Inspection on 03/11/05 for Elizabeth House Benfleet

This inspection was carried out on 3rd November 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 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 15/05/07

Elizabeth House Benfleet 08/06/06

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 Vicky Dutton, Ann Davey Unannounced Inspection 3rd November 2005 08:30 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.V262303.R01.S.doc Version 5.0 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.V262303.R01.S.doc Version 5.0 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) Runwood Homes Plc Manager post 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.V262303.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th July 2005 Brief Description of the Service: Elizabeth House provides care and accommodation for 72 older people. Within this number 36 places are provided for service users who may suffer from dementia. The Home consists of two physically separate buildings sited on the same plot, but run by the same acting 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. Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of ten and a half hours. As there were two inspectors present this equated to twenty one hours input. A further inspector attended as part of their induction programme. The inspection focused mainly on the progress the home had made since the last inspection when there were many requirements made for the home to address. Some other standards were also considered. Elizabeth House does not currently have a registered manager in post, and has not had one in post for some time. During this period the home has been managed by a series of different people. At the time of this visit the home was being managed by an acting manager who had only been in post for a few weeks. The acting manager was not available on the day of inspection, and there was some confusion as to the senior management arrangements for the home. The inspectors were assisted by two operations managers from the organisation, the deputy manager and care team managers (CTM’s) at the home. A partial tour of the home took place. Staff, residents and a visiting professional were spoken with. Records were selected at random in both buildings and inspected. During the inspection visit notices were displayed in the main entrance areas of both buildings, advising all visitors to the home that an inspection was taking place with an open invitation to speak with an inspector. The inspectors gave a full and detailed ‘feedback’ to the operations managers with opportunity for clarification and/or further discussion. What the service does well: What has improved since the last inspection? Since the previous inspection staff and (the previous) management at the home have worked hard to address the areas highlighted by inspectors at previous visits to the home. Although further thought is needed, routines for residents have been looked at. As a result Breakfast is now served from 08.00 Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 6 so that residents do not have such a long wait to be served in the mornings. Menus have been reviewed so that a clearer ‘hot choice’ is available for residents at teatime. Activities have improved. Some outings now take place and the home have started to develop an area where residents can enjoy reminiscence sessions. Storage has been improved so that all bathroom areas are now available for residents. Some new equipment such as hoists have been bought so that there is enough for all residents who might need to use this equipment. Meetings for staff, residents and relatives have been held to try and make sure that the home runs smoothly. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 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 (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 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, 4. Development is needed to ensure that residents needs are fully assessed so that staff have the information they need to assist residents and meet their needs. The home could not demonstrate their ability to fully meet resident’s needs. EVIDENCE: Although not viewed as part of this inspection it was noted that copies of the homes statement of purpose, service users guide and other useful information were displayed in the lobby areas of both buildings. This gives visitors and other interested parties the opportunity to look at written information about the service offered by Elizabeth House. An operations manager said that all residents are now issued with a statement of terms and conditions/contract when moving into the home. This was not however assessed at this inspection. The file of the most recently admitted resident was viewed. A pre-admission assessment had been completed by the home, but no social work or other information was available in the file. The home also routinely complete an Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 9 ‘assessment of needs’. The one on file had only 12 out of the 23 sections completed. Resident’s needs must be fully assessed in order that staff are aware of the assistance service users need. Observations and discussion during the inspection showed some shortfalls in the homes ability to fully meet resident’s needs. Staffing levels are not always sufficient to ensure that residents always receive a timely service, and that adequate assistance and supervision are provided. Staff training in dementia needs to be developed. Intermediate care is not provided at Elizabeth House. Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 In general residents health and care needs were identified and planed for. However development work is needed to ensure that plans encompass all resident’s needs, and provide clear and consistent guidance for staff. Care records need to be maintained consistently to make sure that relevant information is recorded in the proper place, and staff kept up to date with resident’s current care needs. Medication practices at the home were generally well managed and ensured that residents were kept safe, but some attention to detail is needed. EVIDENCE: Over the course of the inspection a range of care plans were viewed both on E1 and E2. It was clear that progress had been made in improving the quality and scope of these. However the quality of care plans did vary. Some viewed did not identify or give staff guidance in how to deal with specific behavioural or medical issues. Some information was disjointed, for example, information identified on ‘body maps’ with no reference to this in daily observation records, and other instances of information not followed through. This could place residents at risk if staff are not fully aware of current information and needs. The systems for reviewing care plans need to be looked at, as sometimes Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 11 these sections are recording events or daily records rather than reviews. The home also operates a system of three monthly reviews, which families can be involved with. Evidence of these was non-existent or patchy on those files viewed. Residents need to be kept safe by having areas of risk fully assessed. One resident had an aid on their bed for which no risk assessment was in place. Although risk assessments were in place for residents who use bed rails, there was no evidence to show that the use of these had been established through a multidisciplinary assessment. Within the care planning system, the home operates two assessment tools i.e. ‘mental status questionnaire’ and ‘barthel score’ (based on physical care needs). The ‘scoring’ from these documents is at variance and does not provide a ‘holistic’ outcome. This also has crucial implications on the way the home determines staffing levels, as current levels tend to be based on the ‘lower’ score which is normally associated with physical care` needs. At this inspection one resident categorised as low dependency was presenting significant challenges requiring a higher level of staff input. The Commission is aware that this current ‘scoring’ system is used throughout the homes owned and managed by the same registered provider. It is also accepted that the registered provider is now aware of the shortfalls associated with the system and is currently reviewing it. Records showed that resident’s health care needs are catered for and that they can access professional services such as chiropody, optician and local and hospital based health services. Some development is needed to ensure that a full and accurate record is kept of what residents have eaten. Residents spoken with were generally satisfied by the level of care offered by the home. Medication was viewed on both E1 and E2. In both cases the system was well organised and staff were able to identify that they had undertaken appropriate training. Some shortfalls were however noted. On E2 one resident had been prescribed antibiotics. There were gaps on the administration records and only seven of the fourteen doses had been given, before the medication appeared to have been discontinued. There was no explanation for this. An inhaler was not boxed and had no label on it to identify who it belonged to/dosage etc. On EI there were shortfalls in signatures where medication had been added to the administration record. In general residents privacy was respected in the shutting of doors and other actions. Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15 The level of activities available for residents at the home is improving, but is reliant on the hours worked by activity co-ordinators. Staffing levels and deployment need to be sufficient to encourage activity and occupation across the day and at weekends. Improvements in menus and times of meals have been made, but monitoring is needed to ensure that some residents are not going for long periods without being assisted to maintain adequate nutrition. EVIDENCE: Currently 20 activity co-ordinator hours a week are provided to each building. The registered provider employs a dementia specialist who has been working with staff at the home. On the day of inspection the activities co-ordinator on E2 was off and residents experienced little in the way of stimulation or activity. From observations on the day of inspection it was evident that staffing levels and routines leave little time for care staff to undertake activities in addition to other duties. This particularly as staffing levels (on E2) drop between 13.00 and 18.00 each day. The activities co-ordinator on E1 identified that they had undertaken appropriate training for the role. Some activities offered were identified and included ‘pampering afternoons’, music and movement, cards/board games and bingo. Regular trips out are offered. Entertainers and a pets as therapy (PAT) dog regularly visit the home. A lounge area on E2 showed that a reminiscence area is being developed. Records viewed and Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 13 resident’s spoken with identified that their spiritual needs are identified and opportunities given for these to be met. Resident’s choices in some areas may be limited. For example, rising times for residents are dictated by how quickly staff can ‘work round’, rather than individual preference. Information on advocacy services was available to residents and families. Resident’s bedrooms showed that they were able to bring in personal possessions. Menus at the home have recently been reviewed, to include a hot choice at teatime. Breakfast time has been brought forward and is now served from 08.00. Residents generally spoke favourably of the food offered by the home. At teatime on the day of inspection staff were seen to offer residents choice, and offer appropriate encouragement and assistance. On the day of inspection ‘tea’ was served at 16.40. As at the previous inspection some residents were observed not to be assisted up until after 09.00. The home need to monitor this to make sure that residents are not going for many hours without being offered adequate food and drink. One resident in bed had a drink in place in their room, but could not reach this or manage independently. A nutrition record in place in this room identified that on 31/10 a drink had been given at 20.00. the next entry was on 01/11 at 13.00. Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. The home has a clear complaints process in place but development is needed to ensure that any issues raised are managed appropriately. To ensure that residents are fully protected any unexplained marks should be properly investigated, explained and recorded. EVIDENCE: The home has a clear complaints process in place that is on display for residents, families and visitors. A complaints folder is maintained by the home. This showed that two recent complaints had not been investigated or managed well, or in line with the company’s policy, procedures and established recording formats. Details of this were fed back to the operations managers present at the inspection. Staff spoken with demonstrated an understanding of adult protection issues, but not all have as yet undertaken training in this area. A training memo showed that further dates are planed for this training to take place. A care plan viewed at this inspection showed several ‘body maps’ identifying marks or bruising. There was no corresponding reference to, or explanation of this in the daily observation notes or accident records. This must be addressed to show that residents are being cared for safely. Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, 26. The overall standard of the furnishings, décor and fitments within the home was good, and provided residents with a pleasant and homely place to live. Some issues need addressing to ensure residents live in a safe and comfortable environment. EVIDENCE: Residents spoken with found the environment of the home pleasant and liked their rooms. Only residents living in E1 have direct access to a garden area. Residents in E2 have to be escorted across the car park area to access the grounds. This is an aspect of provision that has come up in previous inspections. It is understood that plans are now in hand to address this. Both E1 and E2 have a range of communal spaces available to residents. These were well furnished and lit. All bedrooms at the home contain an en suite area. In many of these areas no towels were available to promote hand washing and infection control. The toilet roll holders were broken in a number of areas. The home has a range of Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 16 communal bathrooms and toilets. Liquid soap was not available in all of these areas, again compromising infection control. Since the previous inspection bathrooms are no longer used for storage and are available for residents. Only one bathroom was found to be cluttered and this was cleared during the inspection. Since the previous inspection additional moving and handling equipment has been put in place. This has meant that staff no longer have to keep residents waiting as a result of equipment being used elsewhere. Appropriate pressure relieving equipment was noted in individual bedrooms. The home need to monitor the cleaning of equipment to make sure that it is hygienic for residents, as some wheelchairs were dirty. The home is registered to provide care for residents with dementia. There is a lack of directional and orientation signage at the home. Corridors are not fitted with proper grab rails but only have a dado style rail in place. Appropriate aids should be fitted in all corridors to aid and assist residents. Bedrooms at the home were well furnished and homely. The wardrobe in one room was found to be unsafe. Beds were not fitted with appropriate mattress covers for the comfort of residents. Many clocks in residents’ bedrooms did not show the correct time, which could lead to residents being further confused. Two residents were in bed with no access to a call bell, as this was out of reach. Call bells were tested around the building. On one occasion this was used for a resident who said that they felt unwell. Although several housekeeping staff walked passed, none responded. Care staff eventually attended after 12 minutes. Another call bell was cancelled after no response was received within a reasonable time. On other occasions staff responded promptly to the call bell. The home was generally warm and well ventilated. The home was generally clean and odour free. The homes laundry areas on E1 and E2 were tidy and well organised. On E1 no protective aprons were available in the laundry and the iron was left on when not being used by staff. The laundry space did not allow for a dirty in clean out system of work. The member of staff in attendance, who has worked at the home for some years, could not identify that they had undertaken any training in infection control, although it was stated that this was now arranged. These issues could compromise infection control at the home. To try and improve practice care staff have individually signed for a local policy on infection control procedures. Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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. Staffing levels and deployment need to be reviewed and monitored to make sure that resident’s receive a service in line with their needs and expectations. Staff records must evidence that residents are kept safe by staff being carefully recruited and receiving a comprehensive induction training. EVIDENCE: The previously provided minimum staffing levels at Elizabeth House are: Nine care staff and two senior carers during the morning. (E2 four care staff, E1 five care staff) Seven care staff and two senior carers during the afternoon – between 13.00 and 18.00 (E2 three care staff, E1 four care staff) Nine care staff and two seniors during the evening. (E2 four care staff, E1 five care staff) Four waking care staff and two senior carers at night. (Split evenly between E1 and E2) Observations at this inspection (primarily on E2) indicated that the levels of and deployment of staff is inadequate to fully meet resident’s needs. In the morning on E2 two care