Inspection on 08/01/08 for Elisabeth House

This inspection was carried out on 8th January 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elisabeth House 05/01/09

Elisabeth House 15/08/07

Elisabeth House 30/08/06

Elisabeth House 17/01/06

Elisabeth House 26/07/05

Elisabeth House 13/01/05

Elisabeth House 01/07/04

Elisabeth House 02/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Elisabeth House Rhosweil Weston Rhyn Oswestry Shropshire SY10 7TE Lead Inspector Rebecca Harrison Key Unannounced Inspection 8th January 2008 09:40 Elisabeth House DS0000020684.V357394.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 Elisabeth House DS0000020684.V357394.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. Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elisabeth House Address Rhosweil Weston Rhyn Oswestry Shropshire SY10 7TE 01691 777563 01691 680983 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) Mrs Sonja Eckert-Hopkins vacant post Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2007 Brief Description of the Service: Elisabeth House is registered with the Commission for Social Care Inspection (CSCI) to provide accommodation and personal care for a maximum of nine adults with a learning disability. The registered provider is Mrs Sonja EckertHopkins. A new manager has recently been appointed and is preparing to submit an application for registration with CSCI. The home is located in the hamlet of Rhosweil, some 8 miles north of Oswestry in North Shropshire, in a quiet area next to a canal but within easy reach of main roads and the local towns. Elisabeth House was originally converted from a row of four cottages and provides homely accommodation on two floors in 2 double and 5 single bedrooms. A large kitchen/diner and separate lounge and dining room are provided. The home has pleasant and well-kept grounds and gardens. People who use the service and their representatives are able to gain information about this service from the Statement of Purpose and Service User Guide. Inspection reports produced by CSCI can be obtained direct from the provider or are available on our website at www.csci.org.uk The fees range from £384.00 to £915.00 per person per week. This fee information applied at the time of the inspection and the reader may wish to obtain more up to date information direct from the care service. Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on 8th January 2008 by one inspector over a period of six hours. A range of evidence was used to make judgements about this service to include a tour of the home, discussions with three staff, the manager, proprietor and a health professional. The inspector also looked at a number of records to include care records for two people and observed aspects of care provided. In preparation for the inspection we received fourteen surveys from people using the service and members of staff and some of their comments have been included in this report. The purpose of the inspection was to assess all ‘Key’ National Minimum Standards for Younger Adults and any additional standards considered necessary. The nine requirements made as a result of the previous inspection undertaken in August 2007 were also reviewed. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent/good/adequate or poor based on findings of the inspection. The overall quality rating for the service is assessed as providing ADEQUATE outcomes for people using the service. What the service does well: Elisabeth House provides a clean and homely place for people to live. Bedrooms are personalised and shared areas are well furnished and presented to a good standard. People spoken with during the inspection said that they enjoy living at the home and that staff treat them well. Discussions with staff indicate they are committed to their work. Some of the comments that we received include: ‘I am looked after well and am very pleased when my sister brings me back here. ‘The staff care about what they do and try and make us happy. I really enjoy the food and the staff care about what they do’ ‘I feels as a support worker that our clients are very happy here and because of this I find my job very rewarding and I am pleased that we can make a difference to all that live here’ ‘Provides a warm friendly atmosphere as treats service users as individuals, promoting independence as much as possible. Puts service users first’ Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although much improvement has been made following the last inspection the management team must continue to develop the service and strive to improve the overall outcomes for people living at Elisabeth House. Discussions held with the new manager evidence her commitment to improve the service delivery Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 7 while acknowledging a considerable amount of work remains outstanding to include support planning, risk assessments, staff supervision and health and safety. The manager stated that she has completed her application for registration and committed to forwarding this to our Registration Team at the earliest opportunity. The team would benefit from the appointment of a second senior support worker to provide direction and leadership in the absence of the manager and to assist the manager with administration duties and formal supervision of staff. The new format for support plans should be implemented at the earliest opportunity to ensure that staff are provided with detailed information to effectively support people and provide continuity of care. Staff would benefit from training in adult protection to familiarise themselves with the process of recognising potential abuse and the formal referral process in addition to training in the Mental Capacity Act to ensure they are familiar with their responsibilities. Some of the comments that we received include: ‘It would be useful to have extra staff to support service users in the community’ ‘Sometimes it would be an advantage to have extra staff for activities away from home’ ‘Staff could improve continuity of care by following peoples routines better’ ‘Shift patterns could offer more flexibility particularly when supporting people on days out’ 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. Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 8 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 Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 9 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): 1,2,4 and 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People are provided with basic information to decide whether this service will meet their needs. An assessment of need is obtained and trial visits undertaken to ensure the home can meet the needs of individuals. People are provided with a contract, which tells them about the service they will receive. EVIDENCE: The home has a basic Statement of Purpose and Service User Guide available and each individual have been provided with a copy. Managers committed to developing and updating both documents to ensure they fully comply with the Care Home Regulations as amended. One person has recently been admitted to the home following the proprietor obtaining a detailed assessment of need undertaken by the placing authority. The proprietor stated that she had not undertaken her own assessment but visited the person prior to admission. A transition plan was seen on the persons file and discussions held with the service user evidence that she enjoyed her trial visits to the home and has settled in well. Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 10 A contract was available on the file examined outlining the service agreed and was signed by the manager. The manager was advised that the fee charged must be stated and that the service user and representative should also sign the contract. Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 11 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 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Support plans although improved require further development to ensure staff are provided with detailed information to ensure peoples assessed needs are met in a consistent manner. People using the service are provided with greater opportunities for decision making and enabled to take responsible risks however identified risks must be assessed and regularly reviewed to ensure people are fully safeguarded. EVIDENCE: All records held on behalf of the person most recently admitted to the home were examined. The needs assessment obtained from the placing authority was detailed and there was evidence that the staff are currently developing a support plan with the person concerned. Records indicate that a formal review had recently been held involving the service user and significant others and minutes of the review were available on file with recommendations made. Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 12 A support plan held on behalf of another person was examined however this was incomplete. Discussions held with three staff and managers indicate that the team are currently working to develop new support plans in conjunction with people using the service. The file of a third person was examined and the support plan was found detailed and developed in a much more user friendly format. Managers committed to ensuring this format be used across the service and implemented at the earliest convenience. The majority of staff spoken with considered they are provided with sufficient information to support the needs of the people accommodated however one person stated ‘Staff could improve continuity of care by following peoples routines better’. Since the last inspection two meetings have been held with people living at the home. The minutes of the meetings were available and evidence that people are now being offered greater opportunities to make decisions about daily living, activities, events, meals, support plans and the service. Discussions held with a number of service users indicate that people enjoy the meetings and have a more active ‘voice’ than previously, which was confirmed by staff on duty and observations made during the inspection. Designated key workers have also been introduced and this role has been discussed in both residents and staff meetings. Assessments to support individuals with taking responsible risks were available on the files examined but require further development. For example the assessment to support an individual in the community was basic and did not state the level of assistance or supervision required, which was fully acknowledged by staff and managers. Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15,16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service are provided with greater opportunity to develop positive lifestyles and their independence. They are supported to keep in contact with family and friends and receive a varied diet in accordance with their dietary needs. EVIDENCE: All but four people attend external day service provision on different days throughout the week and discussions held with them prior to them leaving the home indicate that they very much enjoy accessing these services. People remaining at the home are supported by staff to access the community or take part in in-house activities. Service users and staff spoken with reported that activities and opportunities to get out in the community have much improved. During the inspection all but one person went out to access either day services, a health appointment or a Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 14 pub lunch. New activity sheets have been developed and activities, events and daily living discussed at residents meetings. People are involved in the domestic routines of the home and those spoken