Inspection on 19/11/08 for Edmore House

This inspection was carried out on 19th November 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.

Other inspections for this house

Edmore House 11/10/07

Edmore House 12/09/06

Edmore House 31/01/06

Edmore House 06/09/05

Edmore House 01/12/04

Edmore House 11/06/04

Similar services:

Maple Lodge

Heathlands

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Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Edmore House 20 Oakham Road Oakham Dudley West Midlands DY2 7TB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sally Seel     Date: 2 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Edmore House 20 Oakham Road Oakham Dudley West Midlands DY2 7TB 01384255149 01384255149 annnewton@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Charanjit Singh Atwal care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 18 Date of last inspection Brief description of the care home Edmore House is a privately owned care home and is registered to provide accommodation for 18 elderly persons. It is a converted property consisting of three floors. The first and lower ground floors can be accessed via the lift or stairs. All bedrooms are tastefully decorated and service users are encouraged to bring small items of furniture with them if they wish. There are three lounges on the ground floor and a dining area. At the rear of the property is a patio with garden furniture, potted plants and a large garden. Car parking is available at the front of the house and visitors may visit at any time. Care staff are available 24 hours a day to meet the needs of the service users and ancillary staff are employed during the day. A statement of purpose and service user guide is available to inform residents of their Care Homes for Older People Page 4 of 34 Over 65 18 0 Brief description of the care home entitlements. Information regarding fee levels has not been provided to the Commission for Social Care Inspection. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and on aspects of service provisions that need further development. One inspector undertook this fieldwork visit to the home over a two day period. The registered manager, proprietor and staff members assisted us throughout. The home did not know that we were visiting on that day. There were seventeen people living at the home on the day of the visit. Information was gathered from speaking to and observing people who lived at the Care Homes for Older People Page 6 of 34 home. Three people were case tracked and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety records were also reviewed. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us a wealth of information with good examples about the home, staff and people who live there. Improvements and plans for further improvements have been taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. Two completed surveys from people living in the home together with one from a representative of a person living Edmore House and four completed staff surveys were returned to Commission for Social Care Inspection, (CSCI). We also interviewed some staff members on the day of our inspection to obtain the view of staff in relation to the care provided for people who live in the home. Information from all of these sources was used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking three individual peoples care provided at the home. For example, the people chosen consisted of both male and female and have differing levels of care needs. The atmosphere within Edmore House is inviting and warm and we would like to thank everyone for his or her assistance and co operation throughout the day we visited. What the care home does well: What has improved since the last inspection? What they could do better: The homes statement of purpose needs to include the level of fees charged by the home so that people considering living at the home have knowledge around financial implications if they choose to live at Edmore House. All care plans should be drawn up with consultation and involvement from individuals Care Homes for Older People Page 8 of 34 and or their representatives so that people are choosing how they would like their care needs to be met. Evidence that this is happening needs to be produced within care plans. The registered proprietor needs to pursue the homes pharmacy provider to obtain an appropriate approved medication trolley that is secured to the wall when not in use so that medication administration is accurately achieved and the time taken to carry out this task are less labour intensive. All individuals weight needs to be documented. If for some reason the home are unable to undertake this task, or permission is refused, then discussions with the persons doctor and district nursing team need to take place. This will ensure that any weight changes can be seen and any underlying medical conditions do not go undetected. The planning of activities needs to include weekends so that people are offered appropriate stimulation at these times. To ensure that all good hygiene and infection control measures are reviewed in relation to the appropriate areas for staff to wash their hands so that peoples health and wellbeing is safeguarded. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given sufficient information to enable choices to be made as to whether Edmore House is the right home for them. Individuals health and care needs are assessed, and the home acknowledges in writing that these can be met. Evidence: The home have produced a statement of purpose and service user guide which provide people with information about the home, such as accommodation type, staff qualifications, how peoples needs will be met, activities and how to make a complaint. In the homes completed AQAA, (Annual Quality Assurance Assessment), it is stated, Service user guide has full information about the home also in large print. The home is now looking at producing their statement of purpose and service user guide in audio format. This will ensure that these information guides will be accessible to people with visual impairments so that individuals will know what the home can offer if they choose to live at Edmore House. At the homes last inspection it was recommended Care Homes for Older People Page 11 of 34 Evidence: that the fees charged by Edmore House are documented within the service user guide and this is still outstanding. We sampled three care records and found that peoples needs are looked at to make sure that the home are able to meet these before individuals move into the home. We were told by one person who lives in the home that they could have chosen to share a room with a relative. This person did not want a shared room, but stated we like to sit together and we observed that this persons chair was placed next to their relative. This shows that the home listens to individuals choices and preferences and that these are preserved. The home are now recording when people come to look around the home and or whether this offer is declined. In the homes completed AQAA it states that in the last twelve months they have looked at ways of making visits more personal by having one member of staff look after the person for the whole visit. This demonstrates that the home are looking at ways of improving their practices so that people receive a welcoming reassurance when visiting the home for the first time. The homes registration certificate and public liability insurance are displayed in the area next to the front door as you walk into Edmore House for people to view if they wish. People told us: I left another home to come here and I like it. Care is good and I am allowed to do things for myself as I am very independent. Lovely, I like it here. In the completed surveys we received from staff we were told: Edmore House feels like a home it makes everybody who comes through the front door feel welcome at all times. I feel as if we give it our all, to make them feel as happy and comfortable as possible. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some efforts are made to involve individuals in decisions about their lives. The introduction of person centred plans will offer further opportunities for individuals to play an active role in planning the care and support they receive. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: We looked at three peoples care plans and risk assessments in some detail. Each person has a comprehensive care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to maintain their needs. For example, in one care record it stated, likes to dress and wash herself but staff need to supervise. Does not like to change clothes and staff need to assist with this and in another care plan we found, Chooses own clothes, wears tshirts and cardigan but will decide for himself when his clothes need changing and washing. People can choose whether they would like a female or a male member of staff to assist them with their personal care tasks. This shows that Care Homes for Older People Page 13 of 34 Evidence: peoples independence, dignity and preferences are recognised and promoted. People have key workers who get to know the person, their likes and dislikes, and individuals are able to share their concerns or worries with a familiar person. The care records that we looked at reflected individuals health conditions, physical abilities, preferences and dislikes. Care records also highlighted when peoples health and care needs had been reviewed with any appropriate actions that needed to take place. For example, in one care record after a review was held, it stated, Needs more activities and stimulation but it is recognised that it is difficult to get X interested in anything. We found in all of the care records that we sampled visits had been made to the home by doctors, district nurses and chiropodists to attend to individuals health and care needs. For example, there was evidence that district nurses would look at individuals incontinence difficulties to ensure that people are provided with the right pads and no distress or embarrassment is caused through bladder problems. One of the complaints we received was in relation to the home not having adequate supplies of incontinence pads for people. We spoke with staff and in the main it was confirmed that supplies of incontinence pads were adequate, two members of staff could recall when earlier this year the homes stock of incontinence pads did run low but this was due to a delivery error. Chiropodists visit every three months and people can choose their own chiropodist. People that we spoke with told us that they had seen their chiropodist and this was recorded so that individuals can feel reassured that their foot care will take place in a timely manner. People spoke about the care that they received They (staff) called for an ambulance when I needed one, they were very good. No problems with male carers. I am having a bath this morning. Great, very good X, (manager) and X, (proprietor and deputy manager). We observed people walking around the home freely some individuals required walking frames to assist them, others needed a wheelchair and some people required supervision when walking. The home does have a hoist which is a piece of equipment that assists staff in moving people who cannot stand and walk safely. However, we were told by staff that the hoist is only used in cases of emergency and there is nobody living in the home at this time that requires a hoist on a daily