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Inspection on 08/04/08 for Elizabeth House Care Home

Also see our care home review for Elizabeth House Care Home for more information

This inspection was carried out on 8th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People who use the service are cared for by staff who are trained and competent to do so. Each person has a care plan that describes what support they need and when. They are supported to live as they choose to, taking partin activities as they want to and getting up and going to bed when they choose. Meals are appetising and well cooked meeting the nutritional needs of people who use the service. The complaints procedure is available and people who use the service feel able to complain and confident it will be dealt with. Over half of the staff have achieved their National Vocational Qualification to make sure they are trained to meet the needs of residents who need care. Proper checks are done on all staff who come to work at the home to make sure they are suitable to work with vulnerable people. The manager is qualified and was praised highly by residents and staff as being kind, helpful and approachable. The tests and servicing of equipment at the home is done at the intervals suggested and this ensures that residents and staff have their health and safety protected.

What has improved since the last inspection?

Care plans have been reviewed and updated, as have assessments. The medication procedures now ensure that all medication remains in its dispensed container with the prescription label on until needed to ensure its safe administration. Where people have had difficulty swallowing appropriate support has been obtained from the Speech therapist to ensure their safety. Some staff have had Safe guarding adult training to ensure they understand how to protect people who use the service from abuse. Training has taken place over the last few months to ensure that staff have updated their mandatory training.

What the care home could do better:

Care plans need to reflect the care that is actually taking place to ensure that people who use the service have their assessed needs met.The medication fridge must be kept more secure than it currently is to ensure that people who use the service are not placed at risk by consuming anything from it. Some staff could treat residents with more respect for their dignity and the manager could make sure they know the policy and philosophy of the home to avoid poor practice. The home could be better maintained with certain identified areas redecorated and equipment that is not needed stored in more appropriate places or got rid of. All staff who have not attended the safe guarding adult training need to attend to ensure the safety and well being of the people who use the service. The dining area could be tidied and information relating to the running of the service could be placed elsewhere. Information that relates to the individual must be stored according to the Date Protection Act 1998 to ensure the privacy of the people who use the service.

CARE HOMES FOR OLDER PEOPLE Elizabeth House Care Home 2 Church Hill Avenue Mansfield Woodhouse Mansfield Nottinghamshire NG19 9JT Lead Inspector Susan Lewis Unannounced Inspection 8th April 2008 09:30 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 Care Home DS0000008668.V362084.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.V362084.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 631720 d.ramnarain@btinternet.com RAMNARAIN9@aol.com Mrs Vijay Ramnarain Surendra Dev Lutchia, Mr Vivek Obheegadoo Mrs Vijay Ramnarain Care Home 16 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) Category(ies) of Old age, not falling within any other category registration, with number (16) of places Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th April 2007 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 only accessible people who have good mobility. 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 and this can be found in the hallway. The person in charge 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.V362084.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection involved one inspector; it was unannounced and took place over 7.5 hours, including lunchtime. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We were unable to effectively understand and communicate with some of the people living at the home; therefore some judgements in this report are drawn from our observation of staff and resident interactions. Two members of staff and two sets of relatives were spoken with as part of this inspection. In addition the views of two other residents who were not part of the “case tracking” were sought to form an opinion about the quality of the service. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. The registration documents were checked to ensure that they were correct and included any conditions of registration that may have been set. What the service does well: People who use the service are cared for by staff who are trained and competent to do so. Each person has a care plan that describes what support they need and when. They are supported to live as they choose to, taking part Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 6 in activities as they want to and getting up and going to bed when they choose. Meals are appetising and well cooked meeting the nutritional needs of people who use the service. The complaints procedure is available and people who use the service feel able to complain and confident it will be dealt with. Over half of the staff have achieved their National Vocational Qualification to make sure they are trained to meet the needs of residents who need care. Proper checks are done on all staff who come to work at the home to make sure they are suitable to work with vulnerable people. The manager is qualified and was praised highly by residents and staff as being kind, helpful and approachable. The tests and servicing of equipment at the home is done at the intervals suggested and this ensures that residents and staff have their health and safety protected. What has improved since the last inspection? What they could do better: Care plans need to reflect the care that is actually taking place to ensure that people who use the service have their assessed needs met. Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 7 The medication fridge must be kept more secure than it currently is to ensure that people who use the service are not placed at risk by consuming anything from it. Some staff could treat residents with more respect for their dignity and the manager could make sure they know the policy and philosophy of the home to avoid poor practice. The home could be better maintained with certain identified areas redecorated and equipment that is not needed stored in more appropriate places or got rid of. All staff who have not attended the safe guarding adult training need to attend to ensure the safety and well being of the people who use the service. The dining area could be tidied and information relating to the running of the service could be placed elsewhere. Information that relates to the individual must be stored according to the Date Protection Act 1998 to ensure the privacy of the people who use the service. 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. The summary of this inspection report can be made available in other formats on request. Elizabeth House Care Home DS0000008668.V362084.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.V362084.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 and 6 Quality in this outcome area is good. People who want to use the service are given the information they need to make a decision and are assessed prior to moving to the service to ensure that their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three files were viewed and each had an assessment that covered all areas of daily living. They also contained an assessment by a social worker. Discussion with staff confirmed that the manager always visits a person prior to anyone moving to the home and visitors and people who use the service also said that the manager had visited them before they moved in and talked to them about what help they needed. The assessments were used to inform Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 10 the care plan. They also said that they had an opportunity to visit the service before making a decision. Staff were aware of the service user guide and statement of purpose they knew that it was stored in the hallway along with the most recent report. Intermediate care is not offered at this service Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate Each resident has a care plan, but practice of involving residents in the development and review of the plan is variable. The resident’s health is monitored and appropriate action taken. The home has a medication policy, medication records are up to date for each resident and medicines received, administered and disposed of are recorded. There is evidence that staff in the home treat residents in a way, which does not respect their privacy and dignity This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three plans were viewed as part of the inspection to ensure that the people who use the service had their assessed needs met. Each plan followed a similar format and identified the need what the aim of the plan was and what action staff should take to ensure the aim was met. In Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 12 some cases the plan was very basic and did not provide care clear information in how staff were to meet the person’s needs. Staff spoken with did know what they needed to do and said they sit with a new residents and their family to find out what care they need. Although plans were reviewed regularly there was no evidence that people who use the service or their representative were involved in these reviews. In discussion with people who use the service they were unaware of the care plan. Relatives spoken with were and said that they had been discussed with them when their loved one moved in as had reviews. Two requirements were made at the last inspection The first being that 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. This requirement was outstanding from a previous inspection. Although they were reviewed, it was clear from reading the continuation sheet that staff completed that plans did not always reflect what care the person actually received. This wasn’t currently an issue as all the staff had worked at the home for some time and knew the needs of all the people in the service but could be potentially a problem for new staff if they followed the care plan and not what staff were actually doing. Residents spoken with said that they received the support that they needed and were happy with the care. One resident said that the staff were lovely and did everything she needed. The second requirement was that the registered person must 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. Evidence seen in plans showed that reviews were taking place with the commissioning local authority to ensure that the service continued to meet the needs of the people who used the service. Although each plan has a risk assessment, they did not provide sufficient detail to ensure that each person’s full risks were identified and showed how they were met. The Moving and Handling risk assessment was titled ‘lifting and handling’ risk assessment, which is an outdated language and sends the wrong message to staff about how people should be moved. There was a risk assessment concerning where restraint was used such as the use of bed rails. This did not show if alternatives were considered and why Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 13 these were not thought to be suitable or if bumpers were in use to minimise the risk of people getting limbs trapped in the rails. During the tour of the building it was noted that bumpers were in use on beds where rails were used. Plans provided information that people saw doctors as required and also other health care professionals such as dieticians, opticians and dentists. The pre inspection information showed that