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Inspection on 04/06/08 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 4th June 2008.

CSCI found this care home to be providing an Good service.

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

The home is a well-maintained building with a variety of space that is suitable to meet the differing needs of individuals living in the home. There is a stable staff team in place who consider themselves supportive and encouraging of each other. Staff communicate individual needs well with each other and attend regular meetings in order for them to be aware of changes in the home. There is a full time activities co-ordinator who makes sure that there is a lot of information available in the home to the people who live there. This includes posters advertising trips out and copies of an activities programme. This information is displayed in a variety of areas within the home in order to make sure that the majority of the people living in the home are kept up to date. There is a variety of training available to the staff in order to make sure that they can maintain and develop their skills. Records are kept of attendance on training in order to make sure that staff keep up to date.

What has improved since the last inspection?

The general appearance of the home is still being developed and plans include the creation of a garden that has raised flowerbeds in order that the people who live in the home can be actively involved in maintaining the garden. Community links have increased with the involvement of local colleges and schools. The management of health and safety has improved and in the majority of cases risk assessments were available that identified the risk and what actions staff needed to take in order to reduce the risk.

CARE HOMES FOR OLDER PEOPLE Edgeworth House Nursing Home Church Road Bebington Wirral CH63 3DZ Lead Inspector Julie Garrity Unannounced Inspection 10:00 4 of June 2008 th 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.V362752.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.V362752.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 Ltd Acting Manager Care Home 103 Category(ies) of Old age, not falling within any other category registration, with number (103), Physical disability (6) of places Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 103 beds nursing care / 14 beds personal care in an overall total of 103 Six unnamed service users aged 18 - 64 years of age with physical disability 5th April 2007 Date of last inspection Brief Description of the Service: Edgeworth House is registered to provide nursing support to 103 older people. Although registered for 103 the home currently has 80 places available. 68 in single bedrooms and a further 12 places in double rooms. The home is part of a large company that has a number of homes throughout the country. The service is a three-storey purpose built building and offers the majority of Individuals 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 side of the home. Edgeworth House is situated in Bebington and is close to local shops and public transport services. The fees range from £421.82 to £741, but does not include hairdressing, chiropody, newspapers and personal toiletries as examples. Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. The site visit was carried out over a period of two days. We (the commission) and was a total of 15 hours. We spoke with 13 people who live in the home, 4 visitors, 12 staff, and the acting manager and operations manager. We completed the inspection by a site visit to Edgeworth House, a review took place of many of the records available in the home and our offices. These included individuals care plans, assessments, accident records, staff rota, staff files, maintenance records, menus, staff rota, questionnaires, staff training, medications, information sent to the commission by the service and a selfaudit (known as an AQAA) completed by the home. This site visit included discussions with people who live in the home, visitors, staff and management. We followed an inspection plan that was written before the start of the site visit to make sure that all areas identified in need of review were covered. All of the key standards were covered in this inspection, these are detailed in the report, additional standards were identified before and during the inspection these were also looked at and detailed in the report. Feedback was given to the manager during and at the end of inspection. The operations manager was also given feedback on the second day of the site visit. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs and preferences, promote independence and support to make informed decisions in line with personal choices. What the service does well: The home is a well-maintained building with a variety of space that is suitable to meet the differing needs of individuals living in the home. There is a stable staff team in place who consider themselves supportive and encouraging of each other. Staff communicate individual needs well with each other and attend regular meetings in order for them to be aware of changes in the home. There is a full time activities co-ordinator who makes sure that there is a lot of information available in the home to the people who live there. This includes posters advertising trips out and copies of an activities programme. This Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 6 information is displayed in a variety of areas within the home in order to make sure that the majority of the people living in the home are kept up to date. There is a variety of training available to the staff in order to make sure that they can maintain and develop their skills. Records are kept of attendance on training in order to make sure that staff keep up to date. What has improved since the last inspection? What they could do better: Consideration should be made to reviewing a number of records in the home this includes pre-admission assessments that contain little information about the social needs of