basis. Whatever a persons abilities the staff were observed assisting individuals in a respectful manner ensuring that peoples dignity was maintained at all times throughout the day. We were told in one staff survey that, The staff at Edmore always put the needs of the clients first and in a survey received from a person living in the home it confirmed this, When I feel unwell or have one of my funny turns the doctor is sent for straight away. Care Homes for Older People Page 14 of 34 Evidence: The care records that we sampled showed that people are weighed on a monthly basis and sometimes this is done more frequently and recorded. However, sometimes individuals will decline to be weighed or their physical abilities decrease making individuals unsteady in standing. In these instances the home record, refused and or visual weight check. We discussed this with the homes proprietor and deputy manager and requested that district nurses and doctors are made aware so that alternative methods of weighing people can be decided by external professionals. This will ensure that peoples weights can be monitored and any weight loss recognised in a timely manner as this could signify that a individual may be experiencing an underlying medical condition that requires treatment and or further investigations. We looked at a sample of peoples daily recordings and found in one individuals records it stated, X has been interfering this afternoon over Xs welfare. Sitting in Xs room at the time of report. As we explained to the registered manager and proprietor and deputy manager staff should receive guidance to ensure what they record is not an opinion but is a description of events. The home has a medication policy and this is accessible for staff guidance. Staff involved in medication administration have received accredited training from Wolverhampton and Dudley College. Staff demonstrated a good awareness of the use and effects of medications in the home. We observed medication being given to one person and the member of staff took tablets from the tot (small container) and handed the tablets to the person. Medication should be given to people in a hygienic manner, avoiding as little skin contact as possible, to prevent any risk of cross infection. Senior carers administer all medications and the home has introduced red tabards, which read, Do Not Disturb Administering Medication. This demonstrates good practice ensuring that medication is administered to people in a safe way minimising the risk of errors occurring whilst undertaking this activity. We sampled the medication of three people who we case tracked and found that all medication was recorded appropriately on the medication administration records, (MARS), and it tallied with the stock that the home held. At the homes last inspection a requirement was made to seek advice from the homes pharmacy provider about the provision of an approved medication trolley, which must be secured to the wall when not in use. The proprietor told us that they have discussed a medication trolley with the pharmacy and can have a trolley supplied by the pharmacy. In view of this the proprietor confirmed that they will look into obtaining a medication trolley. At the present time staff have to get individuals medication out of the locked cupboards in its Care Homes for Older People Page 15 of 34 Evidence: secure location and take it to the individual wherever they may be in the home. Staff have to repeat this practice for each persons medication. Staff told us that it would be good if a medication trolley was provided as this could be taken around the home with medication given to people in a timely manner and the trolley would be appropriately secured to a wall when not in use as is required. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally social, cultural and recreational activities meet individuals expectations but activity planning at weekends now requires some promotion. Meals provided by the home are nutritional and wholesome and reflect individuals choices. Evidence: On the day of our visit we observed people watching television, crocheting a blanket, reading newspapers, receiving visitors and chatting between each other. We were told by people that the music man would be visiting the home. Some people said that they enjoyed the music and other people chose to sit in another lounge area or go to their room. It was evident from our observations and from speaking with people that they are able to make choices on how they wish to spend their day. People also said that they liked their own chairs and where they sit in the different lounges as it is recognisably individuals own space. People told us: X is a good entertainer. I suppose that is why they employ them. Likes a drop of sherry and why not you have to have something. We go to Walsall lights and Merry Hill shopping. I like the crafts lady and sport. Care Homes for Older People Page 17 of 34 Evidence: We looked at the activities that are organised for people living in the home and found that these range from, quizzes, music man, exercise class, bingo, dominoes, crafts, reminiscing and so on. The home does not employ a dedicated activities organiser but staff are encouraged to consider their own ideas in relation to activities that they feel people would enjoy. For good practice the home does keep a record when each person participates in an activity and if the individual does not want to take part for any reason this is also documented. We were told that at weekends there are no organised activities and we found that on Saturdays and Sundays there are no recorded activities. It is recommended that the home considers planned activities for weekends and these are recorded for evidence purposes as not all