staff are available on each floor. Inspectors were told that at least 10 residents require the assistance of two staff to assist them. Therefore buzzer response times during this busy period were slow/non existent. This has the potential to leave residents at risk. To resolve this a schedule had been put in place by the home for night staff to get some residents up. This did not seem to be based on any consultation with residents, or in accordance with their choices. At this inspection it was discovered that night staffing levels on E2 had been reduced to two, by the Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 18 current acting manager. The operations managers present were unaware of this situation and took immediate action to reinstate the proper staffing levels. During the afternoon residents lounges were left unattended for long periods of time. The homes rotas were viewed and were found not to be an accurate record. Some names were wrongly recorded and rotas did not reflect recent changes. At previous inspections residents and staff had complained about the high use of agency staff at the home. Although this situation has improved weekends on E1 are still heavily depended on the use of agency staff. At this inspection it was not possible to gain an accurate picture of the numbers of staff who have successfully completed or undertaking NVQ training. Staff files sampled did not evidence that resident’s are kept safe by robust recruitment procedures being in place. One member of staff, employed for a year, only had a previous employers CRB check in place. In spite of a letter to request this, there was no evidence of the staff members current immigration or right to work status. For this member of staff there was also no evidence to show that a structured induction had been undertaken when they started work at the home. Two recently appointed members of staff had shortfalls in records which should be available. No references were available. Application forms were not properly completed/had been completed on the ‘start date’. For one of these staff a four week induction programme had been sketchily completed. Induction documentation was not present on the other file. Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 19 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, 32, 33, 35, 38. The registered provider should keep staff informed as to the senior management arrangements for the home, so that they are clear about contact arrangements. Quality assurance strategies are in place. Some health and safety issues need to be addressed so that staff and residents live and work n a safe environment. EVIDENCE: The home has not had stable or consistent management for some time. This has had an impact on staff morale. On the day of inspection The CTM in charge on E2 was helpful and accommodating on the inspectors arrival. She was however unsure of the management arrangements for the home on that day. It was not known if the acting manager would be in, or who the operations manager was for the home, as she had not been made aware of these details by the organisation. Should an emergency have arisen at the Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 20 home this lack of information and awareness of where contact details etc. could be found quickly, may have hampered the management of any situation. Information was seen that showed that staff and resident’s meetings had taken place under the previous management. Staff meetings demonstrated a proactive approach with discussions on the philosophy of care at the home and training and development issues. At the time of the inspection the new acting manager had only been in post at Elizabeth House for a few weeks. It therefore remains to be seen how an open, positive and inclusive atmosphere continues to be developed. The registered provider has strategies in place to monitor the quality of the service provided. Monthly customer Satisfaction Surveys are conducted with residents, with a different small sample of residents selected each month. An annual audit of the service is conducted. The registered provider also nominates an operations manager to conduct a monthly visit to the home to seek the views of people using the service, and make sure that the home is being managed correctly. ‘Floor audits’ are completed to monitor the building, and a catering survey has recently been undertaken. It was not possible to sample resident’s finances as no keys were available. The operations managers present were aware that this situation did not support resident choice, as they should be able to access their monies at any reasonable time. Resident’s financial records viewed however were well maintained. Staff supervision does happen, but not with the recommended frequency to ensure that staff are fully supported in their roles. It was concerning to note that for one member of staff where disciplinary issues had been identified, no additional support, supervision or monitoring was evidenced. Some health and safety issues have been identified throughout this report and need to be addressed to ensure resident and staff safety. Fire and some health and safety records were sampled and were satisfactory. Some staff require training/update training in some core areas such as moving and handling to ensure that residents are assisted safely. COSHH procedures must be adhered to. Where bulk cleaning fluids are used and decanted into other containers, these must be clearly labelled. Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 21 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 2 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 2 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 3 2 2 3 2 3 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 2 2 X 2 Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 22 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 OP2 Regulation 5 Requirement The Registered Person must ensure that the statement of terms and conditions provided at the point of moving into the home is completed fully. This standard was not assessed at this inspection and the requirement is carried forward. The registered person must not provide accommodation to residents unless their needs have been fully assessed. Staff should receive training appropriate to the work they are to undertake. This refers to the need for all staff to undertake training in dementia care. Care plans must cover all service users current assessed needs, including health care needs, social and behavioural needs. This is partially a repeat requirement with a previous compliance date of 14/08/05. Care plans and daily records must be maintained in a way that clearly shows the homes DS0000064577.V262303.R01.S.doc Timescale for action 01/01/06 2. OP3 14 01/01/06 3. OP4 18 01/02/06 4. OP7 15 01/01/06 5. OP8 13 01/01/06 Elizabeth House (Benfleet) Version 5.0 Page 23 response to identified issues or changes in residents conditions. This is an unmet requirement from the complaint report of 14/08/05. The registered provider must make arrangement for the safe administration of medication at the home. This refers to the issues raised in the body of the report. The registered person must make arrangements for all service users to have the opportunity to engage in appropriate activities. It is recognised that progress has been made towards meeting this requirement but further development is required. Previous requiremtent of 14/08/05 not met. The registered provider must ensure that residents receive adequate quantities of food and drink at times that are suitable to them. It is recognised that progress has been made in meeting this requirement but some concerns still remain. Therefore previous requirement of 14/08/05 not met. Staff should receive training appropriate to the work they are to undertake and residents must be protected from harm. This refers to the need for all staff to undertake training in adult protection. Previous requirement of 14/08/05 not met. The registered person must ensure that residents are DS0000064577.V262303.R01.S.doc 6. OP9 13 01/12/05 7. OP12 16 01/02/06 8. OP15 16 01/12/05 9. OP18 13, 18 01/01/06 10. OP18 13 01/12/05 Version 5.0 Page 24 Elizabeth House (Benfleet) protected from abuse, and that any unexplained injuries/marks are fully investegated recorded and explained. Previous requirement of 14/08/05 not met. The Registered Person must 01/05/06 provide external grounds which are accessible to all service users and suitable for the needs service users. Previous requirement of 01/10/05 not met. The registered provider must make suitable arrangements to prevent the spread of infection at the home. This refers to the issues raised in the body of the report, and includes staff training. Previous requirement of 14/08/05 not met. The premeses must be suitable to achieve the aims and objectives. The home is registered to provide care for residents with dementia. Adequate orientation and directional signage must be in place to assist these residents. The registered person must review and be able to demonstrate that sufficient staff are on duty at all times to fully meet the needs of all residents. Previous requirement of 30/05/05 not met. and A full review of the home’s dependency level assessment tool(s) needs to take place. The result of this may have an Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 25 11. OP19 23 12. OP21OP26 13 01/01/06 13. OP22 23 01/02/06 14. OP27 18 01/12/05 15. OP29 19 16. OP30 18 impact of staffing levels. The registered provider must 01/12/05 ensure that robust recruitment procedures are maintained and that statutory records are maintained in the home. The Registered Person must 01/12/05 ensure that staff receive training appropriate to the work they are to perform.This refers specifically to all staff receiving adequate induction training. Previous requirement of 01/09/05 not met. An application from a suitably qualified person to be registered manager at Elizabeth House must be submitted to CSCI. Previous requirement of 01/10/05 not met. Staff should receive training appropriate to the work they are to undertake. This refers to the need for all staff to undertake and be kept up to date in areas of health and safety including moving and handling. Previous requirement of 01/10/05 not yet met. The registered person must ensure that the home is managed to make proper provision for the safety of residents. This refers to the need to manage cleaning products in line with COSHH procedures. 17. OP31 8, 9 01/01/06 18. OP38 18 01/02/06 19. OP38 12 01/12/05 Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 26 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. 3. 4. 5. 6. 7. 8. 9. 10. 11. Refer to Standard OP7 OP8 OP12 OP16 OP22 OP24 OP28 OP30 OP31 OP35 OP36 Good Practice Recommendations Where bed rails are used the risk assessment should evidence that a multidisciplinary assessment has been undertaken. Nutrition records should be reviewed to ensure that they provide a full and accurate record. Care staff should have the flexibility and time, and be encouraged to engage residents in activity/occupation throughout the days and at weekends. The way complaints are managed needs to be monitored to ensure that best practice is adhered to. Appropriate aids/grab rails should be provided in the homes corridors to assist residents. Resident’s comfort should be promoted by the provision of appropriate mattress covers where appropriate. 50 of care staff should be trained to NVQ level 2 or above by 2005. The home should ensure that staff receive an induction programme that is in line with current Skills for Care standards. Management arrangements and contact details should be clear to staff left in charge of the home. Residents should be able to access monies or items held for safe keeping at any reasonable time. Care staff should receive formal supervision at least six times a year. Elizabeth House (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 (Benfleet) DS0000064577.V262303.R01.S.doc Version 5.0 Page 28 - 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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