individuals, care plans that are not always specific to the needs of individuals, risk assessments that are not always monitored or updated and medication records that do not always give clear information to the person giving out medications. There is a new manager in post who needs to apply for registration with us in the next three months. Further development is needed regarding dealing with potential allegations of abuse, the policy and procedure needs to be update to clearly explain what acts the senior management needs to take in the event of an allegation of abuse. It would also benefit the people in the home if senior management both inside and outside the home received up dated training in dealing with adult protection in order that the local policy from social services that the home has contracted to abide by is always followed correctly. Staff training also needs to include how any allegations will be dealt with in order to make sure that they always take appropriate action. Please contact the provider for advice of actions taken in response to this Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 7 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. Edgeworth House Nursing Home DS0000020945.V362752.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 Edgeworth House Nursing Home DS0000020945.V362752.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): Standards reviewed were 1,2,3,4, and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All individuals are assessed to determine if the service can meet their needs before they move in. EVIDENCE: We looked at the information available in the service for people wishing to move into the home. A copy of information known as the service users guide was available, however a number of areas were out of date, such as the manager and the number of single bedrooms. Another document known as the statement of purpose that details the services provided and the service will deliver the care was not available. The acting manager said that both documents were being reviewed and updated and new copies would be made available once completed. Once this is completed this will provide individuals with clear information about the services that are available and help people Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 10 make an informed choice as to whether they want to move into the home or not. Records showed that all individuals moving into the home had a full assessment done once they moved into the home, this highlighted a number of medical and physical needs and there was the opportunity to look at individual social and mental health needs. This was a small section and not always completed. Good assessments help the home determine if they can meet the needs of individuals in all aspects of their daily lives including their social needs. The manager explained the process for admittances, which included an assessment before the individual moved in and a copy of the social workers assessment were applicable. The files viewed did not always have a copy of both of these and the general assessments were not updated and signed by individuals living in the home. Contracts were available for all people living in the home that showed the services that they would received and what funds such as social services and nursing were being paid. This helps keep people up to date and be aware of how the support that they receive is paid for. A full policy and procedure on admitting and assessing individuals into the home was available. This discussed the arrangements for assessing individuals before they moved into the home. This included, visiting people in their own homes and offering individuals the opportunity to spend time in the home before they consider moving in. Individuals spoken with said, “Staff were friendly, the room looked really comfy and big”, “someone came to see me before I moved in, they told me about Edgeworth and asked me lots of questions about what I wanted” and “I looked around with my daughter, we liked the friendly staff”. A family member spoken with said “I choose the home as staff were very friendly when I came to look around. They asked me lots of questions and I felt that they really wanted to get to know my mum”. It is good practice that the service makes sure that individuals can have the opportunity to decide if they like the home before they move in. Edgeworth House Nursing Home DS0000020945.V362752.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): Standards reviewed were 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of medications needs to be improved to make sure the full instructions are always available to the individual dealing with the medication. Each individual has a copy of the plan of care the details to staff how to support the needs. These do not always contain specific details and in some cases are repetitive and overly complicated. EVIDENCE: We looked at the medications for twelve individuals and found that in all cases they had received the medications that they had been prescribed. The records were not always maintained to a good standard and this included not recording items such as creams had been used or giving instructions to the staff undertaking this activity. At the site visit the manager put into place a system that made sure that all staff were given clear instructions and creams could now be recorded. This is good practice as it now makes sure that staff are able to deal with items such as creams in an appropriate manner that meet the Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 12 needs of individuals. There was also inconsistency with records, not all medications were logged in when received by the home and arrangements for supporting individuals who managed some of their medications were not always appropriately assessed and planned for. The manager arranged that a risk assessment be put into place for the individual who did not have one and that the other assessments would be reviewed and include how support was in place and monitored. Instructions to staff were not always