with reported they assist with keeping their rooms tidy and help with duties in the kitchen as seen on arrival at the home. One person made a drink for the inspector and herself. Records evidence that daily routines are flexible. Staff have developed positive working relationships with service users as evidenced through observations made, discussions held and surveys seen. People living at Elisabeth House are encouraged to maintain contact with their family and friends and visitors are made welcome as evidenced in comments recorded in the compliments book which include: ‘Whenever I visit Elisabeth House I am always made very welcome…’ Since the last inspection new menus have been devised in conjunction with people using the service. The new four-week menu was examined and appears well-balanced taking into account specific dietary needs. People’s likes and dislikes in relation to food were available on the files examined. Service users spoken with said that they enjoy the food as evidenced in surveys received. A variety of fresh fruit and vegetables were available and food stocks well maintained. People are supported to assist with shopping and basic food preparation according to their needs. Two people were supported to go out for a pub lunch during the inspection and the person who chose to remain at home was supported over lunch and offered a choice of lunch which was well presented. Elisabeth House DS0000020684.V357394.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 21 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. The management of medication has improved ensuring people using the service are safeguarded. EVIDENCE: As previously stated staff are currently developing new support plans with the people using the service. Information held on the third file examined was detailed and clearly evidenced the individuals preferred preferences in how staff are to assist with attending to his personal care needs. The manager committed to developing a chart to monitor the personal care needs of a person who is reluctant to partake in personal care tasks, as current records do not clearly evidence this. Discussions held with staff and people using the service evidence that privacy and dignity is promoted although privacy screening is not available for people sharing rooms as discussed with the proprietor who stated that this had been discussed with the four people but the Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 16 outcome not recorded. The inspector spoke with two people who share rooms and they appeared happy with the situation. Records seen on two people’s files evidenced people have access to health care services both within the home and in the local community. During the inspection a health professional visited the home to meet one individual and reported that she was happy with the service her client receives. A new format has recently been introduced for recording health appointments as recommended by the previous inspection. Medication procedures appeared satisfactory at the time of the inspection. Procedures were discussed with the manager who demonstrated an understanding of how medication is managed. The senior support worker holds designated responsibility for the management of medication. A medication policy was available however this was not examined on this occasion. It was reported that only members of staff who have undertaken accredited training administer medication as confirmed by staff. A written procedure has been developed for individuals requiring PRN medication (medication given as necessary) as required by the previous inspection. The manager committed to undertake competency assessments for staff responsible for administering medication at her earliest opportunity. Elisabeth House DS0000020684.V357394.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. People using the service and their representatives are able to express their concerns and have access to a complaints procedure. Procedures to safeguard service users from potential abuse are in place but staff would benefit from training in adult protection to ensure they have the knowledge and an awareness of the referral process to fully safeguard the people using the service. EVIDENCE: The home has a basic complaints procedure in place. The new manager committed to update this to reflect the regulators role in the management of complaints, to make the procedure more service user friendly and to ensure it’s readily available. Service users spoken with and the surveys we received evidence that people know who to speak to if they were not happy with the service provided. The manager agreed to also discuss the procedure at residents meetings. A new complaints and compliments book is in place and the manager confirmed that no complaints had been received since the last key inspection. Compliments recorded include: ‘Having worked at Elisabeth House in the past I pop in from time to time to visit service users. I was presently surprised by the recent changes. Standards appear to have changed for the better and a more structured approach appears to be in place’ Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 18 ‘I found everyone so warm and friendly, it is a very homely environment’ No complaints or concerns have been received by CSCI since the last inspection. A copy of the local safeguarding adult protection policy and procedure was available and staff are in the process of signing to say they have read the policy. A member of staff spoken with had an understanding of what to do if she observed an abusive situation although acknowledged that she needed to read up the policy and attend training. Records evidence that only one member of staff has attended training in adult protection however the manager stated that she has liaised with Shropshire Partners in Care and obtained course information and will arrange training at the earliest opportunity. It was stated that four staff have since attended training in the management of actual and potential aggression (MAPA) as recommended at the previous inspection and that a further three staff have been booked to attend. Following the last inspection procedures for the management of peoples finances have improved. Service users are no longer expected to pay for staff meals when supported in the community and staff spoken with considered that new procedures safeguard people. It was reported the policy on finances has been revised as required by the previous inspection. Elisabeth House DS0000020684.V357394.