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Inspection on 27/04/09 for Eldonian House Care Centre

Also see our care home review for Eldonian House Care Centre for more information

This inspection was carried out on 27th April 2009.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Eldonian House is a community based home that provides care for older people. Many of the people who live in the home used to live in the area or have links there, as do many of the staff. The home was built by a community organisation and has firm roots in the area. Many relatives visited whilst we were in the home. People have comfortable bedrooms with en suite facilities and can take their meals in the spacious dining room or in their own room if they want. Care plans set out what the staff need to do to care for the residents. Most staff have appropriate qualifications and there is a training programme. The food at Eldonian House is of a high standard, and people have the choice of two cooked meals a day plus a cooked breakfast if they want one.

What has improved since the last inspection?

A new, experienced manager has been appointed since the last inspection. He has introduced new care plans and is in the process of developing an improved training programme. The keeping of staff records for new staff has improved since we last visited. Medication is well organised and the new manager has carried out a complete review of medication procedures. The dining room furniture has been replaced. The new manager has stared to provide the leadership that the home needs to continue its improvement.

What the care home could do better:

The staff supervision and training programmes need to be developed further to ensure that staff continue to be well trained and able to meet the needs of the people who live at Eldonian House. Some furniture needs to be replaced, so the owners need to continue with the programme of refurbishment.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Eldonian House Care Centre Eldonian Way Liverpool Merseyside L3 6JL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Cresswell     Date: 2 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Eldonian House Care Centre Eldonian Way Liverpool Merseyside L3 6JL 01512982989 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Raydonborne Limited care home 30 Number of places (if applicable): Under 65 Over 65 0 30 dementia old age, not falling within any other category Additional conditions: 30 0 The registered person may provide the following category of service only: Care home only - Code PC 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 Dementia - Code DE The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief description of the care home Eldonian House is a purpose built care home for 30 older people. It is part of the Eldonian Village in the Vauxhall area of north Liverpool, close to the city centre. The home is near to pubs, local shops and the community facilities of the village such as the village hall. The home is registered to accommodate older people with dementia. One person under 65 years old with physical disabilities also lives at the home. Residents with dementia (generally referred to as EMI meaning elderly mentally infirm) are located in a self contained unit called the Seren Unit within the home. Seren is the Welsh word for star. All of the residents have single rooms with en suite facilities. There are two main lounges, one of which is in the Seren Unit, the other in Care Homes for Older People Page 4 of 25 1 2 1 0 2 0 0 8 Brief description of the care home the main part of the home and solely for the use of the other residents. Each wing has a small self contained courtyard and there is a spacious dining room. The home was built by the Eldonian Community but is now run by Raydonborne Ltd who operate the home on a leasehold basis. Eldonian House charges fees of between £335 and £420 a week, depending on the needs of the individual. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means that the people who use the service experience good quality outcomes. As part of this inspection we visited the home without telling anyone that we were going. During that visit we spoke to the new manager (Roger Merchant) the owner and the administrator. We also spoke to a number of staff, several people who live in the home and five of their relatives. We sat with some of the residents whilst they took part in one of the activities provided by the activities organiser. We looked at all areas of the home including bedrooms and the kitchen. We looked at documents including assessments, care plans, safety records and recruitment files. The manager completed an Annual Quality Assurance Assessment (AQAA) before we visited the home. This is a document that we require and it gives the service a chance to provide its own assessment of how it is performing Care Homes for Older People Page 6 of 25 as well as some statistical information. We last inspected this home on 14 April 2008 and a pharmacist inspector also inspected the home in October 2008 What the care home does well: What has improved since the last inspection? 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 set out 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. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Eldonian Houses admission procedures make sure that people are only admitted if the home can meet their needs. People have sufficient information before they move in. Evidence: The new manager has revised the service users guide which gives detailed information for new and existing residents. If somebody wants to move into the home the manager or his deputy go and assess them where they are living. We looked at three files for people who had moved in recently. Two of them had assessment forms completed and these contained the information needed to assess if the home could meet their needs. There was no assessment of their dementia and the manager said that for nearly all referrals he would already have a social work or health assessment. These are not, unfortunately always sent in promptly so it may be sensible to include some basic details of a persons mental state on the Eldonian assessment form. One of the assessment forms was not in the file, having been misplaced, but a detailed care Care Homes for Older People Page 10 of 25 Evidence: plan was already in place. The relatives we spoke to confirmed that they and their relative had been able to visit Eldonian House before making a final decision. Eldonian House does not provide intermediate care so Standard 6 does not apply. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and daily reports ensure that people receive the care that they need. Medication is safely administered, ensuring that people receive the treatment that has been prescribed for them. Evidence: The new manager has introduced new, detailed care plans. We looked at the plans for three people who live at the home. The plans included a brief summary sheet, initial assessments (such as Waterlow skin integrity assessments) and detailed plans and risk assessments for areas such as diet, skin care, falls, manual handling and washing. All of the cases we looked at had detailed and informative personal life histories which gave a detailed and valuable picture of the sort of life the person had led before they came into the care home and their interests. Staff sometimes only see the older person before them and can miss all of the factors that made them who they are. Staff do make daily reports but they were not always detailed and it may help if the summaries were placed in the daily reports file (as long it is kept securely) to inform staffs reports, helping to relate them to the care plan. In two cases an important piece Care Homes for Older People Page 12 of 25 Evidence: of information had not been included in the care plan. In one case the action required was in place and was recorded elsewhere but it is important that this type of information, which is an essential part of everyday care, is included in the care plan. In the other case the incident was very recent and the required action had not been taken. The manager agreed to pursue the issue immediately but it is important that staff refer on and fully record any action that is needed to ensure peoples safety. All of the care plans and risk assessments were regularly reviewed, with the reviews dated and signed by the key worker. We spoke to a number of relatives and they told us that the staff treated the residents with dignity and friendliness. Everyone is registered with local GPs and a community matron is a regular visitor to the home. She told us that she had a good relationship with the home and felt that the management and staff worked well with health professionals. Following an inspection by a pharmacist inspector from the Commission for Social Care Inspection (now the Care Quality Commission) the new manager has carried out a complete review of how the home deals with medication. He has introduced new systems for monitoring the receipt and return of medication and arranged for large quantities of surplus medication to be returned. Most medication is provided in a monitored dosage system where most tablets are in individual sets of blister packs for each person. Medication is kept in a secure treatment and medication room. Controlled drugs are kept in a CD cabinet and their administration was recorded properly. We looked at the medication for three individuals and found that on the whole it was properly stored and administered. Where any medication is to be administered as required there should be detailed guidance as to what that means in each case. This had been done in most cases but we did find a cream where no such guidance was in place. Most entries were properly made though there was one minor error where a mistake had been made with one tablet which was to be administered every other day. If an error like this is made it should be recorded. Any medication that needs to be kept refrigerated is kept in a lockable specialised fridge. Its temperature is checked every day to make sure that medication is kept safely. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 arranges activities and social events to meet peoples expectations and needs. People who live at Eldonian House feel part of the community and keep links with their families. The balanced, traditional diet meets peoples dietary needs and likes. Evidence: The home has appointed an activities organiser who works 15 hours a week. She arranges a variety of activities for the residents and we watched them playing a game of reminiscence bingo. Other activities include games, exercises, a visiting singer and some trips out. People go to tea dances and other activities at a local centre. The manager told us that the singer performs songs that many of the residents know and he feels that the response he gets shows that the entertainment has a marked therapeutic benefit. When people find it difficult to take part in group activities the organiser spends individual time with them. For instance, one resident who does not like tea dances has been taken on alternative trips, including one to Liverpool One. Residents are now members of Merseylink which makes it easier for them to get out and about, with staff support. The home keeps a record of the activities that have been organised with individual records for every resident. One person said that he Care Homes for Older People Page 14 of 25 Evidence: goes to the pub on his own but most people would not be able to do this. Some of the relatives we spoke to felt that more activities would help the residents, though this may have implications for staff costs. The manager said that the intention is for staff to see activities as part of the residents day, not an extra. Eldonian House has firm roots in the community with many of the people who live and work there either living in the area or having lived there in the past. Friends and relatives are encouraged to come into the home and we spoke to a number of visitors during our visit to the home. The menu is varied but consists largely of traditional foods, which the residents have told staff that they like. The main meal is three courses and is usually served at lunchtime, with a formal choice available. We spoke to one person during lunch and he ordered a meal which was not on the menu at all; it was quickly prepared and served to him. He and other people told us that they can always have a choice of their own. The chef said that he does home baking and cakes are always available in the afternoon. One relative told us that her mother had put weight on since moving to Eldonian House. The meal at tea time is also usually a cooked meal and choices are available. Several residents told us that they have a cooked breakfast if they want one. The manager and catering staff are consulting relatives and residents about refreshing and revising the menu. Everyone who talked to us said that they enjoyed the meals and people certainly enjoyed lunch (casserole with mash and vegetables was the main course) whilst we were there. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Eldonians policies for dealing with complaints and safeguarding issues protect the interests of the people who live in the home. Evidence: The manager told us that he and his staff always try to diffuse situations before they become complaints. The home also has a clear complaints procedure and keeps a record of complaints. One complaint had been brought to the attention of the Commission so we checked the records and found that it had been dealt with properly in accordance with the homes complaints procedure. Staff are encouraged to immediately make a report on any incident that they feel had the potential to develop into a complaint. Eldonian has a policy on safeguarding and staff have been trained in how to respond to any allegations of mistreatment. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Eldonian House have well furnished, en suite individual rooms to ensure their privacy and comfort. Evidence: Eldonian House is purpose built for the care of older people. It has two wings, one of which - the Seren (Star) wing - is specifically for the care of people with dementia. The home is gradually moving to care solely for people with dementia so the manager is considering ways of ensuring that those remaining people without dementia have adequate space for themselves during the process. The Seren Unit is protected by keypads to keep residents secure. One of them did not work when we visited and the handyman was sent to repair it as a matter of priority. The Seren unit has a small smoking room for those residents who still smoke. There is a seperate smoking room for other residents. The dining room furniture has been replaced since we last inspected the home and was attractively laid out for lunch, with tablecloths and teapots, during our visit. There are original paintings on the wall giving the room an attractive and individual appearance. New curtains and window dressings are on order. The home has two internal courtyards but they are rather bare and the manager has plans for growing flowers there to make them more attractive for the residents. The two bathrooms (both with assisted baths) and the shower romm are spacious and were clean, though some tiling did need to be replaced in the shower room. Care Homes for Older People Page 17 of 25 Evidence: All of the residents have single en suite bedrooms. Most of them are personalised with photos and decorations to reflect their tastes and personalities. Some bed rails had been fitted to beds for the safety of the residents and risk assessments are carried out when they are used. The rooms were well decorated and furnished though some of the armchairs needed to be replaced or renovated (if possible). The manager said that there is a programme of replacing furniture as and when necessary and when resources permit. The owners of the building are planning to replace all of the windows and to refurbish the en suites. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 needs of people who live in the home are met by qualified, experienced staff. New staff are checked before they start to make sure that they are suitable. Evidence: Most of the homes care staff now have NVQ2 or above in care, which is the appropriate qualification for this work. So people who live at Eldonian House are cared for by people who have the right skills to do so. The new manager has introduced a training programme and this year has concentrated on Moving and Handling and Medication. He and the owner have discussed training with outside agencies and have plans for further training on a range of issues in the coming year, including First Aid, Challenging Behaviour, Safeguarding Adults, Dementia and Nutrition. The management carry out the proper checks on new staff to make sure that inappropriate staff are not recruited. It is essential that evidence of these checks is retained until we have had the chance to see it at the subsequent inspection. The manager and his senior staff have begun a staff supervision programme, where staff have regular one to one sessions with a manager. This helps their development and identifies training needs. The manager concedes that the programme needs to be developed further. Care Homes for Older People Page 19 of 25 Evidence: The home is normally staffed by the manager, senior care and four care staff as well as ancillary staff such as domestic staff, catering staff and the handyman. At night all staff are now on waking duty. We talked to a number of relatives who were visiting and they all spoke very highly of the staff, as did those residents we were able to speak to. One told us that the girls were lovely. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 new manager is providing leadership and is driving improvements which are benefitting the people who live at Eldonian House. Evidence: A new manager has been appointed. He is experienced and qualified, having run care homes before. He has applied to the Care Quality Commission to be registered as the manager. Relatives told us that they felt that the new manager was having a positive impact on the home. The owner, Mrs Pamela Haddock, visits the home frequently and checks on standards in the home. She does not keep a record of monthly visits and should do so, though they do not need to be sent to us. She also carries out regular audits of the home. It may be helpful to develop regular surveys of relatives to ensure that proper feedback is recorded and acted on. The manager has started to consult relatives and residents on issues in the home such as the menu. The administrator deals with a small number Care Homes for Older People Page 21 of 25 Evidence: of residents personal allowances and keeps an accurate record of them. Fire safety records were up to date. The electrical safety certificate was dated 8 August 2006 and the electrical contractor has told the home that it is valid for five years but this is not on the certificate. The manager should make a note of this and when a new certificate is obtained ensure that it has an expiry date. A gas contractor was visiting the home the following week to renew the safety certificate which had run out on 10 April. There should be a central record of when safety certificates are needed so that there is no gap between them. Records are in general well maintained and are securely stored in the offices. The kitchen was clean and well organised. The kitchen staff use the Food Safety Agencys programme Safer Food, Better Business to record food safety checks and the records were up to date. An Environmental Health Officer had visited the home in October 2008 and the few items of action he had requested had been dealt with. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 36 18(2) The registered person shall 01/10/2008 ensure that all staff are appropriately supervised and must therefore arrange for a programme of recorded one to one supervision for all staff. Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 All information that indicates that action needs to be taken should be recorded on the care plan to make sure that all staff involved know about it. Where medication is prescribed to be taken as required the details of when it is to be used should be recorded. The administration of all prescribed meoidication, including creams, should be recorded on a medication administration record (MAR) sheet The owner should continue with their programme of replacing furniture and redecoration. The broken key pad and tiling should be repaired. There should be a record kept of when health, safety and maintenance checks need to be renewed. 2 9 3 19 4 38 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!