people living in the home have visitors. We observed the lunchtime meal and the atmosphere was calm and unhurried with people interacting with each other as they enjoyed their meals. One person required assistance to eat their meal and this was done with respect and dignity. For example, the staff member sat sideways to the person and remained patient throughout ensuring that the individual was able to enjoy their meal at their own pace. Staff waited for people to finish their main meals before bringing out desserts. People were observed to leave the dining room when they chose and if people wanted extra servings they could. People could also choose where they had their meals, for example, meals could be taken to individuals rooms if they wished. A sample of the menus illustrated: Cereals or porridge and toast with jam or marmalade for breakfast. Lunchtime meals are variable with choices such as cheese pie with potato fritters and three different vegetables, gammon and parsley sauce and three vegetables, pork, potatoes and three vegetables. Desserts offered are fruit pie and custard, sponge and custard and gateaux. Teatime choices that ranged from assorted sandwiches, hot dogs and crisps followed by artic roll, toast with cheese, salad and assorted sandwiches followed by cheese cake. One complaint stated that people living in the home received a poor standard and portions of meals. We observed the lunchtime meal, sampled menus, spoke with people who live in the home and staff. Through these processes we found no evidence that would support the complaint made on the days we visited the home. People told us that they did have a choice of meals and staff said, Always a choice and can have more. Lack of brand name foods. Good standard and good sized portions. Meals very good. Fresh vegetables and choices. Not much meat on plate but always plenty of vegetables and pudding. People were offered drinks and biscuits throughout the day. We also observed staff Care Homes for Older People Page 18 of 34 Evidence: asking people what they would like for lunch. The home also has a suggestion box and one request was for sausage and mash to be included on the menu. This meal choice is now listed on the homes menu which confirms that people are listened to in relation to meal choices. People told us: Chicken yesterday, it was nice. Always enjoy what is put in front of me. Its lovely, parsley sauce. The home is very clean and the food is always good. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Edmore House are supported to express their concerns and have access to a robust, effective complaints procedure. Safeguarding procedures are followed so that people are not placed risk. Evidence: The complaints procedure is in the homes statement of purpose, service user guide and is displayed in the reception area of the home as you walk through the front door. People living in the home requested that a suggestion box be made available and this is now placed in the entrance hallway of the home. The home has received six letters of complaint in this box. The Commission for Social Care and Inspection, (CSCI), have received three copies of the same letter of complaint since the homes last inspection. CSCI are currently investigating the complaints raised and the home has already showed their commitment in relation to completing any outstanding action that is required. In the main people told us that they are happy and if they need to complain they would speak with the registered manager or the proprietor and deputy manager. Some people living in the home lack capacity to make decisions in areas of their lives but the staff told us that advocates could be sought. The home does have leaflets that are displayed in its reception area in relation to Independent Mental Capacity Advocates, (IMCAs), which supports best practice. Staff spoken to had good knowledge of how to recognise all forms of abuse together Care Homes for Older People Page 20 of 34 Evidence: with where they need to report these incidents. The training matrix that we sampled confirms that staff have received training in recognising abuse. The home also has a copy of multi agency protocols and staff are asked to sign when they have made themselves aware of these protocols. Staff files sampled reflected a careful and robust recruitment procedure so that people can be confident that they are in safe hands. The home has shown that it is striving to improve its practices to ensure that people get the best possible care in the way they prefer. The proprietor and deputy manager told us that staff are given monthly questionnaires to complete. In the AQAA it states All questionnaires have been received and are very positive and satisfaction is very good. Staff spoken with seem to agree with this. Resident meetings are held every three months and the minutes from these are recorded, surveys are sent out annually to people who live in the home, their representatives and health professionals. The completed AQAA states At one meeting service users asked if stew could be on the menu every week this was actioned straightaway. The menus that we sampled confirmed this. The registered manager has commented in their completed AQAA that their next goal for improvements in the next twelve months is to Arrange monthly time for families and representatives to see care manager about any issues, looking at first Wednesday in every month. This shows that the home want to listen to the people that live there so that individuals are able to influence any improvements that are made within Edmore House. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: We completed a tour of the home with the proprietor and deputy manager and looked at a sample of bedrooms which were personalised to reflect individuals choices and personality. For example, with personal photographs, ornaments and pictures. We spent time in one lounge area which was clean and homely. We asked people about the arrangement of the lounge area and whether it suited individuals. People told us that each person had their own chair and liked this because they were able to keep the space around it the way they chose. Individuals did not want to move around into different chairs. People were observed to have appropriate walking aids if they required these and the home have a hoist which can be used in an emergency situation to safely move a person. At the present time staff told us that nobody living in the home requires a hoist. We looked at the conservatory which is not linked to the home but is a stand alone building within the homes garden area. One of the complaints that we received was in Care Homes for Older People Page 22 of 34 Evidence: relation to people having to go through individuals bedrooms to access the conservatory due to steps from other access points. We were told that the families of these two people had been informed of this arrangement and were happy for this to continue. Social workers are to review both peoples care and this arrangement will also be looked at to ensure that individuals rights and choices were upheld. The conservatory is large with views around the garden and blinds to the windows. Some of the people who live in the home told us that they did not want to go into the conservatory as they were happy to sit in the lounge areas or their bedrooms as they choose. One person said that in the summer they had been in the conservatory and it was very nice. The proprietor is looking at other ways the conservatory can be used, such as, a meeting room for families and or other professionals visiting the home. The laundry area in the home is located in the cellar which has a water leak. This situation has been ongoing for many years, and has previously been assessed by professionals. On the first day of our visit an engineer came to reassess this situation. The engineer confirmed that the leak is from a natural underground spring and stated that it is not a health and safety risk but would consider whether there is anything that can be done to improve the situation. We spoke with staff members who need to access this area of the home and they all confirmed that it was not a difficulty to them and or a health and safety hazard. Some people who live in the home told us that they do not want to hold a key for their bedroom doors but there were two people who would like to. We passed this information on to the proprietor and deputy manager to look at with the individuals concerned. This will ensure that peoples choices and independence are maintained appropriately. Generally the homes decor looked clean and tidy with no offensive odours. The home has a lift for people to access their bedrooms on the first floor. The proprietor and deputy manager are continually looking at ways to improve the home. The completed AQAA confirms what improvements have already been made to the home, Dining room has been decorated and new carpet laid down we have also painted hallways and lounges in bright pastel shades. We were informed that if staff tell the provider or manager straight away if something is broken, he always endeavours to get it fixed immediately. An example was given of a broken toilet window which had been repaired. Staff spoken with confirmed that the proprietor and deputy manager are proactive and as soon as a repair is noted he ensures that it is fixed in a timely manner so that people are not placed at risk by the environment that they live in. Care Homes for Older People Page 23 of 34 Evidence: Staff told us that infection control methods employed by the home are good and could identify the equipment used within their everyday working lives such as gloves, aprons, liquid soap, and paper towels, disinfectant and so on. The garden area of the home is tidy and mainly laid to lawn with borders of shrubs and a patio area next to the home. The proprietor is looking at ways of further improving the garden area by planting up tubs to place on the patio area for peoples enjoyment. The registered manager confirms in the completed AQAA that the home have also painted the homes front exterior and removed tall trees at the top of the drive area replacing them with small trees. This shows that the registered manager and proprietor and deputy manager are continually improving the exterior and interior of the home to enhance the lives of the people who live there. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are committed to their roles and have the knowledge and skills so that individuals can be confident that their needs will be met appropriately. Evidence: There are currently seventeen people living in the home with one person currently being in hospital at the time of our visit. Staff spoken to had good insight into the diverse needs of the people living in the home. For example, staff could tell us the dependency levels of individuals together with what aids people needed and which individuals required some assistance due to their confusion in respect of achieving daily living activities. Staff were seen to interact well with people living at the home and the atmosphere was calm, friendly and relaxed. Staff told us: More staff in the afternoons would be good. Generally people like us to sit and chat with them and seem to enjoy this more than specific activities. When people are confused we talk to them and provide reassurance. Assessment of staffing rotas, speaking with staff and people living in the home, we found that satisfactory staffing levels are maintained with, three staff on