Inspection on 26/05/06 for Edinburgh House

This inspection was carried out on 26th May 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.

Other inspections for this house

Edinburgh House 09/11/05

Edinburgh House 09/06/05

Edinburgh House 25/01/05

Similar services:

Chestnut Walk

Dunwood Manor Nursing Home

Excelsior

Cherwood House Care Centre

Durban House Nursing Home

Dawson Lodge

Court Lodge Nursing & Residential Home

Ferendune Court

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

CARE HOMES FOR OLDER PEOPLE Edinburgh House Sundridge Close Cosham Portsmouth Hampshire PO6 3JL Lead Inspector Mark Sims Unannounced Inspection 26th May 2006 10:00 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 Edinburgh House DS0000044195.V288876.R02.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. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Edinburgh House Address Sundridge Close Cosham Portsmouth Hampshire PO6 3JL 023 9284 1155 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) www.portsmouthcc.gov.uk Portsmouth City Council Miss Sara Helen James Care Home 32 Category(ies) of Dementia - over 65 years of age (32) registration, with number of places Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user under 65 years of age to be admitted for a period of respite 9th November 2005 Date of last inspection Brief Description of the Service: Edinburgh House is a Portsmouth City Council run home providing a service for older persons who have dementia. The home has the facilities to accommodate up to 32 residents providing long stay residential care as well as offering respite and short stay care. The service is in one building with the accommodation on 2 floors. Each floor has two units each with its own lounge/dining area and kitchenette. Service users’ bedrooms are within easy reach of each lounge, and there is a designated staff group for each unit. Edinburgh House is close to the shops and is on a bus route. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection appraised the home’s performance against the National Minimum Standards for Older People over the months following the previous inspection, undertaken on the 9th November 2005. The inspection process considered various sources of information, which together were used to support the decision-making process and the quality rating for the agency, including: pre-inspection information, provided by the Registered Manager, information from previous inspection visits and reports, comments from professional services involved with the home, comment cards and a fieldwork (site) visit, when records were inspected and service users, relatives and staff interviewed. The fieldwork visit was conducted over two days, 26th May 2006 and 30th May 2006 and the following report has been drafted using the information gathered during the visit and the sources of identified above. What the service does well: The availability and variety of activities and entertainments at Edinburgh House is good and range from a daily in house programme of events, organised and delivered by the care staff, to larger events such as the ‘Ark’ garden party (which involves live animals) and a forthcoming event planned to mark the Queen’s official birthday. The enjoyment of the activities arranged was clear to see throughout the fieldwork visits, with pictures of service users and comments from relatives evidencing the benefits and pleasure derived from the ‘Ark’ garden party. People observed participating in various in house leisure pursuits, including jigsaw puzzles, dominos and an unusual but clearly enjoyable game with balloons and static electricity. The care staff are another positive aspect of the service, as their attitudes towards both the residents and relatives were observed to friendly, welcoming and caring. These observations were also supported by relatives’ comments and through the inspector’s own experiences during the fieldwork visit, when he was made to feel welcome. Valuing people came across throughout the fieldwork visit as a prime objective of the management and staff at Edinburgh House, this opinion backed up by Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 6 the active quality auditing system or programme introduced by the management, which includes: • • • • • • • Relatives’ meetings (minuted). Questionnaires for service users, relatives and staff Annual Care reviews Regulation 26 visits and reports Staff meetings, both on a full scale team basis and smaller unit meetings Staff appraisals and supervision Review, revision and updating of records/policies/procedure. What has improved since the last inspection? What they could do better: Whilst attention has been given to addressing the environmental requirements raised at the last inspection, the decorative condition of other areas of the premises has naturally deteriorated. The fascias, guttering, down-pipes, etc., are all in need of attention and must either be replaced, repainted, repaired or made good, as sections are missing, blocked by weeds and generally poorly maintained. The City Council must also consider how the television signal reception might be improved for residents, as currently the reception quality and picture on the televisions is poor. The flooring in a bathroom, as identified, remains an outstanding issue from the previous inspection and must therefore be addressed as soon as possible. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 7 Portsmouth City Council has recently introduced new care planning packages within all of their existing services, which is a positive and proactive measure aimed at improving their general approach to care planning and ensuring standardisation across all services. Whilst the staff at Edinburgh House have taken to the new system, some teething problems persist, including the absence of a credible and appropriate Moving and Handling Assessment, which it is imperative to address given the risks associated to the moving or handling of people and need to comply with the Manual Handling Regulation 2002. 