Inspection on 08/09/05 for Edward House Care Home

This inspection was carried out on 8th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Edward House Care Home 17/04/07

Edward House Care Home 19/04/06

Edward House Care Home 30/11/04

Edward House Care Home 29/06/04

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

CARE HOMES FOR OLDER PEOPLE Edward House Care Home 175 Nottingham Road Eastwood Nottingham NG16 3GS Lead Inspector Joanna Carrington Unannounced 8/9/05 11.00am 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 Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Edward House Care Home Address 175 Nottingham Road Eastwood Nottingham NG16 3GS 0115 9531591 0115 9531591 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) Edward House Care Ltd Jillian Sherry-Ann Seetul CRH 32 Category(ies) of 32 OP registration, with number of places Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 24/05/05 Brief Description of the Service: Edward House is a care home providing personal care for up to 32 people of both sexes who are over the age of 65 years. The property is a coverted house in a residential location. The accommodation is arranged on two floors. There is lift access to the second floor. There is sufficient communal space to allow for a separate smokers lounge. There are twenty eight single rooms and two shared rooms one of which has en-suite facilities. There is a small garden which is accessible to wheelchair users. The company which owns the home has recently been sold and there are new directors. Edward House is situated within half a mile of Eastwood town centre, with shops, pubs, a library, leisure and health facilities. Edward House Care Home C53 C03 S8667 Edward House V247945 080905 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 seven hours on the 8th September 2005 and was the home’s second statutory unannounced inspection for this inspection / financial year. The main method of inspection was called ‘case tracking’ which involved selecting four residents and tracking the care and support they receive through the checking of their records, discussion with them, the care staff and observation of care practices. The focus of the inspection was to follow up requirements set at the previous inspection and to inspect the remaining key standards not assessed at the previous inspection. During the course of the inspection three residents, three visitors and four members of staff were spoken with. A partial tour of the premises also took place. The manager of the home was available for the majority of the inspection for discussion and feedback. What the service does well: What has improved since the last inspection? A mobile hoist has now been purchased for the home, a vital piece of equipment for the safe moving and handling of residents with mobility needs. There has been some improvements to furnishings and décor with communal areas and corridors re-decorated and the replacement of old furniture. For promoting the safety of residents a risk assessment is now in place for the use of bed rails although it has been recommended that this risk assessment Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 6 includes identifying any potential risks posed by their actual use, for instance, can a leg become trapped in them? 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 Care Home C53 C03 S8667 Edward House V247945 080905 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 Care Home C53 C03 S8667 Edward House V247945 080905 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, 3 and 4 Residents still do not have their own copy of the Service User Guide, which without this to hand residents do not have enough information about the home and its facilities. Residents needs are assessed before they enter the home, however, the home is still not registered to meet the needs of older people with dementia. EVIDENCE: At the last inspection it was required that all residents are provided with a copy of the Service User Guide. According to the manager, relatives are given a copy of the Service User Guide and residents are informed that a copy is held in the office for their reference. All residents should have their own copy that they can retain in their bedrooms. An ‘assessment of daily living’, which covers various aspects of physical, healthcare, emotional and social / recreational needs is conducted with each resident and their relative. This then forms the basis of subsequent care plans. In addition to this for all residents funded by Social Services the placing authorities community care assessment should also be obtained by the home. This was only available on three of the residents files examined. For the Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 9 resident that has recently moved to the home there was no evidence seen that written confirmation was given to this resident indicating that the home can meet their needs. This was set as a requirement at the previous inspection. At the last inspection a new resident was case tracked and was found to have a diagnosis of dementia, despite the home not being registered to admit older people that fall within this category. Two of the four residents case tracked at this inspection also have a diagnosis of dementia. There is nothing on their files to indicate that their primary need is around their ageing as opposed to dementia, however, care plans do not effectively demonstrate that their needs around their Dementia are being met. The owners of the home are, therefore, required to apply for a variation to their registration immediately. Otherwise, taking enforcement action will be considered. Edward House Care Home C53 C03 S8667 Edward House V247945 080905 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, 9 and 10 Not all residents have an individual plan of care, which is necessary for ensuring that the needs of residents are appropriately and consistently met. The medication system is safe and residents feel that they are treated with respect, however, if care plans do not state or justify why access to individuals’ own bedrooms is restricted then residents right to privacy is not being upheld. EVIDENCE: The medication system operates on a weekly basis with the community pharmacist being responsible for dispensing individual residents’ medication into dosage cassettes. Medication Administration Records (MAR) provide clear instructions and no errors were found. One of the four residents that were case tracked who has been living at the home since the end of July 2005 has an ‘assessment of daily living’ and some risk assessments in place but there are currently no care plans. These are required to ensure that all staff provide appropriate support in a consistent manner. Visitors spoken with confirmed that they are involved in the development of care plans and there are monthly summaries written in accompaniment to care plans, of which these aim to identify when residents’ needs have changed. Evidently this system does not always work as one resident case tracked was observed to now need some assistance with his Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 11 mobility but this had not been amended on his care plan. On a monthly basis key-workers meet with their allocated residents so that they can discuss their own issues and to reflect over the previous month. This is good practice. Currently, the records of these meetings are held on key-workers own files. It is recommended that a copy of this be retained on residents respective files also as these meetings evidence that residents are involved in their care plans and how their assessed needs are met. All residents spoken with said that staff treat them with dignity and respect. However one resident spoken with mentioned how there have been days when she is not permitted to go to her own bedroom, which is then locked. The manager reports that this approach has been agreed with next of kin and an involved professional in order to promote their health and welfare but there is no identified need or specific care plan for this. A care plan, containing evidence that a relevant professional and relative have been consulted is absolutely essential given the restriction that this imposes on this resident’s life. Otherwise, this practice must stop immediately. The manager reports that one resident uses bed rails and there is now a risk assessment in place for the use of these, which was set as a requirement at the previous inspection. This risk assessment also needs to include identifying any risks as a result of their use. For example, can a leg become trapped and / or will the resident try to climb over them? Edward House Care Home C53 C03 S8667 Edward House V247945 080905 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) 14 Staff help residents to exercise choice and control over their lives. EVIDENCE: It was evident from talking with both residents and staff that residents have opportunities to exercise choice and control over their lives. All staff spoken with gave good examples of when residents are supported to make choices such as with meals, clothing and activities. Bedrooms seen showed that residents can bring their own furniture to the home if they wish to. Residents spoken with said that even though they are now living in a care home they still feel that they have some control in their lives and they can express choices on a day-to-day basis. Residents confirmed that they can go to bed when they want to. Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 13 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 Residents and their relatives know that there is a Complaints Procedure and are confident that their concerns are listened to and acted upon. Staff are aware of the local adult protection policy and procedures but training would enable staff to protect residents from all forms of abuse. EVIDENCE: There is a Complaints Procedure, which is displayed at different parts of the home. Visitors spoken with confirmed that the manager explains to them the Complaints Procedure on their relatives’ admission. None of the residents or visitors spoken with feel that it is necessary to access the Complaints Procedure because first and foremost they don’t have complaints to make and secondly the manager can be approached with any issues or concerns they may have. In order to act upon and take seriously residents’ complaints or concerns then the use of the Complaints procedure should be promoted. Complaints are also helpful in identifying ways to improve and develop the service. The only recorded complaint in the last year is by a member of staff. Staff spoken with demonstrated awareness into the Nottinghamshire Policy and Procedures for Adult Protection and that they would respond appropriately if a resident made an allegation of abuse. However, most staff have not had any form of Adult Abuse training, which is necessary for ensuring that staff have an understanding of abuse and know their role and responsibilities in accordance with the local procedures. Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 14 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, 20, 22, 25 and 26 Vital equipment for meeting the needs of residents has now been purchased and improvements to furnishings and décor have commenced, both of which has helped towards making the environment more safe and comfortable for service users. Replacing the residents’ kitchenette has taken away opportunities for them to retain their independence. The home is clean and hygienic. EVIDENCE: A mobile hoist has now been purchased for the home, which is essential for safely managing the mobility needs of residents. Old furniture identified as in need of replacing at the last inspection has now been replaced and visitors and residents spoken with confirmed that they are pleased with the new easy chairs purchased for the lounges. Ground floor corridors and communal areas including lounges and the dining room have recently been redecorated and visitors described the environment as feeling more fresh. However, the carpets throughout the home are looking very tired and at some parts where the carpet has badly worn it is taped down, which Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 15 has the potential to become hazardous to residents. The lounge areas and corridors still have dim light. The manager reported that the requirement from two inspections ago regarding the provision of adequate lighting has not been addressed. On a partial tour of the premises it transpired that the kitchenette on the first floor no longer exists but has been replaced with an additional bedroom, for which a variation of registration will be required. Now that the kitchenette is no longer available to residents an alternative arrangement for residents to be able to prepare their own drinks and snacks is required. The environment appeared clean and hygienic and residents and visitors confirmed that the standard of cleanliness is good at the home. Edward House Care Home C53 C03 S8667 Edward House V247945 080905 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) 29 and 30 While necessary checks prior to staff commencing employment are not undertaken and staff are not appropriately trained then residents are not protected or assured that their needs can be adequately met. EVIDENCE: At the last inspection a requirement was set for staff not to commence work until a POVA first check, as a minimum, has been undertaken then until the return of a satisfactory Criminal Record Bureau disclosure those staff must be supervised. At this inspection for the four staff files that were examined there was no evidence of POVA first checks being carried out and on two of the four staff files written references and CRB’s were applied for after those staff had commenced their employment. This is not safe practice and as this is an outstanding requirement this is now a serious concern, which if not complied with then enforcement action will need to be considered. There was no evidence that staff receive induction or foundation training to Skills for Care specification but the manager reported that Dementia training has recently been