speech therapists were called to see a person who had difficulty in swallowing. Staff spoken with were aware of what action needed to be taken in ensuring that appropriate meals were provided. Residents weight was recorded regularly to ensure that they were having sufficient nutrition. A requirement was set at the last inspection regarding medication, 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. In checking the medication it was kept in the appropriate containers. The medication fridge was stored where people who use the service have free access and was not locked. There is potential that people who use the service accessing the medication in this fridge particularly as the food fridges are stored in this area as well. The medication administration was observed and the correct procedure was followed. Staff spoken with said that only seniors were able to administer medication and people who use the service said that when staff give them their medication they tell them what it is. Records seen showed that medication was signed for when given and any omissions were explained. Staff were observed throughout the day talking to residents in a pleasant manner and interacting in a positive way. However there were three incidents that caused concern. Firstly a staff member was heard to refer to people who need support to eat their meal as ‘the feeders’ this is derogatory and does not support their dignity. Staff were also heard to shout across the lounges asking other staff if a named person needed toileting. Again this does not support their dignity. The third incident observed was when a member of staff shaved a male person in the lounge. She did not ask if he wanted to go to his bedroom or bathroom. No attempt was made to promote this person’s dignity. When staff were spoken with they understood what privacy and dignity was and said that the manager promoted this. People who used the service said that staff were kind and spoke to them in a pleasant manner. Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 14 Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is good. Staff are aware of the need to plan the routines and activities of the home in a way which meets the choice and wishes of residents. Residents are given the opportunity to take part in a variety of activities both within the home and in the community The food in the home is of good quality, well presented and meets the dietary needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the hairdresser was in and people were having their hair done. There was a pleasant atmosphere in the area this was taking place with people who use the service sat round talking to each other and staff. Staff were seen to bring hot drinks to each person as they finished and commented on how nice their hair looked. There was an activities list on the board and each care plan viewed showed that people who use the service were involved in a variety of activities. People Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 16 who use the service gave mixed views about the activities. One person said that they were involved in things such as when the singers came and could spend their day as they wanted whilst another person said that she was bored and did nothing all day. Staff spoken with said that activities are put on for residents and they encourage them to take part but some residents don’t want to and so they respect their choice. Some choose not to take part but watch whilst others are involved. Care plans indicated when people wanted to go to bed and get up and diary notes confirmed that people were given a choice when to get up and go to bed. People spoken with said that they could take their meals where they wanted to and one person said when he moved to the home he was told that he could have his breakfast in bed if he wanted. He said ‘I do this and I really like it’. He said ‘I get up have a bit of a walk down the hall to stretch my legs then spend some time in my room if I want to watch the telly or I go to the lounge’. From pre inspection information it showed that the service has local visiting clergy to meet the spiritual needs of residents. Care plans viewed showed that local church singers also visited. Visitors were seen during the day and those spoken with said that they were able to see their loved ones in private. The service user guide indicates that visitors may come at any time and staff confirmed that visitors were encouraged to visit when they wanted to, this included meal times as some families liked to support their loved ones to eat. This ensures that people who use the service are able to remain in contact with their families and friends. Bedrooms viewed showed that they were personalised and people who use the service said that they had been able to bring in personal items. Lunch was observed to check that residents receive an appropriate and nutritious diet. The meal looked and smelled appetising, it was homemade meat and potato pie with fresh vegetables, homemade treacle sponge and custard and homemade cakes were made for the afternoon tea. In discussion with the cook it was clear she understood the dietary needs of the people who use the service and how to support people who needed soft diets and people who had diabetes. A requirement was made at the last inspection, that the registered provider must ensure that advice is obtained for people with swallowing difficulties from the community 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. This was an outstanding from last inspection. From information seen in care plans and the pre inspection information this has been met. Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 17 The menu is displayed in one of the dining areas so people know what the midday meal is. People spoken with were mixed in their response when asked about the meals. Some were very positive whilst others said it wasn’t like what they cooked at home. Staff were seen to support people who needed help eating their meal in a pleasant manner, however a member of staff was heard to refer to residents who needed assistance as ‘feeders’. This is dehumanising and disrespectful language and the matter must be addressed. Drinks were provided throughout the day and staff were regularly heard to ask residents if they wanted a drink, this ensures that people remain hydrated. There are two dining areas. The smaller of the two is next to the kitchen and is a multi purpose room. The fridge and freezers are stored here as is the medication trolley, the medication fridge, the filing cabinet with all the care plans and information that relates to the running of the service, most of which is on display. This room is not a congenial setting to take a meal in. Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is good. Residents’ concerns and complaints are responded to and investigated appropriately. Staff ensure that people are safe and protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure and copies are on display throughout the service and in each person’s bedroom. The pre inspection information showed that three complaints had been received by the service and had been dealt with using the complaints procedure. However the complaints book could not be found and so could not be inspected and provide evidence to show that concerns are being recorded, investigated and outcome letters are being sent to inform complainants of action to be taken. None of the residents or relatives spoken with had made any complaints but they said they would go to the manager and would feel confident that she would address the issues of concern. Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 19 Staff spoken with knew what to do if they received a complaint and felt that the manager would take it seriously and deal with it promptly. The Commission has received no complaints regarding this service. The copy of the Nottinghamshire Committee for the Protection of Vulnerable Adults information on display is out of date and the new up date information must replace this to ensure that the manager follows the new procedures should an incident occur. Staff spoken with had a good understanding of what abuse was and what they must do about it to maintain the safety of the people who used the service. Staff confirmed they would take any concerns to the manager and she would deal with it, as there was a zero tolerance of such matters. Visitors were asked if they felt happy leaving their loved ones at the end of a visit they said yes and people who use the service said they felt safe and staff treated them well. A requirement was made to ensure all staff receive training and guidance to promote the Safeguarding of Adults. Staff spoken with confirmed that this had been completed. The training matrix provided after the inspection showed that 5 staff out of a possible 14 staff have attended. Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 20 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 and 18 Quality in this outcome area is adequate. The home is generally fit for purpose but the maintenance and poor storage all negatively affect the level of comfort for residents at the service This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial tour of the accommodation was made and a sample of bedrooms was seen to make sure that the home is clean, safe and comfortable for residents. Two people spoken with said that they had been able to choose the bedroom they had and really liked them. The service, although comfortable and homely, was looking tired and shabby. The second dining area near the kitchen was full of things, such as the fridge and two freezers as well as the Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 21 medication fridge and medication trolley. There were posters on the wall that were information relating to staff practice and not directly for people who used the service. Although not fundamentally impacting on the health and safety of people who use the service it gave the appearance that the home was untidy. The assisted bathroom was in need of redecoration as paint was damaged and was damaged in places. The communal toilets had shelves with pads on display it would better if these were in a cupboard. A level access shower was viewed and it was being used a store room for wheelchairs and a hoist. The person showing the inspector around the building said that the shower wasn’t used but staff spoken with said that they did use it for a male residents who couldn’t use the assisted bath. This means that staff must empty the shower room out every time they use it and then causes problems of where to store for that time. Wheelchairs were also stored in the greenhouse outside. When this was queried the person showing the inspector around said that these belonged to people who had died but as they died without a will they didn’t know what to do with them. This is unsightly and should be dealt with. Access to the garden is through French windows but the pathways are uneven and would make walking difficult for people who use the service. The person who showed the inspector around said that people who use the service do not go into the garden. It was noted at the last inspection that people were not sat outside and the garden was untidy and in need of weeding. The situation regarding the weeding remained the same. The service was clean and the laundry met the needs of the people who used the service. There were policies in place for infection control. Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is adequate. Recruitment procedures are robust and protect residents from people who may abuse them but the approach of staff is not consistent and in some cases this may lead to outcomes for people who use the service that are less than would be expected for a good service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pre inspection information said that Rotas indicate sufficient numbers of staff on duty at all times with extra staff at lunch time whenever needed. The manager is on duty throughout the day for extra support whenever it is needed. People who used the service indicated that they felt there were enough staff to support them as did relatives. Some staff spoken with said that some shifts can be very hectic particularly mornings. The accident book was looked at and it did not have a high level of incidents or falls which would indicate insufficent staff and the Commission has not received any concerns regarding staffing levels. Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 23 Staff spoken with said that training was encouraged and that in the last few months they had attended all mandatory training and had started their Dementia Awareness training. 67 of staff have their National Vocational Qualification level 2 training with a further 4 signed up to take it. This is above the recommended 50 and is very good in ensuring that staff are trained to a minimum competence level. However, it is clear from this inspection (OP10) that there are key areas in which staff need support and training to ensure they are providing a high quality of service to all of the residents in their care. Staff files were viewed and certificates showed that staff had undergone mandatory training a requirement was set at the last inspection requiring this to take place. A training matix was provided after the inspection that showed what training had taken place. The staff files were inspected to make sure that they had all of the information and documentation to ensure that residents are properly protected from people who may harm or abuse them. The files were well kept and contained all of the information and documents needed by Law in order to safeguard vulnerable people. Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. The manager is a caring and approachable person and the service is run in the best interest of the people who use it. Information regarding the people who use the service is not stored securely and does not promote their privacy. The health, safety and welfare of people who use the service and staff is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken with spoke positively about the manager saying she was supportive and approachable as well as giving clear expectations regarding the Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 25 standard of care for people who use the service. Residents also were positive about the manager saying she came and talked to them and one person said ‘she always asks me how I am’. The manager carries out quality surveys for the home and these were seen. Comments that are made in these surveys by people who use the service and relatives are included in the service user guide. A requirement was made at the last inspection for the proprietor to visit the home monthly to carry out quality reports and send them to the Commission. As the manager is both manager and one of the proprietors it is not necessary for this to happen and the requirement is removed. The pre inspection information said that Service Users financial needs are administered by their families and Guardians. The manager is only responsible for their day-to-day expenses such as hair dressing and chiropody fees. This was confirmed by the person in charge on the day. The care plans for the people who use the service and other records for the day to day running of the home were stored in the second dining room. The filing cabinet where the care plans were stored was unlocked and other records such as bathing records were stored on an open shelf this is not in line with the Data Protection Act 1998. The records of Health and Safety servicing and checks were inspected to ensure that residents’ are properly protected. These were all up to date and well recorded. The staff have all completed their statutory training courses and they confirmed that their health and safety is promoted and protected by the provision of training and equipment. Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 26 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 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 2 Standard OP7 OP9 Regulation 15 13(2) Requirement Care plans must reflect the care actually given to ensure that their assessed needs are met. The fridge where medication is stored must be secure to ensure the safety of people who use the service. Staff must respond to residents in an appropriate way and with respect for their dignity Staff must not use disrespectful language about residents and their needs. The identified areas in the bathroom must be redecorated to ensure it is safe and pleasant environment for people use the service. Support, information/training must be provided on privacy, Dignity and Respect. To ensure the staff are competent and understand their role and the needs of people who use the service. Individual records and home records must be secure and DS0000008668.V362084.R01.S.doc Timescale for action 01/06/08 01/05/08 3 OP10 12 01/05/08 4 OP19 23(2)(b) 01/06/08 5 OP30 18 01/05/08 6 OP37 17 01/05/08 Elizabeth House Care Home Version 5.2 Page 28 maintained in accordance with the Data Protection Act 1998. 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 Refer to Standard OP7 OP8 OP8 OP10 OP15 Good Practice Recommendations Provide evidence to show where relatives are involved in reviews and creating care plans. The risk assessment forms should reflect modern practice and not use the term ‘Lifting and Handling’. Risk assessments for bed rails need to reflect what alternatives have been considered. Where continence pads are stored in communal toilets for people who use the service they should be placed in a cupboard out of sight to maintain people’s dignity. Consideration should be made regarding the use of the second dining room; if this area is to be used a dining area it should be tidied and any unnecessary items stored away. All staff who have not attended Safe guarding adult training should attend. Unnecessary equipment should be disposed of to ensure the home is tidy and safe for the people who use it. Information that is relating to the running of the home should be stored away from areas that people who use the service use as communal areas. 6 7 8 OP18 OP19 OP37 Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elizabeth House Care Home DS0000008668.V362084.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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