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. Edinburgh House DS0000044195.V288876.R02.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 Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 3 & 6 Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. Service users’ needs are appropriately assessed and recorded prior to admission. The service does not offer an intermediate care facility. EVIDENCE: As mentioned briefly within the summary of the report, Portsmouth City Council (PCC) has recently introduced a new care planning package for use within its services, this package including a pre-admission assessment element. Whilst this tool has been designed to feed directly into the care planning process and is reasonably detailed and informative, the assessment tool is new to staff and in order to ensure all relevant information is collected the manager and her team have decided to run with both the new pre-admission assessment tool and their existing assessment tool. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 10 Information obtained from previous inspection reports and evidence gathered at those visits, indicates that pre-admission assessments have always been appropriately conducted with relevant and pertinent data gathered by the staff of Edinburgh House. The earlier inspection reports also comment on the availability, on the service user plan, of Care Management Assessments, which are useful sources of preadmission information. During this fieldwork visit it was established that these documents continue to be made available to the home and copies are maintained on the service user files. The availability, to the home, of the care management assessments is made easier, thanks to the management team having access to ‘SWIFT’, an internal PCC computer programme, which records all care management assessments, reviews and contacts. On reading through the service users’ files it was evident that all of these documents were being appropriately used and that information was being adequately transferred from the assessment sheets onto the care plans and supporting documents, nutritional screening tools, tissue viability tools, etc. The relatives of several service users also confirmed that their next of kin had been visited prior to admission and details of their care needs and abilities documented. People also discussed the visit they had undertaken to the home, prior to deciding that Edinburgh House was the right environment for their relative, information provided during the visits and the friendly, open and welcoming attitudes of the staff. Other relatives discussed how their next of kin were known to or knew of the home prior to moving in permanently, as they had experienced periods of respite stay at Edinburgh House or accessed the day centre attached to the premises (this is a separate service) and therefore would not consider going to any other home. Observations and conversations with people living at the home, provided further evidence of the fact that the service users admitted to the home were being appropriately accommodated and feel within the categories of registration at Edinburgh House. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): ST 7, 8, 9 & 10. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. The PCC’s new care-planning programme does not clearly identify or set out the needs of the service users in relation to safe moving and handling, although the practice of staff at Edinburgh House was observed to be good. Service users receive adequate and appropriate support when accessing both health and social care services. The management’s approach to supporting and/or managing service users’ medication is good and no practice issues were identified. Service users and/or their relatives feel they are treated with respect and dignity and that their rights to privacy and self-determination are upheld. EVIDENCE: Evidence gathered during fieldwork visits to other PCC homes has established that the newly created and introduced care-planning package does not include a detailed or robust moving and handling assessment. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 12 This has been discussed with a representative of the PCC, as part of an inspection feedback process, where it was stated that the care-planning package had yet to be entirely rolled out to services, indicating that a moving and handling assessment is available but not in operation. However, the delay in implementing this tool places both service users and carers at risk of injury and it is important that if a tool exists it be introduced soon, alternatively if a credible moving and handling assessment is not available one should be created without delay and rolled out to the services. At Edinburgh House the manager and her team had already identified the shortfall in the care-planning package and had continued to use the moving and handling assessments from the previous care planning process, which whilst not fully compliant with the recommendations of the Manual Handling Regulations 2002, was effective in providing basic guidance to staff. General observations indicate that the practice of staff, when undertaking moving and handling tasks, is good and that access to equipment is sufficient to ensure safe execution of the moves intended. In conversation staff also commented on the excellent opportunities to access training and development and information provided via the dataset, a Commission tool for gathering information prior to the fieldwork visit which indicates that staff regularly undertake updated moving and handling training. Whilst this particular aspect of the new care-planning package requires attention (moving and handling), the general documentation is reasonable and should ensure, as the staff become more familiar with the system, that care plans are informative and insightful records that guide the