Inspection on 27/09/05 for Elizabeth Court Rest Home

This inspection was carried out on 27th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

Other inspections for this house

Elizabeth Court Rest Home 16/10/07

Elizabeth Court Rest Home 22/11/06

Elizabeth Court Rest Home 07/12/04

Elizabeth Court Rest Home 16/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Elizabeth Court 4 Hastings Road Bexhill on Sea East Sussex TN40 2HH Lead Inspector Andy Denness Announced Inspection 27th September 2005 10:00 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 Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elizabeth Court Address 4 Hastings Road Bexhill on Sea East Sussex TN40 2HH 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) 01424 219105 nightnurse83@yahoo.co.uk Mrs Mandy Dade Mrs Carol Beverley Robinson Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. All service users should be older people aged 65 (sixty five) years and over on admission. A maximum number of 24 (twenty four) service users should be accommodated. That the home accommodates one named older person over the age of 65 (sixty five) years with dementia, who has been assessed by the home as suitable for this provision. That the home accommodates one named adult under the age of 65 (sixty five) years, who has been assessed by the home as suitable for this provision. 26 April 2005 4. Date of last inspection Brief Description of the Service: Elizabeth Court is situated in the old town area of Bexhill, with local amenities situated close by. The main Bexhill town centre with its shops and access to bus and rail services is approximately half a mile away. Accommodation is provided on three floors and a stair lift is fitted to assist service users access first floor accommodation; three rooms can only be accessed via stairs. The home is registered to accommodate up to 24 older people. The registered owners are Mrs M Dade and Mrs C Robinson. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over a morning and afternoon in September and lasted 5 1/2 hours. To help gather evidence on how the home is performing the Inspector met with staff and the home’s owners/manager, sat with service users for lunch, examined a range of records and written information and undertook a tour of the premises. In depth discussions took place with ten service users. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 6 contacting your local CSCI office. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, 4,5 & 6. Pre-admission procedures and written information available for potential service users are good and help ensure that they move into a service that they know is suitable to meet their needs. EVIDENCE: Written information about the home, in the form of a statement of purpose and a service user’s guide, are in place; these aim to provide potential service users with information about the home and the service provided; both documents were examined, they were of a good quality. Detailed contracts are issued to service users, copies of these that had been signed by service users were seen on file; the contracts were of a good quality. Prior to admission the manager of the home undertakes detailed assessments of service users needs, a selection of these were examined, they were of a good quality and covered all of the required areas of daily living. Service users confirmed that they were encouraged to visit the home before they move in. The home does not provide intermediate/rehabilitative care. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 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 and 11. The policies, procedures and practices in the home regarding meeting service user’s health, personal and social care needs are good and help ensure that identified needs in these areas are appropriately met with a good standard of care provided. EVIDENCE: Records examined confirmed that service users’ needs regarding health, personal and social care needs are identified through the initial assessment process. Following this individual plans of care are compiled for each service user; these detail the level of care and support that they require from staff to meet their day-to-day needs. A selection of these plans was examined, they covered all required areas, and records examined indicated that identified support was being provided; this was confirmed in discussions with service users who spoke highly of the care provided for them by staff. Improvements have been made to the care planning process since the last inspection. It has been required that risk assessments regarding service users going out unaccompanied are expanded to help minimise risk to them. Records examined confirmed that support is sought from a range of health professionals when required. Medication is managed on behalf of service users Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 10 by staff; records and storage were examined and found to be in order. From observations and discussions with service users it was evident that they were treated with respect and dignity by staff. The home has a cordless telephone so that service users can make and receive telephone calls in private. The manager said that issues regarding privacy and dignity are covered with staff during their induction. The home has a written policy in place regarding dying and death; the Inspector was told that if possible a service user who was dying would be supported to spend their last days in the home in familiar surroundings with people that they know. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 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. Arrangements in the home regarding activities, visitors and meals are good and ensure service users choices in all of these areas. EVIDENCE: Service user’s confirmed that leisure activities and pursuits in the home have been increased since the last inspection; activities now include exercise to music, mental stimulation activities, regular visits by a musician and monthly church services. Several service users spoken to said that they regularly access local community facilities, with transport when required being provided by the home’s proprietors. Service users said that they have choices in all areas of their daily living including how to spend their time and what time to get up and go to bed. The Inspector sat and ate lunch with service users; the meal was well prepared and records examined indicated that a varied and wholesome menu is provided; this was confirmed in discussions with service users who said that the food was good their comments included “ the food is very good” and “the food is lovely”. One service user confirmed that staff provided for their special dietary needs. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Procedures and practices in the home regarding complaints and adult protection matters are satisfactory, ensuring that service users concerns are listened to and acted on and that they are kept safe. EVIDENCE: The home has a detailed complaints procedure, this was examined and it was of a satisfactory standard and provided clear guidance for those wishing to complain about the service. Records examined confirmed that complaints made are managed appropriately in line with the procedure. Service users said that they feel confident that they could make a complaint and would be listened to should they be unhappy with any aspect of the service provided at Elizabeth Court. The home also has a written adult protection procedure; no adult protection matters have been raised since the last inspection. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26. Physical standards throughout the property were generally satisfactory ensuring that service users live in a comfortable and homely environment. EVIDENCE: An inspection of all areas of the environment confirmed that physical standards and standards of hygiene and cleanliness were generally good. Communal areas consist of a lounge and dining room; both rooms were comfortable and homely and furnished and decorated to a high standard. Heating is provided by a central heating system with most radiators guarded. At the last inspection it was required that to reduce the risk of scalding individual thermostatic mixer valves should be fitted to hot water outlets; the Inspector was told that a plumber was calling the day after the inspection to complete this work. The home has sufficient baths and WCs to meet service users needs. One bath is fitted with a hoist to assist those who have mobility problems and a stair lift is fitted to assist access first floor accommodation; also handrails and other adaptations are fitted at strategic points around the home to assist service users. Emergency call points are fitted in all areas, Bedrooms are furnished Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 14 and decorated in a homely and comfortable style, service users confirmed that they are able to bring pieces of their own furniture into the home with them; three bedrooms have ensuite facilities. The carpet in one bedroom was in need of relaying or replacing as it posed a possible trip hazard. The home has a suitably equipped laundry and standards of cleanliness and hygiene throughout the premises were good. It was noted that restrictors were not fitted to some first floor windows that pose a possible danger of falling to service users, it has been required that this matter is addressed as a matter of urgency. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 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. Staffing arrangements are generally satisfactory and ensure that service users are supported by sufficient numbers of well-trained staff. EVIDENCE: Staffing levels on the day of the inspection were satisfactory; records examined confirmed that this is the case at all other times, service users confirmed that there are always enough staff on duty to meet their needs. Their comments regarding staff included, “everybody is so kind” and “nothing is too much trouble for them”. However it was noted that current night staffing arrangements consist of only one member of waking staff; because of the number of service users and the complexity of some of their needs, it has been required that the manager reviews these levels. Records examined confirmed that a good basic training is provided for staff, including induction, first aid, fire prevention, moving and handling and infection control. Currently 50 of staff are not trained to NVQ level 2 as is required by national minimum standards, however the Inspector was told that staff are now enrolled on the required courses and that the home should reach the 50 target in the near future. Records examined confirmed that generally robust recruitment procedures are followed, when new staff are employed, this includes the use of application forms, the following up of two references, ID checks, criminal record checks, Protection of Vulnerable Adult checks and the issuing of contracts of employment. However it was noted that that employment status checks have not been carried on staff employed from overseas. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 37 & 38. Management and administrative arrangements are good and help support the good standard of care provided for service users. EVIDENCE: The manager/joint owner is a trained nurse and throughout the inspection demonstrated a clear understanding of the needs of older people; staff and service users spoke very highly of the her and the other joint owner of the home. The manager has just applied to be registered with the Commission for Social Care Inspection and is part way through her required managementtraining course. Discussions with staff and service users confirmed that regular staff meetings and service user meetings take place. The manager holds some monies on behalf of service users; storage for this was secure and records and balances were examined and were found to be in order. Records examined confirmed that insurance is set at the required level and that a detailed quality assurance process is in place to help the manager monitor and improve the Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 17 service. A range of the records required by regulation were examined, these were in order and were stored securely. Policies and procedures required by national minimum standards were in place. The manager demonstrated a clear understanding of the importance of health and safety matters, a range of health and safety systems backed this up: records and assessments regarding these were examined they were of a good quality and were regularly reviewed. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 2 2 3 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 1 Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12(1)(a) Requirement That risk assessments are undertaken regarding those service users who out unescorted. That the carpet in the room discussed is either replaced or re-laid. That thermostatic mixer valves are fitted to hot water outlets on baths. That the current night staffing arrangements are reviewed taking into account the increase in service user numbers. That the manager ensures that employment status checks are carried out on staff employed from overseas. That restrictors are fitted to those windows that may pose a danger to service users Timescale for action 27/10/05 2 3 4 OP24 OP25 OP27 1291)(a) 12(1)(a) 18(1)(a) 27/10/05 27/10/05 27/10/05 5 OP29 19(1)(a) 27/10/05 6 OP38 12(1)(a) 27/09/05 Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 20 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 OP28 OP31 Good Practice Recommendations That 50 of staff are trained to NVQ level 2 by the end of 2005. That the manager is trained to NVQ level 4 in management by the end of 2005. Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Elizabeth Court DS0000036172.V252023.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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