Inspection on 03/10/06 for Elizabeth House

This inspection was carried out on 3rd October 2006.

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 26/07/07

Elizabeth House 12/02/06

Elizabeth House 12/08/05

Elizabeth House 28/02/05

Elizabeth House 02/09/04

Elizabeth House 12/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Elizabeth House Elizabeth Close Moors Walk Panshanger Welwyn Garden City Hertfordshire AL7 2JB Lead Inspector Mrs Alison Butler Unannounced Inspection 3rd October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elizabeth House DS0000019333.V314903.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 House DS0000019333.V314903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elizabeth House Address Elizabeth Close Moors Walk Panshanger Welwyn Garden City Hertfordshire AL7 2JB 01707 338820 01707 392404 eh@wgcha.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Welwyn Garden City Housing Association Madeline McCann Care Home 48 Category(ies) of Dementia - over 65 years of age (48), Old age, registration, with number not falling within any other category (48) of places Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th February 2006 Brief Description of the Service: Elizabeth House, provided by Welwyn Garden City Housing Association (a charitable organisation) is situated in Welwyn Garden City. The building is a purpose built residential home for 48 service users in the older people category. A section of the building is used by the Housing Association itself. The premises were extensively refurbished in 2003. There are parking spaces in the front of the building. Fees for the service are £445 to £498 per week (this is correct as of 03/10/06) The home has a Dementia Unit (for 13 service users) and a Residential Unit (for 35 service users). The Dementia Unit has its own facilities comprising two lounges, a kitchenette and a small dining room. All the bedrooms are on the ground floor. The garden and the entrance to the unit is security locked. The Residential Unit has bedrooms on two floors that are served by a lift. The unit has a spacious kitchen, laundry and hairdressing facilities and a spacious dining room. There are ample community spaces including a main lounge on the ground floor and other communal rooms. All the bedrooms are single rooms with washbasin and toilet facilities. The bathroom and shower facilities are nearby. The administrative offices and the staff room are situated between the two units. The surrounding grounds and gardens are accessible to wheelchairs. Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place during the day by one inspector. All key standards were assessed. Questionnaires were left with the manager to be returned to the Welwyn Garden City office by the 31st October to include feedback within this report. Discussions took place with staff, residents and the manager. Observations of care took place during this inspection and care records examined. What the service does well: What has improved since the last inspection? What they could do better: The manager must ensure to keep the Commission informed of incidents and accidents as she failed to notify the Commission For Social Care Inspection of two incidents where residents received hospital treatment following an accident at the home. Medication procedures need to be tightened up, especially around medication that is given as required, as the inspector and the member of staff were unable to reconcile some medication. Some work is required on the care plans to give clear instructions as to the support individuals need from staff. Each page of the care plan should include the name and date of birth of the resident to prevent loss or the incorrect information or support being given top the wrong resident. Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 6 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 DS0000019333.V314903.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable to Elizabeth House. Quality in this outcome is good. This judgement has been made using the available evidence including a visit to the service. Full assessments are carried out on individuals prior to admission to the home. EVIDENCE: Residents and/or their families are able to visit the home prior to making a decision on the suitability of the home in being able to meet the needs of the individual. Each resident is provided with a Service User Guide on admission. Residents are usually admitted for a trail period to ensure both parties are happy with the arrangements and the individuals needs can be met appropriately. The manager carries out a full assessment prior to an individual being admitted to the home to ensure they are able to meet their personal care needs. Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome is adequate. This judgement has been made using the available evidence, including a visit to the service. Residents are treated with respect and privacy and dignity is maintained. Medication is stored, and disposed of in accordance with legislation; some errors were noted with the administration. EVIDENCE: Residents spoken to during the inspection were very happy with the care provided at Elizabeth House. Examination of the care plans showed that whilst the format was good, staff need to ensure they are more detailed to ensure that everyone is clear on the needs of the individuals. It is recommended that each page of the care plan contains the name and date of birth of the resident it refers to, this would prevent missfiling when they are removed from the file to be completed. There was contradicting advice on 1 file when the night plan states they like the door open but then later states they lock their door at night. Where allergies have been identified this would be better if it was put on the front of the care plan and highlighted. Within the plan there should be information of what can happen due to the allergy and what action staff should take in the event of an emergency reaction. Where a medical condition has Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 10 been identified such as arthritis staff need to be clear what action is to be taken for example pain relief, exercise etc. All information should be signed and dated by the author such as reviews and risk assessments as this was not always the case. An examination of the medication showed that the temperature of the storage area was being carried out regularly and recorded although at the moment it exceeds the manufactures guidelines by 5ºC, the medication is returned at the end of the month to ensure that it does not loose its clinical effectiveness. Administration records showed that there were no missed signatures although some medication could not be reconciled. The manager stated that they would look into this and check that procedures