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Inspection on 16/01/06 for Eliot House Nursing Home

Also see our care home review for Eliot House Nursing Home for more information

This inspection was carried out on 16th January 2006.

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 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

Residents expressed the view that their care needs were met. This home provides a pleasant, homely environment for residents who live here. Those residents spoken to expressed their satisfaction about those aspects of the care provided. The care staff are a competent team who were observed to be kind and polite when speaking to residents.

What has improved since the last inspection?

The home has addressed the one of the two recommendations made at the last inspection. Since that last inspection six bedrooms carpets have been fitted, new dining room furniture acquired and kitchen appliances as well as a new washing machine has been purcased.

What the care home could do better:

There was no evidence found in this inspection that the following procedures or practices have been undertaken: 1. There was no evidence of residents` or their representatives were involved in the development of, or agreement with, care plans, care admission assessments or risk assessments. 2. Medication was found not to be accurately recorded and two tablets were found on the floor. 3. The home does not have a training profile to show that mandatory training has been carried out. 4. The home has not achieved the required number of staff who are trained to National Vocational Qualifications level 2.5. There is no evidence that new staff have undertaken National Training for Social Care (TOPSS). The homes induction process was seen to be limited in the time given to new care workers for their training needs. 6. The home does not have relevant guidance from the Social Services Department regarding the protection of vulnerable adults. 7. Care staff have not undertaken adult protection training.8. Neither formal supervision or appraisals have been undertaken with care staff. 9. Admission assessment forms do not record the likes and dislikes of prospective residents relating to all aspects of their daily living. 10. A tour of the home found that one bedroom had an unpleasant odour. 11. The homes complaint forms do not have a space for complainants to sign confirming that their complaint has been addressed satisfactorily or not.