the early shifts, two completing the afternoon shifts and two staff working through the night. Staff told us that the proprietor and deputy manager completes shifts if staff members Care Homes for Older People Page 25 of 34 Evidence: are off work due to illness and therefore agency workers are not required. We sampled staffing rotas and they confirm that the proprietor and deputy manager has covered shifts and also the registered manager. This means that people living in the home have consistency in relation to their needs being met together with their preferences by staff members that know them. In the main staff that we have spoken with have said that there are sufficient staff to meet peoples needs, but some have confirmed that it would be helpful having three staff members on duty during the afternoon shift. We did not find any evidence that people living in the home were waiting long periods of time for staff to assist them, and there have been no complaints from residents about staffing levels. The registered manager and proprietor and deputy manager are able to offer some assistance if required during the day. The home needs to keep documentary evidence showing how they evaluate their staffing ratios together with how they assess peoples dependency levels. Within this process the home should account for the time spent by staff cleaning and tidying the home when the cleaning staff are not on duty for three days each week. In addition to care staff the home employs kitchen and domestic staff to ensure that all aspects of peoples needs are met whilst living in the home. The home demonstrates a strong commitment to staff training and development. Staff spoken with also confirmed that the registered manager and proprietor and deputy manager enable staff to complete training courses. Staff particularly enjoyed the dementia awareness training. There are thirteen staff that hold the National Vocational Qualification, NVQ, level 2 which is above the recommended levels of 50 per cent. Some staff are doing their NVQ Level 3. We reviewed peoples training records which indicated that staff have received mandatory training together with more specialist training. For example, food hygiene, health and safety, emergency first aid, infection control, moving and handling, medication training, fire safety, knowledge of dementia and adult protection. Some staff have completed training for end of life care arranged by Dudley Primary Care Trust, PCT. This should ensure that a knowledgeable and skilled workforce can meet peoples needs individually and collectively. Four staff records were reviewed and were found to contain all of the relevant information including two written references, POVA first checks, Protection of Vulnerable Adults, CRB checks, Criminal Records Bureau. Records were well organised and information easy to retrieve. Staff have been provided with job descriptions and there was evidence that people receive a comprehensive induction into the home so that they are aware of their responsibilities and therefore able to discharge their duties appropriately. Due to the complaints that have been received staff told us that staff morale is low at present as there are feelings of uncertainty in relation to which staff have written the Care Homes for Older People Page 26 of 34 Evidence: complaints. In the main staff feel that they cannot wholly trust their colleagues but all the staff spoken to enjoy their work and feel that people receive a good level of care and live in a homely environment. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can feel confident that the home is well run to ensure the best outcomes for people who live there. Quality assurance continues to be improved Evidence: Ann Newton is the registered manager who has worked at Edmore House for a number of years and has experience in a managerial and practical capacity of caring for older people. Mrs Newton has achieved the National Vocational Qualification, (NVQ), Level 4 Care and Management Award and the Registered Managers Award, (RMA). The registered proprietor, Mr C Atwal, works at the home in the role of deputy manager and has also achieved the NVQ Level 4 Care and Management Award and the Registered Managers Award, (RMA). This management structure seems to be working well and we found evidence that is documented throughout this report which confirms this. There are areas that require some improvement and both the registered manager and proprietor and deputy manager have shown commitment to achieving these so that people living in the home can be confident of a home that is run in their best Care Homes for Older People Page 28 of 34 Evidence: interests. The registered manager and the proprietor and deputy manager were seen to have an open door policy with staff asking questions, seeking advice or sharing information about people who live at the home. Also the registered manager and proprietor and deputy manager were seen to greet people as they walked by and it was clear to see that both people have a good rapport with individuals on all levels. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment, (AQAA), and returned it to us. This gave us comprehensive information about the home, staff and people who live there, improvements and plans for further improvements. Throughout this report the reader will find examples of what the registered manager told us. We found that in the main staff praised the registered manager for her support to them and the people living in the home. Some staff stated that conversations the managers had with individual members of staff did not always take place in the privacy of the office. To maintain confidentiality and to ensure good role models are provided to staff, all discussions undertaken with staff members should take place within the privacy of the homes office. In the main we found through looking at paperwork, observations, talking with people who live in the home and staff that the ethos of the home is open and transparent with the views of both staff and people listened to, and valued. The home also has a suggestion box which staff have used and people who live in the home. Staff spoken to feel that the management team are approachable, supportive and individuals are able to air their views in an open manner. Staff told us: Very good, no problem with management, one of the best places I have worked. Proprietor joins in with everything and completes shifts. As far as I am concerned and know this home is run well, it is a caring home, proprietor, manager and co-workers, work united to care and put residents needs first and foremost. Staff meetings are held regularly so that people have the opportunity to voice their concerns and suggestions for improvements. The Responsible Individual visits the home and complete Regulation 26 visit reports on behalf of the registered provider, and reports on the quality of service being offered at the home. The manager and the organisation have a number of audits in place to monitor the service provided. For example, questionnaires are sent out, the manager does monthly medication checks and unannounced visits at night to make sure the staff are following good practices so that people are protected from risks and good outcomes are sought. The arrangements for the safekeeping and financial transactions of peoples personal Care Homes for Older People Page 29 of 34 Evidence: monies are good, this prevents financial abuse. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Maintenance checks are completed on the fire system and equipment so that people should be safe in the event of a fire occurring. Infection control measures in the home are generally good. However, staff did mention that some members of staff do on occasions wash their hands in the kitchen sink, sometimes after staff have used the toilet, and wipe them on tea towels. This practice needs to stop so that all precautions are followed in relation to maintaining good infection control throughout the home. Some staff have also commented that the gloves that are provided by the home are not really sufficient in protecting their hands for some of the duties that are needed to be performed, such as changing an individual who may have been incontinent. The home should look into their choice of disposable gloves to ensure that they adequately protect staff members hands and infection control measures are maintained for all of the tasks that are completed by staff within their daily work. Accident records were reviewed and the manager completes an audit every month in order to monitor trends that are occurring. CSCI have received Regulation 37 notifications which tell us about any incidents that happen within the home, as is required. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Clear information should be included in the homes statement of purpose indicating the level of fees charged so that people who are considering living at the home are able to ascertain the financial implications of choosing Edmore House. The home should ensure that all people living in the home and/or their representatives are consulted and involved in relation to care planning processes so that people are able to make choices in relation to how their needs are met. Where residents are not weighed due to declining this and or other reasons, the home should consult the individuals doctor and district nursing team to find other ways to eliminate the risk of any underlying medical conditions not being picked up. The registered persons must ensure that when staff are administering medication good hygiene control procedures are adhered to ensuring any risk of infections are minimised. The home should consider requesting an approved medication trolley from their pharmacy provider and this should be secured to the wall, when not in use. Staff should receive guidance with regard to the completion of daily records so that they promote individuals rights to Page 32 of 34 2 7 3 8 4 9 5 9 6 10 Care Homes for Older People respect. 7 12 Consultation with residents should take place concerning the planning of activities at weekends. Any activities should be recorded in the same way as the activities that take place on a weekday. This will demonstrate that people are appropriately stimulated at weekends. When the home have received further advice from their engineer in relation to the leak in the laundry room area this information is sent to CSCI. The individuals bedrooms that are being used to access the conservatory by other residents must be agreed by the individuals concerned and or their representatives, and by the placing authority, so that choices and privacy are maintained. The registered persons should complete an assessment of individuals dependency levels so that staff ratios can be maintained at safe levels at all times meeting the needs of the people living there. All conversations about staff members working practices should take place in a private arena where privacy and the right to confidentiality can be maintained. The practice of staff using kitchen tea towels to wipe their hand stops immediately and paper towels are made available in the kitchen area of the home. To ensure that appropriate disposable gloves are supplied that promote good hygiene and infection control measures to protect peoples health and wellbeing at all times. 8 19 9 23 10 27 11 31 12 38 13 38 Care Homes for Older People Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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