were being followed and provide additional training if necessary. A check of the controlled drugs showed they were well recorded and reconciled. Risk assessments were in place for the residents who are prescribed insulin, which is administered by the district nurse Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14 & 15 Quality in this outcome is good. This judgement has been made using the available evidence, including a visit to the service. Residents are able to maintain contact with family and friends. Residents are provided with recreational activities. Residents receive a choice of a well balanced diet. EVIDENCE: Residents spoken to and the comments received from a number of questionnaires showed that residents were happy with the activities on offer. One family felt that staff need to encourage their relative to take part in activities and ensure they maintain mental stimulation. On the day of the inspection there a choice of activities for residents to join in these are run by an activities co-ordinator and the care staff one group were taking part in play your cards right and another group were taking part in a general knowledge quiz, prizes were provided to the winners. Residents felt that the food on offer was generally good and that they have choice. Regular residents meetings are held and minutes taken, the manager and her team ensure that appropriate changes are made to improve the care provided. Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome is adequate. This judgement has been made using the available evidence, including a visit to the service. The home has a Complaints procedure in place, which is available to residents and visitors to the home. The home protects the residents from abuse by the homes policies and procedures. EVIDENCE: There had been no complaints received since the last inspection. Appropriate policies and procedures are in place. Residents spoken to and from the questionnaires received they felt they are able to raise concerns and they will be dealt with appropriately. Policies and procedures are in place for the recruitment of staff to ensure they protect the residents from abuse as far as is possible. Hertfordshire County Council Joint Working Adult Protection procedure is displayed within the home and staff receive training in adult protection. The manager usually informs the Commission For Social Care Inspection under Regulation 37 of accidents that adversely affect the well being of residents, although 2 residents who had received hospital treatment following an accident within the home had been missed and the information had not been passed to the Commission. Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome is adequate. This judgement has been made using the available evidence, including a visit to the service. The residents live in a homely, safe and comfortable environment. Infection control measures should be tightened. EVIDENCE: A tour showed the home was well maintained, clean and safe. The resident’s bedrooms had been personalised to reflect the lifestyle of the individuals. Residents spoken to were very happy with the facilities on offer at the home and that they were able to bring in some items of furniture if they wished and space allows. Water temperatures were tested and were within safe limits. The manager should make sure that soft paper hand towels are available in all communal bathrooms to provide good infection control measures to be in place. Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome is good. This judgement has been made using the available evidence, including a visit to the service. Staff levels are adequate to meet the personal care needs of the residents at the time of this inspection. A rolling training programme is in place. EVIDENCE: Examination of the rotas showed that adequate numbers of staff are deployed to meet the needs of the residents at the time of this inspection. Information received from the returned questionnaires and discussions with the residents stated that usually their needs are met within a reasonable timescale. Comments received “they are wonderful” “ Elizabeth House provides an excellent service” “I am very satisfied with Elizabeth House, the staff do a superb job in difficult circumstances”. The training programme is designed to ensure that residents are assessed and their needs can be met. Training includes, adult protection, moving and handling, fire, health & safety. There is an induction programme in place for all new members of staff and they confirmed they had completed this. The home has policies and procedures in place for the recruitment of staff, examination of staff files showed that all appropriate information had been received prior to commencement of the individuals. Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 15 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, 35 & 38 Quality in this outcome is good. This judgement has been made using the available evidence, including a visit to the service. The home is well managed with a management structure in place. Records are up dated and well maintained. Staff are supervised as part of the management process. EVIDENCE: Staff members spoken with valued the leadership and management approach of the home. They feel they are well supported and receive regular supervision. As part of the quality assurance feedback from residents, relatives, other professionals and visitors to the home is actively sought. A tour of the building showed no obvious hazards and appropriate risk assessments were in place. Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 16 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 17 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement Timescale for action 30/11/06 2 OP38 37 (1)(e) (g) The manager must ensure that correct medication procedures are in place so medication can be reconciled at any point in time. The registered manager must 30/11/06 give notice without delay of the occurrence of (1) any event in the care home which adversely affects the well-being or safety of any service user and RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP7 Good Practice Recommendations Each page of the care plan should include the residents name and date of birth to prevent mistakes when removed from the file. Staff should ensure that full details are provided to meet the individuals care needs and ensure the information is consistent. DS0000019333.V314903.R01.S.doc Version 5.2 Page 18 Elizabeth House 3 OP26 Soft paper hand towels should be provided in all bathrooms to control the spread of infection. Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 19 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elizabeth House DS0000019333.V314903.R01.S.doc Version 5.2 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!