CARE HOMES FOR OLDER PEOPLE
Edward House Albion Row Cambridge CB3 0BH Lead Inspector
Dragan Cvejic Unannounced Inspection 5th February 2007 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 Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Edward House Address Albion Row Cambridge CB3 0BH 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) 01223 316776 01223 368613 Edward Storey Foundation Joy Wood Care Home 16 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (16) of places Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No service users with Dementia to be admitted to the home. DE(E) to cover service users whose needs have changed. 5th December 2005 Date of last inspection Brief Description of the Service: Edward House is a care home proving personal care and accommodation for sixteen older people and up to four people already in the home with dementia. It is run by The Edward Storey Foundation, a registered almshouse charity, and only provides services to women. One of the registered beds is only used for short-term respite care. The home is purpose-built building, on two floors, accessible by stairs or a passenger lift. The home is physically linked to Storey’s House, which provides sheltered accommodation. A number of people living at Storey’s House visit the home for meals and support during the day; however the home is selfcontained and has a separate entrance. The home is within walking distance of Cambridge city centre and local amenities. Despite being on a busy one-way road system the home is peaceful and has access to a patio area and the gardens of Storey’s House. All service user bedrooms are for single occupancy and all but one have en-suite facilities. Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the service. It was carried out during the morning hours and lasted for 2.5 hours. The main methodology used was case tracking of three service users. Additional methodology included a tour of the premises, case tracking two staff, one of whom was a key-worker to a case tracked service user, and speaking to the deputy manager and to the organisation’s finance manager. As the manager was not present, the main sources for reaching the judgements were comments from service users and the outcomes of the care process. What the service does well: What has improved since the last inspection?
The home started using electronic, computerised records. This method already proved to be effective for keeping records up to date, available to relevant people and protecting confidentiality in relation to others not involved in care. The home met requirements set on the previous inspection. Care plans were now regularly reviewed and up-dated. A new controlled drugs register was introduced. The activity co-ordinator significantly improved all the staff’s knowledge of service users interests and hobbies.
Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 6 Records confirming compliance with health and safety were now available in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home carried out a full and comprehensive initial admission assessment, ensuring that users needs could be and were met upon to admission. EVIDENCE: The home’s statement of purpose was displayed in the entrance hall and was available to users, visitors and staff. Three service users were case tracked. One file of a recently admitted service user contained all documents from the initial admission assessment. The other two were mainly stored in the archive, with occasional documents, such as History on admission”, that confirmed the process was identical for all users. The file with documents demonstrated that the assessment covered wide areas of users’ lives in detail. A pressure sore was addressed in the file and following documents showed the home’s action and how the sore was cleared. The
Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 9 assessment stated user’s preferences, likes and dislikes. Interests were also recorded: “likes reading and calligraphy”, or “does not like seafood.” A falls risk assessment was recorded at the admission with external help from the National Osteoporosis Society. Some older contracts could not easily be located in the financial file kept in the home and the head office was the place where the information could be obtained from. The Chief Executive Officer resolved the case by marking the files of users’ whose residence was covered by the contract from County Council. However, the newer files were readily accessible for inspection and contained contracts. Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home offered good health care to service users, respecting their privacy and dignity, but there was a need to strengthen the medication auditing system to fully protect service users. EVIDENCE: Care plans checked demonstrated that they were drawn from initial assessments. Care plans were now kept in an electronic computerised form. All staff had a password and were trained to use computerised records. This format allowed the home to keep care plans up to date. Two checked files demonstrated how changes in needs and actions to respond to these needs were recorded. Electronic records allowed some assessed areas to be explained in detail, without overloading the whole documents with lengthy forms and writing. It was also much easier to record changes on reviews, as only the parts of care plan that addressed changes were updated. The home page of
Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 11 each individual file had the dates of latest changes recorded, alerting all staff to read them and keep well informed. Once this system becomes routine, it will create an opportunity for excellent outcomes. Meanwhile, the management structure must ensure that a hard copy of the page containing changes was offered to service users or their relatives to sign, as one file did not contain a hard copy during the site visit. Health care was well organised and documented to show how it was delivered. The file demonstrated how the users’ preferences were respected. A comment: “use the smaller pad for night”, demonstrated how the users’ preferences from initial assessments were respected and incorporated into care plans. A service user, resident in the home for 6 weeks, commented: “Yes, my care plan was discussed with me more than once”. The dates on changes showed that during the initial trial period, reviews were carried out as frequently as weekly. Clearing pressure sores and incontinence sections were updated every week for the first month. The home had a clear medication procedure. Inspected records were accurate. However, despite the clear auditing system, two users’ medication had discrepancies of the amount of a present medication, showing that the auditing system was not fully effective, despite the good form designed for this purpose. A new records book had been introduced for administration of controlled drugs. The manager stated that the brother of a service user was present at the review. In another example a user stated: “My nephew knows everything, he helped me get in, he has got Power of Attorney to help with my finances.” The files contained information about users’ wishes in case of death. The deputy manager explained that extra care would be provided to those who would reach that stage of their life, or become terminally ill. Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users lifestyles were given full attention in planning their care. Protecting their interests, hobbies and rights was the home’s philosophy. However, users’ records of private possessions were not kept up to date to ensure their full protection. EVIDENCE: The location of the home next to a sheltered scheme created an extra opportunity for social contacts and inclusion into the local community. The activity co-ordinator explained her programme and clearly demonstrated how users were taken out into the community on a regular basis. The organisation paid attention to this aspect of users’ lives and fully understood the importance of users’ involvement in the local community. The activity co-ordinator stated: “I have a sufficient and nice budget for their activities and can organise a variety of activities which ensures the involvement of all users.” The home was helping service users with their finances, if users needed or wanted help. The records checked for two users showed that financial
Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 13 protection was ensured by the system in place. A user commented: “I understand and know facts about my money. My nephew helps me manage it.” The home recorded users’ personal possessions brought into the home on admission, but did not have a system in place to update these records when some new possessions were acquired, or the older items were disposed of. Service users chose the menu at their meetings. A user commented: “Food is excellent. They know what I like or don’t like.” Records showed her preferences, “…likes liver…doesn’t like sea food”. The menu demonstrated varied, nutritional food. Any food consumed outside the menu, provided on users’ requests, was recorded. A dietician was visiting the home to provide advice and ensure an appropriate diet was provided to service users. Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were protected by the home’s policies and procedures and by being well informed about resources available to them for their protection. EVIDENCE: The home had not had any complaints since the last inspection. They did have a complaints book, where the potential complaints would be logged. The procedure was in the statement of purpose and on a notice board. Three service users spoken to confirmed that they would know how and who to complain to if they wanted. This procedure had clear deadlines for responding to a potential complaint. Service users were protected from abuse. A service user’s comment: “I feel safe and secure here”, demonstrated that the final outcome of the working practices for service users offered them reassurance for their rights and safety. The home’s policy regarding the users’ money ensured protection. The records were accurate and signed by two staff for any transaction. The finance department of the organisation carried out a regular audit of these records and helped users decide how their money was managed. Administration of medication, which slightly affected the protection of service users was addressed under medication standards and the recommendation was made in order to improve the outcome in this area of protection.
Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 15 Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a very pleasant and homely environment that service users liked and theyfelt safe and comfortable in the home. EVIDENCE: The home was purpose built and met the environmental needs of service users. It was well maintained, clean and bright. Any faults were dealt with immediately. Service users spoken to were happy with both communal areas and their bedrooms and provisions in them. The home’s working procedure and the state of cleanliness of the home ensured good infection control. Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users needs were met by the competence, commitment and skills of the staff. Staff training and continuous professional development exceeded minimum standards. EVIDENCE: The home employed a sufficient number of staff. The rota, displayed on a wall in the office, demonstrated that staff were covering all shifts according to the assessed users’ needs. A case tracked service user commented: “Yes, I think they have enough staff. Only if they are engaged in an emergency they do not come straight away, but normally they come quickly. They spend time with us.” She commented on staff’s skills and knowledge: “They are well trained. I am impressed with how they use hoist to help some people. They are very good.” The activity co-ordinator commented: “This is a wonderful home, not too big or too small. We have a good relationship with service users. I take them to town and it is lovely. Staff are friendly and there is a nice atmosphere here. I am happy working here.” She stated that staff received about 6 supervision sessions a year, but could approach the manager at any time. Approximately 90 of staff were NVQ trained and some were continuing with their training towards NVQ level 3. The
Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 18 deputy manager was working towards her Registered Managers Award and NVQ 4. The activity co-ordinator attended national training for activity workers twice a year. The staff induction portfolio demonstrated the variety of training staff were undertaking: Networking, Dementia care, Protection of Vulnerable Adults and all mandatory training. Some staff forms were kept in the head office, such as staff application forms, references and CRB disclosures, although the staff records here contained the number under which the disclosure was recorded. The staff records were checked previously and met the standards and the home continued with the implementation of the same recruitment procedure, ensuring protection of service users. The home exceeded minimum standards related to staffing. Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were protected by safe working practices and by an open, inclusive atmosphere. EVIDENCE: Although the manager was not present during the site visit, her style was clearly visible from the atmosphere in the home. A friendly, supportive and open attitude was observed amongst service users and staff. Staff were clear of their roles and responsibilities. One of the main successful achievements of the home was the atmosphere of support, trust and the positive and inclusive approach. This kind of relationship was confirmed during the site visit, when the deputy manager called in a
Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 20 senior manager to clarify financial matters inspected. The ethos in the home was above minimum standards. The organisation carried out a quality assurance review on a yearly basis. The results were displayed in the hall, together with previous inspection reports and with home’s newsletter. The results were also presented in graphs. An insurance certificate displayed was a few days out of date and the deputy manager was alerted to pass on this legal requirement to the manager and to the senior management team. The home helped service users with their finances when users wanted them to. The records were kept semi-professionally, in the semi-professional book that contained recorded signed transactions and balances. The records checked for two service users were accurate. The activity co-ordinator and one care staff commented that they were well supported and supervised regularly. The deputy manager presented a supervision plan and stated: “We aim to provide 6 supervision sessions per year.” Safe working practices were in place. All mandatory training for case tracked staff was up to date. Accidents/incidents were recorded in the appropriate records, separately for service users and staff. Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 X 3 Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. 2. Refer to Standard OP9 OP14 Good Practice Recommendations The medication auditing system must be effective to ensure no discrepancy in the amount of users’ actual medication and records was present. Service users personal possessions list should be kept up to date during their residence and the system for maintaining these records should be developed. Edward House DS0000015267.V329543.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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