CARE HOMES FOR OLDER PEOPLE
Elizabeth House Dolbery Road Parkstone Poole Dorset BH12 4PX Lead Inspector
Amanda Porter Key Unannounced Inspection 10:30 4 September 2006
th 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 DS0000004045.V309063.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. DS0000004045.V309063.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Elizabeth House Address Dolbery Road Parkstone Poole Dorset BH12 4PX 01202 744545 F/P01202 744545 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.care-south.co.uk Care South Mrs Christine Kerr Care Home 42 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (11), Old age, not falling within any other category (31) DS0000004045.V309063.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One named person (as known to CSCI) under the age of 65 may be accommodated within the category of PD (Physical Disability). This condition will not apply after the person’s 65th birthday. The person as referred to in condition (1) may be accommodated under the age of 65 (this condition will not apply after the persons 65th birthday) 20th December 2005 Date of last inspection Brief Description of the Service: Elizabeth House is a large, purpose built home in the Parkstone area of Poole. The building is leased from the Borough of Poole and managed by Care South, a local non-profit making organisation that owns and manages various care homes and community services in Dorset and the South West. The home is registered with the Commission for Social Care Inspection to accommodate a maximum of 42 adults over the age of 65 years, with 11 of these places being registered to accommodate service users with specialist mental health needs, 11 with dementia related needs, and the remainder to accommodate service users with needs relating to old age. No nursing care is provided by the home. Accommodation is offered over two floors, accessed by a 6-person passenger lift. There are various communal areas, thirteen W.C.s: seven on the ground floor and a further six upstairs. There are 6 bathroom facilities (with assisted baths) and all bedrooms are single. Two have en-suite facilities. There is a large conservatory and a secure garden and courtyard area, with further lawn and wooded garden areas. The home is close to many local amenities, and offers access to a main bus route serving nearby towns and villages. The weekly fees rates are from £425 to £565. DS0000004045.V309063.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 4th September 2006 and took four hours. The purpose of the inspection was to assess all of the key standards. The registered provider, Mrs Kerr, and her staff were on hand to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • A pre-inspection questionnaire completed by the registered manager. • 61 comment cards completed by residents; relatives/visitors; GPs; health and social care professionals and care managers. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. Six residents and seven members of staff were spoken with and asked their views on the service provided at Elizabeth House. Comments received in comment cards and through discussion included: “All staff at Elizabeth House are welcoming and approachable. They are always quick to offer any help or support and have been of great help to us.” “I am very happy with the home and have no complaints.” “ All the staff are helpful and friendly at all times. We never have any concerns about the care being received in Elizabeth House.” “ My relative is extremely happy with all aspects of his care at Elizabeth House.” “The staff and management are always nice.” “The staff are lovely, friendly and make me feel welcomed.” All the staff and residents were welcoming and helpful. DS0000004045.V309063.R01.S.doc Version 5.2 Page 6 What the service does well:
Elizabeth House continues to provide a very homely and comfortable atmosphere in which to live. Residents are well care for by well-trained and experienced staff. Residents say that staff are very kind and considerate and their privacy and dignity is respected at all times. The home carries out thorough assessments prior to residents moving in and assurances are given that individual needs can be met. Care plans are clear and easy to follow so that staff know how to care for the residents living at the home. Each one is regularly reviewed with the resident and any chosen representative. Residents’ health needs are well met by the home and community health professionals. Medication is well handled at the home to promote the health and well being of residents. The activities arranged within the home meet the expectations of the residents living there. Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. Residents are helped to exercise choice and control over their lives as far as possible. Meals are wholesome and nutritious and planned around the likes and dislikes of residents. The complaints and quality assurance procedures reassure residents that their views are important to the home and that any complaints they raise will be properly investigated. The house and gardens are well maintained which provides residents with a comfortable place to live. Residents are encouraged to personalise their rooms with small items of furniture, pictures and a variety of mementos. The home protects the residents from abuse by ensuring robust policies and procedures are in place, which staff find easy to follow. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. A thorough recruitment process is followed when employing staff, which ensures that residents are protected from risk. Elizabeth House has an ongoing training programme for staff, which means that residents will be cared for by skilled staff. DS0000004045.V309063.R01.S.doc Version 5.2 Page 7 Mrs Kerr manages her home very well and she is supported by very competent and committed staff who ensure the home is run in the best interests of the residents living there. Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff are protected by the policies and procedures that the staff follow at Elizabeth House. 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 contacting your local CSCI office. DS0000004045.V309063.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 DS0000004045.V309063.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: The care files for four residents were reviewed and each contained a preadmission assessment. The assessments were thorough and contained sufficient information on which a plan of care could be based. Assurances were given to the prospective resident that their needs would be met. Residents confirmed that they or their relatives were encouraged to visit the home before deciding whether to live there. DS0000004045.V309063.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 good. This judgement has been made using available evidence including a visit to this service. There is a clear care planning system in place to make sure that staff have most of the information they need to meet residents needs. The health needs of the residents are well met with evidence of good support from community health professionals. The medication at this home is well managed promoting the good health and well being of residents. Residents are treated with respect and their right to privacy upheld. DS0000004045.V309063.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care documentation for six residents was reviewed. Files contained a variety of assessments including: • Moving and handling • Falls • Environmental risks • The risk of pressure sores. Residents had easy access to a GP of their choice and health needs were well met. Information from the assessments was used to formulate plans of care. Residents and/or their chosen representatives were invited to be involved in drawing up care plans. Care plans were generally very informative but some lacked sufficient information of residents’ social preferences/lifestyle choices so that care can be arranged around them. The home has a well-written and informative medicines policy and procedure including reference to self-administration and associated risk assessment and arrangements for ordering, administration and disposal. Medicines were stored securely. Records were kept of the receipt, administration and disposal of medicines. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Residents spoken with confirmed that staff were kind in their approach. Comments included: “Staff are always quick to offer any help or support.” “All the staff are good and they work very hard.” “All the staff are helpful and friendly at all times.” During the course of the inspection staff were seen to be going about their duties in a calm, cheerful and professional manner. The home presents a very happy and homely atmosphere. 30 residents responded to the question “Do you receive the care and support you need?” and 22 said “Always” and 8 said “Usually”. In response to the question “Do the staff listen and act on what you say?” they all said “Yes”. DS0000004045.V309063.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 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 good. This judgement has been made using available evidence including a visit to this service. There is an adequate range of social opportunities available in the home, which reflects residents’ interests and preferences. There is a strong sense of homeliness and inclusion of family and friends in life at Elizabeth House. Residents are helped to exercise choice and control in their daily lives within their capabilities and desire to do so. The dietary needs of residents are well catered for with a balanced and varied selection of food available that meets their tastes and choices. EVIDENCE: Residents spoken with said that they could choose how they spent their time. One said, “I am quite satisfied. I am quite able to make my own decisions.” Some preferred their own company and spent most of the day in their own rooms. Others enjoyed company and spent time in one of the lounges. DS0000004045.V309063.R01.S.doc Version 5.2 Page 13 The home employs an activities organiser for twenty-five hours per week. He organises activities based on the preferences of the residents. During the morning of the inspection the activities organiser was spending time with individual residents on a one to one basis. During the afternoon he organised a game of skittles for a group of residents in the dining room, which they all enjoyed. 29 residents responded to the question “Are there activities arranged by the home that you can take part in?” 12 said “Always”; 10 said “Usually”; 5 said “Sometimes” and 2 said “Never”. Residents confirmed that their visitors were always made welcome at the home and they could have visits in private. Residents spoken with at the time of inspection said that they enjoyed the food provided. The menu offered choice. 29 residents responded to the question “Do you like the meals at the home?” 11 said “Always”; 15 said “Usually” and 3 said “Sometimes”. DS0000004045.V309063.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 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 good. This judgement has been made using available evidence including a visit to this service. A written complaints procedure leaves residents in no doubt that steps will be taken to deal with any complaint or concern they may have. Staff’s knowledge and understanding of Adult Protection issues provides a safe environment to protect service users from abuse. EVIDENCE: The home has a clear complaints procedure available to everyone. The home had not received any complaints in the last year. Residents spoken with during the inspection said that if they had any concerns they would feel confident about talking to the manager, knowing that she would listen to them. Elizabeth House has a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Staff had received training on abuse. Through discussion staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. DS0000004045.V309063.