Inspection on 14/07/09 for Eldon House

This inspection was carried out on 14th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Eldon House 09/02/10

Eldon House 26/07/07

Eldon House 29/08/06

Eldon House 04/01/06

Eldon House 06/07/05

Eldon House 04/03/05

Eldon House 13/09/04

Eldon House 29/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Eldon House 69 Ricardo Street Dresden Stoke-on-trent Staffordshire ST3 4EX Lead Inspector Linda Clowes Key Unannounced Inspection 14th July 2009 08:45 DS0000008224.V376034.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eldon House Address 69 Ricardo Street Dresden Stoke-on-trent Staffordshire ST3 4EX 01782 326620 01782 313633 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) Eldon House Care Services Ltd Mrs Susan Ibbs Care Home 34 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (34), Physical disability (16) of places Eldon House DS0000008224.V376034.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 Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 16 Dementia (DE) 6 Old age, not falling within any other category (OP) 34 The maximum number of service users who can be accommodated is: 34 26th July 2007 2. Date of last inspection Brief Description of the Service: Eldon House is registered to provide personal care and support for up to thirty four elderly people. Of these six may have dementia care needs and twelve may have a physical disability. The home is located in a quiet residential area in Dresden and close to Longton town centre. There is easy access by public transport. There are local shops and amenities close by. There is parking to the rear of the property. The home comprises a large detached Victorian property, and a single storey extension added some years ago. Accommodation is on three floors with access by passenger lift, stair chair lift or stairs. The lower ground floor has 9 bedrooms. The ground floor, where there are four lounge areas, dining room, kitchen and offices, has 15 bedrooms. The first floor provides a further 10 bedrooms. With the exception of one, all bedrooms are for single occupancy. There are eight en-suite bedrooms. Assisted bathrooms and toilets, including a shower room are located conveniently throughout the home on each of the three floors. The laundry is located in a Porto Cabin to the rear of the property and has good facilities. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 5 There is a well-kept garden to the front of the home which has attractive garden furniture and seating. A large garden shelter is provided for the use of residents who wish to smoke. This structure has exterior specification lighting so that it may be used after dark, if needed. The fees are not outlined in the home’s brochures and therefore the reader may wish to contact the service directly for this information. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is one star. This means that the people who use this service experience adequate quality outcomes. The last Key Inspection for this service took place on 26 July 2007 and the home was given a quality rating of two stars (good). We carried out an Annual Service Review on 25 July 2008 which identified from the information we received that the quality of the service had been maintained. It is our policy to carry out a Key Inspection visit every two years for a service with a quality rating of good. This was an unannounced Key Inspection. We inspected against the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The objective of the inspection is to evaluate whether people who use the service and their family carers experience services of good quality that offer and promote independence. The Deputy Manager, Mary Burrows, was present during this inspection which took place over a period of 9.5 hours. We looked at people’s assessments, care plans, personnel files, complaints files, medication records, and health and safety records and gave feedback throughout. We case tracked three of the people using the service. This is a focussed methodology that we use to analyse the care offered in the home. This means that we checked all aspects of their care and the records kept for them. We spoke to people using the service, their relatives, staff and analysed surveys received prior to the inspection. Prior to the inspection visit the providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to undertake a self-assessment which focuses on how well outcomes are met for people using the service. Information from this AQAA was used to plan the inspection visit and references to it have been made in this report. The AQAA was returned promptly and gave us a reasonable picture of the current situation within the service. Some information regarding staffing had not been completed. We were not informed how many staff have completed induction training or how many staff have National Vocational Qualification (NVQ) level 2 in care. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 7 A high number of people who use the service have dementia or confusion and are not able to give us a full response to some aspects of their care but all are able to tell us that staff are kind to them and help them. We spoke with several relatives on the day who are frequent visitors to the home and who were able to tell us that they are satisfied with the services provided at Eldon House. They tell us they are made welcome and have observed over many months good interaction between the staff team and people who use the service. People who responded to surveys tell us they are satisfied with the service stating, “They are doing everything they can. I have no concerns”, “They look after our needs, entertain us, and feed us well”, and “As far as I am concerned I don’t think they could look after us better”. As a consequence of this visit we identified concerns, mainly with medication that we have asked the management to address without delay. From the information provided, we also identified that when recruiting care staff the service is not taking up all the necessary checks to protect people who use the service. We have made five requirements and sixteen recommendations as a result of this visit. What the service does well: Discussions with people who use the service and feedback from surveys identify high satisfaction rates regarding the quality of services provided by the home. There is an Activities Programme that people tell us they can take part in if they want to. People are encouraged to maintain community links with family and local facilities. The service helps people who need assistance with shopping or other activities. People’s healthcare needs are promptly addressed with regular reviews for eyesight, hearing and other such healthcare monitoring. Community Nurses and Community Psychiatric Nurses visit the home on a regular basis. There is a stable staff team which provides stability and consistency for people who use the service. What has improved since the last inspection? All radiators have been covered to comply with a requirement in the last inspection report. This has greatly improved the health and safety of people who use the service. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 8 Fire Risk Assessments have been introduced and fire training is carried out. There is an on-going programme of refurbishment and redecoration. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 9 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 Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides information, including a current Service Users Guide, so that people are able to make an informed choice about whether the home is suitable for them. No person moves into the home without having their needs assessed. EVIDENCE: No requirements were made in this outcome area in the last Key Inspection report. The home was fully occupied on the day of this visit, although two people were in hospital. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 11 The AQAA tells us that the home “Provides a Residents’ Handbook to all new prospective residents. The information is listed as A-Z of the Home”. We consider this document could be further improved by including information about the number, relevant qualifications and experience of the staff working at the care home. We have made this a recommendation as part of this report. (Recommendation 1) We looked at a random sample of files for people who reside in the home. We found that the manager had carried out an assessment of the person’s needs prior to admission to the home. We could not find confirmation that the home had written to say they are able to meet the individual’s care needs on any of the files. As we have reviewed our inspection process in line with the Inspecting for Better Lives framework we no longer make this a requirement even though it is part of the regulations (Regulation 14(d)). We do, however, consider it good practice. We have, therefore, made a recommendation in this report regarding this matter. (Recommendation 3) Thirty-two people were accommodated in the home on the day of our visit. Many were able to tell us about their lives in the home, although some have dementia or confusion that makes it difficult for them to relay some aspects of their lives in the home. Six people pay for their care privately, the rest are supported under contracts with the local authority. One of the people whom we case tracked paid for their own care but we found no copy of the contract for services in the person’s file. We asked to see a copy of the latest contract for people who paid for their own care. However, this was not available. We have, therefore, made a recommendation that a copy of the Contract is issued to each person who pays for their own care and that a copy be held on each person’s file in order that they may be clear about their Terms and Conditions of Residency in the Home. (Recommendation 2) Information about the fees charged by the home was not available in their documentation. The AQAA tells us that “trial periods are always available”. Two of the three people we case tracked could not recall their admission (they had been in the home for some time) and the third had been admitted directly from hospital. It is understood that any person who is funded by the local authority has a sixweekly review following admission to determine whether everyone is satisfied with the placement in the home. This allows the person who receives the service and their family carers the opportunity to give their views about the care they receive at Eldon House. Eldon House does not provide intermediate care and so Standard 6 (Intermediate Care) was not assessed. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 12 Eldon House DS0000008224.V376034.