Inspection on 11/04/07 for Elizabeth House Care Home

This inspection was carried out on 11th April 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 Care Home 02/07/09

Elizabeth House Care Home 22/04/09

Elizabeth House Care Home 08/04/08

Elizabeth House Care Home 11/04/06

Elizabeth House Care Home 01/11/05

Elizabeth House Care Home 23/08/05

Elizabeth House Care Home 08/07/05

Elizabeth House Care Home 03/11/04

Elizabeth House Care Home 20/04/04

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

CARE HOMES FOR OLDER PEOPLE Elizabeth House Care Home 2 Church Hill Avenue Mansfield Woodhouse Mansfield Nottinghamshire NG19 9JT Lead Inspector Rehana Rashid Key Unannounced Inspection 11th April 2007 10:00 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 Care Home DS0000008668.V334243.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 Care Home DS0000008668.V334243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elizabeth House Care Home Address 2 Church Hill Avenue Mansfield Woodhouse Mansfield Nottinghamshire NG19 9JT 01623 657368 01623 431325 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) RAMNARAIN9@aol.com Mrs Vijay Ramnarain Surendra Dev Lutchia, Mr Vivek Obheegadoo Mrs Vijay Ramnarain Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2006 Brief Description of the Service: Elizabeth House is a care home providing personal care and accommodation for 16 older people. The home is located in Mansfield Woodhouse, in a quiet residential area and close to shops, pubs, the post office and other amenities. The home is an older style domestic property with a more recent two-floor extension. There are 14 single, and 1 double bedroom, which are located on both floors and there is a passenger lift. There are a variety of lounge areas. There is a garden that is easily accessible for service users. There is limited car parking available on the homes driveway and further parking is available on the street. The manager and at least two staff are on duty throughout the day and night care staff are available throughout the night. Information about the service is provided in the statement of purpose and service user guide. The Registered Manager advised on the day of the inspection that the current range of fees are between £283 to £326 per week. There are additional costs for newspapers, chiropody and taxis. Elizabeth House Care Home DS0000008668.V334243.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 inspection which was conducted on 11 April 2007. The inspection took approximately five hours. The main method of inspection was case tracking, which involved selecting three residents and examining their care records. Case tracking is used to establish if the needs of the residents are being appropriately assessed by the home and their needs are being catered for. Indirect and direct observation of practice and interaction between staff and residents was also carried out as part of the inspection methodology. The communal areas, shower room, bathrooms, kitchen, four bedrooms and gardens were viewed during this site visit. Documentation including health and safety records were also examined. Two members of staff were spoken with and two staff files were examined. Residents were briefly observed during lunch. Three residents and two relatives were spoken with. Thirteen surveys from residents, relatives and their representatives were received by the Commission for Social Care Inspection. On the day of the inspection there were sixteen residents in residence. The registered manager supplied much of the information provided for the inspection. Two random inspections have taken place since April 2006, one was a result of an anonymous complaint and another was to see what action had been taken by the registered manager to work towards requirements set at the key inspection in April 2006. What the service does well: Elizabeth House offers a homely environment. Residents feel that the staff provide a good standard of care for them, they also said that staff are friendly and helpful. Relatives spoken with stated that the standard of care provided was good and they feel that their relatives are treated with respect and dignity. The home was clean and free from mal-odour. Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 Page 6 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 Care Home DS0000008668.V334243.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 Care Home DS0000008668.V334243.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 Care Home DS0000008668.V334243.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): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents needs are assessed prior to moving to the home, which provide assurances that their needs can be met . Elizabeth House does not offer intermediate care. EVIDENCE: As part of the case tracking process three resident’s files were seen. The files contained Shared Nottinghamshire Assessment Process (SNAP), which are Nottinghamshire’s health and social care assessments for older people. Basic in-house pre-admissions assessments supported that prospective residents were assessed prior to them moving into the home. Discussion with two visitors confirmed that they had visited the home prior to their relatives moving in. Elizabeth House Care Home DS0000008668.V334243.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. 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 plans identifying individual needs are in place. Arrangements for handling medication need to be improved. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: Three care plans were viewed, which generally set out individual health, personal and social care needs. These also contained basic actions for care staff to carry out to meet the service users needs. One service users care plan did not contain any information on nutrition. Whilst speaking with the registered manager it was clear that another service user’s ability to chew food was variable, this was not reflected in the care plan. There is no evidence that a Speech and Language Therapist has been asked to assess the service user and advice has not been obtained from the Community Dietician about the provision of soft diet. At the last random inspection December 2006 this was set, as a requirement that has not be met at this inspection. Discussion took place with the registered manager with regards to the changing needs of the existing service users. The registered person must Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 Page 11 ensure that assessment of all service users needs are kept