Inspection on 12/03/08 for Eleanor House Care Home

This inspection was carried out on 12th March 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Whiteley House

Tyndale Avenue

Elmleigh Convent

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Farm Residential Home Limited

Cranwell Court Care Home

Eastfield Residential Home

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

CARE HOME ADULTS 18-65 Eleanor House Care Home 19 Eleanor Street Grimsby North East Lincs DN32 9DT Lead Inspector Stephen Robertshaw Key Unannounced Inspection 12th March 2008 08:50 Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 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 Eleanor House Care Home DS0000070558.V360831.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 Adults 18-65. 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. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eleanor House Care Home Address 19 Eleanor Street Grimsby North East Lincs DN32 9DT 01472 359330 01472 359330 L.robinsoner@hotmail.co.uk 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) Kalbro Investments Ltd Miss Lynne Susan Robinson Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Eleanor House Care Home DS0000070558.V360831.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 service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 17 1st March 2007 Date of last inspection Brief Description of the Service: Eleanor House is a care home providing personal care and nursing including accommodation for up to 17 adults with mental health problems. The home is located near to the centre of Grimsby and is close to local shops and there is good access to the public transport system. The accommodation is provided over two floors, a passenger lift is available to the first floor. The home provides double occupancy and single occupancy bedrooms. None of the bedrooms have en-suite facilities. Bathrooms and toilets are provided within close proximity to rooms. Information about the home and services that it provides can be found in the homes statement of purpose and service user guide, both these documents are available from the manager at the home. The current weekly charge for services is between £522.00 and £650.00 per week; there are additional charges for hairdressing, private chiropody treatment, toiletries, newspapers and magazines etc. Some individuals are also expected to pay a top up charge of £63 agreed though third party arrangements. More current information about fees and charges can be obtained from the manager of the home. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was unannounced and took place on 12/03/08. the Commission were at the home for approximately six hours. The Commission gathered other information used for this inspection report from a variety of different sources since the time of the last inspection. This included an Annual Quality Assurance Assessment that was returned to the Commission by the homes management before the site visit took place. Surveys were also sent out to people that use the service, the care staff and we also contacted social workers for some of the service users that were case tracked. The inspector also spoke with eight of the people that live at the home, three care staff and the manager of the service. The Commission also looked around the home and looked at lots of the paperwork that involved the people that use the service: this included care plans, staff training records and other records relating to the running of the home. A number of the requirements detailed in this report are outstanding from previous inspections and if not addressed, could involve further action with the Commission. The owners of the home and manager are therefore, urged to address these outstanding matters, along with any new requirements, as a matter of both importance and urgency. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to him during this inspection. Their comments and input have been a valuable source of information, which has helped provide the information included in this report. What the service does well: The people that live at the home were all very positive about the home and said they like living there. The people that live in the home are given the opportunity to decorate their rooms to their own likes and comforts. The staff and the residents appear to have very good relationships with each other and the atmosphere between them is relaxed. This means that the residents are very settled and feel that they can rely of the staff for any support that they may need. The home is situated close to the centre of Grimsby. This means that the people that use the service can be helped to maintain their independence and persona lifestyles by accessing the local community. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the people that use the service have their needs assessed before they are admitted to the service. This means that the home only admits people that are inside their registration. However the assessment information was very basic and this could mean that all individual needs may not be identified at the time of the assessment. EVIDENCE: The service has been taken over by new providers since the last inspection. The homes statement of purpose at the time of the site visit was in the process of being updated to include the details of the new company. The homes service user guide also needed to be updated to include the details of the new proprietors. However the proprietor stated that a new document had been produced when he took over the service and this should have been available to the Commission at the time of the site visit. The manager of the home stated that new pre-admission assessment material had been established since the company was taken over. This format had not yet been used to determine if it would be appropriate or not. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 9 We looked at the care files for three people that were living at the home. They had all been admitted to the service following an assessment if their needs. These assessments were a combination of the homes pre-admission assessments and where appropriate care management assessments. The home needs to develop clear assessment materials that help to identify personal needs and how they affect individuals, including the support that they would require to help them with any difficulties. All of the records seen by the Commission supported that all people that use the service and received nursing care had an assessment completed by a National Health Service registered nurse from the local Primary Care Trust, to determine the level of nursing input required and to determine the amount of financial support they would receive. Interviews with care staff, management and discussions with people that use the service supported the evidence that the home has the capacity to meet the needs of the people that live there and in line with what the home is registered for. Staff training records also supported that they receive the mandatory training that is required. However some of this training needed to be refreshed for several members of staff. Care workers that were interviewed by the Commission were very knowledgeable about the needs of the people that they were responsible for. Information given by the manager and observation indicates all of the current people that use the service are white/British. However the manager of the home was confident that if required the home would be capable of supporting individuals with specific cultural or diverse needs. She accepted that this would also include specific training for the staff group. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that Individual care plans and risk assessments are in position for the people that use the service, however they are not always kept up to date and do not include clear detail of how needs should be actually met. This could impact on the care that individuals need and receive. EVIDENCE: The Commission case tracked three of the people that were living at the home. This included looking at all of the documentation relating to them at the home, speaking with them as individuals and sending surveys out to other people that are involved with them including families and social workers. The individual care plans had been developed from the needs that had been identified in people’s original assessments. The homes care plans were very basic and did not detail how individual’s needs affected their daily lives or the actual amount of support that they required to help them through their daily Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 11 lives, tasks and responsibilities. There was also no evidence to support that the people that use the service, or their representatives had agreed to the care plans. The care plans had not been evaluated on a regular basis to make sure that any changes that were required to the individual’s needs or care plans had been updated. This is needed to make sure that staff understand what care needs to be provided and when. This would also need to be in position if the manager employed new staff to the service or had to employ agency staff, otherwise they would not be able to determine how some individual’s care needs should be met through the service by reading the current care plans. Nursing care plans were very basic and generic and did not include how nursing care needs affected individual’s daily lives or the amount of support that they required. Where appropriate care plans had been supported with risk assessments, this included areas such as mobility, medication, smoking and use of public transport. Some risk assessments did not always identify the specific risks and the actions staff must take to eliminate or minimise these. It is important that risk assessments are kept up to date and that they are sufficiently detailed to provide staff with necessary the guidance to people that use the service safely and in the best interests of their health and welfare. There was evidence in the care files seen by the Commission that Care management regularly review their care plans and assessments with Eleanor House. Although some times this appears to simply be a paper exercise. All the people that use the service that were spoken to by the Commission said that they are able to make choices about things that matter to them and service users said staff respected their rights to make their own decisions. This included whether or not to become involved in activities or where to have their meals. One person said ‘I like it here, its not home but the people are very friendly and helpful’. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that people that use the service are enabled to keep in contact with family and friends. Some individuals have access to recreational and social activities, however the service still needs to further improve this area of need. EVIDENCE: We spoke with eight of the people that live at the home and they all confirmed that they have a good quality of life at the home. One person said ‘I like it here, the staff are friendly and helpful’. Individual care files seen by the Commission and direct observations supported the evidence that the people that live at the home are supported and encouraged to participate in the local community. However this has been Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 13 restricted in some way since the new company took responsibility for the service as they have reduced the staff availability on any shift. This means that staff are not always available to be able to support individuals to activities in the community. The staff stated that the routines of the home are planned in advance around the needs and wishes of the people that use the service. The individuals spoken to by the Commission said that they can get up from and retire to bed whenever it suited them. Staff observed by us demonstrated that they had a good working knowledge of the individuals that they were responsible for and this included their individual likes and dislikes, what to wear and religious observances. All of the individual care files seen by the Commission identified peoples religious beliefs and any support that they required to follow their beliefs. No visitors were seen at the home on the day of the site visit, and the homes records showed that