Inspection on 17/03/08 for Elizabeth Court Care Centre

This inspection was carried out on 17th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elizabeth Court Care Centre 04/06/07

Elizabeth Court Care Centre 25/10/06

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

CARE HOMES FOR OLDER PEOPLE Elizabeth Court Care Centre New Street Sutton St Helens Merseyside WA9 3XE Lead Inspector Wendy Smith Key Unannounced Inspection 9:30 17th March 2008 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 Elizabeth Court Care Centre DS0000066312.V358558.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 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. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elizabeth Court Care Centre Address New Street Sutton St Helens Merseyside WA9 3XE 01744 821700 01744 821701 ec@keyhealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Key Healthcare (St Helens) Ltd. Care Home 43 Category(ies) of Dementia - over 65 years of age (43) registration, with number of places Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th June 2007 Brief Description of the Service: Elizabeth Court is a care home providing nursing and personal care for up to 43 older people with dementia. The home is privately owned by Keys Healthcare. The modern two-storey building is set in its own grounds in a residential area of St Helens, not far from the town centre. The fees are from £500 to £600 per week. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced visit took place on 17th March 2008. The home had 43 residents, all over 65 years of age. The inspection was carried out by two inspectors. One inspector used the Short Observational Framework for Inspection (SOFI) methodology, which involved spending two hours observing residents in a lounge. Note was taken of their state of wellbeing, whether they were taking part in any activity or interaction with others, and the quality of their interactions with staff. During the visit the inspectors spoke with residents, staff and visitors. A tour of the building, including all communal areas and some bedrooms, was completed. A sample of records was looked at and time was spent in conversation with the home manager. Some of the information contained in this report is taken from the Annual Quality Assurance Assessment that was completed by the home manager at the request of the Commission for Social Care Inspection. What the service does well: What has improved since the last inspection? Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 6 The home has introduced a new medication system. Risk assessments are recorded in each resident’s care plan. All accident forms are reviewed by the manager. What they could do better: Make sure that the information contained in the home’s Statement of Purpose is accurate and up to date. Ensure that care plans are written in a way that is person-centred, and address the difficulties that residents experience as a result of having dementia. Daily entries in the care plans should provide meaningful information about what the person has done each day and how they have been feeling. The care plan monthly reviews should demonstrate that the member of staff carrying out the review has looked at how the person has been feeling over the last month and considered whether any change may be needed to their care regime. There is an urgent need for staff to receive training about dementia. This is needed in order to improve their understanding of residents’ conditions and to enable them to communicate more effectively and have greater empathy with residents. The home should develop methods of enabling residents to exercise choices in their daily life, for example choices of meals. Complaints records need to be more detailed to show how a complaint was investigated and what action was taken. Consider how the environment can be made more stimulating for residents for example by the use of colour, lighting, informal sitting areas, areas of interest around the building. (There is a great deal of good practice guidance available regarding these matters.) Ensure that there are suitable supporting chairs available for the more physically frail residents. Develop safe walkways and sitting areas for residents to use in the garden. Replace glass window panels that contain condensation. Monitor staffing levels and ensure that there is flexibility in staff rotas for the manager to put on additional staff when dependency levels are high to ensure that the needs of residents are met. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 7 Investigate why there has been such a high staff turnover and take whatever steps are needed to ensure a consistent staff group who residents can get to know and trust. New staff must not be employed until two satisfactory written references are received. Staff training with regard to health and safety subjects must be carried out by a suitably qualified person who has knowledge and expertise in the subject. Registered nurses working in the home, including the home manager, must receive clinical support to enable them to develop their professional practice. The home would benefit from the employment of an administrator to deal with day to day paperwork and to answer the telephone. This would allow the manager more time to spend with staff and residents. A system of internal quality auditing needs to be developed and maintained. This will identify strengths and weaknesses in the service and identify areas for improvement. Fire procedures must be clearly written and communicated to all staff so that they are fully aware of their roles and responsibilities if a fire should occur. Regular monthly fire drills should be held and the names of staff attending recorded. 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. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 8 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 Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People interested in going to live at Elizabeth Court are assessed before admission to make sure that their needs can be met at the home. EVIDENCE: The home’s Statement of Purpose was looked at and found to contain some inaccurate information. It states that senior care staff have NVQ level 3, however none have gained this qualification yet. It states that all staff receive twice yearly fire training, but training records did not support this. It also states that the home manager has management experience, but this is her first manager post. The statement of purpose also needs updating regarding the change of nursing and personal care accommodation. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 10 The manager said that people admitted to the home for personal care often come in directly from their own home following assessment by a social worker. People requiring nursing care are usually admitted from hospital. The manager goes out to assess all of the people who are referred to the home. The care plans for two people admitted to the home recently were looked at. They contained an assessment of the person’s needs and a care plan from social services; one also had hospital discharge information. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are met and are recorded in their care plans. EVIDENCE: Each resident has a care plan folder, and five of these were looked at during the course of the inspection. The care plans contained a photograph of the resident, assessments of their needs, a social profile, an inventory of their belongings, risk assessments for pressure sores, falls, moving and handling and nutrition. In some, there was good evidence of the involvement of a relative. Care plans are based on an activities of daily living model. In general the care plans had been well completed with regard to people’s physical health but did not address their primary needs which are due to dementia. They did not Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 12 describe what people like to do, where they chose to spend their time, how their mood is through the day. A care plan for a new resident instructs staff to ‘maintain her dignity and independence’ but does not tell staff how to do this. The evaluations were generally not meaningful and often consist of ‘Care plan in place. No change.’’ This consistent over several months does not demonstrate that the care being provided has been reviewed. Daily entries of ‘settled day’, ‘no problems’, ‘all care given’ are equally meaningless. There had been some good entries in the carer diary. There were also examples of inappropriate language being used in care plans for examples ‘risk of absconding’, ‘speech is clear but irrational content’. The front page of the care plans records a ‘consent to resuscitate’ signed either by the resident or a relative. It is not clear what is meant by ‘resuscitation’ and such issues may be better discussed as and when a specific situation arises where a particular treatment/intervention can be discussed and an informed decision made. On the day of the visit one person was very poorly and was being looked after in bed. The care plan recorded that the gentleman’s family did not wish for him to be admitted to hospital. Appropriate pain relief had been prescribed by his GP and was given regularly. Pressure relieving equipment was in use and charts were used to record the care given. The care plan had not been rewritten to reflect his current poorly condition but good daily records were kept. On the day of the inspection the home was changing over to a new medication system supplied by Boots. The medicines storage room is very small and barely adequate; the room also felt hot but the temperature was not recorded. Medicines are ordered separately for the two parts of the home. Records seen were satisfactory. Care staff involved in the administration of medicines have received training. Visitors spoken with were generally satisfied with the care provided for their relatives and had a good relationship with the manager and staff. A letter sent to the home in November 2007 thanked the staff for ‘wonderful care not only to my Mum but also to my wife and I especially during the last few days before she passed away’. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some social opportunities for residents but a lack of stimulation for them in daily living routines. EVIDENCE: The home employs a full-time activities person, who also has responsibility for staff training. She does not have any previous experience in care work but she has completed NVQ level 2. The home has few facilities for activities and the organiser said that she feels she is ‘struggling’ although she very much enjoys the job and has great commitment to the home and the residents. She organises fund-raising events to buy equipment and pay for entertainment and trips out as there is no budget allocated for this. She does manicures, takes people out when she can, arranges a monthly church service and weekly communion. There is no transport available to take people out. On the day of the inspection two people were taken out by relatives. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 14 Televisions were on in two of the lounges and a radio in the other. Apart from this there was no apparent stimulation for residents and nothing for them to do. Some residents on the first floor spent a lot of their time walking around and engaging in conversation with staff and visitors, but there were no chairs available for them to sit down other than in the lounge. The SOFI observation concentrated on three people in a ground floor lounge. They were people with a high level of need. Two were asleep for most of the two hour period. The inspector observed poor communication with staff. Although the staff’s attitude was courteous, they appeared to have little idea how to communicate with residents. Before lunch two of the residents were taken to the toilet and the whole process of hoisting, taking to the toilet and brought back to their chairs was completed in less than ten minutes. This was their only change of surroundings as they were assisted with their meal in the lounge. In the two hour period the inspector observed only two positive interactions between staff and residents. A member of staff put plastic aprons on to all three residents but did not explain what they were doing and they were left to wait for lunch. It was unclear what means are used to encourage residents to exercise choices at mealtimes. The manager said that residents can eat at any time as staff have access to food supplies in the main kitchen. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse by the home’s policies and procedures and staff training. EVIDENCE: The manager has introduced a new complaints form that residents and/or their visitors can use. Copies are available in the entrance area. Four complaints had been recorded in a book but full details of the investigation carried out and any action taken were not all available. The home has policies and procedures about the protection of residents from abuse. Most staff have received training from the home’s trainer and at present a training session being held each week to make sure that all staff can attend. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean and well-maintained but could be made brighter and more interesting for residents. EVIDENCE: The home is a two-storey building set in its own grounds. Outdoor areas were neat and tidy. A relative spoken with said that she would like residents to have more fresh air. The garden is securely fenced but does not have safe and even paths for people to walk on. The more able residents are now accommodated on the first floor so they are not able to access the garden unless staff assist them downstairs. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 17 The interior is generally in a good state of repair and decoration however there are a significant number of double-glazed window panels that have lost their seal and are filled with condensation, and these need to be replaced. Some areas of the corridors are poorly lit and look gloomy. Corridors finish with dead ends and it would benefit residents who like to walk around if chairs and items of interest were there for them. Each resident has a single bedroom with ensuite toilet and hand basin. Some bedrooms have been nicely personalised by residents and their families. Radiators are fitted with protective covers. Bedroom doors are locked during the day when they are unoccupied but residents who are considered able can have a key for their room. Some residents have a profiling bed and others have a divan. Some divans were fitted with bedrails and this was discussed with the maintenance person. He checks the bed rails regularly and is aware of the risk of entrapment makes sure there is big enough space for head/neck not to be trapped. Padded covers were available for bedrails. There are two lounges and a dining room on each floor, however the small lounge on the first floor is designated as a smoking room for residents which means that there is no choice of lounge for people who don’t smoke. Seating in the lounges is not suitable for all residents. There are straight backed chairs and settees but no recliner chairs for the more frail people who need extra support. One person who was asleep was slumped over in a very uncomfortable position. There was poor identification of bedrooms and toilets and a general lack of stimulation in the environment which is rather bland, dull and institutional. It was also very warm. There is an office for the staff on each floor. The manager said that a shortage of storage space causes some difficulties. There is an assisted bath and shower on each floor. There were no unpleasant smells in any part of the building and this is to the credit of the staff. Two domestic staff are on duty each day between 8am and midday one from midday until 4pm. The kitchen and laundry are spacious and appeared clean and well-equipped. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care of residents is compromised by a high turnover of staff, lack of training about dementia, and incomplete recruitment practice. EVIDENCE: The ground floor accommodates 19 residents who require nursing care. There is a registered nurse on duty at all times, however the home only employs four nurses on a regular basis with other shifts covered by bank or agency staff. None of the nurses has a mental health qualification. In a morning there are four care staff on duty, three in an afternoon/evening, one at night. The first floor accommodates 24 people who require personal care. There is a senior care assistant on duty at all times with three carers in a morning, two in an afternoon/evening and one at night. There is currently a vacancy for a deputy manager. There is no clinical support for the nurses or the manager. On the day of the inspection the number of staff seemed adequate, however relatives spoken with, and the home manager, expressed their concern about staff numbers. Care staff said that they find it difficult to manage at mealtimes, with 26 residents needing help with their meal. Staff are often unable to leave the floor to have their break. The number of staff was reduced Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 19 in 2007 when the number of nursing beds was reduced. The manager must be able to vary staff numbers to meet the changing needs of residents to ensure that the needs of residents can be met at all times. Relatives were also very concerned about the high staff turnover and said that senior staff were constantly ‘scrapping round’ trying to make sure there is enough cover for the next day. The annual quality assurance assessment recorded that 31 staff have left during the last twelve months. 31 care staff are employed, and of these 17 have NVQ level 2 in care and 12 others are working towards a qualification. Senior care staff are working towards level 3. This is a very good achievement. Recruitment records were looked at for three staff who started working at the home quite recently. A nurse who started at the beginning of January had good recruitment records including a CRB disclosure, two good references from previous employment and a nurse registration check. A carer who started working at the home earlier in 2008 had a CRB which showed a conviction from 2003. This had been declared on the application form and discussed with the manager. The application form was poorly completed and there was only one reference which was from her boyfriend. A reference request had been sent to a previous employer but there was no record of any reply. Another carer started working at the home in October 2007. She has good previous experience including NVQ level 2, and a CRB disclosure, however there were no references on record. There is an induction process which is contained in a large folder with eleven sections. Each member of staff receives an induction folder to work through. There were no completed folders to look at as the staff keep their own. New staff work for one or two days supernumerary, and carers spoken with confirmed that they had done this. The home does not have any training facilities and a resident lounge is used for training. The activities organiser also works as the in-house staff trainer. She has completed a course to teach adult protection but does not have any qualification to teach moving and handling or fire safety. The list of staff training provided by the manager shows that staff are up to date regarding moving and handling and fire training. Only three staff have a record of any training regarding care of people with dementia. Some staff have attended external training courses. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The smooth-running of the home may be disrupted by lack of continuity of senior staff. EVIDENCE: The manager has been in post for nearly a year but has not completed the process of registration with the Commission for Social Care Inspection. At the time of the inspection the manager was working her notice and said that she felt she had taken the home as far as she could given her lack of previous management experience and without a deputy manager or an administrator. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 21 Staff and relatives spoken with were disappointed that the manager was leaving. Relatives spoken with said that they had attended meetings with the manager but had never met the registered person. Staff also confirmed that they have monthly staff meetings with the manager and some staff had received one to one supervision. An external quality audit was commissioned in 2007 and a report dated May 2007 was available for inspection. There was no evidence to show that this exercise had been used to identify areas for development or improvement. Internal auditing had not been done recently, but a weekly report is sent to head office and this includes information about accidents. There is a documented system for residents to be able keep small amounts of personal spending money in the home’s safe. The home has a full-time maintenance person. He carries out a weekly fire alarm check and a monthly emergency lighting test. He said that he checks all rooms at least once a week and all hot water outlets are tested monthly. Information in the annual quality assurance assessment indicated that services and equipment had been tested and maintained during 2007. The maintenance person has recently attend training so that he can carry out portable electrical appliance testing. There seemed to be some uncertainty about fire evacuation procedures and this needs to be clarified to ensure that all staff are aware of their roles and responsibilities in the case of a fire. The home needs to have a clear fire plan of how residents should be moved if a fire should occur and this needs to be written by a suitably qualified and experienced person. Fire drills should be held monthly and a record of the names of staff attending. Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 22 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement Ensure that the information contained in the Statement of Purpose is accurate and up to date. Timescale for action 30/04/08 2 OP30 18 (1)(c)i There is an urgent need for all 30/06/08 staff to receive training about dementia. This is needed in order to improve their understanding of residents’ conditions and to enable them to communicate more effectively and have greater empathy with residents. Ensure that there are suitable 30/06/08 supporting chairs available for the more physically frail residents. Monitor staffing levels and 30/04/08 ensure that there is flexibility in staff rotas for the manager to put on additional staff when dependency levels are high to ensure that the needs of residents can be met. 3 OP19 23(2)n 4 OP27 18(1)a Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 24 5 OP29 19(1) New staff must not be employed 31/03/08 until two satisfactory written references are received. A system of internal quality auditing needs to be developed and maintained to ensure that the home is run in the best interests of residents. 30/06/08 6 OP33 24(1) 7 OP38 23(4)(c)(d Fire procedures must be clearly 31/03/08 )(e) written and communicated to all staff so that they are fully aware of their roles and responsibilities if a fire should occur. Regular monthly fire drills should be held and the names of staff attending recorded. 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 OP7 Good Practice Recommendations Ensure that care plans are written in a way that is personcentred, and address the difficulties that residents experience as a result of having dementia. Daily entries in the care plans should provide meaningful information about what the person has done each day and how they have been feeling. The care plan monthly reviews should demonstrate that the member of staff carrying out the review has looked at how the person has been feeling over the last month and considered whether any change may be needed to their care regime. The home should develop methods of enabling residents to exercise choices in their daily life, for example choices of meals. Complaints records need to be more detailed to show how a complaint was investigated and what action was taken. DS0000066312.V358558.R01.S.doc Version 5.2 Page 25 2 OP14 3 OP16 Elizabeth Court Care Centre 4 OP19 Consider how the environment can be made more stimulating for residents for example by the use of colour, lighting, informal sitting areas, areas of interest around the building. Develop safe walkways and sitting areas for residents to use in the garden. Replace glass window panels that contain condensation. Investigate why there has been such a high staff turnover and take whatever steps are needed to ensure a consistent staff group who residents can get to know and trust. Registered nurses working in the home, including the home manager, should receive clinical support to enable them to develop their professional practice. Staff training with regard to health and safety subjects, including moving and handling and fire safety, must be carried out by a suitably qualified person who has knowledge and expertise about the subject. The home would benefit from the employment of an administrator to deal with day to day paperwork and to answer the telephone. This would give the manager time to spend with staff and residents. 5 6 7 OP19 OP19 OP27 8 OP30 9 OP38 10 OP31 Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 Elizabeth Court Care Centre DS0000066312.V358558.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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