CARE HOMES FOR OLDER PEOPLE Eliot House Nursing Home Crooked Billet Street Morton Gainsborough Lincs DN21 3AH Lead Inspector Mr Doug Tunmore Unannounced Inspection 16th January 2006 09:20 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 Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 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. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Eliot House Nursing Home Address Crooked Billet Street Morton Gainsborough Lincs DN21 3AH 01427 617545 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) MPS Care Homes Ltd Care Home 29 Category(ies) of Dementia (29), Mental disorder, excluding registration, with number learning disability or dementia (29), Old age, of places not falling within any other category (29) Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person will: a) provide external support from within the organisation to the home. b) review the current management arrangements within the home within three months of purchase to determine the employment of a manager for registration. The home is registered to provide personal and nursing care for service users of both sexes whose primary needs fall within the following categories: Dementia - over 55 years of age Mental Disorder, excluding learning disability or dementia - over 55 years of age Old age, not falling within any other category The maximum number of service users to be accommodated is 29. Date of last inspection 9th June 2005 2. Brief Description of the Service: Eliott house is a care home providing personal care and nursing care for 29 people who are accommodated within the category of older people all within the category of dementia or mental disorder. The care home is set in the village of Morton, which can be found on the outskirts of Gainsborough. The care home is a listed building, a new extension has been added to the rear of the property. It is surrounded by its own gardens which are totally fenced in providing security for service users staying at the care home. There are a number of patio areas outside the home where service users can sit in the summer months. There are public transport services to the care home and parking is provided at the front of the home. Additional on street parking is available. There are local shops and public houses within walking distance of the care home. The first floor of the care home can be accessed by staircase or a lift. The home has 25 single rooms and 2 double bedrooms. Fourteen of the rooms have toilet facilities. The home was purchased by new owners in May 2005. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. The main method of inspection used was called case tracking, which involved selecting two residents and tracking the care they receive through the checking of their records, policies and procedures and discussion with them, the care staff and observations of care practice. The manager, staff and residents were very open to the inspection. A partial tour of the premises took place. What the service does well: What has improved since the last inspection? What they could do better: There was no evidence found in this inspection that the following procedures or practices have been undertaken: 1. There was no evidence of residents’ or their representatives were involved in the development of, or agreement with, care plans, care admission assessments or risk assessments. 2. Medication was found not to be accurately recorded and two tablets were found on the floor. 3. The home does not have a training profile to show that mandatory training has been carried out. 4. The home has not achieved the required number of staff who are trained to National Vocational Qualifications level 2. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 6 5. There is no evidence that new staff have undertaken National Training for Social Care (TOPSS). The homes induction process was seen to be limited in the time given to new care workers for their training needs. 6. The home does not have relevant guidance from the Social Services Department regarding the protection of vulnerable adults. 7. Care staff have not undertaken adult protection training. 8. Neither formal supervision or appraisals have been undertaken with care staff. 9. Admission assessment forms do not record the likes and dislikes of prospective residents relating to all aspects of their daily living. 10. A tour of the home found that one bedroom had an unpleasant odour. 11. The homes complaint forms do not have a space for complainants to sign confirming that their complaint has been addressed satisfactorily or not. 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. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 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 Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 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): 3 The home needs to amend it assessment process to ensure that residents needs are met. EVIDENCE: The homes admission assessment carried out prior to the admission of prospective residents to the home was seen and did not include the likes or dislikes of residents relating to all aspects of their daily living. One residents files showed that social workers had completed assessments for the home relating to the care needs of residents. Residents being case tracked were not always able to give a considered view of the care they receive due to their age and those infirmities that come with old age. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 9 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&9 Neither residents nor their representatives are involved in the care plans. The home does not administer medication appropriately. EVIDENCE: Residents care plans seen describe the health and welfare needs of residents. Care plans and risk assessments did not evidence the involvement of residents and, or their relatives and were not signed by the resident or their representative. One resident said that she was not aware she had care plans and had not signed anything. nother resident commented that ‘its alright here, they get you anything you want’. No visitors were seen at the time of this inspection. Medication given at lunchtime by a nurse was seen to have been handled by the nurse and not delivered from the blister pact to a container and then given to a resident. It was also found that the medication sheets had not been completed after the breakfast medication was given out, with two gaps, which had not been initialled by the nurse. A tour of the building found two medicine capsules on the floor one in bedroom 17 and another in the medication Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 10 cupboard. The above poor practice is a breach of the homes guidelines on administering and recording of medication. A resident stated ‘that staff give me medicine in the morning and at lunchtime’. The pharmacist inspected the home on the 28/11/05 and recorded that homely remedies and admin records are well kept. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 11 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): The above standards were not inspected on this occasion. EVIDENCE: Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 12 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 & 18 Residents are not empowered by the homes complaints procedure. The home does not have robust adult protection procedures for the protection of residents. EVIDENCE: The complaints form was seen and it was found that there was not a place for a complainant to sign to signify whether they agreed with the outcome or not. A resident said that ‘she had not made a complaint and the matron will sit and understand you’. The home was found not to have Lincolnshire County Councils Adult Protection Procedures nor The Department of Health’s guidelines ‘No Secrets’. These documents must be obtained for the information of the manager and care staff and for the protection of residents. A carer stated that she had not undertaken adult protection training in the home. She also said that if abuse came to her attention she would inform the manager of the home of the Social Service Department. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 13 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): 26 The homes cleaning programme is not effective in addressing unpleasant odours in the home. EVIDENCE: A partial tour of the home found that one bedroom had an unpleasant odour. The acting manager confirmed that the carpet was new and that a cleaning programme had been introduced due to the problems experienced by the resident who lives in this room. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 14 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): 27, 29,30 Appropriate recruitment practices are in place. Staffing level meets the needs of residents. The home does not provide adequate training for care staff. EVIDENCE: Two personnel file seen contained CRB checks (Criminal Record Bureau), references and application forms. All care workers have seen The General Social Care Council Codes of Practice, which sets out their responsibilities as care workers looking after vulnerable adults. The home has thirteen care workers, five nurses, a kitchen assistant, one cook, a cleaner and a maintenance man who is part time. The staff rota showed that adequate staffing levels are available during the night and daytime. A nurse commented that the current staffing levels enables the home to meet the needs of residents living in this home. The home does not have a record of training undertaken by care staff or a planned training programme for the coming year. Two care workers have NVQ (National Vocational Qualifications) level 3, with six carers awaiting to start NVQ training. The home does not meet the standard for 50 of its staff trained to NVQ level 2 by 2005. However, it is recognised that steps are being taken to address this training need. The homes initial training (induction) for new staff was seen and it was found that most of the training for a new worker had been undertaken in one day on the 18/12/05. This training encompasses reading the homes policies and Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 15 procedures, fire training, introduction to residents etc. should take at least two to three weeks. This initial training None of the care workers undertake the National Training for Social Care (TOPSS) induction training. The acting manger commented that TOPSS induction training for care workers is to be introduced in the near future. Not all mandatory training has been made available in the home with moving and handling not undertaken by care staff. One carer stated that she had undertaken; fire training, food hygiene, continence training and infection control. One care worker demonstrated a clear understanding of her role and responsibilities. She said that she would be undertaking nursing training in the coming year. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 16 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): 36 & 38 Records seen show that residents’ health and general welfare and safety are promoted. All care workers have not had annual appraisals undertaken or supervision. EVIDENCE: There are a range of policies and procedures available in the home relating to fire safety and fire risk assessments. There was also evidence that fire alarm, fire drills and emergency lighting checks have been undertaken. Care staff also receive fire training as part of the homes initial training. The Fire officer inspected this home on the 12/08/05 and made a requirement, which has been addressed. Neither supervision nor annual appraisals have been undertaken in the home. There was no records to show that the formal supervision of staff had taken place. The acting manager commented that she has the appraisal forms but was unable to find the supervision record. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 17 Certificates were available showing that the shaft lift, bath hoists, and electrical equipment had been serviced. All wheelchairs seen on the day of the inspection had footplates, which were in use. Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 x x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X 3 Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? yes 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 3 Regulation 14(a) Requirement All assessments on prospective residents must be completed with likes and dislikes recorded relating to all aspects of their daily living. The home must ensure that consultation with residents and relatives is undertaken and that care plans and risk assessments are signed to confirmed agreement on the care to be delivered. The home must record and administer medication as per the homes policies and be mindful of signing for medication when given, not contaminating medication and ensuring that medication is not dropped on the floor. The home must obtain those documents and guidelines required for the protection of residents from abuse. The home must ensure that all workers employed at this home undertake adult protection training. The registered person must keep DS0000063148.V278351.R01.S.doc Timescale for action 14/02/06 2 OP7 15 14/02/06 3 OP9 13(2) 14/02/06 4 OP18 13(6) 14/02/06 5 OP18 13(6) 14/02/06 6 OP26 16(2)(k) 14/02/06 Page 20 Eliot House Nursing Home Version 5.1 7 OP28 18(1) 8 OP30 18(c)(i) 9 10 11 OP30 OP30 OP36 18(c )(i) 18(c )(i) 18(2) the care home free from offensive odours. The home must have a minimum ratio of 50 trained staff members to NVQ level two excluding the registered manager. The home must ensure that new staff undertakes appropriate in house induction training so that residents are well cared for and safe. The home must record all training and planned training to be undertaken by staff. The registered person must ensure that all staff undertake mandatory training. The acting manager is recommended to review the homes policy and procedure for the supervision and appraisal are care staff to ensure that the national minimum standards are being met. (The timescale of 09/06/05 has not been met). It is acknowledged that this was a recommendation at that time. 25/09/06 14/02/06 14/02/06 25/05/06 25/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP16 Good Practice Recommendations The home must empower residents/representatives in enabling them to sign the complaints form agreeing or otherwise to the outcome of any complaint they have made. The home should adopt TOPSS induction and foundation training to ensure that staff are aware of their care duties and responsibilities. 2 OP30 Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 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 Eliot House Nursing Home DS0000063148.V278351.R01.S.doc Version 5.1 Page 22 - 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. 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