people who live there receive few visitors from family and friends. A formal activity programme is not in place at the home, this means that people that use the service do not have access to written information about activities available in the home and in the community. Staff keep records of activities provided but these are not consistently recorded and are very basic in their content. They do not express how individuals reacted to the activities that were made available to them. One person said ‘I don’t like to do much so its (activities) ok for me’ however another said ‘I just watch television or read, there is nothing to do here it is boring’. There continues to be limited evidence to show how the social needs of more dependent residents are being met at the service. In the last report it was identified that ‘Service users social, recreational and psychological needs are not clearly identified in assessments, care plans and daily records. This indicates staff may need to look in more detail at peoples social stimulation needs to ensure daily activities are tailored to the individual wishes, needs and capabilities of some residents’. This remained the same at the time of this site visit by the Commission. The home does not have a dedicated activity co-ordinator and this causes some problems as nobody has the overall responsibility for identifying and implementing appropriate activities at the home and in the community. The manager stated that this is an area that is under consideration and accepted that it would benefit the people that use the service. Three meals are provided each day and a varied menu is available. However the menu is very basic and may not meet the nutritional needs of the people that use the service. Although there was a choice of lunchtime meal the main meal provided was chips, beans and egg. One person said ‘this is my favourite meal, but we don’t have it very often’. Another person said ‘the meals are not Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 14 very good here’. Staff spoken to by the Commission said that the meals are basic but they were of a good quality and said that a choice of food is always available. Fresh fruit is also left out available for people to take whenever they want some. Individual care plans include dietary likes and dislikes. Staff had a good knowledge of the service users food preferences, the portion size that they preferred and any support that they needed to finish their meals. None of the care plans identified any specific ethnic or cultural dietary requirements although the manager gave an assurance that the home would accommodate individual needs and choices where this was needed. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the people that use the service receive personal care in the way they wish to. However the mental health needs of residents although they are generally met they require some improvement in how they are care planned and this also includes the care plans for meeting the physical health needs of people that use the service. EVIDENCE: The Commission case tracked three of the people that live at the service. This included sending out questionnaires to people involved in their care, observation of documentation in the home that related to them, and interviews with the people that they involved and the care staff. People confirmed to us that they are treated with privacy, dignity and respect at all times at the home. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 16 The health care plans that were observed were generic and did not include any personal preferences as to how individual’s health care needs affected their daily lives and the support that they required to try to overcome these. Records were maintained for when people were seen by outside healthcare professionals including district nurses, general practitioners and psychiatrists. However the outcome of these contacts was not always recorded. This means that peoples individual healthcare needs may not be identified or supported at the home. Evidence to support that the mental health need’s of people that use the service is being monitored by regular consultations with their psychiatrist and staff support individuals to attend outpatient appointments where this is needed was seen by us. Peoples physical health needs are generally met at the home, however checks on a sample of care plans identified that the care plans need to be develop to include how the personal needs of each person must be met at the home. There was no evidence to support that the care plans and risk assessments are reviewed on a regular basis to assess if peoples needs have changed. At the time of the site visit there were no individual with pressure sores. The home has a clear medication policy and procedure. This includes a staff signature list for those authorised to administer medication to individuals that use the service. We examined medication administration records (MAR) for three of the people using the service. All of the records were up to date and hade been accurately recorded with any omissions. All of the prescribed medication was also appropriately stored. There were no controlled drugs in the home at the time of the visit. However the home maintains a controlled drugs book and appropriate lockable facilities to store controlled drugs. As a matter of good practice patient information leaflets of medication was included with individual medication records. The photo of the person receiving medication was also on the medication records. This is good practice, as it would help unfamiliar agency, or new staff to make sure that the prescribed medication was given to the person that it was meant for. We observed medication being administered to people that live at the service during the lunch period. The correct procedures were not observed to be followed, as the person giving out the medication did not witness the prescribed medication being taken by the people that they were meant for. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. This means that the service has clear policies and procedures for concerns, complaints and protection, however not all of the staff have received the training to support them with these areas. EVIDENCE: The manager of the service confirmed to the Commission that no formal complaints have been made to the home since the last inspection. The homes records also supported this evidence and no complaints had been received directly by the Commission. Staff interviewed by us, and returned questionnaires said they had no complaints about the home and felt confident to raise issues of concern if they arose with the manager and were confident that they would be appropriately dealt with. All of the people that use the service that were spoken to by the Commission said they were aware of how to complaint. Information was also available on the homes notice board in relation to advocacy services. The home also has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, management of challenging behaviours and management of residents money and financial affairs. No adult protection referrals have been made since the last inspection. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 18 Some of the staff training records showed that they had received some adult protection training however this was not the case for all of the staff group. The manager stated that adult protection was also part of individuals NVQ and induction training. We advised that more formal training should be provided to the staff in relation to the local authorities policies and procedures and reporting procedures. The staff interviewed by the Commission were clear in what they saw as safeguarding adults issues, but were not sure as to how to report any allegations or concerns they simply responded that they would report it to the nurse in charge or manager. There were not very clear of how to report suspected abuse if the manager or the person in charge was involved in the allegations. Staff have not received challenging behaviour training since the last inspection, however the manager stated that this area had been difficult to meet within the local area but she was sure that the training would be available in the near future for all of the staff. This is important because staff need to have the confidence, skills and knowledge to be able to deal with situations in a competent, consistent, safe and agreed way. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the environment of the home is suitable to the needs of the people that live there. However there are areas of the home that need improvement to provide a homely and safe environment for the people that use the service. EVIDENCE: We made a tour of the premises as part of the site visit. Since the last inspection of the service all of the windows in the home have been replaced with double glazed units. The windows were observed to include restrainers to minimise the risk of people falling through them, or unauthorised people entering the building. The manager also stated that the external doors are also going to be replaced in the near future. The lounge areas had been decorated and new carpets had been fitted. New carpets are planned for all of the corridors in the home. The home did not have Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 20 a maintenance and renewal plan that was open to inspection. The manager stated that the new proprietors were in the process of developing this and said that the owners of the service had already invested well in the improvement of the environment. It is essential the management of the service produce a maintenance and renewal of the fabric and redecoration plan for the home to show how and when essential redecoration and refurbishment work will be completed. The staff toilet had the seat missing. This must be replaced to uphold the health and safety of everyone using this area. One of the corridor ceilings had a large hole in it where there had been a water leak. This must be repaired as soon as possible to create a homely and safe environment. The bathroom and toilets in the home generally need to be decorated. There were some infection control concerns in the home. One bathroom included linen towels and blocks of soap and the linen cupboard upstairs was open and was able to be accessed by anyone. This could cause infection control problems if people with infectious diseases used any linen and replaced it in the cupboard. The hallway to the stairs and upper floor had wallpaper hanging off the walls and ceiling. This must be repaired or replaced to provide the users of the service with a suitable environment to meet their needs. The downstairs corridor has had the carpets replaced. However there is a trip hazard in the corridor where the floor changes height. This should be removed or the trip hazard must clearly be identified to support the health and safety of the people that live in and work at the service. All areas of the home seen by the Commission were seen to be clean, tidy and were free of any offensive odours. We were invited to look at several people’s bedrooms seen and these were seen to be clean and tidy. It was also obvious that the people that use the service are encouraged to personalise their own rooms to their own tastes and preferences. People that use the service that were spoken to said that they are happy with their individual rooms. One person said ‘I couldn’t look after myself at home, I like my room here, but I miss my facilities at home like hot water and a bath or a shower whenever I want one. Staff spoken to by the Commission said they had access to all the specialist equipment they needed to make sure that they could support the needs of people who use the service; this included a hoist and additional moving and handling equipment and good supplies of protective clothing. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the staff support the needs of the people that use the service, however the staff do not receive all of the training or formal supervision to make sure that they understand their roles and how to meet the needs of the individuals that use the service. EVIDENCE: Staff interviewed by the Commission clearly understood their own roles and responsibilities and those of their colleagues. Since the last inspection the management of the service have reduced the number of staff available on any shift at the home. There does not appear to be any relation to the number of residents and the reduction in the staff hours. The management of the home must provide a formal review of the staffing n needs at the home to the Commission. This should include the explanation of any reductions already made and provide the evidence where individual’s dependency has been re-assessed and how this will be monitored in the future to see that the staffing levels are effective. The management should also Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 22 identify how people that use the service, their families and funding authorities were consulted in relation to changing staff levels. Currently three staff are on duty in the morning and two in the afternoon and two at night. Staff and people that use the service that were spoken to by the Commission stated that they believe that more staff are needed to safely support the complex needs of the people that use the service. Some of the nurses who work in the home have other jobs. The manger of the home records the hours worked by the nurses at the home and in their other roles to make sure that they are not working too long hours putting themselves and others at risk. The home has a clear recruitment and selection policy and procedure is in place. The Commission observed the personal files for three of the staff working at the home. These all included Protection of Vulnerable Adult register checks, police (Criminal Records Bureau) checks, two written references, health checks and past work histories. Staff interviewed by us confirmed that they could not begin to work at the service until all of their clearances and references had been received. The home has a commitment to National Vocational Qualification (NVQ) training and a two care staff have successfully achieved NVQ level 2 or above and a number of to other staff have enrolled to complete an award. This means that 18.2 of the staff have reached the minimum requirement of NVQ training. The manager has developed a basic training plan to incorporate all of the mandatory and specialist training and updates required by the staff. The manager stated that most of the nurses working in the home have the majority of their training provided through their other roles. There was no record of this training available at the time of the site visit. It is important that all staff are up to date with all safe practice training. The homes induction package meets the Skills for Care Common Induction Standards criteria and is used with new staff. The homes records showed that no staff had been newly inducted to the staff group so these records could not be validated. Staff training records and interviews with care workers showed that some of them had attended a basic mental health course. There continues to be a need to introduce a rolling programme of training for more specialised subjects including the ‘Care Programme Approach’, challenging behaviour and specific mental health training. Failure to provide this training may mean that staff do not have all of the knowledge and skills that they need to meet the needs of the people that use the service and this could impact on the care they receive. It is also important annual appraisals are kept up to date. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 23 The manager has introduced a formal recorded staff supervision programme and each staff member has been allocated a supervisor. Observation of supervision and interviews with management and staff showed that this system has only recently been re-instigated and staff had not received the recommended minimum of six formal recorded supervision periods per year (pro-rata). This must be established to make sure that the staff have the necessary knowledge and skills to be able to care for the people that use the service. However following the draft report the proprietor of the service stated that the only hours that had been reduced were 10 ½ hours on the night shift. They also agreed to send to the Commission the formula that they had used to calculate the required staffing hours for the service. This will help us to identify how any judgement on the staffing ratios had been made at the service. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 and 43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that there has been some improvement in the overall management arrangements for the home, however further progress is needed to make sure that people that use the service and staff benefit from a consistent, wellmanaged and inclusive service. EVIDENCE: The manager of the home has been in position for approximately two years. She is a qualified Registered Mental Nurse (RN13). The manager has almost completed the Registered Managers Award and has completed a clinical leadership course. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 25 The manager was aware the staff supervision was a priority to be developed at the home and accepted that the employment of a specific activity co-ordinator at the home would benefit the need of the people that were living there. The manager of the home must be provided with formal recorded supervision to support them in their role and to identify any training or formal support that they require to do their job safely and in the best interests of the people that use and work in the home. Staff and people that use the service that were spoken to by the Commission said that the manager and deputy manager of the service are approachable and friendly, and listened and acted on what people told them. The home does not manage the finances of service users but keeps safe small amounts of personal allowance for several people. This is managed and recorded well. Some people chose to manage their own personal allowance and facilities to keep this, and other personal items safe is available in their individual bedrooms. Although the registered person visits the home on a regular basis there was no evidence to show they complete monthly reports, these must now be completed and a copy must be retained in the home and be open to inspection. This is an outstanding requirement for the service. The home did not have a formal quality assurance and monitoring system in position. This is important to identify how other people view the services that are provided through the home, and to make sure that relevant others are consulted about the running of the home and to show how the comments from these individuals have shaped or altered practices within the service. Records were observed for the maintenance and servicing of health and safety equipment at the home this included the passenger lift and hoist equipment. Certificates were also produced that showed that the gas and electrical supplies to the home were safe. Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 2 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 3 2 X X 3 2 Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? 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 YA2 Regulation 14 Requirement The registered person must make sure that all of the preadmission assessments completed by the home include enough personal detail so that care plans can be developed from them to support individuals needs in the way that they would expect. The registered person must ensure each service user has a care plan(s) setting out how all their care needs are to be met. Plans must be sufficiently detailed to ensure staff known what care is needed, when it is needed. When the needs of service users change plans must be updated to reflect these changes. (Previous timescale of 30/04/07 was not met) The care plans must also be reviewed on a regular basis to make sure that they are still appropriate to meet the individual needs of the people that use the service. Timescale for action 30/05/08 2. YA6 15 30/06/08 Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 28 3. YA9 13 The registered person must ensure moving and handling risk assessments are kept up to date and that are sufficiently detailed to provide staff with necessary guidance to support service users safely. Where the needs of service user change, risk assessment must be updated to reflect these Previous timescale of 30/04/07 was not met). The registered person must make sure that the people living at the home are provided with a varied and nutritional menu to support the health of the people that use the service. The registered person must make sure that all contact between people that live at the service and outside professionals is fully recorded including any outcomes from the contact itself. This means that any follow up treatments will always be identified for the individuals concerned. The registered person must make sure that when medication is administered is if given to the person that it is prescribed for and is observed to be taken before recording it in the medication records. This will make sure that the person who the medication is prescribed for receives it. The responsible person must ensure staff are provided with adult abuse training. (Previous timescales of 30.4.05, 31.9.05, 8.11.06 and 31/05/07 were not met). DS0000070558.V360831.R01.S.doc 30/06/08 4. YA17 16, (2), (i) 20/04/08 5. YA19 12,13 30/04/08 6. YA20 13, (2) 15/03/08 7. YA23 13(6) 21 30/07/08 Eleanor House Care Home Version 5.2 Page 29 8. YA24 23 The registered person must produce a maintenance and renewal of the fabric and redecoration plan for the home together with dates for completion of any identified work. This is needed to ensure service users live in a safe, comfortable and attractive home (Previous timescale of 30/04/07 was not met). 30/05/08 9. YA24 23 The registered person should 30/05/08 repair all of the damaged ceilings and walls in the home to provide a suitable environment for the people that use the service. The registered person must make sure that infection control policies and procedures and adhered to at the home. This will support the health and safety of the people that live and work in the home. The registered person must make the trip hazard in the downstairs corridor safe for anyone using it. The registered person should provide the Commission with details of how they have assessed the staffing levels for the home, the consultation that they included in the process and how the new levels will be monitored to support the health, safety and welfare of the people that use the service. The registered person must ensure the manager is provided with formal recorded supervision and an annual appraisal. (Previous timescales of 31.1.07 and 30/04/07 were not met). DS0000070558.V360831.R01.S.doc 10. YA27 16, (2), (j) 30/04/08 11. YA28 13, (4), (c) 30/05/08 12. YA33 18 (1), (a) 30/04/08 13. YA36 18 30/06/08 Eleanor House Care Home Version 5.2 Page 30 14. YA36 18 15. YA39 24 16. YA39 26 The registered person must 30/06/08 ensure that a staff supervision programme is implemented ensuring that all staff have access to a minimum of six sessions per year. (Previous timescales of 31.3.04, 31.8.06 and 30/04/07 were not met). The registered person must 30/06/08 develop and implement a structured QA programme. (Previous timescales of 31.1.05, 31.7.05, 30.4.06, 31.1.07 and 31/07/07 were not met). The registered person must 30/05/08 ensure regulation 26 visit reports are completed and copies of reports must be left in the care home (Previous timescale of 30/04/07 was not met). 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 YA12 Good Practice Recommendations The registered person should demonstrate that a healthy diet is made available at meal times and that make sure that the service promotes healthy eating to the people that use the service. The seat in the staff toilet should be replaced to support the health and safety of the people using this facility. The bathroom and toilet areas of the home all should be decorated to improve the quality of the environment. The registered person should make sure that the manager of the home completes her Registered Managers Award. The registered person must make sure that a minimum of 50 of the care staff have achieved NVQ 2 in care or equivalent 2. 3. 4. 5. YA27 YA27 YA37 YA32 Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Eleanor House Care Home DS0000070558.V360831.R01.S.doc Version 5.2 Page 32 - 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!