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Inspection on 13/10/06 for Edgeworth House Nursing Home

Also see our care home review for Edgeworth House Nursing Home for more information

This inspection was carried out on 13th October 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

NHS and other health professionals are actively involved in the care of residents as needed. The residents spoken to told the inspectors that the staff are kind and caring, and that their privacy and dignity are respected. A growing range of activities is offered, with both individual and some group activities being available. Ongoing training and development was seen for all staff. The residents are looked after as individuals, and all residents told the inspector that they enjoyed the "family atmosphere" of the home.

What has improved since the last inspection?

The environment of the home has improved, and was cleaner in most areas.

What the care home could do better:

Updating care plans as resident`s clinical condition changes, rather than within a few days or a week of a change. Recording of the `second signature` in the controlled drugs book must be improved with immediate effect.

CARE HOMES FOR OLDER PEOPLE Edgeworth House Nursing Home Church Road Bebington Wirral CH63 3DZ Lead Inspector Julie King & June Beaver Key Unannounced 13th October 2006 09:00 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 Edgeworth House Nursing Home DS0000020945.V305896.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. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Edgeworth House Nursing Home Address Church Road Bebington Wirral CH63 3DZ 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) 0151 643 1271 0151 643 1352 Ashbourne Homes Limited Mrs Margaret Lynne Walter Care Home 103 Category(ies) of Old age, not falling within any other category registration, with number (103), Physical disability (4) of places Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 103 beds nursing care / 14 beds personal care in an overall total of 103 Two named adults under 65 years of age Four unnamed service users aged 18 - 64 years of age with physical disability 18th January 2006 Date of last inspection Brief Description of the Service: Edgeworth House is registered to provide nursing care to 103 older people, 14 of which may require personal care only. The home is a three storey purpose built home and offers the majority of service users, single, en-suite accommodation with baths or showers. The bathrooms are conveniently situated and provide bathing aids. Each floor has two lounges and offers a choice of a non-smoking or smoking lounge. The dining room is situated on the ground floor. All floors are served by a passenger lift. There are large gardens that are fully accessible to service users and a patio area. There is car parking to the front and rear of the home. The home is situated in Bebington and is close to local shops and public transport services. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over 6 hours. The registered manager, Mrs Lynn Walter, accompanied the inspectors throughout the inspection period. Personal files of both residents and staff were inspected, and a full tour of the building took place, which included all communal areas and resident’s bedrooms. Staff and residents were spoken with as regards their view about the care home. The care home was clean tidy, had no malodour, and had adequate staffing levels to care for the residents. What the service does well: What has improved since the last inspection? What they could do better: Updating care plans as resident’s clinical condition changes, rather than within a few days or a week of a change. Recording of the ‘second signature’ in the controlled drugs book must be improved with immediate effect. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 6 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. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 7 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 Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 8 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): 1,3,4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents assessed needs are being met, and the home is able to provide assurances to residents and their representatives that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: Pre admission assessments provide a holistic assessment of actual and potential needs of each prospective resident; thus allowing a care plan to be developed. These assessments are completed by the registered manager or care manager, and include demographic details of the prospective service user – next of kin, past history both medical and psychological / mental health, a specific mental health assessment and involvement of representatives as needed. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 9 The activities co-ordinator also has a limited input into establishing resident’s life interests and areas that can be continued after admission into the home. Multidisciplinary healthcare team (MDT) input is evident in resident’s care files, and include reference to NHS outpatient’s appointments, opticians, dentistry, and district nurse (DN) input at the home as needed. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 10 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. There is a care planning system in place for all residents. This provides staff with most of the information they need to meet the resident’s needs. Medication management was not compliant with current good practice requirements and guidelines, thus potentially affecting the safety of residents. EVIDENCE: A random sample of new residents files and long stay residents were reviewed. The pre-admission documentation used was informative, concise and contained sufficient detail to inform the care plans once admitted. The care plans were generally completed to a high standard and contained evidence of multi-disciplinary involvement in residents care. The care plans were reviewed on a monthly basis or more often if required. However advice was given to ensure that when treatment plans are changed the care plans should be altered accordingly at the time to avoid confusion and aid staff. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 11 The home’s management were given a strong recommendation to make sure all care plans are updated immediately if treatment plans change. This would help avoid confusion and protect the health and welfare of residents. Medications were examined and found to kept in accordance with current requirements, except for the recording of controlled drugs (CD’s) in the CD register. The manager and care manager commenced an immediate investigation into this matter and will produce a report of their findings to CSCI within the next two weeks. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Links with the local community are good, and support and enrich the resident’s lives. Meals in Edgeworth House are good, offering choice and variety, and cater for resident’s special dietary needs. EVIDENCE: Residents in the home are asked on admission about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in. The residents informed the inspector that they enjoyed the variety of food in the home, and have a choice at each sitting. On admission to the home the resident with help from a family member completes an initial care plan, which includes a social history as well as referring to hobbies, food likes and dislikes information, etc. This information is used to plan organised activities for each resident by the activities coordinator and care staff. Visitors are allowed in the home at any reasonable time for day, residents may entertain their visitors, in the communal lounges, or in their own bedroom. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 13 The gardens have been tidied and are an ideal setting for residents to sit with their relatives, especially in the warmer months. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 14 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): 16,17,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaint and adult protection policy and procedure was in place that helps ensure the safety and welfare of residents. EVIDENCE: The residents, relatives and staff can access complaint policies and procedures as and if necessary. The procedure includes information on ‘whistle-blowing’, in accordance with current Department of Health guidelines. Most of the staff have completed training in adult protection, with the remaining having training planned for the near future. However all staff do receive basic training in the protection of vulnerable adults during induction. Residents are enabled to exercise their right to vote, either via post or in person; and there is no religious or political persuasion in the home. The complaints procedure at the home is robust and meet the standard required by the Care Standards Act 2000. All complaints are investigated thoroughly and complainants are kept informed at all stages of the investigation verbally and in writing. There have been five complaints since the last inspection two of which were founded and dealt with appropriately. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 15 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. All of the resident’s rooms are personalized, providing an attractive and homely place to live. EVIDENCE: Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 16 The premises were very clean and odour free. There was evidence of on-going re-decoration and refurbishment. All rooms were decorated and furnished to a high standard. The décor was homely and in good repair. Most of the residents had personalised their rooms with small items of furniture, photographs and soft furnishings. The communal lounges were bright and inviting. There was a separate activities room with tea and coffee making facilities and a bar/games room was being created with residents input. The dining room was well furnished and the tables well presented. The residents spoken to on the day of the visit spoke highly of the standard food served. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 17 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. There is a consistency of care within the home provided by permanent staff, which helps to offer safety and stability for the residents. EVIDENCE: References were seen in all staff personnel files, and CRB and POVA information was also evident. The registered manager and qualified staff were clearly able to inform the inspectors of their knowledge of the National Minimum Standards and accompanying regulations regarding the recruitment and retention of staff. Training and inductions, including specific training on the protection of vulnerable adults was seen for most staff. The manager has developed a training plan for all staff, accessing many external training providers. The range of training and development includes medication management, moving & handling, health & safety, pressure sore prevention and NVQ in Care. This improvement should continue to be built upon. The manager has also established in-house “link people” to obtain additional information and training as needed. Their role extends to cascade new information to the remainder of the home’s staff. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 18 Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37,38. Quality in this area is good. This judgement has been made using available evidence including a visit to this service. This home benefits from a competent manager and staff team, thus helping to improve the quality of care given to residents. EVIDENCE: The manager (RM) is registered with CSCI, has completed her NVQ4 Registered Manager’s Award, and have, in conjunction with her staff team, made an ongoing improvement to this service. Staff morale appears to be high, and the staff spoken to said they feel valued and appreciated, and are happy coming to work. Policies and procedures are regularly updated with relevant changes in accordance with legislation, and both the Registered Manager and qualified staff were clearly able to demonstrate their ongoing professional development. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 20 Records are kept in accordance with the Data Protection Act 1998, and audits were available for most aspects of record keeping. Required health and safety certificates and service contracts were in place, valid and up to date. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 21 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 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 x 4 x 3 3 Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13.2 Requirement The registered person is required to ensure that all medications in the care home are managed in accordance with current requirements and regulations at all times. Timescale for action 14/10/06 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 strongly recommended that all care plans are update immediately as individual resident’s condition dictates. Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 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 Edgeworth House Nursing Home DS0000020945.V305896.R01.S.doc Version 5.2 Page 24 - 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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