available including medications that were given “when needed”, medications that were “give one or two” and medications that had handwritten instructions. The manager stated that this would be addressed with the staff responsible for medications and addressed. Audits are regularly undertaken but had not identified the areas above which help improve safe practice. We looked at the care records and care plans of five people living in the home. In all cases these were not specific to individuals and included phrases such as “regularly”, which means different things to different staff and does not support a consistent approach to individual care. Although regularly reviewed and signed for by staff, care plans were not signed by the person for whom the care was for and as such they had not included in the process. Staff spoken with said that they did read care plans and that they did reflect the care that they gave the people who lived in the home. Care plans contained little information regarding the social needs of the individuals and how staff were to support their personal preferences and choices. All staff spoken with said that they found care plans overly long and complicated and in many cases information was repeated in two or three places making care plans very long. Care staff commented that they “felt sorry” for the nursing staff who spent “lots of time having to write up care plans and daily logs”. Very long and complicated care plans mean that there is a risk that information will be missed and do not support the people who live in the home to be part of the care planning process. All the plans viewed covered medical needs and included aspect such as consulting professional’s external to the home and what actions had been taken. Records also covered what medical needs were being managed such as pressure ulcers although the quality of the records and photographs did not always support the staff to make sure that the treatment being used was working. Individuals living in the home who were spoken with did not recall having seen a care plan or being involved in determining the actions that staff were to take. All individuals spoken with had positive comments to make including “they are very kind staff, with a lovely attitude, friendly, happy and happy to help”, “I like the staff they try very hard and are really supportive”, “If I need to see a doctor or go to hospital this is arranged and someone comes with me if I need it”. Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 13 Throughout the site visit, staff were observed to treat individuals with dignity at all times. This included addressing people in a manner appropriate to their needs, knocking on bedroom doors before entering and the making sure that individuals clothing was protected during mealtimes as appropriate. Edgeworth House Nursing Home DS0000020945.V362752.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed were 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The community links continue to be developed, this helps increase the people who live in the home capacity to remain part of their local community. To help people exercise more control and have greater choice, the range of activities and food can be further developed. EVIDENCE: Observations through out the site visit showed there was plenty of information detailing up and coming activities. This included posters about visits to Chester Zoo, and what daily activities were happening. The activities coordinator explained that they are limited to the amount of people that they can take on any one trip. There is a minibus available to the home twice a week however the activities coordinator cannot drive the bus she does not have proper licence. One individual said she had not been asked to go on the trip and would like to do so. It is unfortunate that the home can only accommodate limited trips out for the sixty-nine people living in the home due to this restriction. Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 15 The review of the records held by the activities coordinator showed that she recorded all activities undertaken but did not plan for activities in line with individual specific choices or preferences. The activities coordinator said it should not receive training in planning activities to people with dementia and would like to do so. The home does have several residents with a diagnosis of dementia. All individuals spoken with thought that the information available regarding activities was very good. One person commented its always available at the bottom of the lift, I can see whose birthday it is, what we are getting up to and what I can join in”. On the day of the site visits a number of activities were taking place including painting in the dining room. Four individuals were involved in this and seemed to be enjoying this. Observations showed that there are no menus available for the people who live in the home to review. Three people spoken with said that staff asked them the day before what would like this is the choice of two main meals. They all said that they were under the impression that if they did not want what was available they could have an alternative such as sandwiches baked potatoes or an omelette. The home operates a computerised system that provides a variety of different menus, recipes and the food order. The chef explained that he determines the menus the recipes are provided in the food order is automatically generated. The chef explained that he based the menus on what he thought the residents would like to meet. There are no records in the kitchen or individual care plans that discuss all the people living in the homes personal preferences and choices. All of the meals given out over the lunchtime observed showed that each meal had identical vegetables in place. Records relating to asking individuals what would like to eat showed that they were only asked regarding the main meal and were not asked about the vegetables that accompanied it. Five relatives were spoken to during the site visit. All relatives spoken with said that they were