Inspection on 16/08/05 for Elizabeth House

This inspection was carried out on 16th August 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 House 17/04/07

Elizabeth House 27/02/06

Elizabeth House 01/02/05

Elizabeth House 26/11/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Elizabeth House Sandy Hill Werrington Stoke-on-Trent Staffordshire ST9 0ET Lead Inspector Sue Jordan Unannounced 16 August 2005 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 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 House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Elizabeth House Address Sandy Lane Werrington Stoke-on-Trent Staffordshire St9 0ET 01782 304088 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Philip Harold Fradley Mr Philip Harold Fradley CRH 23 Category(ies) of DE(E) - 8 registration, with number OP - 23 of places PD(E) - 6 Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 1 February 2005 Brief Description of the Service: Elizabeth House is a Registered Care Home for 23 older people, initially registered by the present Proprietors.The premises were originally a barn conversion and the proprietor’s former home. There is an existing single storey extension and a four-bedded extension. The Home stands in private grounds, which provides ample car parking for visitors. The Home is situated in Werrington, in a residential area on the outskirts of Stoke-on-Trent, bordering the Staffordshire Moorlands.The Home presents as an attractive and wellmaintained building. Internally the accommodation is of a high standard with a good standard of housekeeping throughout. It is warm, well furnished, appears comfortable with good décor and offers a choice of three lounges/sitting rooms of varying sizes with a separate dining room.Resident’s bedrooms are situated on both ground and first floor with access via stairs and a stair lift. All rooms are single occupancy with various en-suite facilities. Assisted toilet and bathing facilities are available. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours and the methodologies used were discussions with the many of the residents, some of the staff and the management, a tour of the environment, lunch with the service users and the checking of some care records. What the service does well: What has improved since the last inspection? There was a concern expressed at the last inspection regarding the safety of some portable, oil filled heaters. The manager contacted the fire safety officer and the Health and Safety executive and their advice was taken and actioned. The manager has started to compile a list of the residents’ wishes, as to whether they require a bedroom door lock fitted. He is aware of the need to fit locks, which comply with fire safety requirements. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 6 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 contacting your local CSCI office. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 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 standard(s) 2, 3, 4, 6 Prospective residents are assessed appropriately and can be assured that the Home can meet their needs. EVIDENCE: Four permanent residents have moved into Elizabeth House since the last inspection and discussions were had with three of them and their records briefly perused. All three of the residents spoken to said that they had settled well into the Home. One said that he had come from hospital and that the manager had visited him prior to being offered a place at Elizabeth House. This was confirmed within his records. General and mobility risk analysis is undertaken for all new residents at the point of admission, however there is a need for more expansion of detail in some instances, (see NMS 7). Local Authority assessments and care plans are received, where applicable. Another new service user is due to move into the Home after which there will be no vacancies. The management develop individual contracts for all of the residents and they also file those received from the Local Authority, if applicable. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 9 Elizabeth House provides care for up to 23 older people, of which 8 may have dementia and 6 a physical disability. The staff team are trained and supervised to provide care to these categories of service user. This was confirmed in discussions with staff members. There have been some staffing difficulties, in that a number have left since July 2005. However the rota has been maintained and although the residents are aware of the problems they confirmed that they had still received the same level of care. Care needs are clearly identified in the residents’ records and staff knowledge and accessibility is further enhanced at handover periods and by providing pertinent information in the residents’ bathrooms. Elizabeth House does not provide intermediate care. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, 10 Health and personal care needs are recorded in the care plans, which are regularly reviewed. Therefore the staff have the information required to deliver the care required. In order that the rights of all service users are upheld, any limitation or restriction must be carefully assessed, justified and recorded. EVIDENCE: Care planning continues to be clear and concise and reviewed on a monthly basis. Staff have the access they need to deliver the care required. Although general risk and mobility analysis is undertaken, some expansion is required for some circumstances. The manager has risk assessed the use of bed guards, but the same must be undertaken for any situation, which limits or restricts a resident. For example, the Home use alarm systems over some of the bedroom doors and although the verbal reasoning is justifiable, this should be recorded and the risk assessment format is strongly recommended. Records are kept of all contact with medical health professionals and provide ample evidence that health needs are monitored and appropriate services accessed. One of the residents did express concerns that she had to wait for a consultant appointment, however the manager has made the appropriate Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 11 referrals and