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 at least once during a 12 month period. 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 standard of the environment at Elizabeth House is good providing residents with an attractive, homely and safe place to live. The home provides a clean, pleasant and hygienic environment for the residents, staff and visitors. EVIDENCE: The home has a programme of routine maintenance and a member of staff is employed to attend to any running repairs and redecorating that needs to be done. Since the last inspection a number of bedrooms had been redecorated, flooring and carpets changed and the downstairs corridor has also been redecorated. Records show that a variety of outside agencies have attended the home to undertake the routine maintenance of:
DS0000004045.V309063.R01.S.doc Version 5.2 Page 16 • • • • Fire safety equipment. Gas installation. Lift. Hoists. The grounds are safe and attractive and accessible by residents. A call bell system is available in every room. All areas of the home were clean and there were no unpleasant odours. 30 residents responded to the question “Is the home fresh and clean?” 25 said “Always” and 5 said Usually”. The laundry was well managed and adequate supplies of clean linen were seen to be available. DS0000004045.V309063.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 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 good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed and deployed to meet the care needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are well trained and experienced and residents could be confident they would be well looked after. EVIDENCE: Staff rosters demonstrated that there are sufficient staff on duty at all times. 30 residents responded to the question “Are staff available when you need them?” 16 said “Always”, 12 said “Usually” and 2 said “Sometimes”. The home has an ongoing training programme, which includes NVQ level 2 and 3 in care. At the time of inspection approximately 57 of care staff held the level 2 award. Recent training included: • Induction • Moving and handling • Food Hygiene • First aid
DS0000004045.V309063.R01.S.doc Version 5.2 Page 18 • • • Administration of medication Mental health awareness Dementia Care. Staff spoken with during the inspection said that Care South provided very good training opportunities, which they were encouraged to take advantage of. Five staff recruitment files were reviewed. Both files were well ordered and contained all the information required by law. POVA first and enhanced Criminal Record Bureau checks had been obtained for all new staff. DS0000004045.V309063.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 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 run by a committed and competent manager, who creates an open and positive atmosphere, which supports good care practices for residents. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents and relatives. Residents are assured of sound management of their financial interests. The health and safety of the service users and staff are protected by the policies and procedures followed at Elizabeth House. DS0000004045.V309063.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home is managed by Mrs Kerr, who is well supported by a loyal staff. Residents and staff said that all the management team were very approachable and if they had any concerns they would be happy to talk to them knowing that they would be listened to. The home takes steps to review its performance regularly and resident surveys are conducted and results analysed. Since the last inspection satisfaction questionnaires had been sent out to residents, relatives, staff and stakeholders in the community, eg GPs. Topics covered in the survey included: • Catering and food. • Personal care and support. • Daily living. • Premises and facilities. • Staff. The results had been analysed by an independent consultant and a report was available at the home. It showed a high degree of satisfaction from residents and staff and stated, “There remains a very high level of appreciation for the staff working in the home, in particular, for their warmth and friendliness, for the welcome they give to visitors and for their efforts to respect residents’ privacy, dignity and independence.” The quality of facilities and services provided at Elizabeth House are also monitored through internal audits; visits and reports made by senior managers for Care South; feedback through residents and staff meetings and through staff supervision. Residents confirmed that they either deal with their own finances or have appointed a responsible representative to do so. This is frequently another family member. The home does hold a small amount of money for some residents at their request. All monetary transactions were recorded and seen to be accurate. Records showed that staff had received recent training in fire safety and moving and handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded, analysed by the manager and appropriate action was taken as necessary. DS0000004045.V309063.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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000004045.V309063.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations Care documentation should include information on the resident’s social preferences/lifestyle choices so that care can be planned accordingly. DS0000004045.V309063.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000004045.V309063.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
