Inspection on 08/06/06 for Elizabeth House Benfleet

This inspection was carried out on 8th June 2006.

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 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 Key Unannounced Inspection 8th June 2006 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.V299433.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.V299433.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) Runwood Homes Plc Mrs Lorraine Lillian Beatrice Smith 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.V299433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Personal care to be provided to 72 service users over 65 years of age. Personal care to be provided to 36 service users with dementia and who are over 65 years of age. 3rd November 2005 Date of last inspection 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 registered 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 area of the home. 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 homes Pre Inspection Questionnaire dated 26/04/06 was £470.00 to £500.00. Additional charges to residents include chiropody, toiletries, newspapers and some transport costs. Elizabeth House (Benfleet) DS0000064577.V299433.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 inspection was undertaken by two inspectors over a nine and a half hour period. At this inspection all the key standards, and the homes progress against their previous agenda for action were assessed. A partial tour of the premises took place and care, staff, medication and other records were selected at random and inspected. A number of residents, visitors and staff were spoken with. A notice was displayed in the home advising that an inspection was taking place with an open invitation to speak with an inspector. Questionnaires to seek peoples’ views about the quality of the service were given out to relatives, made available to residents and sent out to professionals involved with the home such as doctors and nursing staff. A lead care homes nurse who is involved with the home was contacted for their views about Elizabeth House. The views expressed in the responses have been incorporated into this report. The home had been sent a pre inspection questionnaire before the site visit took place with a request that this be returned to the Commission for Social Care Inspection (CSCI) by the end of April. This was not achieved, and was not available to inspectors before the site visit took place. What the service does well: What has improved since the last inspection? The home has a new registered manager who is very active and committed to improving the services offered to residents at the home. The new registered manager has been trying to create a more open culture where people can air their views, and any issues can be discussed and resolved. Re-decoration is taking place in some areas of the home to improve the environment for residents. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 6 New dining furniture has been provided to improve the dining area. Further improvements to this area are planned. Staffing at the home is more stable meaning that residents are cared for more consistently by staff that know them. Grab rails have been fitted to the homes corridors to improve safety for residents. The home are working with other professionals and agencies to improve the level of healthcare monitoring and intervention. This has improved the level of care offered to residents. 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.V299433.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available to prospective users of the service. Service users have their needs assessed by someone competent to do so. However staff at the home do not always have sufficient specialist knowledge in some areas to ensure that they can fully meet residents needs. EVIDENCE: The home has a comprehensive Statement of Purpose and Service Users Guide available. These, and other helpful information, were available in the entrance areas of both units. A recently admitted resident had copies of these documents in their room. Files of new residents showed that they had their needs assessed before they moved into the home. The assessments viewed had been well completed. Information was also available from other agencies. Daily records following an Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 9 admission showed that staff had worked to settle new residents in and make them feel comfortable. A new resident spoken with said that their family had visited and assessed the home on their behalf. The home had been previously known to the resident as a visitor. Staff spoken with had a good knowledge of residents needs. A number of staff, including senior staff, have not completed recent training in dementia care for which the home is registered. There are shortfalls in other areas where awareness training would benefit resident care. This includes catheter care and sensory loss. The registered manager is aware of these shortfalls and has plans in hand to address them. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care documentation viewed was inadequate, showed shortfalls or inconsistencies, and needs to be reviewed to provide an adequate basis for care to be delivered. Residents receive good healthcare and the home are proactive in involving other agencies and health care professionals. Some aspects of medication management needs to be reviewed to keep residents safe. EVIDENCE: As part of this inspection a number of care files were viewed on both units, E1 and E2. The quality of care plans did vary, but most had shortfalls. A resident admitted six weeks prior to the inspection had a care file in place but care plans did not identify all of their assessed needs. With one care need there was a conflict between the assessment and care planning information. Two established residents have significant sensory impairments, but there was little or no mention of this in care planning information. Care plans are regularly reviewed but when care needs have clearly changed, this was only outlined in the review notes and the care plan itself had not been updated or changed on Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 11 those viewed. This could lead to residents receiving inappropriate care. One residents needs had changed due to a recent illness and an accident. There was no care plan in place to guide staff in their care following the accident. The care planning system in use at the home is quite complex and information is often not