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Inspection on 19/04/06 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 19th April 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

A resident and three relatives expressed the view that the home provides good care and treats residents with respect and dignity. This home provides a pleasant, homely and clean environment for residents who live here. Relatives are actively encouraged to visit and join in the homes activities if they so wish. The three visitors confirmed that they are daily visitors and stay for meals and help their relatives to eat their meals. The home provides daily activities, which are tailored to the need and age of residents. The staff are a competent team who were observed to be kind and polite when speaking to residents.

What has improved since the last inspection?

A key unannounced inspection was made on the 16/01/06, which resulted in a large number of requirements being made. Due to this an additional visit was made on the 10/02/06 which found that efforts had been made to address previous requirements made in January 2006. This inspection found that further improvements have been made in relation to previous requirements made. All residents are assessed before admission, the majority of care plans are now signed by residents or relatives confirming that they agree with the plan of care. The home has introduced a revised training programme for all care staff.

What the care home could do better:

Residents and relatives are not empowered by the homes complaints procedures. The home does not carry out regular residents/relatives meetings or a quality monitoring system and publish the findings for the information of residents and visitors. The home must keep residents monies separate with an up to date account, which can be checked on a key inspection. The home must ensure that hoists and shaft lift are serviced when required.

CARE HOMES FOR OLDER PEOPLE Eliot House Nursing Home Crooked Billet Street Morton Gainsborough Lincs DN21 3AH Lead Inspector Mr Doug Tunmore Unannounced Inspection 19th April 2006 09:00 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.V290015.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.V290015.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 Karen Bowler 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.V290015.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 10 February 2006 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.V290015.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took any previous information held by CSCI, about Eliot House into account. The site inspection consisted of case tracking a sample of the resident’s records and assessing their care. The inspector spoke with one resident, three relatives and one member of staff. A partial tour of the home and a review of a sample of the records was also included. What the service does well: What has improved since the last inspection? What they could do better: Residents and relatives are not empowered by the homes complaints procedures. The home does not carry out regular residents/relatives meetings or a quality monitoring system and publish the findings for the information of residents and visitors. The home must keep residents monies separate with an up to date account, which can be checked on a key inspection. The home must ensure that hoists and shaft lift are serviced when required. Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 6 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.V290015.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.V290015.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 carries out care assessments on all prospective residents prior to admission. EVIDENCE: A review of all information available prior to this inspection and evidence seen at this inspection in residents files and care plans showed that the home does not admit residents without a care assessment being undertaken. Prospective residents are also written to by the home confirming that they can meet the residents care needs or not. 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.V290015.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, 8, 9 & 10 Residents or their representatives are involved in the care plans. The home does not administer medication appropriately to all residents. There is good care planning in this home, which helps ensure that the general health and welfare of residents is addressed. EVIDENCE: A review of all information available prior to this inspection and the additional inspection carried out at this home evidenced that either residents or their relatives are involved in the care plans and sign them to confirm that they agree with the care being provided. Care plans evidence that health care professionals visit the home and that residents when required visit the hospital. Three visitors commented that they are happy with the care provided and confirmed that their relatives see the GP and the chiropodist. Residents files also showed that personal care required is documented and mention is made of maintaining the residents dignity and privacy at all times. Daily entries had been made in care plans by care staff, which identified the care given. Care staff were seen to treat residents with respect and dignity during this inspection. The homes accident book was seen and it was found Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 10 that accidents occurring to residents have been recorded appropriately in the residents file. This information is also made available to the Commission by the home. However, best practice would be to use a body map to show cuts or abrasions that a resident might have from an accident. The carer demonstrated that she had knowledge of giving personal care and confirmed this is addressed in the homes induction training and TOPSS training (The National Training Organisation for Social care), which she is undertaking. Residents medication given at breakfast by the manager was seen to be delivered to residents in the appropriate container in line with the homes medication policy. Medication sheets seen were found to be correctly completed by the senior nurse on duty. A tour of the building found one medicine capsule on the floor in bedroom 17. This is poor practice and is a breach of the homes guidelines on administering and recording of medication. The homes training file evidenced that five nurses at the home are undertaking a twelve week course at Grantham College on the safe handling of medication. A resident stated ‘that staff give me medicine when I need it’. The pharmacist inspected the home on the 10/02/06 and recorded that homely remedies and admin records were checked. Eliot House Nursing Home DS0000063148.V290015.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): 12,13,14 & 15 There is a choice of meals and visitors are encouraged to join their relatives for lunch. Relatives and friends of residents are made welcome in this home. A range of stimulating activities are available to residents. EVIDENCE: The home undertakes a variety of activities for the stimulation of residents. The homes activities diary showed that on four days of the week activities are made available both by the activities organiser and care staff. For the Queens birthday bunting has been put up and entertainers booked for old time music hall songs. During the morning of the inspection a relative of a resident was taking a group of residents for flower arranging. The hairdresser had also arrived to tend to residents hair. Over the Easter period there is a raffle, and the local school visited the home to show off their Easter hats. One resident confirmed that she had gone on a boat trip last summer, with the homes diary evidencing that three such trips are booked for 2006 as well as a trip to Cleethorpes. Three relatives confirmed that activities take place in the home and one visitor stated that he joins in activities with his wife. All three visitors confirmed that they are made welcome at the home. One visitor said that the staff inform me of any changes in my relative. A resident Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 12 confirmed that she can take her visitors to her bedroom. The homes new assessment form identifies all the likes and dislike of a resident and demonstrated that residents are to be consulted about those aspects of their daily living. The inspector joined three residents and a relative for lunch and found that the meal was hot and very tasty and that choices were available. Residents eat with some gusto and the visitors commented that the meals are very good and he is encouraged to stay for lunch. Other visitors were seen helping their relatives with their meal and then had a meal themselves at a second sitting. The cook stated that he was aware of residents dietary needs and had information relating to any allergies. Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 13 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 Residents are not empowered by the homes complaints procedure. The home has a robust adult protection procedures for the protection of residents. EVIDENCE: A review of all information available prior to this inspection and evidence seen at this inspection showed that the homes complaints process does not have a place for a complainant to sign to signify whether they agreed with the outcome or not. All visitors stated that they would feel comfortable in approaching care staff or the manager if they had a concern. The outcome of the additional inspection dated 10/02/06 and evidence seen at this inspection is that the home has obtained those documents required for the safeguarding of residents. The home has also obtained training material relating to safeguarding residents with training to commence the week of this inspection, which will be ongoing and compulsory for all staff. The manager stated that she has diary dated training for all staff in the coming weeks. Visitors commented that they felt that their relatives were safe at this home. Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 14 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): 19 & 26 The home is well maintained and residents are enabled to personalise their rooms. The home is clean and tidy, with a pleasant smell throughout. EVIDENCE: The home maintenance book was seen and showed that the handyman, who also undertakes the decoration of the home, carries out general maintenance. The home was seen to be in a good state of repair with residents rooms personalised with photographs and other memorabilia. A resident said she was happy with her room. A partial tour of the home by the inspector found it to be clean with no unpleasant odours detected. Residents and visitors alike said that the home is clean and there are no unpleasant smells. Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 15 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): 27,28,29 & 30 Appropriate recruitment practices are in place. Staffing level meets the needs of residents. The home provides adequate training for care staff. Staff were seen to be competent in carrying out their care tasks. EVIDENCE: A review of all information available prior to this inspection including the homes action plan and the outcome of the additional inspection evidenced that; The home now provides TOPSS induction training for all carers who do not have NVQ (National Vocational Qualifications) Level 3. The home records all training undertaken by care staff and mandatory training is in place for 2006. The home also carries out appropriate checks for all new workers before they commenced work at this home. All care workers have been given The General Social Care Council Codes of Practice, which sets out their responsibilities as care workers looking after vulnerable adults. Two care workers have NVQ level 2 & 3, with five care workers due to start NVQ level 2 training. Two staff are also due to start their assessors training. The home should have 50 of its staff trained to NVQ level 2. However, it is recognised that steps are being taken to address this training need. Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 16 The duty rota showed that adequate staff numbers are on duty to meet the needs of residents during the day and night in this home. A carer said that the numbers of staff on duty at the busiest times are able to cope with the numbers of residents. One visitor said that care staff are cheerful and friendly and there are a lot of staff when I visit. Another visitor felt that the home needed four more carers. Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 17 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 registered manager is experienced and trained to manage this home. Records seen show that residents’ health and general welfare and safety are promoted. All care workers have not had annual appraisals or undertaken supervision. The home does not hold regular residents meetings. Quality assurance audits of residents and visitors views are not promoted. Residents monies should be kept separate so an accurate account can be kept. EVIDENCE: The Commission has undertook a fit person interview and found the manager to be suitably qualified and has the appropriate training and experience to manage this home. The home evidenced that a quality assurance questionnaire was undertaken. These were seen and showed a positive response from those visitors who had completed the questionnaires. However, there was no evidence that the information accrued from this exercise had been published on the homes Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 18 notice board for the information of residents and relatives. Nor was the questionnaires dated to show when they had been undertaken. Two visitors stated that they had not been asked to complete a questionnaire. The home does not hold residents and relatives meetings. The home deals with residents personal allowances and receipts are kept of monies paid to the hairdresser or chiropodist. However, residents monies are kept together with a monthly account undertaken. This does not enable a spot check of an individual residents money during an inspection audit. All funding is paid direct to the company by standing order or checks. 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 04/08/05 and made a requirement, which has been addressed. Neither supervision nor annual appraisals have been undertaken in the home for all staff. The home has produced a new appraisal form, which has been completed by care staff and now needs to be assessed with the carer by a senior member of staff. The homes supervision form needs to be updated with headings relating to the areas to be addressed during this process. Certificates were not available showing that the shaft lift and bath hoists had been serviced six monthly. 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.V290015.R01.S.doc Version 5.1 Page 19 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 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 2 x 2 Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 20 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 OP9 Regulation 13(2) Requirement The home must make sure that medication given to residents is taken or recoded appropriately as per the homes policies. The home must hold residents and relatives meeting in order to seek their views about the running of the home. The home must undertake an effective quality monitoring system based on seeking the views of residents and visitors with the results of any surveys published for their information. The home must keep an up to date account of residents monies which can be checked at a key inspection. The home must ensure that all hoists and shaft lift are serviced as required. Lifting Operations & lifting Equipment Regulations 1998. Timescale for action 25/05/06 2. OP33 24 25/07/06 3. OP33 24 (3) 25/07/06 4. OP35 16(i) 25/06/06 5. OP38 23(c) 25/06/06 Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 21 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 2. Refer to Standard OP8 OP16 Good Practice Recommendations The home should consider using body maps to record any cuts or abrasions caused by falls or any other means. The home should 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 have a minimum ratio of 50 trained staff members to NVQ level two excluding the registered manager. The manager is recommended to review the homes policy and procedure for the supervision and appraisal of care staff to ensure that the national minimum standards are being met. This recommendation is partly met. 3. 4 OP28 OP36 Eliot House Nursing Home DS0000063148.V290015.R01.S.doc Version 5.1 Page 22 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.V290015.R01.S.doc Version 5.1 Page 23 - 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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