provided to all staff. Staff spoken with confirmed that this training was very informative and has enabled them to provide appropriate support to residents with confusion and mild dementia. Even though it was set as a requirement at the previous inspection staff have still not received moving and handling training. Staff spoken with reported that they have had training in safe working practices but training records showed that refresher courses are now overdue or that new staff still require Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 17 their initial training in health and safety (last recorded training in 2003, first aid, food hygiene and infection control). Edward House Care Home C53 C03 S8667 Edward House V247945 080905 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) 33, 35 and 38 A quality assurance system based on the views of residents is required. Residents’ money is safeguarded. Servicing of equipment and electric and gas systems are all up to date, however, until hazardous substances are kept securely and fire safety precautions are improved then the health and safety of residents is not protected. EVIDENCE: Currently, other than ad hoc questionnaires being passed onto residents, there is no actual system for monitoring and reviewing the service based on consultation with residents and their relatives / representatives. This is required. Staff reported that residents and their relatives were not consulted over the removal of the kitchenette, which was a valued resource at the home. (Please refer to Standard 22) Residents’ relatives give money to the manager to look after on behalf of residents. This money is held securely in a safe and all transactions are recorded with receipts kept. Records and money for two residents were Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 19 inspected and appeared to be in order. Relatives spoken with feel that this arrangement works well and residents stated that they always have access to their money when they want it. There was evidence seen that contractors have been out to service the boiler and lift and annual portable appliance testing is also up to date. On a partial tour of the premises the cabinet for storing substances hazardous to health is not lockable and this cabinet is kept in the staff room, which is also not locked. This must be addressed immediately to ensure the safety of residents. There was no fire risk assessment available for the home. This is a requirement in accordance with Fire Precautions Legislation and the Fire Service will need to be consulted for advice on how to do this. The last recorded fire drill was in May 04. Drills are supposed to be undertaken every six months. Fire Alarm tests are now being done at different fire call points but are now overdue as the last test was on 18th August 2005. Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 20 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 1 x 1 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION 2 2 x 1 x x x 3 STAFFING Standard No Score 27 x 28 x 29 1 30 1 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 1 x 3 x x 2 Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 21 yes 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 1 Regulation 5 Requirement Ensure that each service owns a copy of the Service User Guide. This is an outstanding requirement from the previous inspection. (Original timescale of 30/06/05 not met) Ensure that a copy of the placing authorities community care assessment is obtained for each resident. Ensure that each prospective service user receives written confirmation to say that the home can meet their needs. This is an outstanding requirement, original timescale of 30/06/05 not met. Admissions of people that do not fall within the category of registration must not be made. This is outstanding from the previous inspection, original timescale of 31/07/05 not met. The registered person must evidence through care planning and direct practice how the needs of people with dementia are met. This is an outstanding requirement, original timescale of 31/07/05 not met. Following review, ensure that Timescale for action 01/10/05 2. 3 14 01/10/05 3. 3 14 01/10/05 4. 4 14 Immediate 16/09/05 5. 7 12, 14, 15, 18 Immediate 16/09/05 6. 7 15 01/10/05 Page 22 Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 7. 7 12,15 8. 20 23 9. 22 23 10. 29 19 11. 29 19 12. 30 18 care plans are revised and amended. Develop a care plan that explains and justifies steps taken to promote one residents health and welfare. (Resident is locked out of bedroom) There must be consultation with the relevant professional, resident and their Next of Kin, and evidence of this. A copy of care plan must be supplied to the Commission by 23/09/05. Otherwise this practice must stop. Provide lighting that meets the needs of residents. (recommended to Lux 150). (Previous timescale of 30/01/05 remains unmet). Ensure that alternative facilities are provided so that residents have opportunities to prepare their own food and drink. Staff must not commence work without appropriate PoVA checks as a minimum and must be supervised until receipt of an Enhamced Criminal Records Disclosure. This is an outstanding requirement from the previous inspection, original timescale 21/06/05 not met. Ensure that two written references have been obtained prior to staff commencing employment, one of which should be from a previous employer. Ensure all staff receive training on safe working practices and training that is appropriate to meeting the various and complex needs of service users. Full training records must also be maintained. Providing moving and handling training to all staff is an outstanding requirement, original timescale of 31/07/05 Immediate 16/09/05 31/10/05 30/11/05 Immediate 16/09/05 immediate 16/09/05 31/10/05 Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 23 not met. 13. 38 12 Ensure that substances hazardous to health are held securely in accordance with COSHH and Health and Safety Regulations. Following consultation with the Notts Fire and Rescue Service ensure that all fire safety tests are carried out and that there is a Fire Risk Assessment for the home, in accordance with Fire Precautions Legislation. immediate 16/09/05 14. 38 23 30/09/05 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 16 Good Practice Recommendations Provide further detail on risk assessment for the use of bed rails that indicates that their use is safe, eg no part of residents body will get trapped in the bed rail etc. Actively promote the use of the Complaints Procedure with both residents and their relatives / representatives, to ensure that their concerns and complaints are taken seriously and acted upon. Provide training to all staff on Adult Abuse and the Nottinghamshire Policy and Procedures for the Protection of Vulnerable Adults. 3. 18 Edward House Care Home C53 C03 S8667 Edward House V247945 080905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Edgeley House Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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