Inspection on 15/10/05 for Ellacombe

This inspection was carried out on 15th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ellacombe 06/07/07

Ellacombe 26/07/06

Ellacombe 16/06/05

Ellacombe 01/02/05

Ellacombe 31/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Ellacombe Ella Road Norwich Norfolk NR1 4BP Lead Inspector Kim Patience Unannounced Inspection 15th October 2005 09:45 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 Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ellacombe Address Ella Road Norwich Norfolk NR1 4BP 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) 01603 613173 01603 624005 ellacombe@norfolk.gov.uk Norfolk County Council-Community Care Mrs Carol Ann Bennett Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. It is recommended that the home is registered to accommodate 28 Service Users all of whom will be Older People not falling within any other category. Any person who needs a wheelchair to assist with independent mobility at point of admission can only be accommodated in room 33. The Provider undertakes to review the dependency of all of the Service Users to ensure that the home is not accommodating people with mental fraility, if the home is still operating, by June 2004. The Provider undertakes to create a separate access to the Mental Health Unit if this unit continues to use the premises beyond March 2004. Separate entrance to be constructed by June 2004. 16th June 2005 4. Date of last inspection Brief Description of the Service: Ellacombe is a purpose built residential care home providing care for up to 28 older people. The home is situated within walking distance of the city centre with many shops and facilities. The home has a small car park and on street parking is available for a limited period. The home is also situated close to the railway station and close to main bus routes. At the rear of the home is a garden, which is landscaped and provides a pleasant area to sit during the summer period. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and held on a Saturday, taking 6 hours to complete. During the inspection a tour of the premises was carried out, staff, service users and relatives were spoken with. Records held in respect of staff, service users and the management of the home were inspected. The care co-ordinator and care coordinator were present during the inspection and helpful in facilitating the process. What the service does well: What has improved since the last inspection? What they could do better: The management must ensure that care plans are updated to reflect service users current care needs. The medication arrangements in the home must be reviewed and improved in order to ensure that storage, administration and record keeping demonstrate safe practice. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 6 The home must ensure that service users are provided with meaningful choice in respect of daily living. Consultation with service users in this respect must provide positive outcomes. The management must ensure that they deal with complaints in accordance with their complaints procedure and in a way that demonstrates to service users and their relatives that complaints are taken seriously and positive outcomes are provided. The management must take seriously the concerns raised about service users individual accommodation. If a resident’s quality of life is being reduced by matters that concern them, they must be dealt with. The management must address the issue of staffing inadequacy and demonstrate to the Commission that the staffing levels at this home are adequate to meet people’s holistic needs, as opposed to their basic needs. 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. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. Service users are provided with comprehensive information about the home and the services provided to enable them to judge whether it can meet their needs. EVIDENCE: Ellacombe has produced a statement of purpose and service users guide, which is given to prospective service users and their representatives. Both documents provide clear information about the home and the services provided. The documents can be produced in other formats if needed, to meet the needs of people with a disability. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 9 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. Residents health, personal and social care needs are set out in an individual plan of care, however, the management need to ensure that the plans are updated as peoples needs change. The home has systems in place to ensure that service users health care needs are met. However, they need to ensure a prompt response to health needs that arise on a daily basis. The home has policies and procedures in place for the recording, safe keeping and administration of medicines. However, there was evidence to suggest that these are not being adhered to. EVIDENCE: A number of service user files were selected at random for inspection. The new local authority care plan format enables the assessor to record detailed information about the residents personal, health and social care needs. In the files selected the care plans had been completed in full and where possible had been signed by the resident. Care plans had been reviewed recently. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 10 During the inspection a visiting relative talked about recent changes in her mothers health that have resulted in a need for a greater level of care. On examination of her care plan, there was no evidence that her care plan had been updated to reflect her current needs and action that should be taken to address these needs was not recorded. Care plans must be updated to ensure that accurate up to date information is available to care staff. See requirements. The care plans also contained information relating to the persons health care needs and showed evidence of these needs being met. Residents are registered with a GP of their choice and have access to other health care services such as, opticians, chiropodists and district nurses. Again, during the inspection a visiting relative raised a concern that her mother needed prompt attention from the district nurse and due to a miscommunication, this had failed to happen. The home must ensure that prompt action is taken to address all medical needs and that contact with the relevant health professional is promptly followed up if no response is received. See recommendations. The medication arrangements were inspected. The home has a policy and procedure for dealing with medicines, that was easily accessible to staff. All staff with the responsibility for administration of medicines have received training and a list of staff authorised to administer medicines, along with a sample signature, was fixed in the front of the medication administration records folder. Medication is stored in a locked office and only authorised persons hold keys. Two metal lockable trolleys are used to transport medicines to their destination, one for medicines administered downstairs and one for those administered upstairs. Excess medicines are stored in locked cupboards within the medicines room. The home has a fridge in which to store medicines requiring a low storage temperature and there is a system in place for monitoring the temperature to ensure it stays within the required range. During the inspection, the lunchtime medicines round was observed. The practice used for the administration of medicines was of concern and considered unsafe. For instance, medication was handled incorrectly and left on the dining table for residents to take when convenient. Medication administration charts were signed to verify that medicines had been given even though they were not seen to be taken. Therefore, it is not possible to say with any certainty whether the resident has taken their medication. On inspection of the medication administration records (MAR), a number of errors were found as follows: Gaps appeared in the charts, where it was not possible to say whether medicines had been administered and if not the reason why. Some medicines remained in the metered dosage system (MDS) used, when signed to say they had been administered. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 11 Handwritten charts were not completed correctly and showed only the name of the medicine, no dose or frequency was included. For residents who had additional medicines not included in the MDS, strips of tablets had been removed from the box dispensed by the pharmacist and attached to the name card in the MDS. No other information relating to these tablets, dose, frequency or other was seen on the card. Where the records stated one or two to be administered, the actual dose given on each occasion was not recorded. The application of prescribed creams was not recorded on the MAR charts. Other observations included: A pack of Loperamide was stored in drugs trolley and the packaging showed a date 05/05. A pot of Senna tablets also had the date removed. A tube of prescribed Fucibet cream was seen in a service users room and was not stored in a lockable storage container as required. In addition, the home did not appear to have an effective system for the audit of medicines received, administered and disposed of. The care coordinator on duty at the time of the inspection stated that separate records of receipt and disposal of medicines are not maintained and should be entered on the medication administration records. However, no evidence of such a record was seen. The storage and recording of controlled drugs was appropriate, however the administration of MST to one service user had not been recorded on the medication administration records. The medication arrangements in the home are of serious concern. A referral has been made to the Commissions Pharmacist Inspector in order that a fuller assessment of medication can be conducted. The management of the home must review the medication arrangements to ensure that the health, safety and welfare of service users is protected. A Requirement is made in this respect. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13. 14. The home welcomes and encourages people to visit service users living in the home. Staff working at the home realise the importance of enabling people to make choices and to retain control of their own lives. However, a recent complaint raised questions about the constraints imposed on these choices. EVIDENCE: During the inspection a number of relatives and other visitors from the community were seen to come and go. Some visitors were received in the resident’s private rooms and others were seen in the main lounge. The atmosphere in the main lounge was pleasant, creating a very social environment in which people can meet. Drinks were being served at the bar and people were playing pool. Service user records show details of significant people in their lives in order that the home can facilitate contact. In the main, service users spoken with felt that they were able to make choices in respect of their daily lives and that they were largely in control of what happens. Waking and bedtime routines and other preferences are noted in their care plans. However, during the inspection a relative expressed Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 13 concern that her mother did not have a choice as to where she wished to take her meal. The relative had to negotiate special arrangements for her to eat in her room and then had experienced problems with the conditions imposed for this to happen. Another service user spoken with also expressed the same concern. Whilst it is important to encourage people to come out of their room and socialise with others it is equally important that people are selfdetermining and eating with others is not necessarily the preference for all, real choice should be offered in this respect. The home must consult with residents to ascertain their wishes and must encourage people to live their lives as they wish to. See requirements Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The home has a procedure in place to enable people to make complaints. However, a complaint made recently had not been dealt with in accordance with the procedure. EVIDENCE: The home has a policy and procedure for making complaints that is contained in the service users guide. A complaint was brought to the attention of the Commission approximately three weeks before this inspection and the complainant was encouraged to lodge a written complaint direct to the home. The complainant was contacted to discuss the complaint and in respect of one element, an agreement was reached. At the time of the inspection the complainant had not received a formal written response to the complaint, as stated in the procedure. In addition, a further verbal complaint was made and recorded appropriately. However, the investigation had been carried out but no formal written response detailing the investigation, the outcome and any action taken, had been received by the complainant. The ability to deal with complaints in a proper manner is crucial to the improvement of any social care service. People need to know that their concerns are taken seriously, that they are fully investigated and that the necessary action has been taken to prevent the same concerns arising again. See requirements. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19. 26. The home was found to be clean and tidy with systems in place to ensure it is well-maintained and safe for service users and staff. EVIDENCE: A tour of the home was conducted and some service users rooms were entered. All areas inspected appeared to be clean and tidy with no obvious health and safety hazards. There are systems in place to ensure that the building is maintained and that health and safety hazards are identified and dealt with. The home employs a team of domestics to ensure that it is kept clean and hygienic. During the inspection a service user wished to discuss the window in her room which does not tightly fit the frame and therefore she experiences a draught that causes her to become cold. Because of the restricted space in her room, she has no choice but to position her chair by the window and she enjoys to look outside. However, she is clearly distressed by the cold air blowing through. This matter is affecting this resident’s quality of life and has been Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 16 raised several times with the management and at previous inspections. Therefore, it must be taken seriously and action must be taken to address this problem as soon as possible. See requirements. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. 29. 30. The staffing levels at this home remain a concern and are not sufficient to meet peoples changing needs on a daily basis. This home has robust recruitment procedures that are strengthened by the support of the local authorities human resources team. The local authority has a training and staff development programme in place that ensures all staff are adequately trained to fulfil their role. EVIDENCE: At the last two inspections a requirement was made that the staffing levels must be increased in order to adequately meet the needs of people living in the home. This requirement has not been met and the concerns in respect of staffing levels remain. At the previous inspection staff interviewed expressed concerns about the great pressure to complete work, causing them to be very task focused. Residents expressed the same concern and wished that staff could spend time talking to them or engage in some conversation or activity. Although they felt their needs were being met the indications were that this is at very basic level and that staff do not have the time to really add quality to what they are doing. This situation has not changed. Staff and service users talked of the difficulties the layout of the home presents with service users being situated on the ground and first floor. In Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 18 addition, there are only three care assistants on duty at any one time, reducing to two after 8.30pm. At least five service users require two people to assist with care tasks leaving one care assistant to respond to the needs of the others on the two floors. Only four service users are considered as low dependency and require minimal assistance. A high percentage of service users need assistance with meals and with toileting throughout the day, again, while these needs are being attended to there is a possibility others could be neglected. At times, the downstairs unit is left totally unattended with the door closed for some time while staff attended to the needs of service users upstairs. The requirement to increase the staffing levels is carried forward for the third time. See requirements. This home has robust recruitment procedures that are supported by the local authorities human resources team. The responsibility for applying for references, POVA checks and criminal records checks is held centrally by human resources thus ensuring that no person is employed without these being returned. Face to face interviews are held and offers of employment are made subject to the completion of satisfactory checks. All new staff appointed are offered an initial induction to the home. They are automatically registered on the local authorities full induction programme followed by the foundation training, leading to NVQ2. Staff are required to undertake mandatory training such as, moving and handling, health and safety and fire safety. This training is refreshed on an annual basis. There is a rolling programme of training courses that includes specialist training. Training budgets are allocated centrally and the home has little control over what training is made available. However, staff are adequately trained. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33. 35. 38. The home has systems in place for consulting with service users about the service they receive. There are sound systems for the management of service users finances. The health, safety and welfare of service users and staff is protected by established procedures within the home. EVIDENCE: The home has a system for monitoring quality that includes seeking the views of people who use the service. Quality assurance questionnaires are sent to service users, relatives and staff on an annual basis and the results are published in the bi-monthly newsletter. It is good practice to publish the results of the surveys as it adds value to the consultation process. It is equally Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 20 important that people are able to see change and improvement arising from their input as this supports the process of empowering people to have control over their lives by influencing the way in which their services are delivered. The procedures for assisting people to manage their finances were inspected. The home ensures that clear written records of all financial transactions are maintained. Each service users money is kept in a separate named wallet and stored in the safe to which only authorised people have access. The administrator conducts quarterly audits to ensure that the records and monies held are in order. The home has policies and procedures in place to ensure that they protect the health and safety of staff and service users. Risk assessments are carried out in respect of the environment and the care of individual service users. Electrical equipment checks are carried out and records were seen in this respect. Fire safety checks are carried out as required that include weekly fire alarm testing. New fire evacuation equipment has been fitted recently to ensure that people can be safely moved from the building in the event of a fire. All staff are trained in matters of health and safety. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 N/A N/A N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 N/A 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 N/A 13 3 14 2 15 N/A COMPLAINTS AND PROTECTION Standard No Score 16 2 17 N/A 18 N/A 3 N/A N/A N/A N/A N/A N/A 3 STAFFING Standard No Score 27 2 28 N/A 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A N/A 3 N/A 3 N/A N/A 3 Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14(2)b Requirement The registered person must ensure that care plans are revised at any time necessary to reflect changes in care needs. The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person must enable service users to make decisions about the care they receive and their health and welfare. This relates to meaningful choices The registered person must ensure that complaints are dealt with in accordance with the complaints procedure. The registered person must ensure that the premises are kept in a good state of repair. This relates to the service users window. The registered person must ensure that adequate staff are employed in the care home so as to meet the health and welfare of service users. DS0000035556.V258807.R01.S.doc Timescale for action 11/11/05 2 OP9 13(2) 11/11/05 3 OP14 12(2) 11/11/05 4 OP16 22(3)(4) 11/11/05 5 OP19 23(2)b 11/11/05 6 OP27 18(a) 30/11/05 Ellacombe Version 5.0 Page 23 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 OP8 Good Practice Recommendations It is recommended that the management ensure a prompt response to peoples medical needs and that they have a system for following up on contact with health professionals. Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Ellacombe DS0000035556.V258807.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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