very happy with the activities that was in place. They felt welcome in the home at all times and found the manager and the staff to be very approachable willing to listen and happy to keep them up-to-date. The manager spent a considerable amount of time during the site visit explaining how she was developing local community links, this included links with the local schools, at the local college and with voluntary organisations in the area. Plans included making sure that there was a raised vegetable garden and flower garden for the residents to attend to. A gardening club has been commenced and it is intended to develop this further. The manager explained that this was not funded by the home and therefore they spent some considerable time fund raising to make this happen. Fundraising was also essential in trips out the home does not charge for this and the staff fund raise to develop this further. This includes open days, summer fetes and coffee mornings. This also encourages the local community into the home. Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 16 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): Standards reviewed were 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The majority of staff have received training in recognising concerns of a serious nature and can make sure that they take appropriate action in order to safeguard the people who live in the home. EVIDENCE: The home has a policy and procedure regarding complaints. A file was reviewed that detailed all complaints that the home has looked at what they had done to resolve a complaint. Individuals spoken with were comfortable in explaining that any issues they had they would report to care staff in order to get it “fixed”. One individual said “I had a hard time when I first got here its not my home after all. Lots of little things weren’t what I wanted and sometimes I was not happy. The staff were excellent they made sure they fixed every issue and tried to make sure that I was happy.” Care staff spoken with do on occasions address concerns such as missing items, not liking the food on offer that day, they do not always pass this on to the manager to make sure that its recorded as they don’t see it as a complaint. As such vital information that the manager needs is not always passed on. Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 17 During the site visit an individual made a serious complaint. The staff correctly recognised that this was potential abuse and reported it to the manager. The manager took advice from a legal helpline that the operations manager says is company policy to contact in the advent of serious allegations. The homes own policy and procedure for dealing with adult protection was not available at the time of the site visit but was forwarded later. The policy and procedure states the manager must follow the policy in place from Wirral social services in dealing with potential abuse issues a copy of which is available in the home. The manager was not given the correct advice by the legal helpline, additional once reviewed the homes own policy does not request that they contact the legal helpline it directs staff to follow the policy in place from the local social services. The operations manager and the homes manager also said they had not had training in adult protection. The incorrect information from the legal helpline ran the risk of compromising any clear investigation from external sources. The lack of training for senior staff and the homes own policy meant that the manager was not given proper guidance in dealing with this issue. They did recognise the seriousness of the allegation and attempted to deal with it in the appropriate manner. The deputy manager provides training to all staff regarding adult protection but said that she has not had training in this area for several years. Training records in the home showed that the majority of staff had received training in adult protection. Six staff were asked about who investigates allegations of this nature all staff said that they thought it was the manager and were unaware of the obligations of social service. All would have spoken to the individual before passing on the information and potentially started their own investigation, thereby compromising any external independent investigation. Edgeworth House Nursing Home DS0000020945.V362752.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed were 19,20,22,23,24,25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to personalise their rooms and benefit from a variety of facilities including lounges and outdoor space were they can spend their time. EVIDENCE: The building is purpose built and on three floors. There is a large dining area on the ground floor and a smaller lounge on every other floor including a smoking lounge on the top floor. There are six double rooms and sixty-eight single rooms and can accommodate up to eighty individuals. Although it is registered for one hundred and three places have been reduced as many of the double rooms have been reduced to single rooms. The operations manager requested that number of places remain the same as there maybe plans to use a part of the building currently not is use for additional bedrooms and living accommodation. Nine bedrooms were viewed all were personalised and were Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 19 large and airy, well decorated and included items specific to the individual whose room it was. The home is surrounded by outdoor space that has seating in place for the people who live in the home and the manager has plans to support the gardening club and increase the opportunities for people to enjoy the gardens. The kitchen was looked at this was a large kitchen that was well equipped the chef said that there was more than enough equipment available at all times. There is a cleaning schedule in place that supports the maintenance of equipment and cleanliness. Training records showed that the majority of staff a have received training in infection control. Throughout the home there are clear arrangements