could not personally have done more. The manager explained that telephone consultations could be booked with the general practitioner, which have proved invaluable. Lunchtime administration of medication was observed and was considered appropriate. The senior care worker, recently promoted explained that she had received in-house instruction and that she is working towards the distance learning, ‘Safe Handling of Medicines’ award. There is a clear medication policy on view in the medication cabinet and a second member of staff always checks the administration sheets. The senior care worker did become a little flustered due to being observed by an inspector and she made a mistake, however she sought immediate guidance from her manager and the problem was suitably rectified. There is appropriate storage for controlled medication and a separate administration record kept. The physical health of one of the residents has recently deteriorated and as a result the staff are having some difficulties administering the presently prescribed medication. Records are kept of occasions when medication could not be given, however the manager and deputy agreed to contact the general practitioner for advice as to which medication is priority and whether liquid substitutes could be prescribed. All of the residents have their own bedroom and many have en-suite facilities. The Home has a ‘treatment room’, however the deputy manager explained that most medical visits would take place in the resident’s own room. The application of creams etc is done in the privacy of a bathroom or bedroom whichever is more appropriate. The laundry is carefully separated. Visitors are made welcome in the Home and the residents have various options as to where to receive them. The staff were observed treating the residents with respect and there was a pleasant friendly banter, which was obviously enjoyed. Some of the residents choose to spend the majority of their time in their bedrooms and this is facilitated, although they are encouraged to join the other residents for their meals. The privacy, dignity and rights of the residents will be further upheld by the introduction of bedroom door locks and risk assessments for limitations. These areas are being addressed by the management and highlighted throughout this report. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15 The Home endeavours to provide the residents with interesting daily activities, although staffing problems have created a temporary problem in this area. The residents are offered avenues of choice throughout their daily lives. EVIDENCE: There have been some recent staffing difficulties, which has meant that some of the activities have had to be changed or cancelled. One of the residents said that whilst she understood, she missed the activities. However, the Home still develops a weekly activity plan and alternatives or cancellations are recorded. In order to combat the problem, the management have increased the amount of external entertainers booked for the Home. The manager was made aware of the resident’s comments. A local vicar was visiting Elizabeth House on the day of this inspection and spoke highly of the Home. Visitors are made welcome and some residents visit their families. One explained that she had recently been on holiday with family. One of the residents spoke of her concerns regarding her finances and power of attorney. This was relayed to the manager, who agreed, with her permission to contact an advocate service. Two of the residents have previously used independent advocacy services. The residents are encouraged to bring personal possessions with them and some of the bedrooms clearly reflect this. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 13 An inventory is completed on admission. Two of the residents spoke of being able to choose when they get up and when they go to bed and this was observed. The Home has recently employed two new cooks and one was spoken to during this visit. She has a food and hygiene certificate and relevant experience. She explained that the management were encouraging them to have input into the development of planned new menus. At present the Home has a two weekly menu in place and it was recommended that they consider a four weekly option. Lunch was taken with the residents in the homely dining area and assistance is given sensitively to those requiring it. The day’s menu is written on the board and alternatives are available. One of the residents has recently been diagnosed as being diabetic and at present this is diet controlled. Although there are set meal times, some of the residents choose to take their meals at differing times and this is facilitated. All of the residents spoken to praised the quality of the food. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 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 standard(s) 16, 18 There have been no complaints or Adult Protection issues in the Home and the procedures adopted protect the service users. EVIDENCE: There have been no complaints made to the CSCI, (Commission for Social Care Inspection). The complaints procedure is sited in the lobby area of the Home. One of the residents stated that the manager was approachable and caring. There have been no Adult Protection issues in the Home. The staff are trained in this area and appropriate POVA, (Protection of Vulnerable Adults), checks and CRB, (Criminal Records Bureau), disclosures are obtained as part of the Home’s recruitment procedures. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 23, 24, 25, 26 Generally the Home is well maintained and provides its residents with a comfortable, homely environment. EVIDENCE: A tour of the Home was undertaken and even though there have been staffing difficulties all areas were clean and tidy. The garden area adjacent to the downstairs bedrooms has been tidied and a resident’s daughter has kindly planted the flowerbeds. This area is very attractive and enjoyed by the residents. There is a patio area, with a central fountain, which has available seating for the residents. There is adequate communal space in the Home. There are two lounges, a dining area and various private areas in the Home. A treatment room is also available, which is most currently used by the weekly hairdresser. The Home is furnished in a homely and domestic style. One of the residents is a smoker and an agreement has been made that she smokes on the veranda area of her bedroom or outside. This appears to be working well. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 16 All of the residents have a single bedroom. The Home has two main bathrooms, although many of the residents have ensuite facilities. The downstairs bath is the most popular and has an assisted bath seat. There are numerous toilets in close proximity throughout the Home. The bedrooms are well furnished and many of the residents have brought their own personal possessions into the Home. A requirement was made previously that bedroom door locks be provided. An agreement was made that the manager ascertain the views of the present residents and should they adamantly refuse a lock that this be clearly documented. It was explained that locks should be provided as a matter of course and a risk assessment undertaken with regard to the provision of keys. The manager is aware that the locks must comply with fire safety standards. Since the last inspection the residents and/or their families have been asked whether they wish to have a lock and the manager has started to make a list. Some of the residents have expressed a positive interest. It was noticed at this visit that one of the residents has been wandering into another’s bedroom. Precautions have been taken, but providing a lock and key would certainly solve the situation in this case. The management also stated that some of the residents do become anxious if they think that another resident is wandering towards their room and that they have realised the need for locks and keys in these cases. This will also further promote privacy in the Home. The Home is well ventilated and centrally heated. The water temperatures in both bathrooms were taken. One was 48 degrees Celsius and the other 30. The manager is responsible for taking and recording the water temperatures and has noticed discrepancies even though the valves are pre-set. He reported that a plumber has been contacted and a visit arranged. The importance of the Home’s bathing procedure was discussed and it was noted that thermometers are available in all of the bathrooms. A new laundry area has been created, which includes an industrial tumble dryer and a washing machine with a sluice facility. Alginate bags are used for soiled linen. The manager was informed that a hand washing sink must be installed for staff. A malodour was noticed in one of the bedrooms and a discussion was held with the deputy regarding the cleaning regime. Further action is required and the possibility of washable flooring was discussed. However this should be a last resort, health and safety measures taken and any reasoning clearly recorded. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 There have been recent staffing difficulties in the Home, although the management have maintained safe staffing levels on the rota. EVIDENCE: There have been recent staffing difficulties, in that a number of staff have left the Home to work for the Local Authority. Some replacement staff have left the Home without giving notice. This has created pressure on the management and the remaining staff although the rotas and staff levels have been maintained. The Home employs domestic and catering staff. A recruitment advert is being placed in a local newspaper and the manager confirmed that the recruitment procedures would follow those previously used and agreed as meeting the legal requirements. Discussions with staff confirmed that levels of training remain high. The staff are encouraged to develop their careers. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36, 38 The manager demonstrates an open and transparent approach to the CSCI inspections and continues to maintain, develop and implement robust management procedures, which support both residents and staff. EVIDENCE: The staff and residents spoken to agreed that the manager is approachable and that they are able to discuss any concerns with him. The manager demonstrates openness and is happy to work in partnership with the CSCI. He was open regarding the recent staffing difficulties and sends the required notifications. The staff spoken to confirmed that they continue to be regularly supervised, although it was mentioned that a team meeting had not been held for a while. Some health and safety aspects were checked at this inspection. The manager closely audits all areas of health and safety and maintenance checks and was Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 19 able to demonstrate that he was aware of the need to have the stair lift serviced, which had been identified during this visit. Concerns raised at the last inspection regarding the use of oil filled heaters have been addressed and appropriate guidance sought and followed. Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 2 2 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x 3 x 3 Elizabeth House E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 13 (4b, c) 12 (1a, 2, 3, 4) 12 (4a) Requirement Any limitations or restrictions placed on service users must be risk assessed, recorded and therefore open to review. Locking devices should be provided as standard on bedroom doors to promote privacy and dignity for the service users. Use of approved locking device to be as recommended by the Fire Officer. Previous Requirement Water temperatures must be close to 43 degrees Celsius. Previous Requirement Hand washing facilities should be provided in the laundry area. Timescale for action 01/10/05 2. 24 01/11/05 3. 4. 25 26 13, 23 13, (5) Immediate and ongoing 01/11/05 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 15 Good Practice Recommendations It is recommended that the two-weekly menu be extended to four-weekly. E51-E09 S4936 Elizabeth House V243610 16.08.05 Stage 4.doc Version 1.40 Page 22 Elizabeth House Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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. 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