delivery of care. In discussion with care staff and members of the management team it was evident that care planning is well managed and supervised, with keyworkers in association with an assistant manager responsible for the maintenance, review and updating of care plans, the review dates recorded on the care planning file. The inspector also observed the family of a service user attend the home for a care review meeting, which involves the resident (if applicable), their relatives and an assistant manager, who conducts the review. In discussion with a relative it was established that they are actively involved in the care-planning process, attend reviews and sign to confirm that they have discussed and are aware of updates to their relative’s care programme. Relatives also confirmed that they knew who their next of kin’s keyworker was and the role that person performed in supporting their relative’s stay at Edinburgh House. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 13 Relatives also discussed the responsiveness of staff to changes in their next of kin’s health and how through good levels of communication, across the home, they were kept informed of issues affecting their relative’s wellbeing. One relative stating ‘I have no worries with how the home seeks medical attention for dad’, whilst another commented ‘there are good levels of access to medical treatment and families are kept informed’. Information, relating to contacts with health and social care professionals, is held separately from the data maintained on the service user’s care plan, as this speeds up the flow of information and its accessibility during return and/or additional visits. Comments returned to the Commission from health/social care professionals and general practitioners was scant, although one general practitioner did respond testifying: ‘The home communicates clearly and works in partnership with professionals’ ‘Staff demonstrate a clear understanding of the care needs of service users’ ‘That overall they were satisfied with the care provided to service users within the home’. In addition to the new care-planning package the PCC has also brought into operation a new medication policy, which was available for inspection during the fieldwork visit and was accessible to staff. In conversation with staff responsible for the management and administration of service users’ medications it was established that training had recently been provided around medication administration and that both in house and distance learning courses have been used to update practice historically. Information taken from the dataset, returned prior to the inspection, indicates that medication training, for all staff involved in the administration and/or dispensing of medicines, was to have been completed by May 2006, which coincided with the date of this visit and supports the staff members’ testimony that they had recently completed medication training. The practical elements associated to the safekeeping, handling and administration of medicines to residents were explained and demonstrated to the inspector during the fieldwork visit. The structure and organisation witnessed was reassuring, with most elements or aspects of the home’s medication system duplicated to ensure or reduce the likelihood of errors. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 14 All records inspected were accurately and appropriately maintained and those staff observed dispensing medications were noted to be thorough and methodical. Another positive aspect of the service is the approach of staff and the management towards the promotion of respect and dignity with residents and their visitors/relatives. Several people spoken to commented on how approachable and supportive the staff and management were, people making comments such as: ‘We find all the staff from the management downwards very supportive in everyway to my mother and all are very approachable and we have great confidence in everyone’. ‘The environment is always very welcoming and friendly and staff communicate well with families’. ‘Staff are very caring, welcoming and friendly and the manager’s approachable’ Staff were also observed interacting with service users and their families and these interactions appeared appropriate, with staff using appropriate terms of address when talking to the both the residents and/or their relative. Some specific observations, which support the good practice of the staff, in relation to respect and dignity were also noted: ‘A staff member was witnessed cleaning the nails of a client, who due to her frailty and dementia found the experience, at times, confusing and irritating. However, with a huge amount of patience, care, constant reassurance and communication (explaining what was occurring, etc.), the staff member was able to complete the process without causing any distress or upset to the client’. Another example of the respect shown to people came when: ‘a resident from one unit wandered into the lounge of another unit and sat down. Automatically and quiet naturally the staff member, stationed in the lounge, welcomed the resident by name and offered her a choice of a cup of tea or coffee, as she was in the process of making drinks for the other people in the lounge, which the person gladly accepted’. Edinburgh House DS0000044195.V288876.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 12, 13, 14 & 15. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. The home’s activities programme provides both variety and choice, although the poor quality television reception diminishes from the service’s overall performance. Relatives and visitors are actively involved in the home. Independence and choice are promoted within the home. Meals are well presented, individually portioned and menus varied. EVIDENCE: The dataset, returned prior to the fieldwork visit, documents that the home provides service users with access to a variety of in house entertainments: • • • • • Games, puzzles and cards Videos Entertainers Books Magazines DS0000044195.V288876.R02.S.doc Version 5.2 Page 16 Edinburgh House • • • Bingo Musical afternoons Gardening As well as some external opportunities: • • • Church services/visits Shopping Trips to the seafront. During the fieldwork visit the inspector observed people participating in several of the in house activities listed in the dataset: • • • • • Service users involved in completing a puzzle. A service user and staff member were playing dominoes Several service users were sat watching a video of World War 2 news stories. One group were observed preparing to play bingo. Several people were noted to be using the garden for various activities. People were also noted to be involved in activities not listed on the dataset: • • Several different groups of service users were witnessed enjoying playing with a balloon and its affinity to static electricity. A couple of clients were having their nails cleaned. In addition to the activities observed the inspector also noticed a flyer, attached to a notice board, advertising a forthcoming garden party at Edinburgh House, the party intended to commemorate the Queen’s official birthday. The inspector also become aware of a series of photos within the entrance hall of Edinburgh House, which depicted the events at an ‘Ark’ garden party, these purpose-managed events bring people into close contact with a variety of farm and domestic animals, which they can handle and/or stroke as they wish. It was clear from these photos and later in conversation with a relative, that this event had been well received and enjoyed by everyone, service users, their families and staff alike. The relative was also discussing the Halloween party arranged and organised in house and confirmed that she and her family would be attending the forthcoming garden party, as: ‘these events provided an opportunity to socialise with your relative and for a while remember them before they became ill’. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 17 In discussions with staff it was evident that they too felt the service users benefited from stimulation and activity and that daily they attempt to provide entertainment for people, which suited their varying needs, examples of which have been listed above. The staff also seemed to feel that topical events were important, as highlighted by the planned party to celebrate the Queen’s official birthday and the organisation of an evening to watch England’s forthcoming World Cup warm-up match, the manager also discussing this subject and plans to create a party atmosphere within the (previous) dining room/quiet lounge area, which would be open to families and staff as well. The involvement of relatives and visitors, within the home, appears to be an important aspect of the service’s ethos, as relatives are heavily involved in both social activities, garden parties, etc. and official events, relatives’ meetings, care plan reviews, etc. In discussion with relatives the home was described as: ‘A welcoming and friendly environment’, and staff as: ‘Caring, welcoming and friendly’. One relative spoken to in the lounge confirmed that she visits her next of kin several times a week, at roughly the same time, although she stated she would have no concerns varying her visiting times, as all of the staff are lovely. Information contained on the Commission’s database and previous inspection reports provides further confirmation that visiting arrangements and issues of community contacts have never been a concern at Edinburgh House and that generally the service is considered to: ‘take active steps to involve, as far as possible, relatives of service users in the running of the home’. Whilst service users were generally unable to comment on the frequency of their relative’s visits, etc., people were observed interacting with both their own relatives/visitors and the visitors of other residents. It was also apparent from the photographic evidence, mentioned earlier, that families indeed support their relatives at social functions and that this support occurs in relatively large numbers. Mealtimes at Edinburgh House were observed to be very sociable occasions, with each unit (the home being split into four units), providing sufficient dining space to cater for the needs of the people within that area. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 18 Meals are prepared within the home’s kitchen and transported to the units via heated trolleys, where the food is individually served and individually portioned. On the first day of the fieldwork visits the inspector spent time observing and talking to staff during lunchtime, noting how attention is given to those who require assistance, whilst those requiring no attention are just supported through encouragement and communication. The meal (fish and chips) appeared to be well presented and alternatives (to the main meal) were observed to be available to those who either could not or did not require the main meal option. During the second day of the fieldwork visits, the inspector was fortunate to be sat in the lounge when the cook came around to discuss with the care staff a change to the evening menu. When asked about the ensuing change the cook explained that the menu indicated that salad should be provided, but given the change in the weather (it having turned colder and damp) she felt soup and homemade bread rolls would be more beneficial. The cook adding that menus are a guide and not set in stone. The sample menu provided by the manager, as part of the dataset information, highlights that the meals provided to service users are generally varied and nutritionally balanced, as they contain a mix of vegetables, meats, fish, fruit, etc. In conversations with staff it was also established that people can also have additional snacks throughout the day and that each kitchenette is provided with a selection of fruit (observed in each unit), bread