fully cross referenced between the different elements, for example information from the visiting professionals sheets, where visits and any outcomes are not reflected in care planning and daily observation notes. Again this places residents at potential risk as important information may be missed. The information headed up ‘night care plan’ is not adequate to address the needs of some residents. Documentation showed that the home tries to involve residents and their families in the ongoing review of care needs and planning. Care records indicated that residents access relevant healthcare professionals, and are assisted to attend hospital and other appointments. Chiropody and optical services visit the home. Residents can access dental services. Members of the district nursing team attend the home on a regular basis. The home is proactive in supporting resident’s health care needs. A ‘lead care homes nurse’ from the Primary Health Care Trust is involved with the home to offer support and advice. Through this link staff training in various areas is planned. Referrals are made as appropriate to the falls prevention team. Pressure relieving equipment is provided as required to meet residents assessed needs. Feedback from GP’s who visit the home was positive and they were happy with the level of care offered to residents. Residents weight is monitored, but nutritional monitoring is not supported by good record keeping. Nutrition records on both E1 and E2 were not adequate. They did not clearly or consistently identify what, or how much residents had eaten. Medication records and elements of the system were sampled on both E1 and E2 as part of this inspection. The home had experienced recent difficulties with their supplying pharmacist. To their credit, this situation has been managed professionally by the registered manager and staff at the home. Their vigilance has ensured that resident’s safety was not compromised. The storage areas for medication were noted to be tidy and well organised. Procedures and information was available to assist staff in good practice. Staff confirmed that to date only in house training has been provided. The registered manager said that it was hoped to provide pharmacy training and ongoing competence assessments for staff soon. Protocols were not available for medication prescribed ‘as and when required’ (PRN). This needs to be addressed so that residents receive these medications in a consistent and appropriate manner. Devices such as inhalers should be labelled on the device as well as on the containing box, to ensure compliance with directions should the box and device become separated. On E1 it was noted that where medication had been handwritten onto the medication record, this had not been double signed as required by the organisations own procedures. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 12 During the inspection staff were observed to treat residents with respect. Residents preferred names were recorded on care plans. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The level of activities available for residents at the home is improving, but is largely reliant on the hours worked by activity co-ordinators. This means that opportunities for occupation and activity are still limited. New menus have been introduced at the home to improve the nutritional basis of resident’s diets. Residents are encouraged to express their views and make choices. EVIDENCE: An activities co-ordinator is provided on each unit for 20 hours per week. An activities co-ordinator was spoken with who had a good understanding of their role and residents needs. Activity ‘assessments’ and records of activities were poor on both units. They did not always reflect residents needs, for example sensory impairment, or demonstrate that all residents have the opportunity for regular stimulation, occupation and activity. During the morning of the inspection residents on E1 enjoyed using the garden and took part in a church service. On E2 staff interacted with residents in communal lounges and garden areas of the home. The registered manager acknowledged that the home has work to do in ensuring that all staff are involved, and see it as part of their role, to provide occupation and stimulation for residents throughout the day and at weekends. Residents spoken with felt that they were offered choices in Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 14 their daily lives, and that some activities such as bingo and ‘throwing the ball’ were available to them. Staff were observed to support residents when they expressed choices or made requests. The registered manager outlined staff deployment strategies that try to ensure that residents are offered choices in, for example, rising and retiring times. Visiting is very open at the home and visitors were noted to come and go throughout the day. Information was available on advocacy services. Resident’s bedrooms showed that they were able to bring in their own furnishings and possessions. The registered provider has consulted a nutritionalist and prepared new menus for all the groups homes. At Elizabeth House these new menus have just started on the basis of a months trial. Residents have all been given copies of the new menus. Staff and residents are being encouraged to voice/record their views and any issues that arise from them. Residents generally made positive comments about the food supplied by the home, and one said that they felt the new menus gave them more choice. Breakfast at the home is served at 08.30, lunch at 12.30 and tea from 16.30. This means that the main meals of the day are served within quite a concentrated time period. ‘Supper’ is available later in the evening, but some residents will be in bed by this time. Mealtimes should therefore be monitored to ensure that they provide a balanced and spaced approach for all residents. It was noticed that most residents are having sandwiches for tea on most days. Again staff need to be sure that this is in accordance with individual residents choice, and encourage a varied diet. Since the previous inspection new dining furniture has been provided, the registered said that the delivery of tablecloths is awaited to improve the dining environment further. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints at the home are managed efficiently and well recorded. Staff are aware of adult protection issues. Senior staff however need to demonstrate knowledge and confidence in describing and managing the process to be followed, should an incident occur or allegation be made. EVIDENCE: The home has a clear complaints process in place. This is on display for residents and visitors. The homes complaint records showed that the registered manager is proactive in dealing openly with any concerns or issues raised. The management of adult protection issues has been an area of concern at the home. In December of last year an enforcement notice was issued relating to this. The registered provider was required to take steps to ensure that staff were appropriately trained, and any incident managed in accordance with local adult protection procedures. This was achieved and the registered manager has put much time and effort into educating senior and other staff in responding appropriately to any allegations. At this inspection care staff spoken with were clear about their responsibilities in terms of reporting any concerns. However, one senior member of staff failed to describe the correct process to be followed as a result of an allegation being made. Another knew the process, was aware where adult protection information and alert forms were available, but struggled to clearly describe the actions that they would Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 16 take. The homes training matrix indicates that 25 care staff (including night care staff and night senior staff) have not yet undertaken training in adult protection. There are also gaps for the deputy manager and another senior member of staff. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall standard of the furnishings, décor and fitments within the home was good, and provided residents with a safe pleasant and homely place to live. 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, and at previous inspections it has been stated that plans are in hand to address this. So far there have been no developments. The homes grounds on E1 were well maintained. On E1 decoration work is underway in communal areas. The registered manager said that this work is ongoing and will include residents bedrooms in due course. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 18 Both E1 and E2 have a range of communal spaces available to residents. These were well furnished and lit. In a change from previous inspections residents are now encouraged to use these spaces more, rather than remaining isolated in their individual bedrooms. All bedrooms at the home contain an en suite area. The toilet roll holders were broken in a number of areas. The home has a range of communal bathrooms and toilets. Although improved some of these areas are still used to a degree to provide storage areas for wheelchairs and walking aids. Since the previous inspection all communal corridors in both units have been fitted with proper grab rails for the benefit of residents. Storage remains an issue at the home (see above). However, it is understood that the arrival of storage sheds is now imminent. The home has a call bell system in place. In most cases residents in their rooms had access to this and were able to call for help if required. Bedrooms at the home were well furnished and homely. Beds were still not fitted with appropriate mattress covers for the comfort of residents. Residents are able to hold their own keys and keep their bedrooms locked if they wish to do so. The inspection took place on very warm day. The home remained well ventilated and a comfortable temperature for residents. The home was generally clean and odour free. The homes laundry areas on E1 and E2 were tidy and well organised. Although staff at the home have received guidance, no infection control training has taken place. This could compromise good practice and resident safety. The registered manager is aware of this shortfall and is seeking to address it. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management must continue to monitor staffing levels at the home to ensure that residents holistic needs can be met at all times in a timely manner. Staff are recruited safely, but some attention to detail is needed to prevent any anomalies occurring. Staff are offered appropriate induction and training to help them to care effectively for residents. EVIDENCE: Elizabeth House cares for residents who have a range of different needs and dependency levels. The registered manager felt that current staffing levels were sufficient to meet the needs of residents. The basic levels are: On E1 there are five carers and a care team manager (CTM) on for most of the day with a drop to four care assistants and a CTM between 14.30 and 18.00. 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. The registered managers hours are supernumerary and the deputy manager also has largely supernumerary hours. These levels were confirmed by the homes rotas. The home currently has vacancies for 2 full time care staff on each unit. Agency and bank staff are used to fill gaps in the home rota and some staff work additional shifts. The registered manager monitors this to ensure that staff do not become over tired and that the service to residents is maintained. The home conducts a regular assessment of residents needs using a set Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 20 assessment tool (modified Bartel) This tool however is not used proactively to adjust staffing levels as might be indicated. However the registered manager said that if it was required she would increase staffing levels to meet residents needs. It was understood that the registered provider was to review the assessment tools currently in place but this has not happened. During the inspection staff were well deployed and, in the main, residents were well supervised and supported. The call bell system was tested randomly during the inspection on both E1 and E2. On two occasions the response by staff was slow. (five minutes on one occasion and thirteen on another) Residents said that response times varied according to how many staff were on and how busy they were. One resident felt strongly that the home did not employ enough staff. Comments were also made about some staffs’ ability to communicate effectively. In general however residents were positive about the staff group and management of the home. Very limited afternoon/evening domestic cover is provided at the home. No laundry cover is provided after 13.00. Currently there is no rostered laundry cover at weekends. This needs to be monitored to ensure that these tasks do not take care staff away from caring for residents. At the moment only 2 care staff at the home have NVQ level 2. The registered manager said that the organisation was hoping to start a new initiative soon whereby many more staff would be able to undertake this qualification. The files of four newly recruited staff were viewed as part of this inspection. These showed that staff in general recruited safely to protect residents. POVA first checks and Criminal Records Bureau checks being carried out before staff start work at the home. Some anomalies were however noted in records. For one member of staff dates for employment given by the applicant did not match the employment dates given by the referee. Another had not given their last employer as a reference as best practice indicates. The registered manager agreed to look into these matters. Records viewed showed that staff had completed an induction process that included core training such as moving and handling. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and an open culture is developing. Quality assurance strategies are in place. Staff training in core areas needs improvement. EVIDENCE: After a period of instability Elizabeth House is now benefiting from having an experienced and knowledgeable registered manager in post. Feedback from one relative said that ‘The home is much better since….(the current manager) has been the manager. Hope she stays.’ The registered manager promotes a hands on and open door approach to management. This has had a positive effect at the home where the staff morale, and general atmosphere has improved from previous inspections. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 22 Regular meetings are held for residents and staff. The registered manager is available to relatives at anytime and also holds a weekly evening ‘surgery’. The registered provider has strategies in place to monitor the quality of the service provided. An annual audit of the service is conducted. This is very detailed and includes the use of questionnaires to gauge levels of satisfaction. This process was last undertaken in June 2005 and will be completed again soon. 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. Other internal quality audits are also undertaken. The home holds monies for some residents at the home. Residents can access their money at anytime. Records viewed were well maintained. Monies were accurate and receipts were available for all transactions. Records show that the staff at the home receive regular supervision. A system of annual staff appraisal incorporating aims and objectives for the year, and required targets is being established at the home. Staff training records showed that training in core areas is ongoing, but the homes training matrix showed that there are some gaps. Eight care staff are not recorded as having completed moving and handling training. There are also many staff who have not completed basic food hygiene training. Although staff have received information on this, not many staff have received infection control training. Aspects of health and safety were sampled. Fire records were well maintained and showed that regular checks and drills take place. Accident records were completed. Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 23 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 3 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 2 X 2 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 Elizabeth House (Benfleet) DS0000064577.V299433.R01.S.doc Version 5.2 Page 24 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. 2. OP4 18 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. Previous requirement of 01/02/06 not met Care plans must cover all service users current assessed needs, including health care needs, social and behavioural needs. Previous requirements of 14/08/05 and 01/01/06 not yet fully met. 4. OP8 17 Sch 4 An adequate record of nutrition must be maintained at the DS0000064577.V299433.R01.S.doc Timescale for action 01/08/06 01/08/06 3. OP7 15 01/08/06 01/08/06 Elizabeth House (Benfleet) Version 5.2 Page 25 home. 5. OP9 13 The registered person(s) 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(s) must make arrangements for all service users to have the opportunity to engage in appropriate activities and occupation. It is recognised that progress has been made towards meeting this requirement but further development is required. Previous requirements of 14/08/05 and 01/02/06 not met. 7. OP18 13, 18 The registered person(s) must ensure that staff 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 requirements of 14/08/05 and 01/01/06 not met. 8. OP19 23 The Registered Person(s) must 01/09/06 provide external grounds which are accessible to all service users and suitable for the needs service users. Previous requirement of 01/10/05 and 01/05/06 not met. 9. OP23 21 22 Adequate storage facilities must be provided at the home. DS0000064577.V299433.R01.S.doc 01/08/06 6. OP12 16 01/08/06 01/08/06 01/08/06 Elizabeth House (Benfleet) Version 5.2 Page 26 10. OP26 13 The registered provider must make suitable arrangements to prevent the spread of infection at the home this includes staff training. Staffing levels at the home must be kept under review. and A full review of the home’s dependency level assessment tool(s) needs to take place. The result of this may have an impact of staffing levels. Previous requirement of 01/12/05 not met. The registered person(s) must ensure that robust recruitment procedures are maintained and any anomalies fully explored 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 core areas of health and safety including moving and handling. Previous requirements of 01/10/05 and 01/02/06 not met. 01/09/06 11. OP27 18 01/09/06 12. OP29 19 01/08/06 13. OP38 18 01/08/06 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 OP12 Good Practice Recommendations Care staff should have the flexibility and time, and be DS0000064577.V299433.R01.S.doc Version 5.2 Page 27 Elizabeth House (Benfleet) encouraged to engage residents in activity/occupation throughout the days and at weekends. 2. 3. 4. 5. 6. OP15 OP21 OP22 OP24 OP28 Mealtimes at the home should be kept under review to ensure adequate spacing of main meals during the day. Items such as toilet roll holders should be fit for purpose and kept in a good state of repair. Adequate storage facilities should be provided. 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. Elizabeth House (Benfleet) DS0000064577.V299433.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: 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. 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