for the safe disposal of soiled ands contaminated items. All maintenance records looked at were up to date and showed that the home maintains all equipment including smaller items such as those used to monitor blood sugar. This is good practice as it makes sure that the home has the equipment it needs at all times. The laundry was viewed and this had hand cleaning facilities in place and the equipment such as gloves and proper soiled linen bags (red bags) that help prevent cross infection. Staff stated that one dryer was out of action and they were not aware of when this was to be fixed. The manager was aware of this and had arranged for this to be done. Staff in the laundry also explained that they had difficulty distributing clothing as the equipment that they needed was damaged. The manager explained that new equipment had been order there was no clear arrangements in place to protect staff’s health and safety whilst they awaited the correct equipment. Staff were observed during the day to use health and safety equipment in the appropriate manner. A person living in the home spoken with said that the home was “very clean, tidy and staff really made an effort”. Other people said “the home is very nice, its always very clean, never smells, my room is lovely I choose it when I moved in”. Relatives spoken with said that one of the main reasons that they admitted their relative to the home was the way that it looked. All said, “its very clean and well decorated”. Edgeworth House Nursing Home DS0000020945.V362752.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards reviewed were 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Training is available to staff that helps increase and develop their skills. Some of the staff have not attended training provided, as a result have not developed the skills that they need for their job role. Staff are recruited in a safe manner and their skills are determined before they start working in the home. EVIDENCE: People living in the home said that “staff are very kind, they have a lovely attitude about them and are very helpful”, “some are better than others and but they all work very hard”. They also commented that there was “lots of staff, rarely have to wait for some on”. Staffing files viewed for were up to date and contained full recruitment information such as police checks, 2 references and a full application form. Staff files were well organised, three new staff had been recruited by the head and were due to start work in four days. At the time of the site visit the manager had not received information regarding their suitability for employment. We were contacted by the manager following the site visit who confirmed that she had received information including work permits that the Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 21 staff were fit to work in the home. Arrangements were in place for them to start additional to the normal staffing levels in order that they could be properly introduced to the home and given time to understand the people who live in the homes needs. Good recruitment and the opportunity to orientate into the home is good practice as it supports the recruitment of good staff and gives them the opportunity to develop new skills. Staffing levels were maintained at all times on the duty rota. Staff spoken with thought that there was enough care staff available at all times. Other staff included, domestics, laundry staff, maintenance staff and an activities coordinator. Discussions with all the staff showed that at all times there was sufficient staff available. A spreadsheet was available for staff training that detailed the training in place and was used to monitor if staff training was still in date, this included training such as moving and handling, infection control, adult protection, first aid and health and safety as examples. Several members of staff were out of date for training including moving and handling training. The deputy manager delivers much of the training sessions. She explained that at the last training scheduled none of the staff turned up. The manager and the deputy are reviewing arrangements regarding the training to make sure that they get a better attendance including training that is not mandatory. There were determinations of competency for medications and no evidence of training in tissue viability or medications the manager explained that this is discussed at one to one meetings. Staff spoken with said that there was lots of training available and that the company was supportive in giving training and paying them to attend. They also said that in their opinion there was enough staff available at all times. There are three cleaner’s available daily, three kitchen staff and two laundry staff. A main housekeeper is available 5 days a week to support the ancillary team. An activities co-ordinator is available for 35 hours a week and maintenance staff are on site with others brought in. The maintenance man was redecorating empty rooms on the day of the site visit. Edgeworth House Nursing Home DS0000020945.V362752.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager, although new in post, has identified and put into place plans that will continue to develop the quality of the service. EVIDENCE: Edgeworth house’s manager has been in post for 3 months and as such is relatively new to the home. During that time she has reviewed the current quality arrangements and explained to us at the site visit a number of plans she had to further develop the quality of the service provided. An AQAA was sent to us before the site visit which explained some areas that the service which to improve but did not included the level of plans that the manager has for the net few years. It is always worth including plans for development of quality and assists at the site visit to make sure the we can be aware how the Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 23 home plans to increase its quality. As yet the manager is not registered with CSCI and plans to submit the necessary application within the net three