Inspection on 11/01/07 for Elderholme Nursing Home

This inspection was carried out on 11th January 2007.

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

Elderholme Nursing Home 14/08/08

Elderholme Nursing Home 17/03/08

Elderholme Nursing Home 09/10/07

Elderholme Nursing Home 06/09/06

Elderholme Nursing Home 31/05/06

Elderholme Nursing Home 27/02/06

Elderholme Nursing Home 17/03/05

Elderholme Nursing Home 22/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Elderholme Nursing Home Clatterbridge Road Bebington Wirral CH63 4JY Lead Inspector Julie King Key Unannounced Inspection 11th January 2007 09:30 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 Elderholme Nursing Home DS0000020938.V329914.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. Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elderholme Nursing Home Address Clatterbridge Road Bebington Wirral CH63 4JY 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) 0151 334 0200 0151 334 0200 Wirrelderly Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 60 beds nursing care 6 named adults under 65 years of age Date of last inspection 6th September 2006 Brief Description of the Service: Elderholme is situated within the grounds of Clatterbridge Hospital, Wirral. It is a single storey purpose built care home for elderly people, offering both nursing and personal care. The home has a capacity for 60 residents and a full range of aids such as assisted bathrooms and wheelchair access to all areas. Elderholme has a large dining room and 4 separate lounges, each overlooking the pleasant courtyard. There is good parking to the front of the home and gardens are well kept providing a pleasant outlook from rooms. The home is accessible by public transport, which is routed through the hospital grounds. Fees at the home range from £510 to £540 per week. Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over 8 hours, during which time records, documents and care files were examined. A number of staff and a couple of relatives were spoken to during the course of the visit. All relatives expressed how happy they were with the standards of care received by their relatives, and informed the inspector that they had “confidence in the staff”. Five members of recently employed staff were spoken to, all of which appear to be happy at the home. Training is ongoing for most staff, but further training and development is still needed to fully comply with all standards. What the service does well: What has improved since the last inspection? 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. Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 6 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 Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 7 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): 1,3,4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of the residents assessed needs are being met, and the home is able to provide assurances to the majority of residents that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: The Statement of Purpose and Service User Guide were examined, and both documents had a number of errors regarding contact numbers for the CSCI, and who was the Responsible Individual, and who was the Registered Provider. Neither document contained a summary of the last inspection report (as required), but a copy of the full report was readily available. Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 8 All residents have a pre admission nursing assessment before they are admitted to the home; the acting manager, or one of the senior nurses in the home undertakes the assessment. Residents, family and other health care professionals known to the resident contribute to the assessment. Pre admission assessments provide an assessment of actual and potential needs of each prospective resident; thus allowing a care plan to be developed. It was recommended that the pre admission assessment tool is utilised in more detail to ensure that all prospective resident’s needs are fully identified, therefore providing adequate information upon which to formulate a more detailed care plan. Multidisciplinary healthcare team (MDT) input is evident in resident’s care files, and include reference to NHS out-patient’s appointments, opticians, dentistry, and tissue viability nurse specialist (TVNS) input at the home when needed. Staff training was seen to be ongoing, but more is needed, especially the mandatory aspects, in order to fully meet minimum requirements and reassure residents that they are getting the very best of care. Elderholme Nursing Home DS0000020938.V329914.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s individual health, personal and social care needs are recorded, providing staff with most of the information they need to meet each resident’s care needs. EVIDENCE: Eight resident’s care files were examined, some of which with the input of the specialist tissue viability nurse (TVNS). All files seen evidenced a significant improvement from the last site visit in September 2006, and a new, different care planning system was in place. Residents said that they were involved in their care planning process, and were “consulted” regarding daily choices, etc. Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 10 The majority of care plans seen evidenced the actual care delivered, but the standard and quality of the recording and reviews varied depending upon which Registered Nurse (RN) had completed them. Most files seen evidenced the ‘weekly key-worker diary’ was blank, even for residents that had been admitted into the home for more than a couple of months. Also the activity record was blank in most cases, and none, or little reference to daily activities was made in the daily reports. Risk assessments were in place in all care files, but again varied depending upon which member of staff had completed them. The risk assessments did not evidence the actions to be taken to control or minimize all identified risks, and stating “refer to policy number 00” is not sufficient. Inadequate risk assessments were also seen relating to the use of bed rails – this was discussed with the Responsible Individual and the acting manager, who assured the inspector that suitable training would be provided for all relevant staff. Crossings out, sticky labels over writing and ‘Tippex’ was also seen on various care records – this is not good practice and must cease immediately. One recently admitted resident had on their pre-admission assessment that they had “loose dentures” and had “lost weight”. A care plan was in place for these identified needs, but no monitoring or reviews had taken place, despite the resident loosing another 2kg of weight since admission. It is strongly recommended that the manager completed regular, documented audits of all care files and accident records to check accuracy and content of all relevant paperwork. Medication management has significantly improved since the previous inspection, with the main findings as follows:• One trolley for each unit • Designated RNs for the over management of medications • Transcriptions recorded correctly • Controlled drugs and recordable drugs correct • Some medications stored in the drugs fridge that should be stored at room temperature • Policy and training for all RNs re the disposal of controlled drugs needed Elderholme Nursing Home DS0000020938.V329914.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Links with the local community are good, and support and enrich the resident’s lives. EVIDENCE: Residents in the home are asked on admission about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in, such as outings, bingo and manicure therapy. Since the previous site visit there has been an increase in activities offered to residents - a welcome addition according to residents spoken to, and said, “I love being here”, and, “I’ve got plenty to do”. Visitors are allowed in the home at any reasonable time of day, residents may entertain their visitors in the communal lounges, or in their own bedroom. Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 12 The gardens are accessible and tidy, and are an ideal setting for residents to sit with their relatives, especially in the summer months. It is strongly recommended that the ‘activity records’ in each care file are completed for each resident on a daily basis. Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaint policy and procedure was in place that helps ensure the safety and welfare of residents EVIDENCE: Elderholme has a complaint and adult protection policy and procedure in place to help ensure the safety and welfare of service users that service users, relatives and staff can access when necessary. This procedure includes information on ‘whistle-blowing’, and staff spoken to were able to inform the inspector of their knowledge of adult protection procedures. Residents said that if they had any problems they felt they could “talk to the girls or sister [RN]”. The CSCI has not received any complaints about this service since the previous inspection. Training is inadequate regarding adult protection procedures, and evidence could not be found to prove that mandatory protection of vulnerable adult Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 14 training had taken place for all staff. A requirement will be issued to ensure that all staff receive appropriate training as soon as possible. Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 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. 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. This service is well maintained, providing a safe and homely environment for residents. EVIDENCE: Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 16 The premises were clean and odour free, and there was evidence of on-going re-decoration and refurbishment. All rooms seen were decorated and furnished to an acceptable standard, and some areas of the home had been decorated and / or refurnished since the previous site visit. Most of the residents had personalised their rooms with small items of furniture, photographs and soft furnishings; and they are able to have a direct input into their colour schemes, etc. The communal lounges were bright and inviting, and there have been improvements to the dining and lounge areas on all units. Residents spoken to told the inspector that they “like my room”, and “isn’t it nice”. Elderholme Nursing Home DS0000020938.V329914.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): 29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a consistency of care within the home provided by permanent staff, which helps to offer safety and stability for the residents. EVIDENCE: A selection of staff personnel files were examined as part of the case-tracking process. Most files now contain all the required documents and records, but some are still in process of completion. CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults check) evidence was available, as were references, some training information, NVQ training, proof of identification and basic inductions. The inspector has been provided with the planned training programme for the coming year, which shows ongoing training and development for most staff. Training areas covered include wound care, moving & handling, and some agerelated conditions relevant to the residents. Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 18 The training records other staff were examined, and although they had completed some of their mandatory training, these employees had not received COSHH (Control of Substances Hazardous to Health) training, and prevention of abuse training, which should have been a basic requirement for their job. This was discussed with the Responsible Individual who has assured the inspector that suitable and sufficient training will be provided and recorded as soon as possible. Elderholme Nursing Home DS0000020938.V329914.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): 36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff supervisions are now in place, helping to ensure confident and supported staff throughout the home. EVIDENCE: The acting manager is not registered with the CSCI, but has the support of a general manager (Responsible Individual) for assistance with the day-to-day running of the home. Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 20 Overall this home has significantly improved since the previous site visit, but documented audits and checks of resident’s care files are still not up to the required standard. Risk assessments in care files were lacking, and an updated fire risk assessment was requested by the inspector, but has not been produced in time for this report to be completed. The recording of resident’s accidents and incidents, especially regarding any follow-up or actions taken is not fully compliant with requirements; and does not evidence what actions the RN’s have taken following a resident’s fall. All record keeping must comply with the Care Standards Act 2000 and accompanying Regulations, but RNs must also comply with their professional codes of conduct issued by the Nursing & Midwifery Council. Elderholme Nursing Home DS0000020938.V329914.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 3 X 3 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 2 2 Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13(2) Requirement The registered person must ensure that medication is stored securely and at the recommended temperature at all times. Previous timescales not met. Timescale for action 12/01/07 2. OP4 18(1) The registered person shall 31/03/07 ensure that staff both collectively and individually have the skills and knowledge to provide the service and care provided by the home. (Refer specifically to specialist training – previous timescale of 31/10/06 not met). The registered person shall keep the service users plan under review and after consultation with the service user or their representative revise the service users plan. Previous timescale of 31/10/06 not met. The registered person shall ensure that the care home is conducted so as DS0000020938.V329914.R01.S.doc 3. OP7 15(2) 31/03/07 4. OP8 12(1) 31/03/07 Elderholme Nursing Home Version 5.2 Page 23 to promote and make proper provision for the health and welfare of service users; to make proper provision for the health and welfare of service users Previous timescale of 31/10/06 not met. 5. OP18 13(6) The registered shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Previous timescale of 31/11/06 not met. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (Refer specifically to use of bed rails and protective bumpers). Previous timescale of 31/11/06 not met. The registered person shall, having regard to the size of the care home, the Statement of Purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. Previous timescale of 30/10/06 not met. The registered person shall ensure that all documents and DS0000020938.V329914.R01.S.doc 31/03/07 6. OP38 13(4)(c) 31/03/07 7. OP30 18(1)(c) 30/04/07 8. OP37 17 30/04/07 Elderholme Nursing Home Version 5.2 Page 24 9. OP38 17 & 23(4) records as specified in Schedules 1, 2, 3 & 4 of the Care Homes Regulations 2006, are kept up to date, valid and available for inspection at all times. The registered person is required to produce an up to date fire risk assessment, in conjunction with the Fire (Workplace) Regulations 1999. 28/02/07 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. Refer to Standard OP9 Good Practice Recommendations There should be a formal system for prompting medication reviews in line with National Service Framework for Older People It is recommended that participation in social activities be recorded within residents individual care files 2. OP12 Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 © 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 Elderholme Nursing Home DS0000020938.V329914.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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