Inspection on 23/12/09 for Ellesmere House

This inspection was carried out on 23rd December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ellesmere House 11/11/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Ellesmere House Church Hill Ellesmere Shropshire SY12 0HB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michael Moloney     Date: 2 3 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ellesmere House Church Hill Ellesmere Shropshire SY12 0HB 01691623657 01691623657 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: BestCare Limited care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodatred is 28 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 28 Dementia (DE) 28 Date of last inspection Brief description of the care home Ellesmere House is a care home that is able care for up to 28 older people who have dementia. It is situated on the edge of the small Shropshire town of Ellesmere, overlooking the scenic body of water after which the town has been named. The house is within easy walking distance of the town centre and all of its amenities and is next to a church. To the rear of the building as an ample off road parking for the use of visitors. It is an older building that was converted to its present use some time ago by the inclusion of such things as a shaft lift to aid the mobility of the people who live Care Homes for Older People Page 4 of 27 Over 65 0 28 28 0 Brief description of the care home there. The manager is currently in the process of applying for registration with the Commission for Social Care Inspection. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A range of evidence was used to make judgements about this service. This includes: information from the provider which included a self assessment document that they are required by law to complete and notifications that have been received by the Care Quality Commission from the home about incidents, bereavements and other incidents that affect the welfare of the people who live in the home. The visit was unannounced with the purpose of carrying out a Key Inspection which is where the homes performance is measured against a set of standards identified by the Department of Health. This report also takes into account the information gained at a shorter, more focused, visit that was carried out on 29th September 2009. This inspection was undertaken by two inspectors, Mike Moloney and Deb Holland, and lasted five and a half hours. Care Homes for Older People Page 6 of 27 During that time we Case Tracked a number of the people who live in this home. This means that we talked to them and/or their relatives, where this was practical, to find out their views of the care that was being provided to them. This also enabled us to see if the records that identified peoples needs such as the care plans that are provided for the staff to follow were accurate and covered each individuals personal issues. We also talked to members of the staff team and the manager to check that they were aware of the identified needs of the people who live in this home were and whether or not they had the approach and training required to meet them. The standards set out by the Department of Health are in seven different groups. Each group can be judged as being either poor, adequate, good or excellent. The inspectors reach their judgement by following the guidelines laid down in the document known as the Key Lines Of Regulatory Assessment (KLORA) which is available on the Care Quality Commission web-site: www.cqc.org.uk Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 27 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is gathered about anyone wishing to move into Ellesmere House so that the service, and the individual, can be sure that their needs can be met Evidence: We looked at the records which had been created for someone who had recently moved into the home. These showed that information had been gathered together to form a full assessment of the persons needs and preferences. A member of the persons family had visited the home prior to their admission. The service has produced an updated Statement of Purpose and Service User Guide to help inform people about what is provided at Ellesmere House. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are being put in place to ensure that people get the care and support that they need, including access to health professionals when necessary. Medication management and staff training needs to be improved to ensure that people do receive their medicines safely and as prescribed, and to ensure that people have access to medication at all times Evidence: We looked at the care provided for three people in detail. A care plan had not yet been drawn up for the person recently admitted, although there was good information about his admission and first few days in the daily records which are shared between the staff team at handovers. As this persons needs were relatively straightforward, this did not appear to have affected his care but the service needs to ensure that care plans, particularly where there are any risk areas, are started quickly after admission to ensure that staff provide care consistently and safely. We looked at the new style care plans for two longer term residents whose care was also looked at when we visited in September 2009. These were much improved and provided a very good reflection of the persons needs and highlighted where particular attention is needed, Care Homes for Older People Page 12 of 27 Evidence: such as in skin care, mobilising safely or managing particular problems such as diabetes. We saw that peoples health needs are monitored and professional help, from doctors, community nurses or other professionals, is sought when necessary. We looked at how the home manages peoples medication and the records that are kept. Medication is stored in a trolley secured in the homes general office, along with a refrigerator and the cupboard for controlled drugs. The majority of the medication is managed through a monitored dosage system which is intended to make it easier to ensure that people get the correct medication and is easier to audit. We found some errors in signing for and recording balances of medicines, and were told that mistakes that had been identified were being discussed in supervision with specific members of staff. It was established that the staff that were making mistakes had only done a one-day course rather than a more in-depth course. We were told that none of the night staff have been trained and are therefore not allowed access to the drugs trolley, meaning that residents do not have access to medication such as pain relief during the night. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home are able to choose their life style, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet their expectations. They receive a healthy, varied diet according to their assessed requirement and choice. Evidence: We talked to a member of the proprietors management team. He showed us documents containing the records of the activities that had been run and we spoke with the staff and some of the people who live in the home who said that they had enjoyed taking part in them. Each person had a record that showed which activity they had taken part in as well as any comments that they had made. The managers told us that they were in the process of recruiting an Activities Co-ordinator and it will be her job to develop further activities and systems for recording who gets involved. We talked with one person who liked to go into the town on an electric scooter so that he could keep up his friendships with people that he knew. We saw that staff from the home had carried out a risk assessment on this activity to try and reduce any dangers that could be involved. We talked to the staff in the kitchen and they said that new menus had been recently introduced. We looked at the records which showed that Care Homes for Older People Page 14 of 27 Evidence: choices such as chicken pie, steak pie, cottage pie and fish and chips had been among the meals recently offered to diners. The kitchen staff also told us that food is specially prepered for people who have different diets for cultural or medical reasons. We watched people who needed assistance at meal times receiving discrete help from the staff. The meals had been presented in an appetising way. We also spoke with diners about what they thought of the meals. They were very complimentary about them sayingthat the choice had improved recently. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home have access to a robust and effective complaints procedure, are protected from abuse and have their legal rights protected. Evidence: We looked at the homes complaints policy and this was seen to contain information on how and with whom issues of concern could be raised. We spoke to a number of the people who live in this home and their relatives who all said that they knew how to raise any issue and that they were confident that they would be dealt with. We looked at the records kept of complaints and these outlined what the complaints were and how they were dealt with by the managers. Three referrals had been made into the local procedures that deal with allegations of abuse of vulnerable people recently. The home was seen to have co-operated fully with the local authority when they had investigated the first two and had taken on board the lessons to be learned from the findings. The third issue was ongoing and was in relation to the general drop in standards of care within the home. Again the home has been seen to co-operate within the local procedures that are designed to investigate and improve such matters. We looked at the training records and saw that a number of the staff had recently received training in the identification of abuse and the procedures that they must Care Homes for Older People Page 16 of 27 Evidence: follow if they see such an instance and the managers told us that the remaining staff would be trained as soon as places on an appropriate course were available. We also spoke to a number of the staff who confirmed that those records were accurate. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home gives anyone living there a safe, wellmaintained and comfortable environment which encourages independence. Evidence: We looked around the home and saw that building improvement work had been undertaken. We saw that some issues were still to be addressed such as the replacement of the lighting in the corridor outside rooms 16 and 17, the replacement of the flooring in one of the upstairs toilets and the self-closing mechanisms on some doors were not functioning properly. Work had also been carried out on the walls of the kitchen. The managers told us that the kitchens were to be re-organised in the near future so that eventually the dining area could be relocated closer to the food preparation areas. We saw a number of bedrooms had been personalised to the taste of the person whose room it was. People had been able to bring pictures, ornaments and small pieces of furniture with them to make their rooms more homely. We saw that all of the rooms were clean, tidy and odour free. Inside the house we saw Care Homes for Older People Page 18 of 27 Evidence: two large communal areas, one being a lounge and the other a dining room. The furnishings in both areas were seen to be clean and in serviceable condition. The home has a well maintained garden. It has clear views across the Mere. We also saw that the home has a well equipped and ordered laundry area so that peoples clothing and bedding can be kept clean and hygienic. We saw car parking at the back of the home that could be used by visitors. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ellesmere House is fortunate in having a group of staff committed to providing good quality care. However, staff have been recruited without the checks required to ensure that they are suitable to work with vulnerable adults and we cannot be sure that people have had sufficient training to provide safe care to the residents. Evidence: During the day there are three staff on duty at the home, which includes a senior member of staff, supported by catering and domestic staff. At night there are two waking staff on duty. The provider needs to keep this under review given the size of the home and the complexity of the needs of the residents at any time. Although there are a number of experienced staff with care awards above the expected minimum, the home generally does not meet the ratio of 50 staff trained to a recognised national qualification at present. We looked at the personnel files for three staff, recruited to the home recently. These showed us that people had started work before the manager had received the information required by regulation to ensure that they are safe to work with vulnerable adults. One person had started work in the home before any references or up to date checks on their criminal background had been obtained, and two others appointed with one reference rather than the two required. Care Homes for Older People Page 20 of 27 Evidence: Although we were told that people had received induction and had been mentored in their work by senior staff, we found little written evidence of this. One of the files contained an orientation form, which is a basic checklist to help someone start work. The other two files did not contain any record of orientation and none showed that a full induction, compliant with an accepted national framework, had been started. Training has been provided for staff in the recent past, including Moving and Handling, Fire, Dementia and Challenging Behaviour, Protection of Vulnerable Adults, 1st Aid, a one day Medication course, Health and Safety, Food Hygiene and Infection control. An overall training record is being maintained from which the manager will be able to identify where the gaps remain and which staff still require training and/or updates to their training. As mentioned earlier in this report, there is a need for more training for staff to ensure that medication is administered safely and is available to residents at all times. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although improvements have been made in key areas of the homes perfomance the safety of the people who live in the home is not monitored well enough and safe recruitment practices are not followed. Evidence: We talked with the Manager as well as another member of the providers team who is involved in the running of the home. They confirmed that while the manager still has overall responsibility for the running of the home the other had specific responsibilities for making sure that the improvements that were required in the home were addressed. The manager had been appointed since the inspection in September. We saw that monthly inspections had been carried out by the managers line manager and the written reports of these had identified work that was required to meet the needs of the people living in the home. We were also told by the managers of a meeting that had been held with the people who live in the home on the previous week. They told us that this had been held to get the views of the people who live in Care Homes for Older People Page 22 of 27 Evidence: the home about what improvements could be made so that more of their needs and wishes could be met. We spoke to a number of people who told us that the meeting had taken place. We also saw satisfaction questionnaires that had been completed by a number of the people who live in the home. The managers told us that these had been devised and distributed in an attempt to find peoples views on how well their needs and wishes were being met. The manager showed us how peoples monies would be recorded should they wish the home to store it for them. Various records were seen that monitored systems and the environment in order to make sure the people living in the home safe such as the checking of the fire alarm system. We saw that fire alarms had been tested once a month but the sheets that were used to record the tests contained the note that they should be carried out weekly meaning that there was more chance of the system failing to sound in an emergency. We saw that bath water temperatures were only checked monthly allowing more chance for the thermostatically controlled water mixers to develop a fault and possibly scald someone in the bath. We saw that the records kept of fridge and freezer temperatures were regularly maintained and the temperatures were appropriate ensuring that food was kept in useable condition and that electrical equipment had been checked for faults to avoid people being electrocuted. We looked at staff training records and saw that some training had taken place since the inspection in September. There was, however, not enough trained first aiders. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The home must make sure that the administration of peoples medication is recorded accurately so that they can be sure that the right person receives the correct medication at the right time 21/01/2010 2 28 19 All pre-recruitment checks 21/01/2010 must be undertaken on new employees before they commence direct work. This will ensure people living at Ellesmere House are protected by the homes recruitment policy and practice. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 30 The home should develop a full induction training plan for Page 25 of 27 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations staff who have little or no experience in the care industry to ensure that they have the skills, knowledge and approach to enable them to carry out their duties effectively. 2 38 The home should follow their own written practices and test fire detection equipment weekly to make sure that it is working should it be needed. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. 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