Inspection on 14/09/06 for Elliott House

This inspection was carried out on 14th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elliott House 23/10/08

Elliott House 13/12/05

Elliott House 17/08/05

Elliott House 04/01/05

Elliott House 16/08/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Elliott House 22 Reculver Road Beltinge Herne Bay Kent CT6 6NA Lead Inspector Jenny McGookin Unannounced Inspection 14th September 2006 10:00 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 Elliott House DS0000023385.V314101.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. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elliott House Address 22 Reculver Road Beltinge Herne Bay Kent CT6 6NA 01227 374084 01227 740750 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) Mr Ian George Nicoll Mrs Linda Valerie Elks Care Home 71 Category(ies) of Old age, not falling within any other category registration, with number (70), Physical disability (1) of places Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. People with a physical disability is restricted to 1 person whose date of birth is 18/06/37 Registration is restricted to one (1) person with a date of birth of 03.12.1916 13th December 2005 Date of last inspection Brief Description of the Service: Elliott House Home is registered to give care for up to 71 older people, and this currently includes (by special arrangement) one individual with a physical disability. Mrs Elks is the registered manager. The property is an impressive Listed building, comprising three floors, and situated in its own extensive, landscaped grounds. It was previously known as Heronswood, and was purchased by Mr Nicoll, the current Registered Individual, in 1997. It then underwent a major re-furbishment programme, but retains many of its original period features, including a rotunda room. Each floor is characterised by its own colour scheme, and the floors are linked by two shaft lifts and four stairways. Elliott House has 49 single bedrooms, which have en-suite facilities, and six, which do not. There are also eight double rooms, all of which have en-suite facilities. Only two of the bedrooms are slightly undersize, but in one case, this is compensated for by the provision of an en-suite WC and basin. Many bedrooms far exceed the National Minimum spatial standard. In terms of access and scope for community presence, the home is one mile from Beltinge and two miles from Herne Bay. It is a short distance from the A299 linking it to London, Margate and Ramsgate. There are bus stops directly outside the front boundary, to Herne Bay, Whitstable and Canterbury with all the further transport links that implies. There is ample parking space along the circular driveway at the front, and an access road to one side to another parking area for trade and staff. The current fees for the service at the time of the visit range from £303.25 £480 per week. Any double rooms used as single rooms would be charged at £550 per week. Information on the Home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose and Service User Guide. There is also an e-mail address for this home: elliotthouse@btconnect Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on two site visits, which were used to inform this year’s key inspection process; to check progress with matters raised from the last inspection (December 2005,) given all the timeframes had run their course; and to review findings on the day-to day running of the home. The inspection process took sixteen and a half hours, spread over two days, the first of which was unannounced and the second of which was agreed with the manager. It involved meetings with ten residents (including two groups of four residents over lunches), four relatives and a number of staff representing a range of functions of the home - the manager and deputy manager; a senior carer; a carer; the housekeeper; the cook, and the home’s administrator. The inspector also met with a visiting care manager, chiropodist and dentist. The inspection involved an examination of records; the selection of three residents’ case files, to track their care; and three personnel files, selected at random. Interactions between the staff and residents were observed throughout the two days. Seven bedrooms were checked for compliance with the National Minimum Standards on this occasion, along with some communal facilities / areas. What the service does well: What has improved since the last inspection? Good progress had been made with a number of matters raised by the last inspection (December 2005), in some cases well in advance of the receipt of the report and timeframes set, and with promising results. This was judged a good use of the inspection process. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 6 One unused bathroom on the first floor has been converted into a medication room, to comply with best practice standards. This new arrangement offers good storage and working facilities and its central location means the dispensing arrangements are much more efficient. Considerable work has been done with the care planning processes. The home is better able to demonstrate the active involvement of residents and their relatives, and promising outcomes are emerging. Social activities have also emerged as a key strength. There is a dedicated activities co-ordinator, who has set up a full programme of events (on and off site) and also does one-to-one activities with individuals who are disinclined to mix with others. 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. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 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 Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 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, 5, 6 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. 3. Prospective residents are assessed prior to admission to establish the extent to which their needs can be met by the home, and how potential risks will be managed. Service users are generally content with the way they are supported by the home. 5. Prospective residents, or their representatives, have the opportunity to visit the home before proceeding with the admission and there is a trial stay to further inform their choice. 