Inspection on 04/05/05 for Elizabeth House

This inspection was carried out on 4th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 House 13/12/07

Elizabeth House 10/05/06

Elizabeth House 12/12/05

Elizabeth House 17/01/05

Elizabeth House 17/06/04

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

CARE HOME ADULTS 18-65 Elizabeth House 59/61 St Ronans Road Southsea Portsmouth PO4 0PP Lead Inspector Richard Slimm Unannounced 4 May 2005 10:00 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Elizabeth House Address 59/61 St Ronans Road Southsea PO4 0PP 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) 023 9273 3044 Mr M Khoyratty Mr M Khoyratty Care Home 20 Category(ies) of MD - 20 registration, with number LD - 20 of places Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Current service users over 65 years of age may remain at the home. 2. One Named service user whose date of birth is 06/04/1936 3. Service users in the MD/LD categories must be at least 35 years of age. Date of last inspection 17th January 2005 Brief Description of the Service: Elizabeth House is situated in a residential area of Southsea and is close to local amenities. The home has been running for a number of years and consequently service provision models for the service user groups, for which the home is registered, have moved onto new models of care. Accommodation is provided over three floors and the home has a stair lift to the 2nd floor. There are 5 day/quiet rooms in the home and there are 3 bathrooms and a shower facility along with 6 WC’s. The home has 16 single rooms, one of which has en-suite facilities. There are also 2 double bedrooms in which service users share facilities, one of these double rooms has en-suite facilities. The home is very large given current trends to house people with learning disabilities and people recovering from mental health problems in smaller, more domestic accommodation, with an emphasis on independent living. Consequently it is important that the registered person give careful consideration to the future configuration of services provided at the home, in line with current social policy, commissioning trends and potential new service users needs and wishes. Currently all food, laundry and domestic services are provided to the service user group, with little or no emphasis on encouraging and enabling increased independent daily living skills. The home is registered with the Commission for Social Care Inspection (CSCI) and provides accommodation and support for up to 20, younger adults who have a learning disability or a mental disorder, with additional conditions as identified above.. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 4th May 2005 at 10 am. The inspector met and spoke to 13 residents, all of whom confirmed that they were happy living at Elizabeth House. The inspector also spoke to a visiting relative who was also happy with the services provided at the home. The manager/owner assisted throughout the inspection, and the inspector met with care staff, toured the premises, inspected records and documentation, and joined residents for lunch. Action had been taken by the registered person to comply with requirements made in the last inspection report and a number of recommendations had been implemented. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 6 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The home assesses new residents admitted to the home. The home does not keep key information and assessments up to date for some long stay residents. EVIDENCE: The home admits residents who have been assessed by social services care managers Records of key information were available, but some of this information was dated and no longer accurate for a number of well established residents. Current and up to up to date assessment/risk assessment information was not always readily available or being used by care staff working with residents and a daily basis. Assessment and care planning files need to be culled, as too much historical information was evident, and not enough current information. Daily monitoring records did not appear to feed into any form of re-assessment of resident need. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6-7-9 The home does not involve residents fully in their care plans. The home supports residents to make decisions about their lives when needed. The home does not fully promote the independence of residents within an appropriate and comprehensive key worker system or risk-taking framework. EVIDENCE: Each resident has a care plan. The degree of negotiation with individual residents in the development of care plans appeared to be unclear. Residents spoken to were not fully aware of the content or purpose of their care plans. Care plans were not signed by the residents’/representatives or advocates where necessary. There is no system of key working to promote consistency and accountability. There was a lack of specific goal planning in current planning formats. Care plans were kept in an office in the basement, and while care staff were told where plans were, there was little evidence that care staff were working off specific plans with all residents on a daily basis, other than recording events at the end of each shift. There did not appear to be adequate linkage between shift records and care planning/re-assessment processes. There had been some improvements in care planning and monitoring for one very frail resident since the last inspection; Risk assessment systems were unclear and not always fully documented, leading to situations where restrictions and/or limitations being applied due to special needs, without Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 10 appropriate lines of accountability. Some care plans of more established residents were very large and held very dated information, some that was now inaccurate. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11-12-13-1516-17 The home does not provide facilities to promote the development of independent living skills with residents. Residents are supported and encouraged to be part of their local community. The home support and encourage the maintenance of links and contact with family members, and the rights of residents to have relationships. The home does not fully promote the rights of residents to be involved in their care planning about their daily lives. The home provides a full varied and nutritious diet, based on the needs and wishes of the resident group. The home respects the right of residents to be vegetarian. EVIDENCE: Many residents have lived at Elizabeth House for many years, have come from backgrounds that have led to some degree of institutionalisation, and appear to be happy with the model of care provided at the home. However, the home still admits residents who are younger, and would benefit from increased opportunities to practice and improve their independent daily living skills in their home. Residents are enabled, encouraged and supported to attend a variety of activities outside of the home, some of which are educative in nature, but there appeared to be little opportunity for those residents learning Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 12 how to shop, cook, clean, launder etc to do these tasks for themselves at the home. One resident confirmed that she no longer attended day services but regularly attended her local church, including church meetings with her friends from outside of the home in the local community. Other residents said that they were able to come and go as they wished, and that their privacy and dignity is respected. Some residents are unable to leave the home without supervision due to their particular needs, this is not fully documented or risk assessed. However, the home try to ensure that support is provided to these residents to get them out and about regularly. At the time of the visit the manager had been to collect two relatives of a resident to facilitate a weekly visit. On alternate weeks the resident is taken to his family home to spend the weekend with his family. Two residents who have had a long-term relationship have been supported in staying together at the home. Residents spoken to confirmed that they were happy with the quality of food provided on a daily basis at the home. The manager is about to carry out a resident survey. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18-19-20 The home provides personal support in a manner that respects residents choice and dignity. The home makes arrangements to meet the physical and emotional health needs of residents. The home respects the rights of able residents to self-medicate. Arrangements are made to manage medicines safely. EVIDENCE: Most residents are fairly independent in the area of personal care, but do occasionally need some support and encouragement. Residents spoken to confirmed that they are happy with the arrangements made at the home, but were unaware of their specific plans of care that were in place to guide staff in these areas. Residents spoke highly of the staff team, and the inspector observed staff engaged in activities with some residents during the visit. The inspector was advised that currently 2 resident’s look after their own medicines, and the remaining residents all need support in this area of daily living. A number of residents do not take regular medications. The home operates a monitored dosage system to deal with administration of drugs and medicines, and records of administration are maintained. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22-23 The home respects the rights of residents to make complaints. The home makes arrangements for the protection of vulnerable adults living at the home. EVIDENCE: The home has a complaints procedure and all residents/representatives have been provided with information about making a complaint. The inspector was advised that staff training had been given in the area of adult protection. Adult protection policies and procedures were available. Staff member receive induction that includes familiarisation with the home policies and procedures. There had been no incidents of an adult protection nature at the home since the last inspection. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24-30 The home was not well maintained. The home was not cleaned to standards identified in the procedures and policies manual for the home. EVIDENCE: Some areas of the home are now beginning to show signs of wear and tear. The previous report highlighted the need for the manager to develop a maintenance and redecoration plan. The manager agreed to use the maintenance book. It was clear that a more pro-active approach was now needed to ensure the home was kept up to the national minimum standards (NMS). At the time of the visit there was a ground floor communal toilet that needed painting, a vanity unit in bedroom 6 needed replacement, wallpaper was beginning to peel in the communal bathroom, there was significant damp in the cellar area below the laundry, and the front aspect of the home now needs to be repainted and maintained. The development of the basement is nearing completion. There was a minor odour of urine in bedroom one that needs attention. Some areas of the home were not cleaned thoroughly, in line with the home’s procedures. Residents confirmed that they received support from staff in keeping their own rooms clean and tidy when needed, but they were not actively involved in keeping their home clean and tidy. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33-34-35 The home does not have a clear key worker system to promote clarity of staff roles and responsibilities. Staff members were working excessive hours. The home does not have the appropriate staffing levels. Commitment to staff training had improved, however, there is a need to provide staff with training relevant to the needs of the service user group in such areas as promoting independence and the learning disability award framework (LDAF). EVIDENCE: The staff team consisted of 7 people including Mr and Mrs Khoyratty the registered owners. The inspector was advised that the home was looking to appoint a full time night carer and a part time day carer. Staff rosters were in place and indicated an intention to provide 343.5 hours for the week of the visit. The NMS would expect 408 care staff hours to be provided, and minimum of 12 full time equivalent staff members. Mr and Mrs Khoyratty are as a consequence, having to work long hours to cover staffing for the home. One care worker was identified to be working 62 hours and another for 52 hours for the week of the visit. Mr Khoyratty was planning to work in excess of 72 hours. One resident is now very frail, and every attempt is being made to enable this person to continue living safely at the home. This will require additional staff if the needs of this resident are to be met without staff member hours being taken away from other residents accommodated. Nigh-time staff arrangements need to be reviewed due to the moving and handling needs of the frail resident at night. The home should now be providing 2 waking staff members on the Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 17 premises. Four of the staff had NVQ level 2 qualifications, but not under the promoting independence or Learning Disability Award Framework (LDAF). Residents spoken to stated that they were happy with the staff that supported them at the home. There was evidence of packs to provide training to staff members in more specialist areas of mental health and learning disability, and progress with this training will be monitored during future visits to the home. Baseline training in such areas as moving and handling, Basic first aid, basic food hygiene, fire safety, and health and safety had been provided to all care staff, with the exception of the latest recruit who needs top up training in first aid. The registered manager confirmed that this training is being arranged. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39-42 The home’s policies and procedures are not regularly reviewed and residents are not consulted. The home promotes and protects the residents health and safety. EVIDENCE: The homes policies and procedures were last reviewed in 2000. There is now a need for the owner/manager to review these documents in line with the changing needs of the service and resident/staff group. The manager agreed to carry out this task and will be seeking resident input via the resident survey he is carrying out in the near future. The results of the review and the survey will be published and copies sent to the CSCI. Action had been taken to improve safety in the laundry area. The registered persons had consulted an environmental health officer. Baseline training to staff members had been provided in relevant areas. Risk assessments under the work place regulations had been carried out. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 2 3 Standard No 31 32 33 34 35 36 Score x x 2 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Elizabeth House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 1 x x 3 x H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 20 No 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 33 Regulation 18 Requirement The registered persons must employ sufficient staff in numbers that are adequate to meet the needs of residents both day and night. The registered person must ensure that all records are kept up to date, and are relevant to the assessments and care plans for residents. Residents must be involved in the development of their care reocrds. The registered persons must ensure that all areas of the home are maintained and decorated. Residents must be consulted in any proposed changes at the home. Timescale for action 28/5/05 2. 2/6 17 3. 24 23 Update 2 residents per month at care reviews up to 12/12/05 28/11/05 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 2/6 Good Practice Recommendations It is recommended that care records are culled and only relevant records kept in the care folder. Care folders need to be kept where staff members have access. The home H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 21 Elizabeth House 2. 9 3. 16 /30 4. 24/39 should develop a key worker system with staff memebrs and residents. Resident care reviews need to be carried out and records updated according to the needs of the resident concerned. The registered person should refer to recommendation 1 of the previous report dated 17/1/05. Risk assessments should be developed within care plans relevant to the needs and wishes of the resident and covering any activity where risk is an issue or limitations or restrictions are in place due to special needs. Action should be taken to support more able residents to take appropriate responsibility for housekeeping taks such as; shopping, cooking, cleaning their home, doing their own laundry, in line with their assessed needs and wishes. Residents should be fully consulted about the upkeep of the home and any changes such as colour schemes etc, and the review of the homes policies and procedures, including the introduction of a key worker system. The results of the resident survey should be displayed and copies sent to the CSCI when completed. Elizabeth House H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 22 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW 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 H55-H03 S12234 Elizabethhouse V220150 040505.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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