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 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people living at Elisabeth House are provided with a clean, comfortable and homely place to live appropriate to their needs. EVIDENCE: Elisabeth House is located in the hamlet of Rhosweil, next to a canal and provides accommodation across two floors. A large kitchen/diner and separate lounge and dining room are provided in addition to five single and two double bedrooms. En-suite facilities are not available however suitable bathroom and shower facilities are provided. Bedrooms are personalised and shared areas well furnished. People spoken with said that that enjoying living at the home. Since the last some new kitchen appliances have been replaced and the floor covering in the hall renewed. A maintenance book has recently been implemented. The proprietor reported plans to redecorate some areas of the home and agreed to develop a programme of renewal as required. Gardens are well maintained with adequate outdoor seating provided. Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 20 The home was found very clean during this unannounced inspection. A number of people spoken with reported that they help staff with basic household chores. Liquid soap was readily available in addition to personal protective equipment. Paper towels were not available and reasons for this shared with the inspector and the proprietor was advised to complete a risk assessment. Substances hazardous to health are appropriately stored and data sheets available. Following the last inspection five staff have attended distancelearning training in relation to infection control procedures. One staff visited the home during the inspection to undertake some course work with the proprietor. Elisabeth House DS0000020684.V357394.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): 32,33,34 and 35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use the service are safeguarded by the homes improved recruitment procedures and staff receive training appropriate to their job role in order to effectively carry out their duties. EVIDENCE: Staff spoken with appeared committed to their job and had a clear understanding of their role. They were seen to interact with the people they support in a positive manner throughout the inspection. Feedback gained in discussion with service users and surveys received evidence that they are treated well by the staff. It was reported of the ten support workers employed six hold a recognised care award known as a National Vocational Qualification and a further two staff are currently undertaking this award. The team currently consists of the proprietor, a manager, one senior and ten support workers. The staffing ratio is two staff to support nine service users. Feedback received through surveys and discussions indicate that staffing levels could be improved to enable the service to provide more person centred and Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 22 flexible support as identified at the previous inspection. Comments we received include: ‘It would be useful to have extra staff to support service users in the community’ ‘Shift patterns could offer more flexibility particularly when supporting people on days out’ This was fully acknowledged by the proprietor and newly appointed manager who committed to review current arrangements and shift patterns. Since the last inspection three staff have left employment and reasons for this shared with the inspector. The position of manager and a support worker post have been filled and three further people have been offered positions and awaiting all pre-recruitment checks prior to commencing work. Previous inspections have highlighted serious shortfalls in the homes recruitment practices, which have potentially placed people using the service at risk. Following the last inspection we have met with the proprietor, company secretary and new manager to discuss our concerns about the findings of the last inspection and in particular recruitment of new staff. Such shortfalls were fully acknowledged by managers. Records held for the two recently appointed staff were found well organised and contained the relevant documentation as required by Schedule 2 of The Care Homes Regulations 2001, as amended, with the exception of no health declaration on one file, which the manager committed to obtain. A file of an existing staff member was examined and also contained the relevant documentation. The new manager has developed an overall team training matrix, which helps identity what training staff have attended and dates. Following the last inspection a number of staff have attended training in dementia awareness, the management of actual and potential aggression and manual handling, which was confirmed by staff on duty. Further training in first aid, food hygiene and adult protection is being arranged. A training and development plan as required by previous inspections was not available however the manager committed to developing one following staff supervision which will help identify staff individual training needs. The manager has obtained information in relation to external induction training for new staff (LDQ). Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 23 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): 37,39,41 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management of the home has improved in the best interests of service users. Quality assurance requires further development to assess performance and evaluate outcomes for people using the service. The premises are generally managed and maintained in a manner, which ensures the safety of service users and staff. EVIDENCE: Mrs Sonja Eckert-Hopkins is the registered provider and previously managed the service prior to appointing a manager in July 2006. Following the last inspection the former manager has since left employment and a new manager appointed in October 2007. The manager is employed full time and due to staff Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 24 shortages is currently providing direct care to service users in addition to managing the service and implementing change. Discussions with staff and surveys received indicate that the new manager is approachable and is providing staff with greater direction. It was also reported that service users are very much more consulted with and that the overall management of the home has definitely improved. Discussions held with the new manager evidence her commitment to improve outcomes for people using the service while acknowledging a considerable amount of work remains outstanding to include support planning, risk assessments and health and safety records for the effective and efficient running of the service. The manager stated that she has completed her application for registration and committed to forwarding this to our Registration Team at the earliest opportunity. Surveys to gain the views of people using the service, their relatives and stakeholders have yet to be distributed however the new manager committed to undertake this shortly in addition to developing an annual development plan as required by the precious inspection. Visits and reports required under Regulation 26 are now being undertaken. The care documentation held on behalf of two people evidenced that formal reviews had been undertaken in conjunction with the placing authority. As previously stated residents meetings are now in place and minutes of the two meetings held evidence that people living at the home are being consulted with and their views listened to and acted upon. It was stated that policies and procedures had been reviewed and updated and that staff are currently in the process of reading these and signing to say that they have read and understood them. The file was available but was not examined as part of this inspection. Records examined evidence that health and safety checks are generally carried out at the required frequency. Assessments to support risk taking and for safe working practices to include assessments for first aid, carrying soiled laundry through the kitchen and infection control require further development, which the new manager committed to undertake. Neither the Environmental Health or Fire Officer have visited the premises since the last inspection however the proprietor was advised to seek advice from the Fire Officer in relation to development of a fire risk assessment and the fitting of window restrictors to the first floor windows. The proprietor committed to having the electrical hardwiring tested and the excessive water temperature in the one bathroom actioned. Staff do receive some training in safe working practices however a number of staff still require training in food hygiene and first aid, which is currently being sourced. Staff have received training in manual handling as required by the previous inspection. The manager committed to ensuring heath and safety documentation such as the certificates for the servicing of equipment were made more readily available and to purchase more suitable thermometers for the testing of water temperatures. Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 25 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 3 3 x 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x 2 2 x 2 x x 2 x Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 26 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 YA9 Regulation 13 (4)(b) Requirement Timescale for action 08/01/08 2. YA20 13(2) 3. YA42 13 (4) All identified risks must be assessed and regularly reviewed to ensure service users are not placed at risk of harm or neglect. Previous timescale of 28/09/07 partly met. 08/01/08 Medication procedures must be reviewed and competency assessments be undertaken to ensure staff are competent to handle and administer medication to service users at the prescribed time and that staff have a procedure to follow for people prescribed PRN medication. Previous timescale of 28/09/07 partly met. Health and safety procedures 08/01/08 must be reviewed to ensure safety checks are carried out, service certificates are available and that staff receive training in safe working practices for the health and welfare of service users and staff. Previous timescale of 28/09/07 partly met. Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 27 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 YA6 Good Practice Recommendations The new format for support plans should be implemented at the earliest opportunity to ensure staff are provided with detailed information to effectively support people and provide continuity of care. Staff should be provided with training in safeguarding adults at the earliest opportunity to ensure they are familiar with the process of recognising potential abuse and the formal referral process. 2. YA23 Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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 Elisabeth House DS0000020684.V357394.R01.S.doc Version 5.2 Page 29 - 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. 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