under review and revised as necessary. The registered person must carry out an urgent reassessment of a service users needs who is presenting with mental health needs, this is to ensure the placement remains suitable and their needs can continue to be met by Elizabeth House. The three service user files seen during the case tracking process did include healthcare information. There was evidence relating to contact and visits by health care professionals such as GP, Chiropodist and District Nurse. Policies and procedures were in place with regards to the administration of medication. Medication is stored in a lockable trolley, which is secured to the wall. The inspector viewed the medication fridge one bottle of eye drops was not in the dispensed container and no date was recorded as to when the three bottles of eye drops were opened. All prescribed medication must remain in the dispensed container until the stock is depleted or returned to the pharmacy. Ten surveys from relatives and representatives were received and two relatives were spoken with during the inspection. They were all positive about the care staff and the level of care provided. Comments in the survey stated, “ I am perfectly happy with the care my mum receives from the staff, “They care for my mum very well and she is as happy as she can be.” Two service users spoken with stated that staff that the care workers treat them with respect and that they are always polite towards them. Another service users stated that some staff are more friendly than others. Staff stated they always knock on the service users door before entering, this practice was observed by the inspector. Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 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. 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. Service users are supported to access social activities, parts of the local community and maintain contact with family and friends. Service users generally receive a wholesome diet. EVIDENCE: Service users were observed sitting around in the communal areas for a long period of time. During the afternoon some service users who wished to participate were observed in the main lounge taking part in a keep fit session. Two relatives and two service users spoken with confirmed that social activities organised included Bingo and keep fit. One service user spoken with stated that she did not enjoy the social activities, but was unable to state what types of activities she may like. Comments in a survey for relatives, carers and advocates stated that Elizabeth House “should introduce day trips for residences.” Three service users were spoken with about family visits; two said that they had regular visits from their family members. Two relatives spoken with confirmed that they are able to maintain contact with their relatives and there are no restrictions regarding visiting. Two service users spoken with reported that they are taken out by their relatives to the local community, which they enjoy. Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 Page 13 A relative comments included in a survey stated, “the home are flexible about peoples requests and lets them feel they are at home.” Three of the service users spoken with stated that they are generally able to make their own decisions including times they wish to go to bed and wake up. Two service users spoken with commented positively on the quality of food, whilst one stated that she did not like the meals provided. All three said they received ample portions. Lunchtime was briefly observed, staff assisted service users with eating. A requirement was set at the last inspection, which remains outstanding at this inspection; the appropriate healthcare professionals should be consulted for service users who require a soft or liquidised diet. There is a four weekly menu in place, which offers variety and choice. Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 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. 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. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously. Service users at Elizabeth House are not protected from abuse, and are potentially at risk. EVIDENCE: The records of complaints received were recorded in a book. Since the last inspection the registered manager stated she had not received any complaints. The Commission for Social Care Inspection received one anonymous complaint, which was followed up by a random inspection. Discussions with the residents indicated that they were clear who to talk to if they wished to complain. A copy of the complaints procedure was on the notice board and a copy is kept in each service users room. Two members of staff spoken with demonstrated an understanding of the whistle blowing procedures and what action to take should they suspect an allegation of abuse. These members of staff stated that they had not attended training in adult protection since being employed by Elizabeth House. The training matrix viewed indicated that four members of staff have only received training in adult protection but this was some considerable time ago 2004 and 2005. Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was generally clean and tidy at the time of this inspection. The home is not fully maintained to the benefit of the residents. EVIDENCE: A partial tour of Elizabeth House was undertaken. A passenger lift and stairs provide access to the first floor. The toilets, bathrooms and shower room were clean. At the last random inspection a requirement was set to repair/replace missing tiles in the shower room, this has know been achieved. Three bedrooms and communal areas were viewed which were well maintained and homely. To the rear of the property in the garden the grass was in need of cutting, and the garden weeding. Despite it being a warm day, no residents were using the garden during the inspection. When asked whether the home could improve, two relatives wrote in the surveys “The home is very homely, could do with a little updating” whilst another wrote, “the décor could be up dated.” Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 Page 16 The cleaner was on duty and was observed carrying out domestic tasks. The building appeared clean and free from mal-odours. Three surveys from service users stated that the home is always fresh and clean. One relatives, carers and advocates survey included “the cleanliness of the home is to a high standard.” Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 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. 