CARE HOMES FOR OLDER PEOPLE
Edward House Albion Row Cambridge CB3 0BH Lead Inspector
Lesley Richardson Unannounced 07 July 2005 @ 10:00 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 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 I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Edward House Address Albion Row Cambridge CB3 0BH Telephone number Fax number Email 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 Old age, not falling within any other category registration, with number (OP), (16) of places Dementia, over 65 years of age (DE(E)), (4) Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 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. Date of last inspection 26th October 2004 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 I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 5½ hours and was carried out as an unannounced inspection on 7th July 2005. Two hours was spent examining records and documents and three and a half hours was spent looking around the building and spending time with service users and staff. Seven people who live at the home and five of the staff on duty were spoken to during the inspection. What the service does well: What has improved since the last inspection?
The home has completed everything it was asked to do at the last inspection. People who are thinking of entering the home are given as much information as possible to help them make a decision and then reassurance in writing that the home will be able to look after them. Service users are now involved with the plan that tells the carers what help they need, so that decisions are not made about a person without their or their relatives knowledge. An application to vary the conditions of registration to enable service users who develop dementia to remain living at the home has been granted. The home is not registered to admit service users with dementia. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 6 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. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 Pre-admission assessment of service users and information given to them ensures service users are able to make an informed choice about where to live, and the home is able to meet their needs. EVIDENCE: The home has a statement of purpose and service user guide that contains all the information required and which, when given to prospective service users, would assist them in make a decision about whether to live at the home or not. Copies are sent to prospective service users and the manager or deputy manager carries out a pre-admission assessment to ensure the home would be able to meet that persons needs. Assessments are also sought from social service departments and hospitals, and were seen on one service user’s file, as that person had been admitted to the home from a hospital in London. The deputy manager said the manager had questioned information in the pre-admission assessment with the hospital team before the service user’s admission. Although due to the distance involved it had not been possible to personally assess this service user. The deputy manager said the organisation now confirms in writing that the home is
Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 9 able to meet the needs of a service user, and supplied a copy of the letter template. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 Personal care is offered in such a way as to promote and protect service users’ privacy and dignity. EVIDENCE: Individual care plans and risk assessments are available to ensure personal and health care needs are identified and planned for. Care plans are reviewed, although not always on a monthly basis, and are re-written when care needs change; ensuring changes were recorded. Service users are included in planning their care and all care plans seen had service users signatures to show their agreement with the plan of care. However, a risk assessment for one service user had not been reviewed following a fall and injury, and this did not reflect that service users changing needs at that time. Not all care records had accurate dating, which means it would be difficult to follow an audit trail should a record of particular care practice be required. Service user’s files showed the home sought help and advice from a variety of different healthcare professionals, including district nurses, opticians, dentists, chiropodists and the National Osteoporosis Society. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 11 Service users said they were happy at the home and that staff members were always available if needed. One service user said the carers were always polite, they knocked on the door and treated her respectfully. Carers were polite towards service users during the inspection and call bells were answered quickly. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Social activities provide stimulation and interest for people living in the home, and visits from relatives and friends ensure continued social contact. But, as service users are not consulted about their interests, individual preferences may not be catered for. EVIDENCE: The home has an activities co-ordinator who arranges group and individual activities for service users at the home. A weekly plan of events is placed on notice boards around the home. However, service users perceptions were that there were only a few activities organised. One service user said she would like more activities that were personalised for her interests, but all other service users that the inspector talked to say they are happy with what is available. There was no information on the service users files seen about their social interests, although staff members thought this was discussed with service users after admission. The deputy manager felt service users perception may be because the activities co-ordinator was on leave and individual time was therefore not available. The activities co-ordinator keeps records of activities, service users who attend and information about activities specifically for this service user
Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 13 group. A musician entertained service users on the day of inspection, with renditions of wartime songs. Three service users told the inspector about their families and that they could visit or go out to visit them at any time. The home helps service users with arrangements to go to family outings, such as weddings or at Christmas. All the service users spoken to said they are able to get up and go to bed when they want to, comments include, “the girls let me lie in, when I wake up they’ll come in and ask if I want to get up”. Service users are also able to choose what they want to eat; although there is only one main meal, service users are asked what they want put on their plate and alternatives are available every day. The meal on the day of inspection was ham salad and each service user was asked what they would and would not like to eat. Although service user’s dietary preferences are documented in the admission assessment the inspector was pleased to see staff members not taking this knowledge for granted. Salt and pepper, and jugs of water were also available for service users on each table, enabling choice. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints system with evidence that service users are able to confidently raise concerns. EVIDENCE: Service users said they would be able to raise concerns with either staff members or the managers and would have not qualms about doing so. Some service users also went on to say they felt safe at the home and that staff looked after them well. The home has complaints, protection from abuse and whistle blowing policies, which are available for staff members and service users, and are kept in the home. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26 The standard of the environment within this home is good, providing service users with a attractive and homely place to live. EVIDENCE: The home is purpose built and accessible to all service users. Although the main corridors in the building are not carpeted, all service user individual rooms have carpet and all but one rooms has an en suite. Each room, bar one, has a short entrance hall and all rooms contained service users personal possessions. Service users are also able to bring in their own furniture to add to their rooms, should they wish. The home is comfortable and well maintained, with a good standard of décor. There were no offensive smells in the home on the day of inspection. The laundry is situated away from the kitchen to reduce any cross infection risk. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Staffing numbers and staff training opportunities were sufficient to meet the needs of service users. EVIDENCE: Service users needs are met by a staffing complement of two carers during the day and one waking and one sleeping carer at night. During normal working hours the manager or deputy manager is available on the premises to help. After normal working hours a duty manager is available on call should staff members need to contact them in an emergency. Service users said staff members are always available to help and gave no indication that their needs were not met in a timely fashion. The home has not employed any new staff members since the last inspection and it was therefore not possible to look at how recruitment and vetting practices for new staff members had changed. Amendments made to the Care Homes Regulations in 2004 and specifically to Schedule 2, regarding information that must be kept on staff files, were discussed with the deputy manager at the time of inspection. Staff members said they had all mandatory training plus training in other areas identified during the year. This included bereavement and training from the Community Psychiatric Nurse (CPN) in managing dementia as the home has recently been granted a condition of registration for service users already in the home with these needs. The deputy manager said the activities coEdward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 17 ordinator has also been given specific training in her field for the service user group. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The home has made alterations to further protection service users. EVIDENCE: An electronic fire closure device has been placed on the kitchen identified in the previous inspection. This ensures service user safety is promoted. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 3 Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 20 NO Are there any outstanding requirements from the last inspection? 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 12 Regulation 16(2)(m) Requirement Service users must be consulted about their social interests. Timescale for action 15th August 2005 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 7 7 Good Practice Recommendations Care records should be dated with day, month and year to enable an audit trail. Risk assessments should be reviewed following a change in service users circumstances. Edward House I53 I03 15267 EDWARD HOUSE V15267 070705 STAGE 4.doc Version 1.40 Page 21 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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