Inspection on 15/05/07 for Elizabeth House Benfleet

This inspection was carried out on 15th May 2007.

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 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 Benfleet 28/10/08

Elizabeth House Benfleet 08/06/06

Elizabeth House Benfleet 03/11/05

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 (Benfleet) 42-45 Benfleet Road Hadleigh Benfleet Essex SS7 1QB Lead Inspector Ms Vicky Dutton Unannounced Inspection 15th May 2007 08:00 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 (Benfleet) DS0000064577.V339199.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 (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elizabeth House (Benfleet) Address 42-45 Benfleet Road Hadleigh Benfleet Essex SS7 1QB 01702 555786 01702 555786 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) www.runwoodhomes.co.uk Runwood Homes Plc Vacant Care Home 72 Category(ies) of Dementia - over 65 years of age (36), Old age, registration, with number not falling within any other category (72) of places Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Personal care to be provided for up to 72 older people. Personal care to be provided to older people with dementia. Date of last inspection 8th June 2006 Brief Description of the Service: Elizabeth House provides care and accommodation for 72 older people. They can also offer care to older people who have dementia. The Home consists of two physically separate buildings sited on the same plot, but run by the same manager. They are referred to by staff and residents as E1 (the original building) and E2. Each building has its own kitchen and laundry areas. E2 does not have the benefit of a garden, however residents can be escorted to use the garden facilities at the rear of E1. Accommodation is all (apart from one room on E1) in single rooms, and there is a range of communal areas in both buildings. The furnishings and fittings are of a good standard. The home is situated close to local amenities and local transport links. Inspection reports are readily available for visitors to the care home and are displayed in the entrance areas of both E1 and E2. Also on display, and available for visitors and residents are copies of the homes Statement of Purpose and Service Users Guide. The current scale of charges, as quoted in the home’s Pre Inspection Questionnaire dated 24/04/07, were £374.50 to £650.00. Additional charges to residents include chiropody, toiletries, newspapers and some transport costs. Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced ‘key’ site visit. The visit took place over an eight hour period. As two inspectors undertook the site visit this equated to sixteen hours of input. At this inspection all the key standards and the home’s progress in meeting previous requirements was assessed. Prior to the site visit the home had submitted a pre-inspection questionnaire (PIQ), and provided additional information that assisted with the inspection process. At the site visit a partial tour of the premises took place, care, staff, medication and other records and documentation were selected and various elements of these assessed. During the site visit residents, visitors and some of the home’s staff were spoken with. As part of this key inspection questionnaires were sent out in the post to health and social care professionals. Visitors, staff and residents questionnaires were made available at the home/given out during the site visit. The views expressed at the site visit and survey responses have been incorporated into this report. The inspectors were assisted at the site visit by the acting manager and other members of the staff team. An operations manager also attended the home for part of the site visit. Feedback on findings was given throughout the visit, and summarised at the end. The opportunity for discussion or clarification was given. A feedback card on the inspection process was left at the home. The inspectors would like to thank the acting manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the service does well: The entrance areas of both parts of the home are bright, welcoming and provided useful information for residents and visitors. Staff at the home were welcoming and helpful. Residents can have visitors at any time, and those visitors are always made welcome. Routines at the home can be flexible to meet residents’ individual needs and preferences. Many positive comments about the home were received. One relative said, Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 6 ‘I can say with all honesty that I can’t think of a nicer, more caring place for my relative to live out the rest of their days. All of the staff – management, carers, kitchen, laundry and cleaners are all very kind to my relative and very caring.’ If residents or relatives have any concerns or worries they can raise these with staff at the home and will be listened to. 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elizabeth House (Benfleet) DS0000064577.V339199.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 House (Benfleet) DS0000064577.V339199.