CARE HOMES FOR OLDER PEOPLE
Elderholme Nursing Home Clatterbridge Road Bebington Wirral CH63 4JY Lead Inspector
Mrs Joanne Revie Key Unannounced Inspection 11.30 9th October 2007 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.V347303.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.V347303.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 3431312 elderholme@btconnect.com Wirrelderly Mrs Christine Mary Whiteside Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP The maximum number of people who can be accommodated is: 60. Date of last inspection 11th January 2007 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 2 dining rooms and 3 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. The home charges £455 to £555 per week depending on available funding and which bedrooms are to be occupied. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Prior to the visit taking place the manager was asked to complete a document called an Annual Quality Assurance Assessment. This arrived in time for questionnaires to be sent out to relatives and representatives for completion and enabled a plan to be drawn up which would focus the visit on key areas. Six completed surveys were returned. Two inspectors visited the home over two days and spent twelve hours talking to the people who lived there, relatives and staff and time was also spent reviewing a variety of records. Comments from the discussions held have been used in the summary section of the report. In total discussions were held with nine relatives, eleven residents and eleven members of staff. The records viewed related to resident’s care, how risk was managed, the service provided by the home and health and safety. The environment was viewed and personal information relating to staff as well as staff training was also viewed. Elderholme is progressing with meeting the equality and diversity needs of individuals however further progression is still needed as identified within the report. What the service does well:
A full assessment of the persons needs is carried out before admission takes place. People are encouraged to visit the home prior to this happening to make sure that they like the home. Thorough assessments are important as this information can be used to make sure that the staff have the skills to care for the person and can plan for the forthcoming admission. Three people commented “one of the nurses came to see me twice in hospital. My daughter came and inspected the place” and “Overall it’s very, very good. You would be hard to please if you didn’t like it” and “Its comfortable, kind and friendly. Generally quite good”. Someone who had not lived at the home for long commented that” “I’m happy with the care, no complaints up to now”. The people living at Elderholme have a plan of care, which is kept, in their bedroom. This means that staff have access to written instructions about how to care for the person and the person can read their own records. This promotes good practise as it helps to include people in the delivery of their care.
Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 6 Other people commented positively on staff’s ability to care by stating: “I please myself. They knock on the door to see if you are all right. Check you three times a night. I always get my medication on time, the same time every day. “ Staff are quick to respond to changes in peoples health needs by consulting doctors and other health care professionals when needed. People said that staff do help with personal care also but one explained, “but I prefer to do my own “. This shows that people are supported to be as independent as possible and that staff are respectful of their wishes. Staff know how to maintain peoples privacy and dignity. One person explained, “ I have a bath twice a week -they do it nicely, you don’t feel embarrassed, they are full of respect”. All the residents spoken with agreed that staff are patient and kind. One relative commented that “the care has always been good” and “I’m happy “with the standard of nursing”. Another resident commented that “nurses are very good, very caring.” They offer and arrange the GP if needed.” All completed questionnaires received, commented positively on the carer’s ability to care. One relative stated that the staff were” gems” and that “ you couldn’t get any better”. Another stated that the staff were” very kind” and “very good”. Elderholme ensures that any new staff have thorough checks carried out so that the people living there receive care from staff who are suitable to provide it. New staff receive a thorough induction which means the most junior of staff will have the basic skills to provide care. . The home welcomes visitors and supports them to be involved in their relatives care. Everyone spoken was positive about the quality of food served at the home. Comments included “ The food is good, very good” and” the catering is very good” Activities are provided on a daily basis including regular trips out, although space is limited due to wheelchair provision. One person commented, “there is loads of activities, I don’t get bored”. Another stated “Its my home, there’s not too many rules, you can go to bed and get up when you want” Elderholme presents as a clean comfortable place to live. It has gardens which are acessible for people who use wheelchairs. One relative commented on a survey that “The handyman service is first class nothing is too much trouble and items are attended to promptly. He keeps the inner garden immaculate as well as the carpets clean and smelling fresh which contributes to the freshness of the home”.
Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 7 The home acts responsibily towards maintaining the Health and Safety aspects of the building which could impact on peoples welfare if neglected. This includes maintaining security . One resident commented that “I feel safe living here, they are particular, about closing windows”. What has improved since the last inspection? What they could do better:
Although people are receiving an assessment prior to admission taking place records need to be improved so that they are meaningful and include the persons likes, dislikes and diagnosis. Any information found during an assessment (including risks to health care) should be recorded on the plan of care. There is little, if any, consultation taking place with the people living at Elderholme. This must be carried out so that the people living there feel empowered and are encouraged to take ownership and feel in control of their lives. This should include all provision of care including activities. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 8 Serious concerns were highlighted regarding the call bell system. Comments included “sometimes there’s nobody about” “ it can take a long time to get a response to the buzzer. - If it was something serious it would be too late,” There is no call bell system in the lounge areas and staff cannot always hear the call bell ringing if they are behind a bedroom door. This must be addressed as it could seriously impact on the people’s health and welfare. Although medications are being managed safely staff need to be reminded to check the medication fridge and room temperature daily and to check which items require fridge storage. Storing medications at the wring temperature could impact on how they work. Staff should be reminded to wear protective clothing over their uniforms when serving meals to reduce the risk of contamination occurring. The manager must ensure that all concerns are investigated as thoroughly as formal complaints as this appears to have caused confusion with some relatives and has resulted in them believing that their concerns have gone unanswered. This has impacted on the trust that some residents and relatives have in the service. Comments were made that “I don’t know if they would listen” However another resident commented that “they see to it if I do”. Lounge areas should be reviewed to prevent people from using them as a corridor to access other areas and to promote privacy for the people living there and their visitors if they wish. The manager should risk assess the use of the laundry room to ensure that staff can access clean linen when the laundry is closed. Some residents and relatives commented that they believed there were not enough staff in the home. Although staff spoken with denied this, no system is in place to show whether staffing levels are adequate. The manager should respond to this by developing auditing tools such as monitoring staff sickness levels , monitoring falls and accidents and monitoring resident’s support needs and choices. Some concerns were raised about poor communication between nursing staff. This concern should be explored to ensure that good communication exists other wise this could seriously impact on people’s health and welfare. Two relatives commented that it would be nice for care to be delivered by carers of the same sex as the person receiving it. This should be explored through consultation with the residents. A training audit needs to be carried out so that strengths and weaknesses in the staff team can be recognised and training given to address any shortfalls. This would ensure that staff have all the skills to meet the residents needs. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 9 The manager should also ensure that audits are carried out on the level of falls and accidents within the home and that staff carry out practise fire drills more regularly. Senior management should thoroughly explore and eradicate any conflict, which has arisen with the relatives group. If this conflict continues it could impact on the peoples lives who are living there . 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.V347303.R01.S.doc Version 5.2 Page 10 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.V347303.R01.S.doc Version 5.2 Page 11 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 was assessed Standard 6 was not assessed, as Elderholme does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with information including a visit to the home (if they wish)before they decide to live there. EVIDENCE: A discussion took place with three people who had recently moved into the home. They all spoke positively about staff’s ability to care and support them. Care records were looked at for these people and another three people who had lived in the home for a while. The information gathered showed that before anyone moves into Elderholme staff meet with them and carry out an assessment of their support needs and choices. Staff also gather information about the persons needs from other sources such as social workers and speech therapists. The person or their
Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 12 representative are able to visit the home to decide whether it is a suitable place for them to live. Although an assessment of the persons needs is carried out not all the records viewed were signed and dated. Some records viewed described the person’s needs but did not reveal their diagnosis or past medical history. This information would help to track possible changes to the support people need and the lack of clarity in recording could lead to changes not being quickly noted and acted upon. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents cannot always summon staff to help when they need it. Staff are respectful to the residents and understand the importance of promoting dignity and privacy. New systems have been developed to ensure that medications are now managed safely EVIDENCE: Six sets of care records were reviewed. Six surveys were received prior to the visit in the home, which had been completed, by relatives or their representatives. Discussions took place with nine residents, six relatives and eleven members of staff. Observation of the call bell system also took place. The information gathered showed that everyone living at Elderhome has an individual care plan in place which they aware of and which is accessible to them and to staff as it is kept in their bedroom. These plans give information
Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 14 about the persons support needs and gives some instructions about how to support them to meet these. Staff keep daily records on the support and care that they have given to each person. This enables staff to ensure they are offering the support the person needs and will help staff to quickly note any changes that occur. However there is not always a care plan in place where an assessment shows that the person may be at risk. For example in two out of three care plans an assessment showed that the person was at high risk of developing pressure sores. However no written instructions were in the plan stating how the staff are preventing this from occurring. This lack of clear planning may lead to risks to the person’s health not being identified and dealt with. The plans viewed had been reviewed monthly, which addressed a requirement, which was made following the last inspection. This means that staff are checking to make sure that the information within the plan is still up to date. The manager has started to carry out care plan audits since the last visit to help to ensure that the care plans are written correctly and are up to date. This helps to ensure that staff have access to up to date written instructions and are therefore able to deliver the correct support and care. The people living at Elderhome get support to access health care professionals such as the GP and specialist Nurses when they need it. For example one person had been supported to see an Occupational Therapist in order for them to maintain as much of their independence as possible when attending to their personal care. Where possible staff will support people to attend outside health appointments. The people living at Elderholme said that they like the staff and that they get support to look after their health and personal care. The completed surveys provided a mixed view of whether the home provided a good standard of care. All agreed though that care staff work hard and provide a good service however some commented that communication between nursing staff was not as good as it should be and were able to give clear examples of when a breakdown in communication had occurred. Two other representatives praised the staff’s ability to care stating that they were first class and empathetic towards residents and relatives needs. One relative commented that they are always kept informed of any changes in care and that they could not wish for their relative to better cared for. Several of the people living there and their relatives said they do not always get a quick response when they use their call bell. No call bells are located in the lounge; therefore people cannot summon help whilst in there. Call bell sounds are very quiet and cannot always be heard by staff if they are in
Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 15 another bedroom. This could lead to people not getting the help and support they need as quickly as possible. Some of the instructions within the care plans referred to how to maintain peoples dignity and promote privacy. Staff were observed during the visit to be polite to the people living there and to knock on bedroom doors before entering. Two residents and a relative confirmed during discussions that staff did promote dignity and privacy. A discussion with the manager and reviewing literature revealed that she has developed Dignity champions training which she aims to deliver to all staff later in the year. The homes medications systems were viewed. In the past requirements were outstanding around management of medications. Relatives have also raised serious concerns regarding the management of medications. The manager has responded to this by carrying out weekly medication audits. The audits check that each resident has their prescribed medication available and that nurse staff are administering and managing this correctly. The medications for the six residents who were casetracked were viewed. All were found to be managed safely with staff keeping clear records of receipt, administration and disposal. The homes storage systems were viewed which are contained within a dedicated locked room. These were found to be organized with a system of stock rotation in progress. Two residents spoken with agreed that they always get their medication on time. Staff are recording the temperature of the storage room and the medication fridge. This was within range but was not being recorded daily. The stock of the medication fridge was viewed and a tube of eye ointment was found that did not need to be stored at such cool temperatures. The effect of medication can change if it is not stored at the right temperature. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents who don’t like group activities need to have support to undertake them individually. The home welcomes visitors and their opinion is sought through a relative’s group- this opportunity needs to be extended to residents also. EVIDENCE: Six care plans were viewed. Discussions were held with four of the people living there, two relatives, the cook and three members of staff. Activities records, menus and notices around the home were also viewed. The kitchen was visited. This information gathered showed that some attempts had been made to determine how people wished to spend their time but this was brief and usually happened shortly after admission to the home. This information had not been carried over to the actual plan of how to care for the person and the daily records kept by staff showed that people were spending their time doing other things than those, which had been identified on the plan. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 17 The people living at Elderholme can have newspapers delivered if they wish and also have their own TVs in their bedrooms. Records show that people often go out with their families or representatives and that some go home regularly. Signs displayed in the foyer of the home showed that a weekly minibus trip out occurs on a weekly basis and residents confirmed that this happens. A discussion took place with an activities organiser and records were also viewed. These revealed that the majority of the people living there are offered group activities on a regular basis but there appeared to be little planning or consultation with them about what was being provided. The home does not have residents meetings. The activities organiser revealed that due to the number of hours provided he is able to give some “one to one” support for those people who cannot participate in a group but that he would like to expand his hours to be able to offer more. On the first day of the visit some of the people living there were seen participating in a game of bingo and on day two were taking part in a singalong with an outside entertainer. Two people who did not wish to take part in the group activity were playing snakes and ladders in a quiet lounge with staff. Staff stated that they often undertook individual activities with people, however no records were available to support this. Activities rotas were pinned to various notice boards through out the home but some of these were out of date. A relative confirmed that they believed that staff do their best to provide stimulating activities. It was evident that the home receives a large amount of visitors. Two relatives spoken with said that staff were welcoming and friendly and always offered them a cup of tea. Both agreed that they felt that they knew what was going on in the home. However two surveys revealed that two relatives did not know what was going in the home without constant checking. The manager has liaised with outside religious groups and as a result regular church services are happening within the home. Communion is also available for those people who wish to take part. All surveys received stated that the food offered by the home was excellent. . Generally there is one main meal and a vegetarian option at lunchtime with a choice of lighter meals in the evening. Residents said that the meals are of a good quality and that they are offered a choice.
Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 18 A couple of residents said that they would like to have a cup of tea when they wake up as at present they have to wait for long periods of time. There is no formal process at the home for consulting with the people living there about the quality of food and ensuring as far as possible their wishes and views are taken into account. For example menu changes have been based on staff’s knowledge of residents preferences rather than asking the person themselves. The menus viewed showed that a variety of nutritious meals are made available. The manager has changed the use of one lounge into a second dining room since the last visit. Both dining rooms were observed during mealtime. Each was set nicely with tablecloths, napkins etc. Staff assisted people in a dignified and unhurried manner and served food to residents from a hot trolley. Staff were seen to be supporting people, whilst wearing their care uniform with no further protected clothing. This could increase the risk of cross infection occurring. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 19 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. Residents and relatives are not confident that their concerns will be listened to, however residents say that they feel safe and they are protected from abuse. EVIDENCE: Discussions were held with five residents and four relatives. There was a mixed response as to whether they knew how to complain and who to complain to. Two of the six surveys received stated that a relatives group had made complaints to the company secretary and relatives stated that an unsatisfactory response was received. A similar response was received from a further two surveys regarding individual concerns that had been made to the manager. Concerns forms were viewed in the foyer along with a copy of the homes complaints procedure. Complaints records showed that if the manager received a written complaint a thorough investigation is conducted with an outcome and action plan being sent to the complainant within timescale. However completed concerns forms are addressed by the manager but no record is made and no feed back given
Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 20 to the complainant which could be causing confusion and suggesting that all complaints are not investigated. This was discussed with the manager during feedback who agreed to address all concerns as” complaints” and to keep a record of any verbal concerns that are made also. A copy of the local authorities adult protection procedure was available in the homes office. A copy of the homes abuse prevention policy was also viewed. Four staff spoken with were able to correctly describe what abuse was and the action they would take if they suspected it had occurred. Viewing staff training records showed that training had been undertaken in this area. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 21 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. Elderholme is a safe, clean well-maintained place to live.However risk assessments do need to be developed around the use of the laundry, which could impact on this. EVIDENCE: A tour of the home was conducted which included viewing a selection of bedrooms, sluice areas and communal areas including bathrooms and toilets. The information gathered showed that overall the environment is clean and tidy with people being encouraged to personalise their own rooms. There are sufficient aids and adaptations to support people with their mobility and personal care needs. All lounges viewed appeared to have adequate comfortable seating and all areas were decorated to a good standard. However the way seating was
Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 22 positioned in the lounges and the environmental layout of the building meant that staff were walking through the middle of the lounge, which gave the impression that these areas were being used as corridors. The manager stated that she had tried to address this by moving seating about but residents always asked for the chairs to be moved back again. A discussion with the maintenance officer revealed that redecoration is on going with the majority of bedrooms being redecorated, as they became vacant. However the bedrooms of people who have lived there a long time were redecorated as needed or when the resident requested. The maintenance officer is also responsible for the up keep of the grounds. During the site visit these appeared very well tended and presented as a pleasant place to sit. The maintenance officer also explained that he did not work to a budget but had accounts set up at local stores where he could access whatever he needed for the homes maintenance. Through discussions with four members of staff it was evidenced that staff are aware of infection control measures and have the equipment and supplies to put these into place. However from 3pm each day until the following morning no staff are allowed in the laundry room to use the washing machines or dryers. This could lead to complications if there was an outbreak of infection and could impact on supplies of linen within the home. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all residents and relatives believe there are sufficient staff to meet residents needs. However residents like the staff and trust them. Staff have basic training but do not have the specialist training to meet the residents individual needs. EVIDENCE: Discussions were held with seven members of staff. All agreed that they had sufficient training to do their job with one stating that they had had” loads of training “ and another stating that “ this manager is really good about things like that. All agreed that although there had been many changes within the home they had been for the best. A newly qualified nurse stated that she had three full days induction and that the other qualified staff had been very supportive and welcoming towards her. Two of the staff spoken with were key workers for two of the people who were case tracked. They were able to describe their support needs in detail. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 24 All staff spoken with agreed that there were sufficient staff available providing all staff turned up for duty. They also agreed that the manager tried to get agency staff whenever sickness occurred. Off duty rotas were viewed for the previous month. The manager explained that a staffing increase had occurred around about August when the home became full. The off duty showed that the home is staffed with a supernumerary manager and deputy manager during the day. There are five nurses every morning with eleven care staff and the afternoon care staff numbers have been increased from eight to ten. Eight waking staff are available at night, two of whom are Nurses. The manager stated that she believed that the staff have good morale and a good team spirit. She also confirmed that a dependency tool is not in place to determine what staffing levels should be. The views of the residents and their relatives were mixed as regards to whether there are enough staff to support them. Some felt that changes to the staff team on each designated care area had an impact on the care provided, others felt that at times shortage of staff meant that relatives had to help provide basic care for their relative who lives there. The off duty showed that recently four staff had reported as unwell for duty on the same day and that the manager had sought agency staff. During discussions the manager confirmed that she does not monitor overall staff sickness levels within the home. Records showed that the manager does monitor individuals’ sickness record and follows company policy in dealing with these. A discussion with the activity organiser revealed that he had not received training in Dementia Care. The manager stated that this training was on going and not all staff within the home had received this training yet. A period of 30 minutes was spent sitting in one lounge with three residents. Through observation it was determined that staff interact very well with people when they are delivering care and support to that person but not when they approach them as a group. Viewing the forthcoming training “ Dignity Champions” showed that this topic was to be discussed. The manager expressed her intention to deliver this in the near future. All surveys received commented positively on the carer’s ability to care. Some criticisms were made about the nursing staff and the poor communication between this group. One relative stated that the staff were” gems” and that “ you couldn’t get any better”. Another stated that the staff were” very kind” and “very good”. One survey received also commented that it would be nice for people to receive care and support from a same sex member of staff and this thought was repeated by another relative during the visit.
Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 25 Viewing staff records showed that before anyone is employed to work at Elderhome a series of checks are carried out to ensure that they are safe and suitable to work there. Staff undertake training in basic care practices such as moving and handling people and fire as well as more specialist training such as use of medical equipment and nursing practices. However there is no set plan for training based upon the needs of the people living there. For example one persons plan showed that they had had a number of falls however there was no record of whether their primary nurse or other staff had had training in this area. Other records did show that Nurses undertake a specialist role within the home, for example taking the lead on tissue viability or Parkinson’s disease. This is good practice as it helps to ensure the team have up to date knowledge. However the lack of future planning for training may mean staff do not have all the skills they need to successfully support the people living there. Everyone spoken with said they liked the staff team and found them polite and helpful. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 26 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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed safely and the resident’s financial interests are safeguarded. However residents are not consulted and do not have a “ voice” therefore the home is not run in their best interests as it is not known what their opinion is. EVIDENCE: The manager has become registered with CSCI since the last visit. Discussions with the manager the Responsible Individual and the company secretary revealed that there are few management structures in place to monitor the service. The manager has addressed outstanding CSCI requirements and is carrying out audits which relate to residents health and safety (bedrails, wheelchairs)
Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 27 and has introduced audits which impact on care ( medications ,care planning). No audits are in place to monitor falls and accidents. A number of accident forms were viewed and these showed that there had been a decline in the number of falls since the staffing increase had occurred. The records viewed had been completed to a good standard and close examination of one (which resulted in hospital admission for a resident) showed that staff had acted in the best interests of the person and had sought appropriate advice. The manager signs all accident forms to show that she has seen them and records any further preventative actions taken. Staff have been provided with booklets which cover food hygiene, moving and handling and an introduction to health and safety. Training records showed that they had received basic training in these areas. Quality assurance was discussed with the manager and the responsible individual. Little progress has been made in this area and the views of the people who live at Elderholme are not sought on any aspect of the service provided. This means that they do not have a formal“ voice” and