CARE HOMES FOR OLDER PEOPLE
Elizabeth Homes 67 Hailgate Howden East Riding Of Yorks DN14 7ST Lead Inspector
Ms Anne-Marie Foster Key Unannounced Inspection 12th September 2006 09:30 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 Homes DS0000067724.V310521.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 Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Elizabeth Homes Address 67 Hailgate Howden East Riding Of Yorks DN14 7ST 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) 020 8458 8685 Eaveshill Limited Mrs Josephine Doris Tipping Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To admit one named service user under age 65 in category Physical Disability (PD). 23 August 2005 Date of last inspection Brief Description of the Service: Elizabeth Homes is a privately owned care home. It has recently undergone a change of provider. It is registered to provide care and accommodation for 30 older people, including those with dementia. The home is situated in the centre of the small rural town of Howden, with the local shops and amenities being in close proximity. Service users have a choice of single or shared rooms, and most of these have en suite facilities. The garden is well kept and private, with a pleasant planting arrangement. There is a small car park to the side of the home. Weekly fees as at September 2006 range between £328 and £358.This does not include hairdressing chiropody service and individual items like newspapers. Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection report follows an unannounced site visit to the home on 12th September 2006.The site visit took place over six hours. The registered manager was available to assist the inspector. This was the first inspection since the new provider bought the home. Information about the home was gathered prior to the site visit from a variety of sources, which included a pre inspection questionnaire, and reports of notifiable incidents sent in to the Commission from the home. Surveys were sent to health professionals that visit the home, to obtain their views and one response was received. A tour of the home was made, this included communal and service areas and, with permission, service user’s rooms. Staff were observed throughout the day as they were carrying out their duties, and their interactions with service users was noted. Some policy documents were looked at and the care files of service users were inspected to see how individual needs were assessed. Discussions were held with both the staff team and the service users. What the service does well:
The home is clean and welcoming, it has a homely appearance and is pleasantly decorated. There is a friendly, positive atmosphere within the home, the staff work to a high standard and they enjoy their work. The home has a stable group of staff, many of which are long service employees, and the service users enjoy and benefit from this. There is an open style of leadership at the home; the registered manager is approachable and enjoys her work. The menus looked balanced and wholesome, and the service users said that they enjoy their food. Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
A service user guide and statement of purpose needs to be made available in order to give prospective service users as much information as possible about the home. This will help people to make a more informed choice about moving in to the home. Locks should be fitted, where appropriate, to service users rooms, and to one bathroom upstairs so that privacy and dignity can be promoted and upheld. The local authority guidance that relates to the protection of vulnerable adults should be available in the home so that staff can refer to it when necessary. The home should continue to arrange training for staff in the National Vocational Qualification certificate in care level 2 (or above). This will help to increase the skill mix of staff and ensure that over 50 are qualified and competent to do their jobs. The home should develop its quality assurance system. The views of the service users, their families or friends and other contacts, for example G.P ‘s,
Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 7 district nurses, the chiropodist , should be sought about the home. This information can be used to help self monitor any progress, and measure any success, so that the home can be run in the best interests of the service users. The provider must make available a copy of the financial and business plan for the home, and ensure that this is open to inspection. 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. Elizabeth Homes DS0000067724.V310521.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 Homes DS0000067724.V310521.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 Quality in this outcome area is good. Service users do not move in to the home without a detailed assessment, so that staff can be sure that they can meet the individual’s care needs. This judgement has been using available evidence including a visit to this service. EVIDENCE: The registered manager carries out an assessment of prospective service users prior to accepting them in to the home. Discussions take place with the service user, their relatives/ friends, care management and health professionals wherever possible. The assessment records at the home were inspected, these were found to be well written and link into the care plans, and no service user is admitted to the home unless their needs can be met. The staff could not show the inspector the service user’s guide. This, and the statement of purpose should be made available in the home for prospective service user’s so that they, and their relatives or friends have the information they need to make a choice about where to live. There is no intermediate care offered at the home currently.
Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10,11 Quality in this outcome area is good. Service users live in a home where their needs are met, and they are supported by staff who respect their rights to privacy and dignity. This judgement has been made using available evidence including a visit to this service EVIDENCE: Care plans are simple but are well set out and reviewed regularly. Risk assessments for those individuals that need them are in place and are reviewed regularly. Care plans are signed by the service user, or their families whenever possible. Eight service users were spoken with and all told the inspector what a good standard of home they lived in and remarked on how caring the staff were, and said ”I want for nothing” “All my needs are met” “ staff are very kind”, this helps to demonstrate that healthcare, personal, and social needs were well met. A small group of service users with dementia had their individual needs assessed and appropriate care plans were in place. They were cared for in a smaller ,quiet lounge which was of benefit to them, and their needs were met through good planning, and good numbers of available staff.
Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 11 The medication system was inspected, and the monitored dosage system and records were looked at and found to be satisfactory. The system for ordering and return of medication works well, and service users are supported by a safe administration of medication procedure. The inspector observed the care staff carrying out their duties, and they were noted to work in a calm unhurried fashion. The staff were noted to work in a quiet and polite way, and were heard to use the preferred and appropriate terms of address; service users were treated with respect, and their right to privacy was upheld. Where risk assessments have been carried out, some of the more independent service users should be able to have a lock and key to their room, so that they can enjoy more privacy in their life. Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 12 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, and15 Quality in this outcome area is good. Service users live in a home where there are a variety of activities, and where their likes and dislikes are taken into consideration. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Whilst the home does not employ an activities person, service users told the inspector “ there is enough for me to do” “they get it right - not too many activities”. Service users are supported if they wish to attend church, or take communion in the home. Other activities are arranged by the care staff who each get involved with, for example; sherry and music afternoon, market day trips, garden centre trips, bingo and dominoes. Service users say that they find their social, cultural, religious and recreational needs are met. The home makes visitors welcome, and they are allowed to come and go at times convenient to the service user. The home is well placed in the centre of the village, which helps to promote community contact, and service users are helped to maintain contact with their family and friends as they wish. The routine at the home is flexible; service users have a variety of lounges to sit in, or could choose to stay in their room if they wish. A sample of menus
Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 13 was given to the inspector, and, since the last inspection all service users are now aware that there is an alternative choice to the main menu each day. The menus looked varied balanced and wholesome. The lunchtime meal was observed, it looked appetising and was enjoyed by the service users. One service user was celebrating a birthday, and a cake and buns had been freshly baked for the occasion. The dining areas were pleasant, staff were available to assist as necessary, and service users received a balanced diet in congenial surroundings. Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. Service users are supported and protected by a robust complaints procedure and well-trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four service users said to the inspector that they would know how to make a complaint, and they felt that they would be listened to and taken seriously. Staff also reported that they would be happy that any complaints they had would be listened to and acted upon by the management. One of the care staff talks to each service user on a monthly basis about any complaints, this opportunity further allows the service user the chance to disclose any problems. The complaints book was inspected, and records show that all complaints are taken seriously and are dealt with promptly. All of the staff on duty were spoken with; they have recently had the protection of vulnerable adult training, this was delivered by the registered manager and her deputy, and has helped to raise their awareness of adult abuse issues. Whilst the manager has seen the latest local authority guidance that relates to adult abuse, and is familiar with it, she was unable to access the home’s copy of it. This should be available readily in the home so that staff are able to refer to it as necessary. There have been no complaints received by The Commission for Social Care Inspection about the home. Service users are protected by the home’s policies and procedures and open complaints system Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is good. Service users live in a safe, homely care home that is kept clean. This judgement has been made using available evidence including a visit to this service EVIDENCE: The home is comfortable and well maintained, service users rooms are personalised and looked fresh and clean. Rooms are redecorated as they become empty, or as required. The garden is safe, pleasant and private. Staff work hard to keep the home clean, the care staff have cleaning duties, which include laundry duties. The home was found to be hygienic on the day of the site visit. The laundry was inspected and whilst it is small, it was found to be clean and tidy. This laundry room has only on e sink, which must be kept for staff to wash their hands. A staff member confirmed that, as is good practice, soiled clothes go directly into the machine, which has a sluice facility. The home’s policies, procedures and practice relating to hygiene and laundry practices will help to reduce any risks of cross infection.
Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 16 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 and 30 Quality in this outcome area is good. The service user’s needs are met by a kind, stable, mature and well-trained staff group. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff numbers at the home are good, and staff say that they can meet the service users needs. Service users talk highly about the staff and say “ they are kind” “they are the best” “ there seem to be enough of them” which helps to demonstrate that service user’s needs are met by the numbers of staff. Whilst the home does not currently have enough of its care staff with the National Vocational Qualification (NVQ) 2 certificate in care, one staff member is enrolled for NVQ 3, and several staff members are enrolled for NVQ 2, this will meet the requirement of 50 , by 2007 and help to ensure that service users are in safe hands. The recruitment process at the home is robust. Five staff files were inspected and each of these contained the necessary documentation required by regulation, for example, two satisfactory written references, and a satisfactory Criminal Record Bureau check, this along with the home’s recruitment policy and other practices will help to further protect the service users. Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 17 There is a training plan in place, which shows the courses that staff have attended, and the relevant certificates were available in the staff files. All staff have induction training, which covers for example fire safety, moving and handling, and food hygiene. Further training is available, both in house and externally, and staff confirmed that they have enough training opportunities, so that they are trained and competent to do their jobs. Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35 and 38 Quality in this outcome area is good. Service users live in a safe home that is well managed, although the quality assurance system should be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is run by a qualified, and experienced registered manager. Service users and staff spoke positively about the manager of the home, and said they found her easy to communicate with. The quality assurance system should be improved; the registered manager was not sure if a questionnaire is sent out to service users, their relatives and other contacts of the home. This was the responsibility of the previous provider and as such the registered manager did not get involved. A quality assurance system is necessary so that the home can seek the views of those people using
Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 19 the service, which could then be used as a tool for continuous self-monitoring and improvement. Service users monies held at the home were inspected. These are stored safely and are looked after by the manager and her deputy. All transactions are recorded, and receipts are kept so that service users financial interests are safeguarded. Whilst the inspector has seen a financial and business plan for the home in July 2006 , this should be available at the home. The registered manager takes the responsibilities that relate to health and safety seriously. Staff receive the necessary training that will help to keep themselves and the service users safe, for example moving and handling, first aid, and infection control. Certificates or records were available for the most recent safety checks for example; gas safety systems, portable electrical appliances, water temperatures, fire fighting equipment and maintenance of equipment, these were all found to be in order. Water temperatures tested by the inspector were found to be within safe limits. All accidents are recorded and reported and the accident documentation was inspected and found to be in order. Policies and procedures that relate to safe practices are available to view, and are kept up to date; these help to further protect the safety and welfare of service users and staff. Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 20 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 3 8 3 9 3 10 2 11 X 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 2 3 X X 3 Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 21 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 OP33 Regulation 24 Requirement The registered provider and registered manger should develop a quality assurance system based on seeking the views of those people living in, or coming into contact with the home. This must include the publication of the outcomes of any surveys. Timescale for action 01/11/06 Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 22 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 OP1 Good Practice Recommendations The service user guide and statement of purpose should be available in the home to give out to prospective service users, so that people can make a more informed choice about moving into the home. An assessment should be made of those doors in the home that require a lock, such as bedroom doors where appropriate, and the upstairs landing toilet, in order to offer privacy and dignity to the service users. The registered manager should have the latest copy of the local authority guidance that relates to the protection of vulnerable adults, available in the home. Over 50 of the care staff team should have the NVQ 2 or above certificate in care. The registered provider should have a financial and business plan at the home, available for inspection and reviewed annually. 2 OP10 3 4 5 OP18 OP28 OP34 Elizabeth Homes DS0000067724.V310521.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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