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, 3, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have sufficient information about the home to help them make choices. People can be sure that their needs will be assessed before they move into the home. EVIDENCE: The home has a Statement of Purpose and Service Users Guide available. Copies of these documents were available in both lobby areas of the home, this included a Braille copy of the service users guide. A senior member of staff did not think that copies of the homes service users guide were given to people at assessment, or before they moved into the home. The acting manager however said that copies of the organisations brochure and the service users guide would be made available to potential new residents. 100 of survey responses said that they had received sufficient information about the home to decide if it was the right place for them/their relative. Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 10 The files of recently three recently admitted residents showed that staff from the home carry out an assessment of needs before a resident moves into the home. Files viewed also had information available from social services departments. Many people moving into Elizabeth House have a diagnosis of dementia. The home is registered to provide dementia care. The home’s training matrix showed that, in spite of previous requirements, six senior staff and fourteen care staff were identified as having yet to undertake training in dementia care. This means that the care offered to residents may not be consistent, or based on current knowledge or models of best practice. From records it was seen that training in dementia planned for April 07 had been cancelled. Elizabeth House (Benfleet) DS0000064577.V339199.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, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents at Elizabeth House will generally have their basic care needs met, be assisted to maintain good healthcare and have their medication managed safely. This would be improved by better care planning and record keeping. EVIDENCE: Responses on surveys showed that people at Elizabeth House felt that they ‘usually’ received the care that they need. One respondent felt that their relative needed more help than they were given by staff, and that details such as help with aids were not always carried out by staff. This was also noted during the site visit when one resident asked inspectors to assist them with their hearing aid, which had not been attended to by staff. Feedback about care at the site visit was generally positive with comments such as ‘the staff are all very good and attentive’ being made. The family of one resident who is cared for in bed felt that ‘the care was excellent.’ Relatives also felt that staff had a good awareness and understanding of individual needs. One comment Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 12 made was ‘the staff are totally aware of how my relative likes to be cared for, and respect their preferences.’ All residents at Elisabeth House have an individual plan of care in place, and several of these (on both E1 and E2) were viewed as part of the site visit. In general care plans viewed provided a satisfactory basis for care to be delivered to residents. Improvements were noted from the previous inspection of the home. The acting manager said that the home was trying to move towards a more person centred approach to care planning. Shortfalls identified in care planning that had the potential to compromise resident care were fed back to the acting manager. This included a recently admitted resident with no care plan in place relating to a recent bereavement. One resident was identified as having the potential to exhibit behaviour that challenges. A care plan was in place that identified the need for one carer to assist with personal care. On the review section it was acknowledged that two carers were now sometimes required, and a good explanation of how to have a sensitive approach with the resident given. This information had however not been included on the working care plan. Another resident, noted to become agitated during the site visit, also had entries in daily observations indicating that this was a fairly frequent occurrence. No care plan was in place to guide staff in the management of this. One care plan had so many discontinued sections and revisions that staff might find it difficult to identify current care needs and how these were to be addressed. Records showed that residents at Elizabeth House can expect to receive a good level of healthcare, and have access to appropriate services to meet their needs. On surveys residents felt that they ‘always’ or ‘usually’ received the medical support that they needed. District nurses spoken with during the site visit were positive, felt that the home was effective in addressing residents’ health needs and offered a good level of care. They felt that the level of care had improved at the home over recent times. Elizabeth House benefits from having regular contact with a lead care homes nurse who can offer help and support in meeting residents’ health care needs. Again to ensure that residents’ healthcare needs are consistently met record keeping and the cross referencing between the various elements of the care planning system needs to be improved. One resident had been seen by a medical practitioner. They advised that the resident continue to be mobilised, as they were at high risk of developing ulcers. There was no reference to this in daily notes or care planning. The risk assessment relating to pressure ulcers/skin viability indicated ‘low risk.’ Another resident had seen a doctor about a medical problem that had arisen and had been advised to keep their legs elevated. Daily notes showed no record of the lead up to this, or of staff being informed in notes or care planning of this new care need. Pressure relieving equipment was noted to be available for the benefit of residents. Nutrition records maintained at the home were not always complete, and, if a resident had refused a meal did not identify what alternatives had been offered. One resident’s weight was noted to be erratic. Since January moving from 66.2 kg, to 70.1 kg then down to 63.1 kg. There Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 13 was no explanation for this, or indication that this had been picked up by staff to query the accuracy of the record, or initiate further investigation. Medication systems were sampled on both E1 and E2. Generally medication at the home is managed in a safe and effective way with safeguards such as regular audits in place to protect residents. Only minor issues relating to the management of medication were raised with senior staff. Feedback on medication management was mixed. One relative said that ‘sometimes the supply of tablets runs out and a new prescription has not been ordered.’ Others were more favourable with one relative saying that when they take their relative home their ‘medication is always organised and ready.’ Since the previous inspection the acting manager has developed a medication resource file that provides additional and useful information for staff relating to medications in use at the home. There was some confusion about the level of medication training being undertaken by staff at the home. One care team manager (CTM) said that although they had received training in a previous employment, they had not undertaken medication training since working at Elizabeth House. Another said that they had only undertaken basic system training given by the supplying pharmacist. (Both of these staff were identified on the training matrix as having undertaken training.) The home’s training matrix did not identify the level of medication training being undertaken. On the training matrix two day CTM’s and three night CTM’s had no medication training identified. The acting manager and operations manager said that staff at the home undertook the more in depth pharmacy training and had completed workbooks. During the site visit staff were noted to treat residents respectfully and uphold their privacy and dignity. Many residents benefit from having their own telephones installed in their rooms. Although standard eleven was not specifically assessed district nurses commented that for a resident who had recently died, staff at the home had carried out end of life care to a high standard. A relative said that their loved ones wishes following death had been sensitively discussed with them and recorded. Elizabeth House (Benfleet) DS0000064577.V339199.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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People will be supported to follow their own routines and have the opportunity for stimulation and activity. People will be provided with a good diet. EVIDENCE: The level of activity provided for residents is an area that has improved since the previous inspection. Feedback on surveys about activities was varied, but at the site visit both residents and relatives commented on the improvements made in activity provision. One activity co-ordinator has recently left, leaving only a part time activities co-ordinator. In spite of this a weekly activities timetable was in place and, as seen during the site visit, was being carried out by care staff at the home. One resident commented that ‘they were never bored, and kept their mind active.’ Activities on offer included music, word games, arts and crafts and seated exercise. A pets as therapy (PAT) dog visits the home on a regular basis. During the site visit staff were noted to actively engage with residents and encourage participation. Some residents had enjoyed a trip to the theatre on the previous day. A list of forthcoming outings and activities was on display. Residents’ individual past interests and history were recorded together with a record of their involvement in activities. Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 15 Opportunities are available for residents to fulfil their spiritual needs, with a church service held weekly in the home, and representatives calling to give communion when this is wished for. Routines of daily living are flexible at the home. Residents spoken with felt free to follow their own routines. Staff were aware of individual preferences and respected them. A member domestic staff cleaning in one area commented that they always came back later to clean a resident’s room, as they preferred not to be disturbed until nearly lunchtime. A resident commented that they had stayed in other homes but that ‘Elizabeth House is best as it is more easy going and free and easy, you can do what you want when you want.’ Some residents were observed to have breakfast in their rooms. Visiting at the home is open and visitors were noted to come and go during the day. Those spoken with said that they were always made welcome. One said that ‘they were always offered a drink,’ another said that on the previous week staff had arranged for them to have tea and cake with their relative. Residents are able to exercise personal autonomy and choice. Residents can choose to hold their own key and keep their room locked. Rooms viewed were very personalised and residents had been able to bring in their own possessions. Information on advocacy services was available to residents and their families. Feedback on the food at the home was variable. Residents spoken with were generally positive about the meals served at Elizabeth House. One said ‘the food is home cooked using as many fresh ingredients as possible, and is varied and nourishing.’ Feedback on surveys was less positive. One felt that the portions were sometimes too small, and that residents were not offered a choice about if they wanted gravy or not. Another felt that the meat was often tough, and not suitable for people with false teeth. The main meal served on the day of the inspection offered a choice of fish or roast chicken pasta with mashed potatoes and vegetables or salad, followed by apple crumble custard or fruit and cream. The food served looked appetising, and residents were observed enjoying their meal. Hot and cold drinks were seen being served during the day with jugs of water available in their rooms and lounges. The menu was observed displayed in two dining rooms. The home operates a four weekly menu. This is a corporate menu that had been developed for Runwood Homes based on dietary advice of the required nutritional needs of older people. The cook advised that the menus had been adapted following consultation with residents. The home had regular deliveries of fresh fruit and vegetables supplemented by frozen produce. One relative said ‘kitchen staff are marvellous and the food is excellent.’ Relatives also felt that staff at the home were good at encouraging residents to maintain a good diet. One said, ‘they have asked what my relative likes and are prepared to cook anything.’ One resident felt that they did not always get the help that they needed and said ‘I have asked to have my meals cut up but this does not always happen.’ Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 16 Some improvements could be made to the dining environment: there were insufficient table cloths, the large plastic beakers in use were not suitable for all residents, the cutlery in use was mismatched, and some residents independence and dignity might be better supported by the use of specialised cutlery. The acting manager said that these matters were in hand. Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 17 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to raise concerns about the service. Staff training and practice will protect residents from abuse. EVIDENCE: The home has a clear complains process in place that is understood by residents and families. On surveys all but one respondent said that they knew how to make a complaint. Relatives and residents spoken with at the site visit confirmed this. One resident said ‘if I am worried or concerned about anything I would first talk to ………my key worker.’ The homes complaints records showed that concerns raised are recorded and managed effectively. Since the previous inspection one anonymous complaint, and information about another complaint was received about the service by CSCI. Both were investigated and managed by the registered provider. Most staff at the home have received recent training in adult protection. Those spoken with demonstrated a good understanding of this area. Observations during the site visit showed that some residents can present staff with challenges. One relative said, ‘I have seen the staff dealing with difficult residents, they have the utmost patience.’ The acting manager confirmed that staff have not undertaken training in managing challenging behaviour. This would assist staff in caring for residents consistently and ensure that their practice is up to date and in line with current ideas about best practice. Elizabeth House (Benfleet) DS0000064577.V339199.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, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a pleasant environment, but there are insufficient safeguards in place to minimise the risk of infection. EVIDENCE: Feedback on surveys from relatives about the premises was varied. Some felt that there were cleanliness and odour issues that needed to be addressed, also that new chairs and more coffee tables were needed. Residents in general were happy with the accommodation provided, one however said that signage needed to be improved to meet their needs. ‘I asked for the toilet in my room and the one on the ground floor to be signposted with a picture. This was about four weeks ago, nothing has happened.’ Since the previous inspection some redecoration has taken place and new dining room furniture has been provided to improve the environment for residents. Further redecoration works are in progress. Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 19 At this site visit the home appeared generally clean, but there were isolated pockets of odour. Domestic staff reported that carpets are regularly cleaned but the odour returns. It was stated that the home are planning to replace some carpets. Both E1 and E2 have their own laundry areas. Both are quite small and do not allow for an in/out system of laundry management to be used. During this site visit a number of issues that had the potential to compromise infection control and safe care were highlighted. Although corporate policies and procedures were available, local policies, action plans and practice guidelines were not readily available for staff. (These were found and provided following the site visit.) Many staff have not received infection control training to enable their practice to be safe and based on sound