Inspection on 04/07/08 for Elizabeth Homes

This inspection was carried out on 4th July 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 Homes 12/09/06

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Elizabeth Homes 67 Hailgate Howden East Riding Of Yorks DN14 7ST Lead Inspector Diane Wilkinson Key Unannounced Inspection 4th July 2008 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.V368875.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.V368875.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) 01430 431065 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.V368875.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). 12th September 2006 Date of last inspection Brief Description of the Service: Elizabeth Homes is a privately owned care home that is registered to provide care and accommodation for 30 older people, including those with dementia related conditions. 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 private and well kept, and provides seating for residents and visitors. There is a small car park to the side of the home. The registered manager told us that the current weekly accommodation fee ranges from £365.00 to £390.00 per week. Prospective residents are informed of this in the home’s statement of purpose and service user’s guide. Elizabeth Homes DS0000067724.V368875.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 inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last Key Inspection of the home on the 12th September 2006 including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day; it began at 10.30 am and ended at 5.45 pm. The registered provider and registered manager submitted information about the service by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. On the day of the site visit the inspector spoke on a one to one basis with three residents, two visitors, three members of staff and the registered manager. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. Comments from discussions with people on the day of the site visit were mainly positive, such as, ‘good home cooked food’. Other anonymised comments are included throughout the report. At the end of this site visit, feedback was given to the registered manager on our findings, including requirements and recommendations that would be made in the key inspection report. What the service does well: Meal provision at the home is good but would be further improved if a choice of meal were offered at lunchtime. Health care professionals are consulted appropriately about the specific care needs of residents. Visitors are made welcome at the home and residents are supported to remain in touch with family and friends. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 6 People are made aware of the complaints procedure and any complaints made to the home are acted upon appropriately and to the satisfaction of the complainant. The home is well furnished and well decorated and is maintained in a clean and hygienic condition. Residents monies are held securely and all transactions made on their behalf are recorded by staff. This ensures that the financial interests of residents are safeguarded. What has improved since the last inspection? What they could do better: All residents living at the home must have an individual care plan so that staff are provided with information to advise them on how to offer appropriate care to meet the person’s individual needs. Care plans should include risk assessments to determine a person’s dependency levels in areas of care such as moving and handling, pressure care and nutrition. This would ensure that the care provided for each person is appropriate to meet his or her needs. More care needs to be taken with the administration, storage and recording of controlled drugs to ensure that the practices used by staff protect residents from harm. Staff must have training updates on safeguarding adults from abuse to ensure that they are able to recognise good and poor practice and act accordingly when they have concerns. The registered manager should check that staff are using the latest guidelines on safeguarding adults. New staff at the home must complete induction training that meets Skills for Care requirements within 12 weeks of commencing work. This is to ensure that staff have the knowledge and skills to provide the care needed by residents. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 7 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 Homes DS0000067724.V368875.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.V368875.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): 1 and 3. Standard 6 was not assessed, as there is no intermediate care provision at the home. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. In most cases a thorough assessment is undertaken for residents prior to their admission to the home but this is not consistent. EVIDENCE: On the day of this site visit we examined the care records for two newly admitted residents to the home; one of these included an initial enquiry form and a pre-admission assessment. The assessment completed by the home included all of the information needed to enable a decision to be made about whether the home was able to meet the person’s needs. The care records for the other person were very limited; we were told that this person was admitted to the home as an emergency admission and that they had had respite care at the home previously. No assessment had been Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 10 undertaken and there was no care plan in place. In addition to this, no community care assessment or care plan had been obtained from care management; the only records in place were daily notes recorded by care staff on each shift. When someone is admitted to the home in an emergency situation their care needs must be assessed as soon as possible after their admission, and a care plan must be developed. A care plan is needed to set out in detail the action that needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the resident are met. In the other care records that we examined on the day of the site visit we saw that a community care assessment/care plan had been obtained from care management, where appropriate. People told us that their relatives had been to look around the home on their behalf prior to their admission, and the registered manager confirmed that they visit people in their own homes or in hospital prior to their admission whenever it is possible to do so. Some residents have respite care prior to making a decision about permanent care. On the day of the site visit we noted that some people attend the home to have lunch. We advised the registered manager that this information should be included in the home’s statement of purpose and service user’s guide. The registered manager told us that the home’s statement of purpose is readily available to give to anyone who makes enquiries about the home. Elizabeth Homes DS0000067724.V368875.