therefore are not encouraged to take ownership of the home. A relatives group has been formed at Elderholme since the last key inspection; this is attended by approximately 50 of residents relatives. The group meets regularly within Elderhome, however residents are not members of the group and do not attend meetings. Several members of the group said that they do not feel the organisation work in co-operation with them or listen to the suggestions they make that they believe would improve the service offered. Some staff spoken with said that they are aware of the groups existence and whilst they think it is a good idea they feel that their views are filtered down to them as criticism and this can have an affect on staff morale. Evidence was seen that not all of the relatives comments are responded to professionally and thoroughly and discussions with the group, senior management and staff indicate there is a conflict that may impact on the quality of care provided to the people living there and lead to genuine issues not being addressed for the benefit of the people living there A variety of records were viewed which related to Health and Safety. Fire records showed that necessary checks are carried out on a regular basis however staff have not carried out a practise fire evacuation since December 2006. small electrical appliance testing records and a discussion with the maintenance officer revealed that he had undertaken training and specialist equipment has been purchased so that he can undertake these checks himself Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 28 rather than relying on an outside contractor. There is an up to date fire risk assessment in place. A variety of contracts were viewed which showed that any machinery including hoists are regularly serviced for safety. Suitable Gas and Electricity certificates are also in place. Records viewed also showed that water temperatures are regularly tested. A discussion with the Responsible Individual revealed that Elderholme has a policy that they do not manage residents personal allowances. Relatives and representatives manage finances on their behalf. Some people have small amounts of cash in their rooms but their majority prefer any expenses to be billed to the person who manages their personal allowances. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 29 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 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 3 Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 30 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. 1. Standard OP14 Regulation Requirement Timescale for action 31/01/08 24. Residents must be consulted 1(a)(b)2,3 about their opinion of the home, how they wish to spend their time and how the home can match their expectations. This will ensure that they receive the support they need and choose. Residents must have access to a means of summoning help, which staff can respond to in a timely manner. Delays in answering call bells may seriously impact on the resident’s health and welfare. 2. OP38 12.-(1)(a) 30/11/07 Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 31 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 OP3 Good Practice Recommendations Assessment documentation should be clearer so that a full overview of peoples needs, likes dislikes and diagnosis are available to staff. This information should be signed and dated. Care plans should include all the persons needs not just those identified around the “activities of daily living”. The plans should also include their likes, dislikes and personal preferences. Assessments undertaken to identify risks to peoples health and welfare should be followed through on the plan of care so that written instructions are available detailing how this risk is to be reduced. Medication fridge and room temperatures should be recorded on a daily basis to ensure that medication is being stored at the correct temperature. Staff should check all items before choosing fridge storage to ensure that the medication needs to be stored at a cooler range than room temperature. I.e. Store medication in the fridge if a temperature of between 2 and 8 degrees is required. The provision of activities should be explored so that they are meaningful to people and are planned according to how they wish to spend their time. Records should be developed further to support this. Staff should be encouraged to wear clean protective clothing when serving food to reduce the risk of contamination occurring. The manager should ensure that all concerns are investigated in the same way that she investigates complaints and that records are made of any verbal concerns including actions taken and outcomes. Lounge areas should be reviewed to prevent them from being used as corridors and to promote privacy for the residents that use them.
DS0000020938.V347303.R01.S.doc Version 5.2 Page 32 2. OP7 3 OP8 4 OP9 5 OP12 6 7 OP15 OP16 8 OP19 Elderholme Nursing Home 9 OP26 10 11 12 13 OP27 OP30 OP38 OP38 The manager should risk assess the use of the laundry room and infection control policy to ensure that the lack of accessibility to the laundry for many hours in the day will not have a negative impact that could affect peoples well being. The manager should introduce tools to monitor peoples support needs and staff sickness so that staffing levels are flexible to meet the peoples current needs. The manager should develop a training plan based on staff strengths and weaknesses to ensure that staff are given the skills to meet the peoples individual needs. The manager should develop an audit around falls and accidents and act on the findings. Staff should carry out practise fire drills more frequently. Elderholme Nursing Home DS0000020938.V347303.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Merseyside Area Office 2nd Floor, South Wing Burlington House Crosby Road North Waterloo L22 0LG 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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