for toast or sandwiches, biscuits, cereals and homemade cakes. On several occasions throughout the day the inspector observed clients being either offered or provided with snacks and access to fluids was plentiful, with teas, coffees and squashes constantly being offered to people. In conversation with service users, and through observations, it became apparent that the meals generally met people needs, although one person commented that the meat’s always tough and the vegetables like bullets. It was, however, suggested by staff that this person always comments about the meals no matter what is provided and how it is cooked. Comments from relatives supported the general premise that the meals provided at Edinburgh House are good and tend to meet the needs of the service users. A comment on a questionnaire (returned to the home) indicates that: Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 19 ‘The food seems very good and is cooked on site’. Issues of choice and independence have been addressed throughout this section of the report and it was felt throughout the fieldwork visit and other inspection processes that evidence of people’s abilities to self-determination, etc. have been established. However, where it becomes necessary to limit people’s choices, etc. this is undertaken in consultation and agreement with the service user and key personnel. An example of this would be a client who smokes and has agreed to staff managing her cigarettes (one every hour) to ensure she has sufficient to last and to manage the ever-increasing cost of her addiction. During the fieldwork visit this service user was observed coming to seek out staff, as the hour elapsed, demonstrating that she understood the plan and in conversation seem to be happy with the arrangement, although effective communication was difficult. Records of the management plan were available on the service user’s file and the managers and staff aware of the agreement. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 20 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): St 16 & 18. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. Service users are confident that complaints or concerns are handled appropriately. Appropriate measure is taken to ensure service users are protected from abuse. EVIDENCE: It was noticeable on entering the home that a wide range of documentation is made available, within the hallway, to visitors and that amongst these documents is a copy of the statement of purpose, which contains details of the home’s or PCC’s complaints process. In discussions with both service users and their relatives it was established that they would feel confident in bringing a complaint or concern to the attention of the management and/or staff, as they felt the matter would be appropriately addressed. People consistently described the staff and management as approachable, supportive, etc. and testify to the fact that good levels of communication are maintained at all time: Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 21 ‘‘We find all the staff from the management downwards very supportive in everyway to my mother and all are very approachable and we have great confidence in everyone’. Relatives also stated that they had no complaints or concerns about the service at this time and confirmed their satisfaction by stating: ‘The place is smashing and we have no problems or concerns’. ‘The managers and staff are approachable so we have no worries in bringing issues to their attention’. An in house questionnaire (part of the home’s quality auditing programme) records: ‘my mother has been well cared for at Edinburgh House for the past twelve years, any problems we have had have always been sorted out to out satisfaction’. Information contained within the dataset, provided prior to the fieldwork visit, indicates that within the last twelve months 2 complaints have been received and that both of these have been successfully managed within the 28 day timescale. Service users whilst unable to discuss the finer points of the PCC’s complaints process were able to confirm they were happy within the home, one person stating: ‘I’m happy with things the way they are’. The information provided as part of the dataset evidences that adult protection training is available to the staff, although some records would appear to suggest staff have not updated their skills or awareness since 2004, whilst others indicate that abuse awareness training was accessed within the last twelve months. What is clear is that all new employees are required to complete a full and detailed induction programme, which considers various topics including: moving and handling, health and safety, food hygiene and abuse and that this training is provided to all new employees by the PCC. In discussion with staff, whilst none specifically mentioned the abuse training, it was established that the PCC provides access to numerous educational and skills development courses and that at the core of their roles is the health, safety and wellbeing of the service users. As already mentioned within the body of the report, relatives feel the home is meeting the needs of their next of kins and no concerns regards their safety or wellbeing were identified. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 22 Observations also demonstrate or support the belief that people feel happy and safe within the home, service users and staff interacting well throughout the fieldwork visits. The dataset, also provides a clear statement of the fact that the service has access to an adult protection policy and procedure, although this would appear to have been implemented in 2003 and not revised or updated since that date. Whilst the inspector feels it is important to review the adult protection policy and update it accordingly, the overall indication is that service users’ wellbeing is promoted within Edinburgh House and that they are safeguarded from abuse. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 23 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): St 19 & 26. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The premises is well-maintained, clean, tidy and a pleasant environment for the service users. EVIDENCE: A tour of the premises was undertaken with the management, when in addition to following up on issues outstanding from the last inspection the inspector also checked the premises for continued compliance with the standards. Issues identified during the last inspection included: • The external grab rails need redecorating. Grab rails to the front of the premises have been redecorated, although railings around the balcony were noted as requiring attention. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 24 • Toilet/bathroom floors are in need of replacement The manager provided the inspector with sight of an email (between herself and a representative from the estates department), where she has been negotiating to have the flooring replaced in the bathroom, although to date this has not occurred. • The staircase to the back of the home has wallpaper hanging off the ceiling and the floor is bare concrete. This area needs attention. Access to the stairwell, which is a fire exit, is no longer possible to the service users, as it has been fitted with a code locking device, (which releases should the fire alarm ring), the décor in this area still needs attention, however, as it no longer accessible to residents this is less of a priority. • One dining table is in need of replacement /adjustment as it wobbled considerably when leant on and could potentially cause spills/hazards. This issue has been resolved and all communal areas are well maintained and furnished. • An area in the garden was assessed by health and safety and requires work to make it safe. On touring the grounds it was evident that the problem encountered at the last inspection has been addressed by the planting of shrubbery. • The home’s cooker needs to be replaced. It is understood, through conversation with the manager, that all issues, except the bathroom flooring, have been addressed. The actual tour of the premises was useful to the inspector, who had not visited the home before, as it enable him to orientate himself to the environment and its layout. During the tour a few minor issues were brought to the manager’s attention, which prior to the end of the first day in the home were already being addressed. Emergency call bells, within bathrooms and toilets, were being untied and extended to the floor. However, issues, which could not be immediately addressed by the manager, as they will require input from the PCC, are the need to review and upgrade Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 25 the home’s current television system (aerials), as the picture quality is generally poor throughout the home. A plan and/or schedule is required for the repair, replacement, redecoration and cleaning out of the guttering, down-pipes, fascias, etc. and the redecoration of the railings along the balcony and down the steps to the garden. Conversations with visitors established that the environment is generally seen to be good with one visitor stating that: ‘the environment is good for mother’, whilst another person described how the environment was: ‘welcoming and friendly’. During the fieldwork visit the inspector observed service users walking around the home and noted how people made use of the facilities, garden, balcony area, different lounges, etc. The inspector also spoke with or spent time with a number of service users across the two days of the fieldwork visit and established that people were happy with the home, one person commenting that they were ‘happy with things the way they are!!’ although a comment provided via the home’s internal questionnaire documented ‘I would like to be able to go shopping more’. When asked about this specific comment the manager advised that she does use feedback from service users to measure and monitor the standard of the service provided and that recently they had introduced one-to-one outings with clients. The manager also discussed how she intended to increase these outings, through the recruitment and deployment of additional care staff, this process having commenced, as evidenced during the review of the service recruitment and selection process. The dataset provides evidence of the fact that 5 cleaners are employed by the home and that a total of 129 hours are available to the manager for domestic duties, although some of the staff perform dual roles i.e. domestic/kitchen, which would reduce the available hours slightly. Evidence from the tour of the premises revealed that the home is clean and tidy and that no malodorous aromas existed around the premises. It was also evident that all bathrooms and communally used facilities are supplied with paper towels and liquid soaps, to reduce cross contamination issues. In addition to ensuring the environment of the home remains clean and free from sources of potential infection and/or cross contamination, the staff were Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 26 noted to be assisting the service users maintain their personal hygiene standards, one carer as reported earlier helping clients with nail care, etc. The training records, provided as part of the dataset information, also contain evidence of the home’s and PCC’s approach to managing infection control, as staff have recently (March 2006) completed infection control training. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 27 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): St 27, 28, 29 & 30. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. Staff are deployed in sufficient numbers to meet the needs of the current service user group. Staff have access to good levels of educational, vocational and skills development courses. The home’s recruitment and selection strategy is being followed appropriately and therefore ensures that the safety and wellbeing of the service users is promoted. EVIDENCE: Comments received from service users and their relatives confirmed that staff are: ‘very caring, welcoming and friendly and the manager approachable’ ‘We find all the staff from the management downwards very supportive in everyway to my mother and all are very approachable and we have great confidence in everyone’. People also confirmed that they knew who their relative’s keyworker was: ‘the family know dad’s keyworker’ and gave the impression that this service was well received and useful. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 28 Service users spoken with and/or met during the inspection were equally positive about the care staff and several people commented on liking it at the home, one person recording via questionnaire that: ‘I’m happy with things the way they are’, whilst people’s relatives expressed opinions that: ‘mother appears content’ and ‘generally dad seems settled and grateful he’s here’. Interactions, observed throughout the inspection, between staff and service users were warm, positive and supportive. Care staff stated they work together as a team and help each other out, although for management purposes each unit has its own permanent staff group, who regularly work with the clients in that unit, promoting consistency and continuity of care. The staff and assistant managers also discussed how the teams, working within each unit, are supervised or are attached to an assistant manager, who directs team meetings, etc. The dataset, provided prior to the fieldwork visit, unfortunately did not contain copies of the duty roster, although copies were noted to be accessible to the staff within the manager’s office and demonstrated that staff are deployed across the home in sufficient numbers. In addition to care staff an assistant manager is available within the home, across a twenty-four hour period, their general responsibilities being to liaise with relatives, professionals, direct care, supervise staff, etc. The manager stated she has some flexibility over staffing budgets and is able to increase shift numbers, as required, the manager explaining how presently she is involved in recruiting a new member of care staff, to help promote activities and outings for service users. Information supplied prior to the inspection indicates that the home employs twenty-five care staff of whom thirteen have at least level 2 National Vocational Qualifications (NVQ). This equates to approximately 52 , which exceeds the 50 ratio recommended within the National Minimal Standards for Older Persons. One member of care staff interviewed stated that he had completed NVQ level 3 and was now considering undertaking level 4, this member of staff being an assistant manager. Whilst care staff did not specifically discuss NVQ courses, they did confirm that access to training was very good and that the PCC actively promoted access to courses. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 29 In discussion with the manager and her assistant managers it was established that supervision and appraisal sessions are used to identify staff training needs and to plan access to forthcoming training events. The manager also discussed the PCC’s requirement for staff to complete annual updates on those courses they consider mandatory, evidence of staff having attended these courses was provided as part of the dataset information received prior to the inspection. The files of three care staff employed since the previous inspection were reviewed during the fieldwork visit. These files were noted to contain a completed application form, work history, interview notes, health declaration, two written references, photo, contract and copies of certificates from previous employment, etc. The files also contained evidence of Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, disclosure numbers maintained on the staff’s files. The manager described the induction process for new staff, which includes a five day corporate induction off-site, covering all mandatory induction training; certificates were seen in the new staff files. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 30 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): St 31, 33, 35, 36 & 38. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. The manager possesses a relevant care qualification but not a relevant managerial qualification. The home’s quality assurance systems ensure the home is run in the best interests of the residents. The arrangements for handling service users’ monies are adequate and designed to ensure people’s financial interests are safeguarded. The staff do not receive adequate supervision, although their practice is supervised. The health, safety and welfare of service users and staff is not appropriately managed and promoted. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 31 EVIDENCE: Information contained within the last inspection report reflects that the manager holds both a National Vocational Qualification (NVQ) level 4 in care and the Registered Manager’s award (RMA). Evidence gleaned from the dataset and other documentation, provided prior to the fieldwork visit, provides further evidence of the manager’s qualifications and indicates that she regularly accesses additional courses to maintain her skills and knowledge basis. In addition to the registered manager the home also employs four assistant managers, which based on evidence from other PCC inspections, would appear to be the norm for staffing arrangements at PCC establishments, the staffing rosters indicating that at least two assistant managers are on duty each day, in addition to the Registered Manager. Service users and relatives are afforded the opportunity to discuss concerns with regards to the day-to-day operation of the service at various meetings and via the home’s questionnaires, which are periodically circulated to gather additional feedback