CARE HOMES FOR OLDER PEOPLE
Eleanor Palmer Trust Home 27 Cantelowes House Spring Close Barnet Hertfordshire EN5 2UR Lead Inspector
Tola Akinde-Hummel Unannounced Inspection 13th February 2006 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Eleanor Palmer Trust Home Address 27 Cantelowes House Spring Close Barnet Hertfordshire EN5 2UR 020 8364 8003 020 8449 7215 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) Eleanor Palmer Trust Ms Diane Burgess Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st July 2005 Brief Description of the Service: The Eleanor Palmer Trust is a care home registered to provide care for 32 older people. The home is owned by a registered charity called The Eleanor Palmer Trust. A board of Trustees manages it. The homes aims and objectives state that it provides accommodation where sensitive and skilful care is available and it aims to enable service users to live as normal a life as possible within an environment where they are respected. Eleanor Palmer is a purpose built care home on two floors. A lift shaft connects the two floors. There are thirty single bedrooms and one double bedroom. On the ground floor are interconnected lounge areas, a dining room, a reception area, and the main office, kitchen and laundry room. On the first floor, in addition to bedrooms, there is a large meeting room a kitchenette and the managers’ office. There is a communal assisted bathroom on each floor. There are gardens to the side and the rear of the home as well as the patio area. The gardens are paved and are accessible to service users. The Eleanor Palmer Trust Home is in a pleasant residential area of High Barnet close to local shops and amenities. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took approximately five hours to complete. The manager Ms Diane Burgess was available throughout the inspection. The inspector completed a tour of the building spoke in detail to three service users and four members of staff. The inspector sampled four care plans, examined medication recording and storage, observed a handover, sampled the safekeeping of service users finances and looked at training plans. The inspector received 20 service user comment cards, 13 from visitors and relatives, 3 from health and social care and 5 from GP’s. On the day of inspection, 1 senior carer and four care staff were on duty. The home had six vacancies at the time of inspection. Some service users in the home were preparing to attend day centre at the time of the inspectors’ arrival. What the service does well:
Eleanor Palmer Trust Home is a well- maintained, welcoming environment. Staff are appropriately familiar with service users and understand their needs. A total of fifteen service user comment cards stated that they feel well cared for and all comment cards received from relatives, GP’s and health and social care professionals state that they are satisfied with the care. One service user described the care staff as “very good, whatsoever you ask, they always say yes. They care about you”. The home provides a nutritious balanced diet for service users, which takes into consideration their preferences, health needs and culture. The menus are carefully selected for interest and variety. The home is managed in an open manner with the manager supporting care staff to take a more active role in running the home. This has increased the confidence of staff and promotes a more unified approach to the service delivery. The manager is committed to providing a quality service and seeks to rectify any areas for improvement swiftly. One care assistant stated, “ The best thing about the job is working with the service users in a friendly atmosphere. I am so enthusiastic about the job that I don’t rush to go home”. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 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. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 7 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 Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Service users are properly assessed prior to entering the home ensuring that the home is able to meet their needs. Improvements have been made to the care plans of service users. This provides staff with clear, easy to follow information about the needs of service users. EVIDENCE: Four service user plans were sampled. All files had assessments completed by the Local authority or Health Authority. These are suitably detailed. The assessment undertaken by the home compliments the initial assessment and provides other information relevant to the service users stay in the home. A service user new to the home stated, “ I was assessed by a social worker who gave me a list of homes. I visited here and had detailed discussions with the manager before I choose to move in”. The files inspected all had occupancy agreements some of which had been signed, others awaiting the signatures of service users or relatives.
Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 9 The previous requirement to ensure that care plans are standardised and assessing staff sign completed assessments has been met. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 The homes care plans; risk assessments and reviews are clear and up to date. This allows any changes in need to be identified and dealt with appropriately. The home must ensure that robust procedures are in place for staff where changes in medication administration are advised by the prescribing authorities. EVIDENCE: The new care plans in the home are easy to follow with alerts on the front sheet designed to draw the readers’ attention to specific difficulties experienced by the service users. Staff claimed this is particularly useful when dealing with emergency services that require information swiftly. Service users abilities are recorded as well as areas where extra support is needed. The plans cover all aspects of care including recreation, mobility and personal care. The plans include risk assessments for all areas of activity of service users. The new format is easy to follow and includes actions to be undertaken to minimise risk. The plans are also reviewed on a monthly basis. There is evidence that these plans are reviewed more regularly if there is deterioration in service users abilities. The manager advised that they receive support from the
Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 11 Mental Health Care of Older peoples’ team, the falls clinic, GP and other primary care services should the need arise. All service users are registered with a GP of their choice. The home deals with six separate GP practices with a total of 18 GP’s. Twelve service users stated that they like living in the home and feel well cared for all the time. Five stated that they like living there sometimes. All care plans examined have been signed with the exception of one where the service user has refused to sign and this is clearly documented. An inspection of the medication found that changes had been made to the times of administration for a number of patients. There was no evidence that this had been approved by the GP although staff stated that the pharmacist had advised them verbally. The labels on the MAR sheets had not been amended to reflect the change. This could pose a problem for staff that may be confused about the changes made in the absence of written guidelines. This will also confuse service users who know what medication is prescribed and when it should be taken. The temperature recording of the medication cabinet is not up to date. This must be done daily to guarantee that medicines are kept at the correct temperature. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 Service users in Eleanor Palmer Trust Home are encouraged to participate in activities arranged by the home. This promotes mental and physical exercise to maintain stimulation and minimise boredom. However opinions of service users need to be more formally sought. EVIDENCE: The home has a dedicated activities organiser who is responsible for ensuring service users are adequately stimulated during the day. These include board games, Tai Chi and reminiscence. On the day of inspection some service users had gone to a local day centre, others were playing board games and others were resting in the lounge and their bedrooms. The home has a room upstairs which is used as a reminiscence room. The room is well decorated with posters and pictures of old Barnet and surrounding areas relevant to peoples’ background and history. One service user said” The manager has arranged for me to attend the Chinese day centre I used to go to when I lived in the community” and added, “ I am also supported to attend church every Sunday which I enjoy”. Evidence shows that service users have a variety of activities both inside and outside of the home. However, the home does not formally organise residents
Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 13 meetings. This will enable the home to gain a wider opinion from service users about the way in which the home is run. Staff have decorated the lounge for Valentines Day and the cook has already planned the Valentines menu for service users. Service users are encouraged to bring personal items to the home. One service user who recently moved in explained that she has brought objects that she considers precious in to the home with her and this did not pose any problems. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 Service users live in a home that has a complaints procedure, which is accessible and transparent. This allows service users and their relatives to express their views about the quality of the service provided. EVIDENCE: Staff have received training on understanding abuse organised by The London Borough Of Barnet. The senior members of staff advised the inspector that following the training, they take the lead on training other staff members within the home. . The home has received two complaints since the previous inspection. These were concluded within timescale. The recording of complaints has now been improved to record the actions taken by the home when investigating complaints. This requirement has now been met. Fifteen out of twenty service users stated that they know whom to make a complaint to. The manager is very clear about the procedure for protecting service users from abuse and where appropriate shares information correctly and without delay. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20, 21 and 26 were examined at the previous inspection and assessed as met. EVIDENCE: Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 30 Staff in the home have access to ongoing training. This further increases their skills making the care provided to service users more professional and consistent. EVIDENCE: The home employs 22 Care staff. Twelve have completed NVQ level 2 and two are in the process of completing NVQ level 3. The home is committed to supporting staff to continue NVQ training. The home has employed two new staff members since the previous inspection. All induction training includes ensuring familiarity with the homes policies and procedures and practical foundation training such as fire awareness, infection control and manual handling. Staff in the home have access ongoing training, which is provided externally. All Staff have training profiles. Some staff have completed training including falls prevention, train the trainers and safe handling of medication. During handover with two senior members of staff, it was clear that staff are familiar with service users needs. Minor changes in behaviour, health, emotional and physical abilities are noted with suggestions of potential solutions to any problems. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 17 The home has a good skill mix of staff, which attempts to reflect the ethnicity of service users in the home. Staff are sensitive to the cultural backgrounds of service users and a planned international day will highlight to service users the cultural diversity of staff. Previous requirements relating to obtaining a full criminal records bureau check, and an additional reference for a member of domestic staff has been met. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, 38 The home is well managed and positive changes have been implemented to ensure smooth running of the home. EVIDENCE: The registered manager Ms Diane Burgess has now been in charge of the home for approximately nine months. The two senior staff members spoken to at the time of inspection stated, “It is a lot better here now, we know what is going on. Morale is good because the manager listens and if we are not happy about something we are able to say so”. The home has since reviewed all policies and procedures as required in the previous inspection. These were completed in August 2005. There have been some amendments made and policies bought for particular areas of the service.
Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 19 Service users finances were examined. The home has a system for managing service users finances. No service user has more than £20.00 at any one time kept on their behalf in the home. Separate accounting is in place for all individuals, which are signed for when relatives bring money for service users. This system was easy to follow with a clear audit trail. The home does not act as appointee for service users and family members take care of any investments of service users. The previous requirement to ensure that sauce bottles in the kitchen are labelled has been met. The kitchen is well organised and clean. The home is up to date with health and safety checks such as emergency lighting, Legionella and weekly fire tests. Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Sco3re 3 X 3 X 3 X X 3 Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 21 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 13 (2) Requirement The registered person must ensure that any changes to medication are properly recorded. The GP or pharmacist must make any changes in writing. These changes must be clear and accessible to staff administering medication. The registered person must ensure that the temperature of the medication cabinet is recorded daily. The registered person must formalise residents meetings and record the opinions of service users. Timescale for action 28/02/06 2. OP9 13 (2) 14/02/06 3. OP12 24 (1) 30/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Eleanor Palmer Trust Home DS0000010427.V271098.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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