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Plans provide sufficient information to enable staff to deliver a personcentred service in which people are treated with respect and their rights to privacy are upheld. The home’s procedures in regard to medication put the people who use the service at risk of harm. EVIDENCE: No requirements or recommendations were made in this outcome area in the last Key Inspection Report. The AQAA tells us that, “All residents have a care plan which has been drawn up in conjunction with all concerned”. We found support plans set up by the Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 14 home, generated from the social work care plan and the home’s own preadmission assessment for all three people we case tracked to inform care staff how to provide for the person’s care needs. Reviews of the Support Plans were carried out once a month or at point of change. We spoke with the three people being case tracked and two sets of visiting relatives as well as a number of other people who use the service. We also observed staff interaction with people who use the service. Personal support is, in the main, responsive to people’s varied and individual needs and preferences. People tell us that staff are kind and considerate. We observed people being encouraged to be as independent as possible. Staff we spoke with had an overall understanding of the needs of people living in the home and were seen to be patient and kindly when interacting with them. Relatives spoken with were satisfied with the services provided by Eldon House. We received comments such as, “(name) is very settled here. I visit regularly and (name) is always well dressed. I am happy with the way they look after (name)”. Another said, “I have been visiting for several years. (name) is well looked after. Even though they are very forgetful and cannot remember what they had for lunch, they always appear relaxed. Staff in the home are always very welcoming”. Information in the AQAA tells us, “We take great care in checking for & preventing pressure sores & we have charts on file and update as & when needed”. We spoke with one person who complained of being uncomfortable in their seat. We identified that they should be using a specialist support cushion as pressure relief. This was not in place. We discussed this situation with the Deputy Manager and she addressed the situation immediately. It is important that people with fragile skin have use of the equipment they need at all times and we have made a recommendation regarding this issue. (Recommendation 4) Records show that people have access to healthcare and remedial services. The service ensures that people unable to leave the home receive visits from general practitioners and other healthcare professionals. In relation to medication the AQAA states, “Dealing with medication is a very high priority & only Senior Care deal with drugs. They attend refresher courses. Also our chemist visits to ensure we are correctly storing & recording for all drugs given. All residents have an individual MAR (medication administration record) chart where the staff sign for giving out and notes any refusals”. The AQAA also tells us, “From feedback received we feel that our Home is ran to a high standard both in Personal Care & in General. We feel that even though we are working to a high standard, improvements can always be made, as & when needed”. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 15 We monitored the lunchtime medication round. We are concerned that some medication is not being administered as prescribed. We saw gaps in some of the MAR charts. We discussed this fully with the Deputy Manager on the day and outline some of the other medication issues discussed below as illustration: Controlled Drugs must be stored in a specific Controlled Drugs Cabinet which is appropriately secured to the wall. The home does not have a controlled drugs cabinet and, therefore, controlled drugs are not being stored as required by regulations. We have made a requirement regarding this issue. (Requirement 1) We have also recommended that the service uses a controlled drugs register which requires the signatures of two people when administering such drugs and also shows a clear audit trail for the controlled drugs. (Recommendation 5) It was identified that prescribed creams and drops are being stored in people’s bedrooms and administered, by staff who have not received medication training. There is no robust administration record being completed to show when and who has administered some prescribed treatments as required by the regulations. This includes prescribed creams and drops. We saw a record for the administration of eye drops which did not have the person’s name recorded and the record showed that eye drops had not been administered at bedtime for five nights in a row. We have made a requirement regarding this issue. (Requirement 2) All staff who are involved with the administration of prescribed treatments, including creams and drops, should receive training on how to administer and how to maintain an accurate record in order that they are able to accurately demonstrate that such treatments/medicines are administered as prescribed. (Requirement 3) Medication should be included within the home’s risk assessment framework in order to provide staff with written instructions on how prescribed treatments and prescribed medicines are to be administered. We have made a recommendation regarding this matter. (Recommendation 7) We were unable to identify the quantities held in the home of some prescribed medicines. We were unable to find prescription labels for prescribed pain relief tablets and therefore we were not able to monitor whether these are being administered as prescribed by their doctor. We found loose foil blister sheets of pain relief tablets in the medication trolley. We were not able to determine whose pain relief tablets these were. Prescribed medication must be administered only to the individual for whom it is prescribed. The system of ‘pooling’ pain relief at Eldon House is totally unacceptable. We have made a requirement regarding this issue. (Requirement 4) Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 16 We have also made a good practice recommendation that a good quality, current photograph of people who use the service is attached to their Medication Administration Record as this would promote the health and safety of people who use the service. (Recommendation 6) We are concerned that the present medication systems put people using the service at risk and that the home is unable to demonstrate that people receive their prescribed medication. We will return to the Eldon House to monitor progress with medication procedures and practices. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a relaxed and welcoming atmosphere. Routines are flexible to accommodate individual choice. The home offers a wholesome diet to suit people’s individual needs. EVIDENCE: No requirements or recommendations were made in this outcome area in the last Key Inspection report. Generally, staff are aware of the need to support people who use the service to develop their skills including social, emotional, communication and independent living skills. Individual rising and retiring times are accommodated. Televisions were switched on in three lounges throughout the day, although not many people we spoke to said they were watching them. The home Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 18 provides a ‘quiet’ room where people can sit away from televisions if they so choose. People who use the service have the opportunity to develop and maintain important personal and family relationships. Relatives were observed visiting the home and being received by people who use the service either in the lounge areas or their bedrooms. Relatives told us that they are always made welcome in the home whatever time they visit. One relative told us that they visit the home most days and that, “Everyone is very kind. They are very good with (name)”. The following comments were added to surveys by relatives: “They look after all my mother’s needs and they always try their best to make her happy”. “The staff are extremely caring, supportive and make my mother feel very much at home” “They look after my mother’s needs”. “The service provides everything that is needed”. “I am pleased with how my mother is looked after. The staff are very caring and seem genuine”. “We are highly satisfied with all aspects of the service”. The front garden has been redesigned and new outdoor furniture provided so that people can enjoy the warm weather. We did not monitor menus or the kitchen on this visit. The Environmental Health Officer inspected the kitchen during their visit on 30 June 2009 and has made recommendations for improvements which the home will need to implement. People told us on the day that they enjoyed the food served and that they are able to make suggestions for items to be added to menus. One person who responded to the surveys felt, “There could be more variety”. We observed people eating lunch and teas on the day. Care staff were sensitive to the needs of those people who find it difficult to eat and gave prompts or assistance when required, making them feel comfortable and unhurried. Sandwiches for teatime were prepared by the cook, although cooked teas (e.g. beans or egg on toast, hot dogs) were prepared by care assistants. The AQAA tells us that one catering staff and two care staff have received training in safe Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 19 food handling. It is important than anyone who prepares food in the care home receives Food Hygiene training in order to promote best practice and we have made a recommendation about this as part of this report under the Management and Administration Section (Recommendation 15). One staff member who responded to the surveys tells us that they consider the home could do better by providing, “More activities!!”. The AQAA says that, “All activities are by choice, everyone is persuaded to participate but no one is forced. We try to arrange 2/3 main outings a year, e.g. going to Rhyl, Blackpool, going to the Theatre”. People told us that there is a choice of activities such as bingo, dominoes, cards and crafts. Someone visits to play the organ and encourages people to sing along. Everyone’s birthday is celebrated with a Birthday Tea (if they wish). Relatives are encouraged to take part in any activities and trips. The home traditionally holds an annual Summer Fete to which families and neighbours are invited. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their relatives are confident that their complaints are listened to and appropriately handled. The people using the service need to be confident that the service knows how to respond appropriately to any issues of suspected abuse or neglect. EVIDENCE: The service has a complaints procedure which is up to date and readily available. Details about the home’s complaints procedure are contained in the ‘Service User Guide’. The complaints procedure is also displayed in the home. Relatives spoken with told us they know how to complain. People who use the service told us they would speak with staff or the manager if they were unhappy. The Director told us in the AQAA that they had received one complaint since the last Key Inspection on 26 July 2007 which had been investigated and Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 21 resolved. We have received no complaints about the home in the last twelve months. There were policies and procedures for safeguarding people who use the service and staff are aware that where they have concerns they must raise these with the manager. Staff are given information about “Whistle Blowing” procedures at the start of their employment so that they know what to do if they have concerns about someone. The AQAA tells us that they have made no safeguarding referrals in the past twelve months. We received information about one safeguarding alert regarding Eldon House and discussed this with the Deputy Manager who confirmed that the issues had been investigated and resolved. We discussed safeguarding procedures