from the clientele and/or their relatives. Comments contained within some of the questionnaires included: ‘We find all the staff from the management downwards very supportive in everyway to my mother and all are very approachable and we have great confidence in everyone’. ‘I’m happy with things the way they are’. ‘Food seems very good and is cooked on site’ ‘I would like to be able to go out shopping’ ‘My mother has been well cared for at Edinburgh House for the past twelve years any problems we have had have always been sorted out to our satisfaction’. Other files and/or records checked prior to the fieldwork visit indicated or suggested that since the last inspection visit the PCC had not undertaken visits to the home in accordance with Regulation 26 and/or had not produced reports Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 32 following these visits, however, visits are occurring and copies of the reports undertaken available on site, although these are not routinely being forwarded to the Commission. Another important element of any quality auditing system is the work undertaken with the staff, which from a training and development perspective is good, as evidenced earlier in the report. The assistant manager is also undertaking periodic work based supervision, formal supervision, and appraisals and organise and chair small unit team meetings, records for all of the above process are maintained. Staff also confirmed, during conversations, that team meetings, appraisals and supervisions are regular occurrences and that generally they found or considered these events as useful and productive. The manager retains responsibility for larger team meetings, which generally occur if corporate issues require discussing, etc., these meetings are also minuted. A serious concern for the Commission recently has been how the PCC supports service users to manage their monies, as the PCC was banking all (residents’) incoming monies within its own accounts. This issue has now been addressed, as the PCC has opened ‘client national accounts’, which are individual accounts operated on behalf of the service users and pays interest. During the fieldwork visit the inspector was able to discuss the new accounts and establish that they are operating effectively. However, an issue that caused concern for the inspector, whilst visiting another PCC service and which remains unanswered is: ‘what happens to the monies of clients, whom the PCC are appointees for, when their money is paid to a PCC finance house’, as administrators were having to draw down service users’ monies before paying it into the ‘client national accounts’. No immediate health and safety concerns were identified, with regards to the fabric of the premises and full health and safety policies, etc. are made available to staff by the PCC. However, as highlighted earlier within the report the new care planning process is lacking a moving and handling assessment, which should be addressed, as soon as possible. This issue is directly linked to health and safety, as the 2002 manual handling regulations are produced by the health and safety executive (HSE) and are one Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 33 of a number of regulator instruments devised by the HSE that directly impact on this area. However, other elements associated with health and safety would appear to be being handled much more effectively with actions taken to address the previous inspector’s concerns, as evidenced via the actions taken over the stairwell. The availability of the maintenance person is a benefit to the home, as this ensures that the general fabric of the environment is kept up together and does not pose an immediate risk to people, although this position is voluntary and all major projects, etc. are managed by the PCC’s estates department. Copies of emails from the estates department, to the manager, evidence that concerns or issues affecting the fabric of the building are identified and scheduled for attention, although this is on a priority basis, determined by the PCC. Access to paper towels and liquid soaps in bathrooms/toilets in parts of the home are indicators of attention to infection control, as is the availability of a specific infection control policy, which the management has stated they possess via the pre-inspection returns, although it would appear not to have been updated since 2002. The staff training programme, details of which were also provided preinspection, contains educational information relating to fire safety, infection control, moving and handling and general health and safety considerations. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 34 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 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 X 18 3 2 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 3 X 3 X 3 3 X 3 Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 35 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 OP8 Regulation Requirement Timescale for action 21/07/06 2. OP19 Regulation The PCC must introduce an 13 appropriate and effective Moving and Handling Risk Assessment for use within its services. Regulation The bathroom flooring 23. requires replacing – this issue is outstanding from the last inspection. Attention must be given to improving the quality and/or reception of the television signal. A plan or schedule is required for the redecoration, replacement or repair of the guttering and fascias, etc. 21/07/06 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 OP37 Good Practice Recommendations Evidence on the dataset indicates that the PCC’s policies DS0000044195.V288876.R02.S.doc Version 5.2 Page 36 Edinburgh House and procedures should be reviewed and updated. Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Edinburgh House DS0000044195.V288876.R02.S.doc Version 5.2 Page 38 - 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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