CARE HOMES FOR OLDER PEOPLE
Ellesmere Community Nursing Home Trimpley Street Ellesmere Shropshire SY12 0AE Lead Inspector
Janet Adams Unannounced Inspection 21st February 2006 11:30 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 Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 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. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ellesmere Community Nursing Home Address Trimpley Street Ellesmere Shropshire SY12 0AE 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) 01691 622364 01691 624592 Ellesmere Community Care Centre Trust Lydiann Kym Wright Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (7), Physical disability (2) of places Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home must comply with the Staffing Notice issued by the Shropshire Area Health Authority dated 14th February 1995 The home may accommodate a maximum of 9 service users The home may accommodate a maximum of 9 Older Persons and 1 person may be receiving respite care, 2 may have a physical disability. The bedroom with the high window must only be used for clients receiving respite care or, in other instance, by direct written agreement with CSCI. 15th November 2005 Date of last inspection Brief Description of the Service: Ellesmere Community Nursing Home is situated in Ellesmere Town Centre and benefits from varied local amenities. Occupying the upper floors of the former Ellesmere Cottage Hospital, it is owned by the Ellesmere Community Care Centre Trust, and is accessed via shaft lift or stairs. The ground floor of the building is leased to the Meres Day Centre, which is managed by Shropshire Social Services. The Home is registered to provide accommodation and care, including nursing, for nine persons, one of who may be terminally ill, and two of who may have a physical disability. Accommodation comprises seven single and one double bedroom. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and commenced at 11.30am lasting four and a half hours. It included observing activity within the home, inspecting the premises, an ‘in depth look’ at records for residents and staff, observing, talking and listening to the 9 people living there, and the staff on duty during the time of the inspection. No visitors were met. Discussions with people were carried out in private on a one to one basis, or together in groups. Everyone was happy to share comments, which are explored and reflected in the main body of the report. Everyone including the residents was very welcoming.The nurse in charge of the home at the of the inspection was most helpful and professional, she was assisted by a most knowledgeable and efficient Administration Manager who located all necessary information requested. The Registered Manager for the home was not on duty at the time of the inspection. A total of 21 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. What the service does well:
The Home provides a welcoming, well furnished good quality homely, caring environment. It is impressive that the home more than meets National Minimum Standards for several parts of the service and support it provides for its residents. The home excels at identifying and meeting the care needs of individual residents in a flexible and effective manner. Unanimous comments from residents living at the home confirmed they appreciated living and being looked after at Ellesmere Community Nursing Home. Staff appeared knowledgeable, enthusiastic and happy in their roles. The records they keep to account for the care delivered to the residents reflected the good standards of ‘hands on’ care observed and overheard. The home has forged excellent links with the local community. One of the volunteers at the home has recently received the’ Citizen of Ellesmere’ award in recognition of his hard work and commitment to the home. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 6 Ellesmere Community Nursing Home has a well developed, and successful fundraising culture with the benefits of related expenditure being evident throughout the Home. 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. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 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 Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 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): 3&4 Professional systems and the efforts the home’s team make ensures people living at Ellesmere Community Nursing Home are looked after in the way they need and prefer to be. EVIDENCE: When the care records for four residents were looked at in depth, including the last admission to the home, some very good examples of professional record keeping were seen. A private in depth talk with all four residents on a one to one basis about their care delivery was all positive and mirrored what was seen written about them. They were all unanimous to confirm that staff went out of their way to make sure they got to know their individual needs and preferences. One person made the comment; -‘I knew they would take good care of me the minute I got here – I’m very happy – all the staff are lovely and are always kind.’- this sums up all other comments received. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 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): 8,10 &11 The information in the good care planning system mirrors the professional, individual, respectful standards of care residents say they receive and were seen to get. EVIDENCE: Several observations made whilst at the home confirm the management of health and nursing care is most desirable. As recorded earlier, the care plans of four residents at the home were looked at in depth were found to be most satisfactory as they contained many relevant details for the people concerned. Working practices at the home have similar high standards. Examples show that the home excels in this aspect of the service it provides are as follows; - A conversation overheard between the nurse in charge and a visiting physiotherapist about specialist footwear to help one of the residents to walk was most professional and went into great detail to ensure the person got looked after properly for this matter.
Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 10 The inspector was in the vicinity when the shift handover was being carried out to a nurse and carer who had just come on duty. The discussion content showed that all necessary information and changes to people’s care was relayed in a knowledgeable and professional manner. It was noteworthy to comment that one of the nurses involved had only worked at the home for two weeks, which shows that a successful induction to the home had meant she was confidently aware of her roles and responsibilities in her new care setting. The staff were also overheard discussing the content of a new book purchased for ‘end of life’ care, and how it could compliment the already established care for this important time of a person’s life. A folder seen at the nurse’s station also contained a variety of information on this matter for staff to access. The combination of this information, a one to one discussion with a staff member, and the records kept for an individual who had recently passed away show the home has a commendable approach to this sensitive issue. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 11 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 Full involvement of individuals living, visiting and working at the home as well as within the local community promotes choice and control over residents lives wherever possible within a stimulating, homely atmosphere. EVIDENCE: Similar findings as seen at the inspection in October 2005 confirm the home continues to excel in providing a stimulating lifestyle to match the wishes, choice and feelings of the people living at Ellesmere Community Nursing Home. The Home works hard to involve residents in a range of leisure opportunities, consistent with each resident’s capabilities. Continuation of religious practices is encouraged and supported wherever possible. The availability of up to date magazines from local churches and societies around the home show this continues. The administration manager commented on how proud the home were to have one of their volunteers to have been presented with the ‘Citizen of Ellesmere’ award for all the good works he is involved in at the home. The home provides the type of meals preferred by the residents – several expressed comments that they were of good quality and variety, similar to the meals seen being prepared and served on the inspection day. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 12 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): 17 & 18 The home has effective systems to ensure support and appropriate guidance for any professional issues. Existing systems for protecting service users are in place EVIDENCE: From the information seen available, it was seen that the home’s team have the necessary resources to promote the well being of the people at Ellesmere Community Nursing Home on a day to day basis. The policies and procedures seen in place at the inspection of November 2005, to facilitate protection for vulnerable people, which meet the requirements of this standard are still in place. These have been further enhanced by the way improvements to the management of residents monies have been made. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,24, & 25 All residents living at Ellesmere Community Nursing Home have a clean, comfortable and homely place to live. EVIDENCE: The standard of décor and quality of furnishings and cleanliness in many of the areas of the home is high. The home also has the added advantage of a ‘guest rest’ room where visitors are welcome to make themselves drinks, and wait in comfort should their relative need nursing care during the course of their visit. During the home tour, the administration manager discussed the arrangements made for when the bathroom is to be fully refurbished in the forthcoming week. Hot water temperatures tested at random show that the measures to maintain them were working effectively. It is noteworthy to comment that all bedrooms are furnished with appropriate nursing equipment, and every room has a reclining chair for the resident to
Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 14 use if they choose to. For the first time ever in November 2005, the home has had an external audit by the Health Protection Agency to look at its standards for infection control. This was unexpected, and the overall scoring confirmed the home has indeed very high standards for this matter. However, as a result of the audit, the home manager has already undertaken changes at the home to make sure the already good standards are now even better. Although some changes were seen, as the manager was not on duty at the time of the inspection not all aspects of this audit could be entirely discussed, therefore will be looked at in full at the next inspection. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 15 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 The home employs supportive staff in sufficient numbers to meet the needs of residents. EVIDENCE: The staffing levels seen on the rotas, as well as staff on duty at the time of this inspection indicated that adequate numbers and skill mix of staff are on duty at all times. Comments by two staff members on the ‘late’ shift as well as all the residents spoken to confirm that there were always enough people on duty to deliver the care they needed. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 16 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): 32, 35 & 38. Ellesmere Community Care Centre Trust employs a registered manager to lead the staff team on a day to day basis. Some systems for the health, safety and welfare for residents, staff and visitors need to be improved and adjusted to make sure that they are kept up to date, to meet changing needs as well as necessary legislation. EVIDENCE: With the additional support from its trustees and administration manager, the knowledgeable staff team generally ensure the effective and smooth running of Ellesmere Community Nursing Home. Shortfalls in some of the safe systems of work show a few of the practices observed need to be updated. For example, records seen for residents monies held in safe keeping by the home are required to show that two staff members sign for any of these transactions. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 17 It is obvious from the results of the recent infection control audit and practices observed in the home, that the home management have a high regard for the safety and well being of all people living, working and visiting the home. Random checks of equipment and six monthly servicing records for the hoists and shaft lift show the home keeps up to date with all necessary maintenance, although attention to risk assessments and maintenance checks for bedrails seen used is required. Appropriate information about this matter was given to the administration manager at the end of the inspection in order for this matter to be given priority. Furthermore, chemical storage in the laundry, which is in a separate building to the home, needs to be reviewed, alongside the way some of the chemicals themselves are used in order for the home to fully comply with all necessary legislation. Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 18 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 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 4 9 X 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 3 3 X 3 3 4 3 X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X 3 X X 2 Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Not applicable 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 OP38 Regulation 13(4) Requirement Timescale for action 03/04/06 2 OP38 13(4) 23(2) All chemicals used in the home must be done so and stored appropriately in order to comply with COSHH Regulations Risk assessments and 03/04/06 maintenance records within the home must be updated to fully meet the guidelines for the safe use of bedrails as per the Medical Hazard Reporting Agency guidance. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ellesmere Community Nursing Home DS0000022248.V266759.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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