knowledge. For example in one laundry area foul laundry was not being washed at an appropriate temperature of 65 degrees Celsius for infection control purposes. The laundry person was not aware of correct temperatures. Laundry staff were also using non-disposable gloves for handling laundry, rather than single use gloves that would provide better infection control. Care staff spoken with were not aware of appropriate methods of cleaning or decontaminating equipment. One bath had not been left clean after use. Sluices are provided at the home but these were not always functional. A number of pedal bins around the home were not working and needed to be hand operated increasing the risk of spread of infection. The acting manager said that new bins were on order. Appropriate hand washing facilities were not always available in toilets, bathrooms and en suites. On a survey one resident said ‘Since 2002 I have been reporting a shortage of hand towels. They are removed after washing in the morning and not returned until late pm – what are residents supposed to do in between? Hygiene!!’ Elizabeth House (Benfleet) DS0000064577.V339199.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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are cared for by safely recruited and adequately trained staff, who are usually available in sufficient numbers to meet their needs. EVIDENCE: Elizabeth House cares for residents who have a range of different needs and dependency levels. The acting manager felt that current staffing levels were sufficient to meet the needs of residents, and would be flexible to accommodate additional needs as they arose. This was not always staffs’ perception and one said that staff were too stretched when additional residents needs, such as end of life needs have to be accommodated within existing staffing levels. Examples were however given by management of when staffing had been increased to accommodate need. The basic levels at Elizabeth House are: On E1 there are now five carers and a care team manager (CTM) during the day with no drop, as previously, to four care assistants during the afternoon/early evening. On E2 there are four care staff and one care team manager throughout the day. There are two care staff and a CTM on each unit at night. Rotas confirmed that these levels are being maintained. The acting managers hours are supernumerary and split between the two units. Formerly the home had one deputy manager whose hours were largely supernumerary. Now there are two staff who work one supernumerary shift a week as a deputy manager. Ancillary staff are provided but no domestic staff are provided during the afternoon or evenings, and there can be shortfalls at weekends. The Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 21 acting manager is working hard to fill vacancies, and change rotas so that they better meet the needs of residents. The amount of agency staff used at the home has been significantly reduced. Feedback from relatives and residents about staffing levels was not always positive. Some made comments about ‘staffing shortages.’ One said ‘the staff at the home are very busy so cannot always spare the time to do things owing to the fact that they are short staffed.’ Another said ‘There may be a delay when the staff are all busy e.g. mealtimes. They work very hard and do their best to come as soon as possible.’ Feedback on the staff themselves was positive. ‘The staff are very caring, even though they are busy they do their best to care and support,’ and ‘staff are very caring but they can only work with what is available to them there needs to be more of them.’ When call bells were tested during the site visit, carers responded promptly. Morning routines did not seem too rushed and staff were available to undertake activities with residents. Eight care staff at the home (including 1 bank staff) hold a National Vocational Qualification (NVQ) in care at level two, and a further eight are currently undertaking this training. One member of the care team holds NVQ at level three. The home has not yet achieved the National Minimum Standard of 50 of care staff trained to level two or above. The recruitment files of five recently employed staff were inspected. These showed that recruitment at the home is carried out to a satisfactory standard with appropriate checks and procedures undertaken to protect residents. All files had two satisfactory references. Criminal Records Bureau and Protection of Vulnerable Adults checks had been undertaken before staff took up employment. The manager said that new staff were to receive induction to Skills for Care Standards from next week. One member of staff confirmed they had received the induction pack and had a meeting planned with their manager to discuss it. New staff had been provided with appropriate core training such as moving and handling. Elizabeth House (Benfleet) DS0000064577.V339199.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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is generally well run and safe. They will have the opportunity to express their views about the service. EVIDENCE: An acting manager has been in post at the home for about six months. An application for registration has been made, and is being progressed by CSCI. The acting manager is experienced, and is completing their Registered Managers Award. Since being in post they have demonstrated a good level of ability and competence in managing the home in a way that focuses on delivering good care to residents. Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 23 The registered provider has strategies in place to monitor the quality of the service provided at Elizabeth House. An annual audit is undertaken. The audits include the use of questionnaires to seek residents and others views on the service and forms the basis for an annual report for the home with actions needed and targets set. The home also has other internal procedures that contribute to overall quality monitoring of the home. These include monthly manager audits, daily floor audits to monitor standards of cleanliness at the home, and daily medication audits. Monthly visits are undertaken by a senior manager in the organisation as required by regulations. Secure storage is available for residents’ monies to be held. A sample of residents monies viewed were satisfactory with good records, receipts kept and monies balancing. The homes pre-inspection questionnaire identified that systems and services are monitored and maintained. Certificates relating to this were sampled during the site visit and were satisfactory. Fire records viewed were clear and a comprehensive fire risk assessment was in place. Some health and safety issues were noted during the inspection. Some Zimmer frames in use by residents had ferrules that were worn through to the metal posing a potential hazard. External clinical waste bins were not locked. An internal cupboard containing cleaning materials had been left open. The homes training matrix showed that a significant number of care staff are due to be updated in moving and handling skills. Other staff, including senior staff, have yet to complete training in other core areas such as food hygiene, and health and safety. A good level of staff at the home have completed first aid training. Accident records are maintained at the home. Those viewed on E2 had not been ‘signed off’ by a senior member of staff, as per company policy, since the end of March. This means that incidents that might have particular significance, or remedial actions necessary may not have been picked up on. Elizabeth House (Benfleet) DS0000064577.V339199.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 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X 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 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 25 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 OP4 Regulation 18 Requirement So that residents receive skilled care based on current knowledge and models of best practice staff at the home must receive adequate training in dementia care. Previous requirements of 01/02/06 and 01/08/06 not yet fully met 2. OP7 15 So that residents are cared for safely individual care plans must identify all their assessed needs. Care plans and associated health documentation must be kept up to date and provide staff with sufficient information to enable them to offer residents proper care and assistance. So that residents’ health care is fully supported an adequate record of nutrition must be maintained at the home. Previous requirement of 01/08/06 not met. 01/07/07 Timescale for action 01/07/07 3. OP8 17 Sch 4 01/07/07 Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 26 4. OP9 13 (2) So that medication at the home is always managed safely, staff administering medication must receive a clearly identified, and consistent level of good quality training. Residents and staff must be kept safe by adequate infection control and cleaning processes being in place. Staff must be trained in infection control so that their practice is competent, and the risk of the spread of infection at the home is minimised. Previous requirement of 01/09/06 not met. 01/07/07 5. OP26 13 (3) 01/08/07 6. OP38 18 So that residents are cared for safely by skilled staff, all staff must be kept up to date in core skill areas. This includes food hygiene, health and safety and moving and handling. This is a repeated requirement. 01/08/07 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 OP15 Good Practice Recommendations The home should continue to improve the dining environment for residents by the provision of sufficient items such as adapted cutlery and tablecloths. So that residents have their needs met in a consistent manner staff should receive training in managing challenging behaviour. DS0000064577.V339199.R01.S.doc Version 5.2 Page 27 2. OP18 Elizabeth House (Benfleet) 3. 4. OP26 OP27 Suitable hand washing facilities should be available at all times in resident’s en suite areas. Residents/relatives views about staffing numbers and availability should be taken into account. Staffing levels at the home should be closely monitored and kept under review. Staff at the home should be facilitated to undertake training that will assist them to care effectively for residents. 50 of care staff should be trained to NVQ level 2 or above. Accident records should be properly maintained so that any necessary actions will be undertaken in a timely manner. Equipment such as Zimmer frames used by residents must be kept in a good state of repair. So that there is no health and safety risk to people, external clinical waste bins should be kept locked. 5. OP28 6. OP38 7. 8. OP38 OP38 Elizabeth House (Benfleet) DS0000064577.V339199.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 House (Benfleet) DS0000064577.V339199.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. 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!