with the Deputy Manager. She was unaware of the current Staffordshire and Stoke-on-Trent Safeguarding Protocols and Procedures. It is important that the home has a copy of these procedures so that they know how to respond and who to contact should there be concerns about abuse or neglect in relation to anyone who is accommodated in the home. We gave contact information so that the service can contact local Safeguarding Co-ordinators to obtain a copy of the current Safeguarding Procedures and have made this a recommendation as part of this report. The manager will also need to ensure that the whole staff team receives training updates in line with the new safeguarding procedures. (Recommendation 8) We have made a recommendation for the home to ensure that people are further protected from abuse or neglect by monitoring the competence of all staff who are involved in the recording, handling, safe keeping, safe administration and disposal of medicines received into the home. (Recommendation 9) The deputy manager was aware of the need to introduce advocacy services should these be appropriate where users may lack capacity. She confirmed that the home has a copy of the Mental Capacity Act and Deprivation of Liberty Act. These will advise her how to seek appropriate assistance. People we spoke with told us they feel comfortable and safe in the home. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and clean but would benefit from being upgraded to better assist and promote independence for people who have dementia care needs. EVIDENCE: One requirement was made in this outcome area in the last Key Inspection report. The home was asked to ensure that all radiators and pipe work are maintained at a temperature of 43 degrees centigrade in order to protect people who use the service from risk of harm. We checked a random sample of bedrooms and communal areas and found that this requirement had been complied with by the fitting of radiator covers. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 23 The home is registered to provide services to people who have dementia. Some of the existing people who use the service also exhibit some confusion. In view of the size and geography of the home we have made a good practice recommendation that signage and colour coding and other aids to living are introduced that will promote independence for as long as possible for people who have dementia. (Recommendation 10) The last inspection report made a good practice recommendation for the laundry floor to be covered with an impermeable material. This had not been implemented and will be carried over into this report. It is important that appropriate flooring is fitted in order to keep the area hygienic and to reduce the risk of cross-contamination. (Recommendation 11) There is an outside covered area at the home that is the designated smoking area for people who live in the home. The AQAA confirms that hygiene equipment is available and carpets are regularly deep cleaned, although there was a strong malodour in the main corridor on the day of our visit. The AQAA also states that, “Decoration & maintenance is an onward going event. We have recently had areas of the home redecorated”. People told us they are comfortable in the home and it usually smells clean and fresh. We visited a sample of bedrooms and found these clean and tidy and decorated to personal choice and style. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from a stable workforce. The recruitment practices do not fully protect people who use the service. EVIDENCE: No requirements were made in this outcome area in the last inspection report The home employs a care staff team of eighteen. We have been informed that no shifts have been covered by agency staff in the past three months. We are unsure about the qualifications of the care staff team as the AQAA does not give details about the number of staff with NVQ level 2 in care although it does state, “Staff are working towards their NVQ level 2. Some have achieved level 3, 1 level 4 & 1 level 5”. The service tells us that six people with dementia are accommodated in the home. However, we were unable to confirm from the information provided that staff have received training in dementia awareness and have recommended that this is introduced as soon as possible. Staff have also told Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 25 us in surveys that they would like more training to help them with their job. See quotes from surveys below. (Recommendation 12) It was not possible to easily identify what training has been provided to all staff in the home. We have recommended that a Training Matrix is introduced that will show all staff training, together with dates of training, ‘at a glance’. This will allow the manager when undertaking supervision of staff to quickly identify training needs and when refresher courses need to be provided. It will also be a useful tool to demonstrate that staff have the skills mix to meet the needs of people who use the service. (Recommendation 13) We left surveys for staff in order that they could tell us about their employment in the home. We received seven responses. Feedback was positive with all staff expressing satisfaction with their employment at Eldon House. The following comments were added to surveys: “The home is a lovely place to work”. “I am proud to be part of the team at this home. I would like more information about training”. “I would like more training so that I can do my job well”. “The home should give more training”. “They should give more training on different needs” “I would like to see the residents going on more trips”. “The home provides for every resident well and it’s always kept clean & tidy”. We looked at the files