents and staff. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager is a Registered General Nurse and has almost completed the Registered Manager’s Award. She has many years experience in caring for older people and has worked at the home for several years. She has a ‘hands-on’ approach and staff and relatives felt that the manager was accessible. A deputy manager has been appointed to assist with the management of the home. Staff surveys and interviews indicated that staff generally felt well supported. Staff were generally happy with the new provider’s commitment to the home, one said, “They are approachable and willing to provide the resources needed.” The home is developing systems to ensure the quality of the service is monitored. Questionnaires have been sent to relatives and some residents, although no formal review has been undertaken yet to assess the satisfaction levels of those who responded. Once this information has been collated a report will be produced for all interested parties, including resident, relatives and CSCI. The home plan to organise meetings with residents and relatives in the near future, to hear their views. The majority of staff responding with CSCI surveys said they did attend staff meetings on a regular basis. 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 resident’s monies are managed appropriately. Three of the eight staff responding to the CSCI survey said they received formal one to one supervision. Staff files indicated that formal supervision was being introduced, which will give staff an opportunity to review targets and training, and access improvements and achievements. Observational supervision will allow the manager to identify where staff may need support. The manager and deputy are to oversee supervision but had not received training to support them. The manager thought specific training would assist greatly when undertaking this role. Poor manual handling techniques were seen on several occasions, which put both residents and staff at risk. On two occasions staff employed an outdated ‘lift’ to assist a resident to get up off the floor and into a chair. The inspectors saw another incident where care staff lacked confidence with equipment and did not use it properly. Fire safety appeared to be well managed; records showed that fire equipment is serviced and maintained regularly and that staff receive training. The Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 26 manager was aware of the new fire regulations and a newly completed risk assessment had been completed. An environmental health inspection in April identified work to be undertaken in the kitchen, including the replacement of some tiles. The inspector was told that parts of the kitchen were due to be refurbished and this work would be completed then. The kitchen was generally clean and well organised. Regular fridge temperatures are recorded to ensure safe storage and foods stored in freezers and fridges were labelled and dated. The pre-inspection questionnaire showed maintenance of equipment and water, gas and electrical systems. Window restrictors have been fitted to first floor windows to reduce the risk of falls and all radiators were covered which reduces the risk of scalding to residents. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 27 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 28 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 13 (4)(1) Timescale for action The registered person shall 29/11/06 ensure that unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. (Risk assessments must identify behavioural, situational and environmental risks.) The registered person shall make 29/11/06 arrangements for the safe recording and administration of medication in the care home. (The home must have clear guidelines available for the administration of “when required” medication and for all hand written entries on the Medication Administration Record (MAR) Charts, the person making the entry dates & signs it, & this is then checked.) Previous requirement of 01/01/06 not met The registered person shall 29/11/06 maintain in the care home the records specified in Schedule 4. (In this case a record of all complaints made by service users or representative about DS0000066336.V307286.R01.S.doc Version 5.2 Page 29 Requirement 2. OP9 13(2) 3. OP16 17 (2) Edenmore Nursing Home the operation of the care home, and action taken by the registered person in respect of any such complaint) 4. OP29 19 (1) (a)(b) The registered person shall not 29/11/06 employ a person to work at the care home unless he/she has obtained in respect of that person information and documents specified in paragraphs 1 to 7 of Schedule 2. (This refers to the need to ensure that CRB or POVA first checks are obtained for each new employee before they start working at the home.) (Previous timescale of 01/01/06 not met). The registered person must, 21/02/07 having regard to the size of the care home, the purpose and the number and needs of the service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. (In addition to statutory training, staff should receive training to develop their understanding of Dementia and Mental disorder) The registered person shall make 20/12/06 suitable arrangements to provide a safe system for moving and handling residents. (This relates to staff training needs.) 5. OP30 18 (1) 6. OP38 13 (5) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 30 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 (specifically communication and mobility 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 an agreed range of acceptable levels for blood sugars be recorded in care plans to ensure that staff are aware of the appropriate action to take should levels fall outside agreed levels. It is recommended that care plans detail how staff will manage residents’ weight loss. It is recommended that further staff training and support be available to ensure that residents’ dignity is maintained at all times. An appropriate lock should be fitted to the ground floor toilet to ensure privacy for residents. It is recommended that residents’ preferences for their daily routine be planned for and that social needs and interests are clearly documented so they can be met appropriately. It is recommended that staff ensure choice and autonomy is promoted for less able residents. It is recommended that staff ensure that mealtimes are a pleasant and unhurried experience, and that all residents get the assistance they require. It is recommended that all staff receive adult protection training to ensure residents are safeguarded from abuse or harm. It is recommended that the home review the level of staff supervision in communal areas to ensure that all residents are safe. It is recommended that the home review changing facilities for kitchen staff. It is recommended that staffing levels are monitored and increased when necessary to meet the individual needs of the residents, with particular consideration given to mealtimes. It is recommended that the home ensure 50 of staff achieve NVQ 2 or above. It is recommended that the results of surveys together with any action plan be made available to residents, CSCI & other interested parties and that resident and relative meetings are re-established. It is recommended that all staff receive supervision and DS0000066336.V307286.R01.S.doc Version 5.2 Page 31 2. OP8 3. OP10 4. OP12 5. 6. 7. 8. 9. 10. OP14 OP15 OP16 OP18 OP19 OP27 11. 12. OP28 OP33 13. OP36 Edenmore Nursing Home that people providing supervision should be trained and supported to do so. Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 32 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 Edenmore Nursing Home DS0000066336.V307286.R01.S.doc Version 5.2 Page 33 - 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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