Inspection on 06/10/06 for Elizabeth House

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What the care home does well

The needs of residents are reflected in their care plans (Essential Lifestyle Plans), and the manager reported that he planned further improvements to these documents. Residents are involved in some day-to-day decision making and choices about their lives, with support from staff. Staff demonstrated awareness of the individual communication methods and support needs of residents. The enabler, employed specifically to work one-to-one with one resident was observed to be focused and engaged with the resident and to have a good rapport with them. The residents have previously been involved in choosing some of the carpets and curtains in the unit and the manager also plans to consult them about the colour scheme when the communal areas and bedrooms are redecorated. Residents have opportunities to take part in a range of activities, both on and off-site. Feedback from residents about the activities they took part in, was mostly positive, though one resident wanted to have more activities. Residents all have some contact either with family of former carers, and this is supported by the staff. Residents are involved in planning the menus each week, though most take relatively little part in meal preparation. The advice of a dietician has been obtained, and staff maintain an overview on healthy eating. Meals are prepared so as to meet the needs of one resident who is diabetic. The identified spiritual needs of two residents are addressed effectively with staff support. Others residents had no identified spiritual needs, though they had been given opportunities for participation. Healthcare records were in good order and indicated that the health needs of residents are met effectively and the home has good links with external healthcare professionals. The preferences, dignity and privacy of residents are taken into account in planning personal care support. The staff had provided effective care for a resident who had developed a friction-related skin injury, and this had healed quickly. Medication management on behalf of residents is effective. Most of the residents indicated they were aware of how to complain and examination of the unit`s complaints log indicated appropriate action, though one record needed to be anonymized. The majority of the environment was satisfactorily decorated and furnished, and the bedrooms in particular, were individualised to reflect the interests of their occupant. Bathrooms and bedrooms had appropriate locks, and suitable adaptations were provided to meet the needs of the residents. Appropriate laundry facilities were provided and hygiene standards in the home were good. The needs of residents were met by a staff team which had been through an period of uncertainty and inconsistent management, having had three manager in the past year. The team was settling down now, under the current manager and staff indicated they felt appropriately involved and consulted. Staffing levels meet the current needs of residents and the additional staffing funded for two of them, had provided clear benefits. Staff receive a core training based on the guidance, though POVA training updates should be provided more frequently.

What has improved since the last inspection?

The unit now has an experienced manager in post who has begun to develop the staff team and its skills. He reported that there are plans to involve unitmanagers more in the process of assessing prospective admissions to their unit, which is a positive development. There has been an improvement in the completion of daily record sheets, following a previous inspection requirement, and the manager plans to develop these further as individualised tools to monitor progress on care plan goals etc. A new financial record format has been introduced to record expenditure of residents` funds by them or on their behalf, following a previous inspection requirement. The benefits to the two individual residents, of the additional one-to-one staff funding were clear, and the active engagement of one resident in constructive activity with their enabler, was observed during the inspection. The new GP now visits individual residents who are unable to attend surgery, in the privacy of their own bedrooms, which is appropriate practice. Progress is again being made with NVQ now that a new provider has been found. It was now possible for team leaders to attend management-related training to help them develop the skills to deputise effectively and possible go on to become managers themselves.

What the care home could do better:

Any future prospective residents, including transfers between Purley Park Trust units, should have a new assessment documented, detailing the needs and reasons for the proposed transfer. A transition document should also be prepared outlining the proposed sequence of visits etc. The manager is seeking to develop the skills of staff in enabling residents to take a greater part in decisions about their care and daily lives, and have a greater involvement in daily household chores etc. The manager also plans to improve residents` immediate access to their personal allowance, out of office hours, within an appropriate risk assessment framework, and is seeking to develop the use of risk assessment in general, within the unit to ensure that residents` opportunities are maximised. The manager plans to increase the level of off-site activities, and access to offsite day-care, to broaden opportunities for residents within the wider community. In order to facilitate this, it may be necessary to train additional drivers since this can be a limiting factor at times. Consideration should be given to some incentive for staff to take the necessary tests to enable them to drive Trust vehicles. The manager is seeking to provide opportunities for additional holidays or short breaks for individuals or small groups to address specific interests orneeds, where they have the funds to support this, in addition to the annual holiday, which tends to involve the larger group. Evidence suggests that the unit provides effectively for the protection of vulnerable adults, but it is recommended that POVA training updates be provided to staff on amore frequent basis. Some communal areas are in need of redecoration, where they have become scuffed or cracked, and there was an area in the hallway where rainwater was getting in, and had stained the wall and ceiling. This was reported to a contractor during the inspection. There was also a need to repair or replace the staff sleeping in bed, which was reported to be broken. Consideration should be given to broadening the opportunities for staff to attend training alongside staff from other agencies, and the provision of teambuilding input to the staff team should be considered, given the unsettled period the unit has been through, to help consolidate the new team. Though a quality assurance system had been devised there was a need to prioritise a QA survey and produce a summary report of the findings.