of two care staff. One had commenced work on 17/12/08 but the Criminal Record Bureau Enhanced Disclosure (CRB -police check) was dated 21/06/09 some six months later. There was no record to confirm that a POVA First check had been taken up. There was only one reference instead of two. There was no Job Application Form in the file. For the second, who was employed in October 2008, there was no record of a POVA First check or a CRB check on file. We asked the Deputy Manager whether there was any documentation filed elsewhere but she said she expected all recruitment information to be in staff personnel files. It is imperative that the service has robust recruitment procedures and ensures that no one is deployed in the home without thorough checks in order Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 26 to protect the vulnerable people in its care. The regulations give specific details of the documents required under Regulation 17(2) Schedule 4. We have made a requirement regarding this issue as part of this report. (Requirement 5) Both staff had attended training for moving and handling and induction training which includes protection of vulnerable adults from abuse (safeguarding) training. The AQAA states, “Some staff have attended training days for Parkinson’s disease and Incontinence & we hope to add to this”. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed by a registered manager who is qualified and experienced. Some areas need to be managed more effectively in order that the health and welfare of people who use the service are better promoted and protected. EVIDENCE: No requirements were made in this outcome area in the last Key Inspection report. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 28 The manager has the required qualifications and experience to run the home. The AQAA, which is a legal document, was completed by the Director of Care. It could be improved by providing examples to support the statements made. There was also some incomplete statistical information. People who returned surveys and whom we spoke with on the day expressed satisfaction with the service they received at Eldon House. There is low staff turnover and several staff have worked in the home for many years providing consistency for people who use the service. From information provided we are able to confirm that regular staff supervision takes place and staff tell us in surveys they are well supported by the managers in the home. Management need to monitor the medication practices in the home regularly to ensure that people receive their medication as prescribed, that staff are competent and that records are accurate and complete. It was not possible to confirm from the information provided that hoists, including bath hoists, are being tested and maintained as required by regulation (six monthly). (Recommendation 14). We were shown a letter to the home from the Environmental Health Officer that stated, “Certain items were found to require some action”. We could not locate the gas or the electricity maintenance records. We were advised by the Deputy Manager that Gas and Electricity Certificates have been requested by the Environmental Health Officer. The home is reminded that annual maintenance documents must be readily available for inspection in the care home in order to demonstrate that routine maintenance is taking place. We have made a recommendation regarding this issue. (Recommendation 16) The AQAA tells us that only three permanent staff in the home have received training in safe food handling. We have made a recommendation that all staff involved in food preparation should hold a current Food Hygiene Certificate. (Recommendation 15) There was evidence to confirm that Fire Alarms are being tested weekly and that fire training is taking place. Fire equipment is regularly maintained. The last Fire training was recorded as 21/2/09. We understand that the Fire Authority recommend that night staff have training every three months and suggest that the manager discusses this with the Fire Authority. The home is responsible for the security and handling of small sums of money for a number of people who use the service. We looked at the finances of three people and found these to be satisfactory with supporting documentation that showed a clear audit trail. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 29 During our tour of the building we found quantities of hazardous materials stored in an insecure area. We have made a recommendation about the secure storage of Controlled Substances Hazardous to Health as part of this report. (Recommendation 17) There was current insurance in place. The current Certificate of Registration is displayed in the home as required by our regulations. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 30 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 2 3 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 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 3 17 x 18 2 3 x x x 3 x 3 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x 3 x 2 2 Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 31 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 OP9 Regulation 12(1)(a) & 13(2) Requirement The service shall provide a suitable approved cabinet/cupboard for the storage of controlled drugs as required by the Misuse of Drugs (Safe Custody) Regulations and ensure that the controlled drugs held by the home are stored in this facility. This will promote security and comply with regulations. The service shall ensure that the recording of the receipt, administration and disposal of prescribed treatments is robust and accurate so that the home can readily demonstrate that treatments have been administered as prescribed. This