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. Staff numbers meet the current service user’s needs. Service users at Elizabeth House are generally in safe hands and protected by the recruitment policy and practices. Staff are not adequately trained and competent to do their job. EVIDENCE: The staffing rota was viewed for the week. Two members of staff and the registered manager are on duty during the day. In addition to this there is a cook and a domestic. The domestic also assists with lunchtime. During the night there are two members of staff on duty. Currently there are sixteen service users at Elizabeth House. Two members of staff spoken with expressed that there are enough staff on duty to meet the needs of the current service users. Three service users and two relatives said that staffing levels seem ok. They also said that the staff are polite and friendly. Two staff files were reviewed during the inspection, they contained evidence that necessary pre-employment checks ensuring service user’s safety had been carried out. The most recently employed staff member commenced work after recruitment checks had been carried out which included Protection Of Vulnerable Adults (POVA) first check and a satisfactory Criminal Records Bureau (CRB) disclosure. Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 Page 18 A review of the training matrix showed that not all staff members have received mandatory training including infection control. There was also no evidence to show annual updates are taking place to ensure that staff were aware of the latest best practice. Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Elizabeth House is generally run in the best interests of its service users. Service users financial interests are safeguarded. The health, safety and welfare of service users and staff are not adequately promoted and protected. EVIDENCE: Two members of staff spoken with stated the manager is supportive and approachable. Service users and relatives said that the manager is good. The quality assurance systems operated by the registered manager includes questionnaires to service users. One completed questionnaire was seen at this inspection, which was generally positive. Quality reports from the proprietor who is required to conduct visits to the home and report on their findings to the commission for Social Care Inspection as required in Regulation 26 have not been received. Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 Page 20 Service users financial interests are safeguarded by the homes financial procedures. Resident’s money is kept in a secure lockable cabinet. On the day of the inspection two financial records were viewed, which were satisfactory. The home maintains these records, receipts for amounts spent are kept for a period of time and then handed over to the resident’s relative or representative. A range of records relating to health and safety were examined. Records for equipment servicing for the hoist and lift and other health and safety records including portable appliances testing were observed and were found to be carried out at the required intervals. On the day of the inspection records viewed regarding fire testing showed that some issues had been identified with regards to a couple of fire checks not taken place at regular intervals. The health and safety checks must take place at regular intervals to ensure the safety of service users and staff. Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 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 3 X X N/A 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 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 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 2 X 2 X 3 X X 2 Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 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 OP7 Regulation 15 Requirement Timescale for action 11/05/07 2. OP7 14.2 3. OP9 13(2) 4. OP15 13(1)(b) The registered person must ensure care plans are reviewed and updated to reflect changing needs in respect of their health and welfare.) Care plans to be reviewed at least once a month. Outstanding from last inspection. Target date of 31/01/07 NOT MET The registered person must 11/05/07 ensure that the assessment of service users needs are kept under review and revised. This is in particular to the service user presenting with mental health needs, to ensure the placement remains suitable. 25/04/07 The registered person must ensure medication remains in dispensed containers with the prescription label on it until stock has depleted or returned to the pharmacist for appropriate disposal. This will ensure safe administration. The registered provider must 11/05/07 ensure that advice is obtained for people with swallowing difficulties from the community DS0000008668.V334243.R01.S.doc Version 5.2 Elizabeth House Care Home Page 23 5. OP18 13(6) 6. OP30 18 7. OP33 26 dietician and if necessary the speech and language therapist. About appropriate diets, food preparation and feeding and that the care needs are entered into a care plan. Outstanding from last inspection. Target date of 31/01/07 NOT MET. The registered person must 30/05/07 ensure all staff receive training and guidance to promote the Safeguarding of Adults. The registered person must 30/07/07 ensure all staff receive mandatory training and receive refreshers and updates when required. This will ensure staff are competent to do their job The registered person should 30/04/07 ensure provider monitoring visits are conducted and the commission are supplied with findings. 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. Refer to Standard OP12 OP18 Good Practice Recommendations The registered person should encourage residents to engage in a programme of activities, which has been devised following consultation with the residents. The registered person should review the adult protection policy to reflect the procedures outlined in the Nottinghamshire County Councils Policy For The Protection Of Vulnerable Adults. The registered manager should ensure results of service user surveys are published and made available to current and prospective users and the Commission for Social Care Inspection. The registered person should ensure all fire tests are DS0000008668.V334243.R01.S.doc Version 5.2 Page 24 3. OP33 4. OP38 Elizabeth House Care Home tested on a weekly basis to ensure that it is working properly, and a record of all the test should be kept. Elizabeth House Care Home DS0000008668.V334243.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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