CARE HOMES FOR OLDER PEOPLE
Elaine Herbert House The Great Hospital Bishopgate Norwich Norfolk NR1 4EL Lead Inspector
Mr Pearson Clarke Key Unannounced 3rd January 2007 09:15 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 Elaine Herbert House DS0000052349.V326000.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. Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Elaine Herbert House Address The Great Hospital Bishopgate Norwich Norfolk NR1 4EL 01603 610066 01603 766093 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) The Great Hospital Miss Anne Loveday Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Twenty-one (21) older people may be accommodated. Date of last inspection 18th October 2005 Brief Description of the Service: Elaine Herbert House is a care home offering personal care and accommodation for 21 older people. The service is operated by the Great Hospital Charity and the care home stands within the overall complex of the Great Hospital. The site is located in the city centre of Norwich near to Norwich cathedral. The home has been open for some time, however it is new to registration having previously been exempt by royal charter. The home is purpose built with accommodation on the ground and first floor. Those living at Elaine Herbert house have access to the grounds of the whole site. There are 21 single bedrooms all of which are en-suite. Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers ,the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home and this report gives a brief overview of the service and current judgements for each outcome. What the service does well: What has improved since the last inspection?
The service has had some difficulties in the last year with staff sickness and dealing with a lot of deaths in a short period of time. As such effort has gone into maintaining the service as it stands. Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Elaine Herbert House DS0000052349.V326000.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 Elaine Herbert House DS0000052349.V326000.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the Inspector looked at the admission process for the most recent two admissions to the home. As such it was possible to see that the service has a needs led assessment process which allows for informed judgements to be made as to the ability of the home to care for the person considering admission. Discussion with the service users concerned, confirmed that they were happy with the process and confident that the home would meet their needs. The service manager was clear about the service users for whom the home was appropriate and could give examples of screening out inappropriate admissions. Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 9 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users told the inspector that they felt well cared for and that their privacy and dignity was respected by staff. Each resident has a plan of care and a sample of six plans were looked at by the inspector. The plans are based on assessment, contain evidence of review and service users or their representatives have signed to indicate acceptance of the plans. The plans tend to be stronger in the areas of direct care needs and would benefit from better life histories to help underpin a holistic approach to care. Examination of the plans and daily recording show an appropriate approach to meeting and promoting the medical needs of service users and those spoken to were happy with this aspect of their care. The arrangements for the storage and management of medicines were inspected at the site visit and were found to be sound. The service uses a monitored dosage system and has a designated
Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 10 and secure storage room for medicines. Sample medication records were seen and found to be accurately recorded. At the time of the visit one service user was self medicating and they had secure storage provided and had been subject to a risk assessment. Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 11 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the site visit the inspector spoke to four service users and took lunch with residents. All of those talked to were very happy with the care received, describing the home as very relaxed and somewhere that they felt could not be improved. Service Users felt in control of their lives and they praised the kindness and commitment of those that cared for them. The service has designated staffing hours for the provision of activities. In discussion with the staff member concerned it was apparent that there was more difficulty in engaging people with structured activity. Service users told the inspector that they enjoyed opportunities for one to one conversation and given the above there is perhaps a need to switch the balance of provision with less large scale activity and more time spent one to one. Consideration might also be given to the creation of a news letter in order promote involvement in the homes community.
Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 12 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The services complaints process and complaints record show there has been little activity and that complaints received have been taken seriously and addressed. However there was some concern that a recent incident involving a service user had not been appropriately recorded and addressed within the context of the services approach to adult protection. This was discussed with the management during this visit and consideration was given to making a formal requirement, however given the services normally sound approach in this area it was agreed that the management will reinforce with all staff the importance of prompt reporting any areas of concern involving service users and where necessary to consult with the adult protection team. Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 13 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): 19,23 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector undertook a general tour of the building during the site visit and all areas were found to be clean and fresh with no unwanted odour. The home is comfortably furnished and well maintained. Service users confirmed that they had no complaints about the environment and those bedrooms seen offered good space and had been personalised by their occupants. Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 14 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service continues to offer good staffing levels and all of the service users spoken to during the site visit found staff to be kind caring and committed to their welfare. Four members of care staff were spoken to and all were happy in their jobs and felt that they worked in a good home which they would recommend. Staff who had previously worked in other settings said that this was the best home they had worked in. Sample employment records were checked and these indicated that the home has a robust and appropriate employment process. The service manager confirmed that there had been a number of longer term absences in the last year, however despite the strain placed on the home, cover had been arranged. Staff training records show the service to have an active training process with all basic training given and repeated as necessary. In addition to this the service meets government targets for staff trained to NVQ level 2 or above. Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 15 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): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users and staff spoken to by the inspector found the home to be well managed and said that the manager was friendly and approachable. Service users said that they felt their views were listened to and respected. The service has an internal audit process which is supported by regular trustee visiting. Some service users have small sums of money held by the service. Full individual records are held although it was agreed on the day that it would be better practice if each persons money was held separately rather than pooled as at present. The service has a thorough approach to health and safety with a
Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 16 health and safety manager for the whole site. Service and other health and safety records were inspected and found to be well maintained Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x x 3 x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 18 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 3 Refer to Standard OP7 OP12 OP18 Good Practice Recommendations It is recommended that the service management review care plans to ensure that a good social history is available for each service user. It is recommended that the service consider ways in which the provision of stimulation and activity can be better matched to the wishes of service users. It is recommended that the service management reemphasise to the whole staff team the importance of prompt recording and reporting of any issue of concern raised by service users. It is recommended that the service management seek ways to improve the service year on year in a planned manner. It is recommended that the service hold monies on behalf of service users separately. 4 5 OP33 OP35 Elaine Herbert House DS0000052349.V326000.R01.S.doc Version 5.2 Page 19 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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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