will promote the health and welfare of people who use the service. All staff who are responsible for the administration of prescribed treatments, including creams and drops, should receive training on how to administer and maintain an accurate record of such treatments. The home must ensure that all staff are DS0000008224.V376034.R01.S.doc Timescale for action 14/10/09 2 OP9 12(1)(a) & 13(2) 21/08/09 3 OP9 12(1)(a) & 13(2) 15/09/09 Eldon House Version 5.2 Page 32 4 OP9 12(1)(a) & 13(2) 5 OP29 19(4)(a), (b,)(c) & 19(5)(a), (d) & 17(2) Schedule 4 competent to administer prescribed treatments. This will assure people who use the service that they are in safe hands. The home must ensure that medicines prescribed for an individual are administered only to the individual for whom they are prescribed. This will protect the health and welfare of people who use the service. No person shall be deployed in the home until full and satisfactory written information is obtained which includes the taking up of Criminal Record Bureau Enhanced Disclosures (police checks), POVA First checks and two written references. This is to protect people who use the service from risk of harm. 21/08/09 21/08/09 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 OP1 2 OP2 Refer to Standard Good Practice Recommendations The Statement of Purpose would be further improved by adding the numbers of staff and their qualifications who are employed at the home as outlined in Schedule 1 of the Regulations. The home should issue a contract to all people who fund their own care a copy of which should be held on their case file. This will ensure that people are fully aware of the terms and conditions of residency in the home. Prior to admission to the home the registered person should confirm in writing to prospective people who wish to use the service that, having regard to the care needs assessment, the care home is suitable for the purpose of DS0000008224.V376034.R01.S.doc Version 5.2 Page 33 3 OP4 Eldon House 4 OP8 5 OP9 6 OP9 7 OP9 8 OP18 9 OP18 10 OP19 11 12 OP26 OP30 13 OP30 meeting the person’s needs in respect of his health and welfare. This will assure people who wish to reside in the home that their needs will be met. (Regulation 14(d)). The home should ensure that where pressure relieving cushions are recommended for people who use the service, these are in place. This will promote the comfort, health and welfare of people who use the service. It is recommended that the service uses a controlled drugs register for the receipt, administration and disposal of controlled drugs. This will promote good practice in providing an audit trail for controlled drugs. A good quality current photograph of people who use the service should be attached to the Medication. Administration Record as this would promote health and safety for people who use the service. Prescribed medication should be included in the home’s risk assessment procedures in order to provide thorough written advice to staff on the way it should be administered and other relevant information. The manager should contact the local authority Safeguarding Co-ordinators to obtain a copy of the current Safeguarding Procedures. This will enable the service to respond appropriately to any situations of suspected abuse or neglect. There should be robust procedures and practices in place to monitor the competence of staff who are involved in the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. This will protect the health and welfare of people who use the service. It is recommended that the service considers providing signage and colour coding to enable people who have dementia or confusion to find their way around the home. This will promote their independence for as long as possible. It is recommended that the service ensure that the laundry floor is covered with an impermeable finish to promote hygiene and reduce risk of cross-contamination. Good quality, specialist training should be provided to the staff team in order to meet the changing needs of people who use the service. For example, as the home is registered to provide care to people with dementia, appropriate dementia care training should be provided in order that staff are aware how to respond to and how to meet people’s specific needs. It is recommended that a Training Matrix is introduced so that all staff training (together with dates) is visible ‘at a glance’. This will promote health and safety in the home DS0000008224.V376034.R01.S.doc Version 5.2 Page 34 Eldon House 14 OP38 15 OP38 16 OP38 17 OP38 and enable the manager to monitor and demonstrate that all mandatory and specialist training has taken place and is up to date. All hoists in the home need to be tested and maintained regularly to comply with regulations. This will protect the health and safety of people who use the service. All staff responsible for food preparation should hold a current Food Hygiene Certificate. This will promote health and hygiene for the benefit of people who use the service. The home should maintain a record of the routine maintenance of equipment in the home, e.g. gas boilers and five year electrical wiring certificate, located at the home to demonstrate that such equipment has been maintained as required by regulation. This will promote health and safety for the benefit of people who use the service. The service should ensure that all hazardous materials are stored securely in the home to comply with the Control of Substances Hazardous to Health (COSHH) Regulations. This will protect the health and safety of people who use the service. Eldon House DS0000008224.V376034.R01.S.doc Version 5.2 Page 35 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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