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): 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Health care needs are met in a way that respects a person’s privacy and dignity but current practices for the administration of medication do not protect residents from harm. EVIDENCE: We examined three care plans; these record the action that should be taken by staff to ensure that appropriate care is offered to residents, including the goals that they should be working towards. It would be helpful to include more information about how staff should work with the resident concerned to enable their goals to be achieved. There is no evidence that residents are involved in the development of their own plan of care. We noted that the care needs assessment includes information about the risks associated with each section of the assessment, but that there are no specific risk assessments regarding mobility, pressure care and nutrition that measure Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 12 a person’s level of risk or dependency. There should be a risk assessment in place for each of these areas and this information should be reviewed on a regular basis. Monthly reviews of the care plan are a thorough record of the care provided during the previous month, including any important events and incidents. We noted that annual reviews of the care plan are undertaken by care management when the placement is commissioned by them, and the registered manager told us that they hold in-house annual reviews for those residents who are self-funding. There is evidence that health and social care professionals are consulted appropriately when staff at the home have concerns about a person’s welfare. A separate record is kept of each contact a resident has with their GP; this does not record the reason for the visit or the outcome. This information is recorded in daily records but recording it on the separate sheet would provide a quick checklist for staff and would alleviate the need for staff to search through old records. There is no separate record used to record a person’s contact with other health care professionals such as the chiropodist, the dentist or the optician. Again, this would provide a quick reference tool for staff. We noted that residents are weighed on a monthly basis as part of nutritional screening and that any special dietary requirements are recorded in care plans. There is evidence that a person’s need for continence care and pressure care is acted upon; appropriate assistance is offered and the necessary equipment is obtained. We examined medication systems and records at the home. There is evidence that some of the staff that administer medication have undertaken accredited training, but other staff are awaiting formal medications training. There are sample signatures in place for the staff that have had formal training but no signatures in place for the other staff that are administering medication. Sample signatures are needed to enable records to be checked for authenticity. We spoke to the senior carer on duty about medication practices at the home and they displayed a good understanding of safety procedures when administering medication. They also confirmed that staff at the home do not sign medication administration records until the resident has actually taken the medication, apart from in one instance when the resident refuses to take medication whilst being watched by staff. There have been no indications that this person has not taken prescribed medication – the senior carer was advised that this should be recorded in the resident’s care plan and discussed at their next care plan review. Medication records were examined and we noted that there were some gaps in recording. More care must be taken when recording on medication administration records to evidence that residents have taken prescribed medication. When medication is prescribed part of the way through the week, Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 13 the details are recorded on the medication administration record by a member of staff; this is witnessed by a second member of staff and records are signed appropriately. Medication is stored in a locked medication trolley that is kept in a locked cupboard. On the day of the site visit we observed that controlled drugs were stored on the work surface in this room, and that there is no controlled drugs cabinet or book provided. We also observed that Temazepam is provided by the pharmacist in the standard blister packs and recorded on the medication administration record along with other medication; the registered manager agreed to discuss this with the home’s pharmacist. The registered manager contacted us after the site visit to inform us that they had ordered a controlled drugs cabinet and a controlled drugs book via their pharmacist. A medication fridge is being used and it is also located in the medication cupboard; fridge temperatures are taken to ensure that medication is stored at the correct temperature. Staff told us that they collect each new supply of medication from the pharmacy and that they return any unused medication to the pharmacy; they do this on foot whilst carrying bags that clearly indicate that medication is being carried. They were advised to discuss the safety aspects of this with the pharmacy, and to request that the pharmacy deliver the medication. Residents and visitors told us on the day of the site visit that staff always speak to residents politely and with respect; we observed this on the day of the site visit. Residents confirmed that any assistance with personal care is done sensitively, in a way that promotes their privacy and dignity. Some residents have a single room so they are able to see visitors in private and there are private areas of the home where meetings can be held with family and friends, health and social care professionals and other visitors. We noted that some bathrooms and most bedrooms do not have lockable doors. Doors must be able to be locked to ensure privacy for residents. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are encouraged and supported to maintain their chosen lifestyle and to take part in activities inside and outside of the home. Visitors to the home are always made welcome. Residents tell us that meal provision at the home is good. EVIDENCE: Care plans record information about a person’s life history and life preferences; this includes details about their hobbies and interests and choices about their religious beliefs. Residents told us that they are able to spend the day how they choose, and that they can get up and go to bed at a time chosen by them. On the day of the site visit residents were sitting in various areas of the home, including their own room. The inspector observed that bedrooms are a reflection of a person’s chosen lifestyle, including their hobbies and interests. We observed that a person’s individual differences were acknowledged and respected by staff. Daily entries in care plans record details of the personal care provided throughout the day and night, but there is little information about how a person actually spends their day. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 15 There is no activities coordinator employed at the home but care staff try to encourage residents to take part in activities, either as an individual or part of a group. A care worker runs a craft session every Wednesday afternoon and at a recent residents meeting everyone said that they enjoyed this. Entertainers attend the home occasionally and there are occasional trips out. We observed that residents are encouraged and supported to take part in activities in the local community as well as those within the home, and that they are supported to remain in touch with family and friends. Some people take a daily newspaper or a magazine and some people have their own telephone to enable them to remain in contact with family and friends. The two men that attend the home for lunch on six days per week are very sociable and it was evident that their arrival created some interest amongst the other residents, who enjoyed the ‘banter’ and chatting about the daily news. They told us that the home, ‘feels like a family’. There is no information available about advocacy services; this information should be available in the home should a resident need independent advice, and should also be displayed in the home so that people can access it independently without having to ask for support. On the day of the site visit we observed that there was a menu on display; this recorded one choice of meal at lunchtime but a wider choice at breakfast and teatime. Staff told us that the likes and dislikes of residents are known by the cooks and an alternative meal is provided if they do not like the meal on the menu. We recommend that there is a true choice of meal each lunchtime and that residents be consulted about the provision of a cooked breakfast, even if this is only on one day per week. Residents confirmed that there is a choice of meal at teatime. The residents told us that they like the meals provided by the home and that they always have fresh vegetables, and the two men that attend the home to receive a meal said that the home provides ‘good home cooked food’. The registered manager told us that residents continue to have breakfast in their bedroom so that it can be eaten at a leisurely pace, but that most residents came to the dining room for lunch and tea. There are three dining rooms at the home and all are pleasant and bright. Staff were seen to assist residents appropriately to eat and drink. We observed that there are ample drinks provided throughout the day. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 16 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): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and others know how to use the complaints procedure and residents said that staff listen to them. Staff have an understanding of safeguarding policies and procedures, including whistle blowing, and this offers residents protection from harm. EVIDENCE: There are appropriate complaints policies and procedures in place, and the complaints procedure is displayed in the entrance hall and in each resident’s bedroom. Residents told us that they know how to make a complaint and that they know who to speak to if they are dissatisfied with any aspect of care. They told us that they were confident that their complaints would be listened to and acted upon. No complaints have been made to the CSCI since the last key inspection of the home. Two complaints have been made to the home – these were recorded in a complaints book and records evidenced that the complaint had been investigated and the complainant had been informed of the outcome. Some improvements had been made to the security of the home as a result of one of the complaint investigations. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 17 We had previously received information that confidentiality policies in place at the home were not being adhered to by all staff. We discussed this with the registered manager, who told us how she had addressed this issue. Staff at the home told us that they are now willing to raise any issues or concerns and are confident that information will remain confidential. It is part of the complaints policy at the home that each resident is asked one a one to one basis every month if they have any complaints. This has been recorded up to March 08 and has then lapsed. This should be reinstated, as it is good practice. There is information displayed on the notice board to alert staff to the various types of abuse, and there are some policies and procedures in place regarding the safeguarding of vulnerable adults. However, it is not clear if staff are using the latest guidelines issued by the Adult Protection Committee; the registered manager agreed to check this. Staff were able to explain about possible types of abuse and about the purpose of whistle blowing. Some new staff need to undertake training on this topic to ensure that they are conversant with the policies, procedures and practices in place at the home and how to use them, to ensure that residents are protected from harm. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 18 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): 19 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is clean, well maintained and well furnished and provides comfortable surroundings for residents. EVIDENCE: There is no maintenance programme in place but the home use a ‘handyman’s log’ – staff record any minor repairs that need to be undertaken and the handyman signs when these have been done. We observed that the home is well maintained and there is evidence that equipment is replaced as necessary. The manager recorded in the Annual Quality Assurance Assessment (AQAA) that the exterior of the home has been renovated and this was observed on the day of the site visit. A maintenance log should be developed to record the home’s on-going plans to replace equipment, redecorate etc. This could be recorded as part of the business and financial plan; we noted that there Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 19 19 and People This ju this se The ho comfor continues to be no business and financial plan available at the home for inspection. We observed that the home was clean, well decorated and well furnished on the day of the site visit and we noted that there were no unpleasant odours. Bedrooms are decorated to reflect the needs of each resident, including small items of furniture brought in from their own home. There is ample access to sunlight in communal areas of the home and in bedrooms. The laundry facilities at the home are satisfactory. The washing machine has a sluice facility and the registered manager told us that the washbasin is used for staff to wash their hands. A notice should be placed above the washbasin to inform staff that it should only be used by staff to wash their hands; this would ensure that the risk of cross infection is reduced. Some staff have already undertaken training on infection control and we saw information in the home to advertise a training course for staff on infection control that was due to take place shortly. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care staff are not recruited in a way that protects residents from harm and they do not receive appropriate induction training. Staff do receive on-going training to equip them to care for the residents living at the home, but some need refresher training to ensure that their knowledge and practice is up to date. EVIDENCE: There is a satisfactory staff rota in place although it is quite complex and would be easier to understand if it were simplified. However, it does evidence that there are sufficient staff on duty and it identifies the role of each person on duty. There is a ‘NVQ tracker’ in use that records the staff members that have already achieved National Vocational Qualification (NVQ) Level 2 or 3 in Care, and those staff working towards this award. Nine of the eighteen care staff have achieved NVQ Level 2 or 3 in Care so the requirement for 50 of care staff to have completed this award has been met. Four care staff are currently working towards NVQ Level 2 in Care and a further three care staff are working towards NVQ Level 3 in Care so it should be possible for the 50 requirement to continue to be met. The registered manager told us that all staff have undertaken the Induction into NVQ training. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 21 We checked the recruitment records for two new members of staff. An application form is completed by prospective staff members and this includes details of their employment history, a declaration about criminal offences and the details of two referees. A record is kept of the interview questions and responses. Written references had been obtained for both of these applicants, but one of them had started work prior to their Protection of Vulnerable Adults (POVA) first check being received. The registered manager told us that the person had been shadowing a member of staff until their POVA first check arrived, but we informed them that no-one should be working in the home until a POVA first check has been received. We reminded the registered manager that a POVA first check should only be used in exceptional circumstances. Under normal circumstances, a Criminal Records Bureau (CRB) check should be obtained prior to someone starting work at the home. If someone is employed prior to the receipt of a satisfactory CRB check, they should remain under the supervision of a named member of staff, and these supervision arrangements should be recorded. We noted that CRB checks had been applied for in respect of these two members of staff. We noted that the records for these two members of staff did not include any information about induction training; there was a Skills for Care induction pack in one of the staff files but it was blank. The registered manager acknowledged that this was an area where they needed to improve. There is a training and development plan in place and this records the training achievements for all staff, including the date that the training was undertaken. This is good practice, as it assists the registered persons with identifying refresher training. The training and development plan did indicate that some refresher training is needed, for example, the last training provided on dementia care was in 2005 and some people had not had training on moving and handling since 2002. Some refresher training has already been arranged; this includes infection control and medication. The registered manager must ensure that all staff have regular training on core topics such as moving and handling, first aid, health and safety, food hygiene, fire safety and infection control. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 22 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): 31, 33, 35 and 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced person but the health, welfare and safety of residents and others are not fully protected by the systems in place at the home. EVIDENCE: The registered manager has the experience and skills to manage the home. She told us that she keeps her experience up to date by attending in-house training with the rest of the staff group. There has been a deputy manager in post until very recently and they have had responsibility for some aspects of management. Some of these have not been kept up to date, and the registered manager was reminded that she remained responsible for any work delegated to other people. Staff told us that they work well as a team and that Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 23 they have a lot of respect for the manager, and that she is always available to offer advice and support. Since the last key inspection of the home some improvements have been made to the quality assurance system and the home has achieved QDS Parts 1 and 2 - this is the quality assurance scheme operated by the local authority. The registered provider distributed quality surveys last year and is in the process of issuing them again this year. The registered manager said that the information from these surveys will be collated, any necessary work will be actioned and the results will be published. The collated results from the survey conducted last year were not available for inspection. The registered manager was reminded that the results of quality assurance surveys should be used to inform the development plan for the following year. Staff meetings are held on a regular basis – staff told us that they are able to raise concerns and make suggestions, and that these are listened to. The minutes of a recent staff meeting recorded that staff that were not able to attend the meeting were asked individually if they had any concerns. Residents meetings are also held on a regular basis. Service users monies held at the home were inspected; records were crossreferenced with actual monies held, and these were found to be accurate. Monies are stored safely; all transactions are recorded and receipts are kept so that residents financial interests are safeguarded. Some health and safety training is provided on a regular basis; records evidence that 15 staff did fire safety training in April 2008. However, some other training on health and safety topics is not updated on a regular basis and this could leave residents at risk of harm due to staff not having up to date information. Certificates or records were available for the most recent safety checks such as the gas safety certificate, passenger lift and hoist service certificates, portable electrical appliances and an annual fire test. We asked to see the latest fire risk assessment and the registered manager told us that they are in the process of updating this, as the current one is very brief. A copy of the updated risk assessment should be sent to the CSCI as soon as it is completed. Policies and procedures that relate to safe working practices, including risk assessments, were not available on the day of the site visit. The registered manager must ensure that these are in place. We saw the records kept regarding tests of water temperatures at outlets accessible to residents – bathrooms are tested on a regular basis but infrequent checks are made in bedrooms. We recommend that more bedrooms be added to this auditing system to ensure that residents are protected from the risk of scalding. Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 24 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13(2) Requirement Controlled drugs must be stored in a controlled drugs cabinet that meets the Royal Pharmaceutical Society guidelines, and administration should be recorded in a separate controlled drugs book. There must be a record of medication received, medication administered and the balance held; the balance of medication should be checked on each occasion medication is administered and be signed by two staff. There must be no gaps in recording on medication administration records so that it can be evidenced that residents have received their prescribed medication. A POVA first check must always be obtained prior to someone commencing work at the home. Staff must complete induction training that meets Skills for Care requirements within 12 DS0000067724.V368875.R01.S.doc Timescale for action 01/08/08 2. OP9 13(2) 04/07/08 3. OP29 19(1) 04/07/08 4. OP30 18(1) 01/09/08 Elizabeth Homes Version 5.2 Page 26 weeks of commencing work. 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 meal service provided by the home should be recorded in their statement of purpose and service user’s guide. There should be risk assessments in place on such topics as moving and handling, pressure care and nutrition to determine a resident’s dependency level, and these should be reviewed on a regular basis. Care plans should be more specific when recording the support that people require to ensure that they receive appropriate care. All doors to bathrooms, toilets and bedrooms should be lockable to promote privacy and dignity for residents. There should be information available in the home about advocacy services. There should be a true choice of meal each lunchtime and residents should be consulted about their wishes to have a cooked breakfast. The registered manager should check that they are using the latest guidelines on safeguarding adults from abuse, and should ensure that all staff have recent training on this topic. There should be maintenance plan in place to evidence planning for future expenditure on equipment, furniture and fittings. A notice should be placed above the washbasin in the laundry room to inform staff that it should only be used to DS0000067724.V368875.R01.S.doc Version 5.2 Page 27 2. OP7 3. OP7 4. 5. 6. OP10 OP14 OP15 7. OP18 8. OP19 9. OP26 Elizabeth Homes wash their hands. 10. OP29 A POVA first check should only be used in exceptional circumstances. Under normal circumstances, a CRB check should be obtained before people start work. Anyone commencing work before a satisfactory CRB check has been received should work under the supervision of named member of staff. Staff must receive refresher training on core topics such as moving and handling, fire safety, food hygiene, health and safety, first aid and infection control to ensure that their practice is up to date. A copy of the Fire Risk Assessment should be sent to the CSCI as soon as it is completed. The testing of water temperatures at outlets accessible to residents should be expanded to include more bedrooms, to reduce the risk of scalding. 11. OP30 OP38 12. 13. OP38 OP38 Elizabeth Homes DS0000067724.V368875.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Homes DS0000067724.V368875.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. 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