months. During the site visit it was identified that neither the manager, the operations manager nor the deputy had received training in dealing with AP. As this is a responsible role it is good practice if senior management are fully aware of their roles and responsibilities within this area. People who live in the home, relatives and staff were very complimentary about the manager and deputy. They said that they were both “supportive”, “kind” and “wanted the best for the people who live in the home”. The service has undertaken an external quality audit and achieved the top rating that they could. This is good practice as it supports them to look at the areas that they can develop and build on to strive for the best service that can be can achieved. As part of their own quality development the manager undertakes a variety of audits on a number of areas including care plans and medications a review of the audits showed that they checked to see if the relevant paperwork was available and the process had been followed, but did not actually look at the practice. Subsequently they did not identify the areas for development highlighted in this report. The service does hold some personal allowances for people who live in the home. This is funds left with them by relatives to buy items for individuals. There are clear records available that record what money was received and what is spent by the individual. All the funds are in a non-interest baring account and as such no interest can be earned on individual funds. This information is not available in the information in the home. Individuals can access their funds when the senior staff or the administrator is available and as such their access to their own funds is limited by the availability of certain staff. We looked at the arrangements for managing heath and safety in the home. There are risk assessments available for individual activities of the people who live in the home. Some of these had not been reviewed and in one case a risk assessment for an individual self-medicating was not available. The manager made sure that this was done at the site visit. During the site visit an individual had an accident in which they did not receive an injury the manager made sure that their care plan and risk assessment was updated and the person agreed to the actions that needed to be taken. Risk assessments regarding the activities of the staff such as moving laundry around the home or fire risk assessments were either not available or out of date. Risk assessments need to be readily available and updated in order for the risk to be minimised. Edgeworth House Nursing Home DS0000020945.V362752.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 2 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 2 X X 2 Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 25 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 OP31 Regulation 9 (1) (2) (a) (b) (c) (3) Requirement The manager needs to submit an application for registration with CSCI in order that she can become registered and comply with the necessary regulations. Timescale for action 04/09/08 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 OP3 Good Practice Recommendations Consideration needs to be made regarding pre-admission and admission assessments. These are currently medically based with little opportunity for the home to determine and plan how to meet individual social and psychological needs. Care planning arrangements and staffs competency to complete care plans needs to be review. The current system is very complicated and repetitive and subsequently is not always updated appropriately and does not plan for care in a specific, objective and meaningful manner. The individual for whom the care plan is written needs to be involved in the care planning process and care plans need to be in a format that meets DS0000020945.V362752.R01.S.doc Version 5.2 Page 26 2. OP7 Edgeworth House Nursing Home 3. OP9 4. OP18 5. OP33 the individual needs. Best practice needs to be maintained regarding medications this includes all handwritten medication to have clear instructions and checked as correct, medications to be returned kept as securely as those in current use, staff competency and training needs to be reviewed and kept up to date Best practice would also include PRN and one or two dose medications have full instructions available to inform the individual giving out the medications when to give. All external preparations need to be recorded and manufactures instructions on storage need to be followed at all times. Any medications such as Warfarin that can change need to be clearly recorded on the medication administration records and a new entry created if the dose changes. All staff need to be familiar with the “alerters” role in the local authorities “no secrets policy”. Senior staff need to have up to date training in Adult protection particularly those responsible for managing any potential allegations, those giving advice and guidance in managing potential allegations and those members of staff involved in the training. The current practice of contacting the legal helpline needs to be included in the policy and procedure. The organisation should take the opportunity to check that the advice coming from the helpline is in line with current best practice in managing adult protection as incorrect advice can result in indirect interference in any potential eternal investigation. Consideration to reviewing the current auditing arrangements in the home should be undertaken. Currently the audits look at process ie is a particular record available and not practice ie is it completed to a good standard. This will make sure that quality areas for development can be clearly identified and addressed. Edgeworth House Nursing Home DS0000020945.V362752.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston, PR2 2YQ 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 Edgeworth House Nursing Home DS0000020945.V362752.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. 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