6. This home does not provide Intermediate Care EVIDENCE: Discussion with residents largely confirmed feedback obtained at previous inspections; specifically that the decision to apply to this home was influenced more by its locality (i.e. close to where the resident or their relatives lived) and Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 9 by personal recommendation, than by any public information produced by the home itself. The home carries out a comprehensive preadmission assessment (covering the health and social care needs of prospective residents), which has a standard format to ensure a consistent approach. The prospective resident or representative is invited to visit the home, and meet the staff and residents. Although none of the residents spoken to on this occasion was able to confirm this process as described, this site visit coincided with the conclusion of one such preadmission visit. The manager had taken time out to show the prospective resident and her relatives around, to answer their questions and to help them feel comfortable about the admission (in this case, a respite placement to enable the relatives to take a holiday break) – and this process is usefully underpinned by the issue of the home’s “Welcome Pack”, so that they have something to reflect on. Given the generally poor recall of some residents, the inspector would recommend that the admission checklist include the issue of the Statement of Purpose and Service User Guide and whether other formats were warranted. Other residents’ relatives confirmed having been shown around as part of the preadmission process. Although one or two residents spoke with some sadness of their loss of possessions and property by coming into residential care, they were generally content to entrust the choice of home to the judgement of their representatives. Each resident is offered a month’s trial stay. On their admission, the home carries out further assessments and risk assessments. The manager confirmed that this home does not provide intermediate care Elliott House DS0000023385.V314101.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 judgment has been made using available evidence including a visit to this service. 7, 8. Residents and their representatives are actively involved in their care plans, as far as they are able and willing to do so. The care plans are designed to meet their health, social and personal care needs. 9. The home’s arrangements for the acquisition, storage and administration of medication are complaints with good practice standards, and residents are supported to self medicate as far as they are able. 10. The layout of the property and practice standards, as confirmed by observation and feedback from residents and relatives, make proper provision for privacy and respectful care. EVIDENCE: The preadmission assessment covers the residents’ most critical health and personal care needs, as well as some social care needs. Since the last inspection, a lot of work has been done to promote a more holistic approach to Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 11 the care planning that flows on from admissions, with the introduction of “family tree” information; introductory comments at the front of daily reports, and more active input from relatives and other stakeholders such as care managers. The home is now better able to demonstrate it is taking the lead on the review process, and there have been some promising outcomes. Talking points between staff and the residents have been established and outings and activities organised. The manager has also introduced key working, though this has been hindered to some extent by staff turnover. Elements of the care plans are generally reviewed monthly thereon, and adapted accordingly. There have also been signal improvements in the home’s arrangements for medication administration. The home’s own policy was amended to take into account guidance obtained from the Royal Pharmaceutical Society, and there is now a dedicated medication room, which the inspector assessed as generally compliant with good practice standards. The administration of medication is divided into two separate but concurrent rounds, each the responsibility of a senior carer, so that rounds can be completed earlier and free up staff for other duties. This is likely to be appreciated by residents, who had said at a previous inspection that they felt staff were not as readily available as they would have liked. Residents, who are risk assessed to have the capacity to self medicate, are supported to do so. There is a mini contract designed to commit residents who self-administer their medication to keep their medication secure, and to a periodic review to ensure the arrangements remain safe. Inventories are used for any medication taken off the premises and risk assessments of the medication arrangements are an integral part of the care plans. The home accesses a range of healthcare professionals, but residents would need to pay for chiropody, physiotherapy or any special or private treatment or medication themselves. If the home needs further nursing advice it can use the District Nurses, and the home is served by four GP practices, so individuals have some choice. The inspector sought feedback from the District Nursing Team earlier in the year (May) and was advised that they are being suitably notified of any concerns from staff about pressure area care. These have, on examination, tended to be judged low risk incidences – in some cases residents have been admitted from, or returned from hospital with pressure ulcers. The District Nursing Team was also able to confirm that, following the assessment of the residents, any pressure relieving equipment supplied by the community nursing service is being used correctly, to good effect. And the home uses a pressure area chart for clients that are at risk of pressure damage. A visiting district nurse met with the inspector during this inspection and confirmed that the home’s diligent practice was being maintained. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 12 The inspector also took the opportunity of meeting with a visiting chiropodist, dentist and care manager, each of whom reported a sound level of satisfaction with the level of care given by this home. Most bedrooms in this home are single occupancy (only four are doubles), and have en-suite facilities, which means personal care and treatments can be given in privacy. Shared rooms have screening to afford occupants some privacy. Feedback from the residents has confirmed that their privacy was respected and that staff generally treated them well. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 13 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 judgment has been made using available evidence including a visit to this service. 12. This home offers a range of activities inside and outside the home, and is benefiting from having a dedicated activities co-ordinator. Most residents are generally very content with their lifestyles in this home, and the home has been able to address their needs on a group and individual basis. 13. There are open visiting arrangements, and the home is well placed for access to local shopping and seafront outlets. 14. Daily routines are flexible and responsive 15. The meals in this home are generally satisfactory, offering both choice and variety and catering for special diets. Residents can also opt to eat where they and at different times. EVIDENCE: As with previous inspections, the residents were not able to give many examples of any particular interests and hobbies being promoted by the home but were aware of some of the communal activities organised for them. The home has an Activities Co-ordinator but she was on annual leave for the period Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 14 during which these site visits took place; but records, a colourful photo album and staff were able to supply many more examples. Examples include seasonal events (such as Valentines Day, Easter bonnets, Strawberry Cream teas, garden parties); arts and craft sessions; bingo and a range of themed quizzes; tabletop gardening; special interest talks (e.g. from local community police officer, air ambulance service, local history, on Chatham docks); and entertainment (e.g. choirs, a dance group, Karaoke) and residents’ birthdays. The communal events are rotated between different communal areas to encourage participation, and the activities co-ordinator also takes activities into one-to-one sessions with residents in their own bedrooms, if they are disinclined to mix. There are also small group outings in taxis to the sea front where residents can enjoy traditional snacks such as fish and chips or ice creams. These trips out are such welcome opportunities to access the community for a few residents, the inspector recommended the manager give consideration to the purchase or hire of an adapted minibus to extend the benefit to other residents. Most residents indicated that they were generally very content with their lifestyles in this home. The daily routines are as flexible as healthcare needs will allow, and residents confirmed that they can choose when to get up and go to bed. The Statement of Purpose commits the home to making arrangements to enable residents to pursue their religious inclinations, and the inspector was advised that the local Roman Catholic Church sends two representatives to hold services, and that one-to-one visits are also made by a representative of a local Church of England church. The home has open visiting arrangements, and meals can be provided for visitors if required at “reasonable” cost, though this did appear to apply to the relatives spoken to on this occasion. Most bedrooms in this home are single occupancy (only four are doubles), so residents can have privacy. Catering needs and preferences are properly established in the first instance as part of the admission process, and amended or updated thereon. Although the current cook has had no specialist training in catering for the elderly of for special needs (this is strongly recommended), she reports having had food hygiene and manual handling training, and has been offered NVQ training. She has also undertaken training in Indian cuisine, of her own initiative. Records and feedback confirm that the menu (generally, but not exclusively traditional English fare) is varied and alternative options are available. Residents can choose where to take their meals (there is a choice of attractive Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 15 dining facilities as well as bedrooms), and also have some choice over meal times. All of the residents spoken to on this occasion said they were generally very satisfied with the meals, although the inspector noted on both occasions during this inspection, that several of them left a lot on their plates, without alternatives or assistance being offered; and intervention had to be sought from staff to support one resident with visual impairment, whose meal went cold while she tried to find what she wanted. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 16 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, 17, 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. 16. There is a complaints procedure readily available, and residents feel that any complaints they had would be listened to and acted on. The complaints register is being used as required. 17. There is also information on display on accessing independent advocates. The home relies otherwise on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. 18. Residents feel well cared for and safe there is a policy on adult protection. EVIDENCE: The home’s complaints procedure is on display and describes the process and timeframes involved, in general compliance with the provisions of Regulation 22. There is another version of the complaints procedure in the Statement of Purpose. The residents confirmed feedback obtained at the last inspection, that they would know who to talk to if they had a complaint and felt safe. The home still does not currently use any independent advocacy services but has information on display in its lobby of how to access the CareAware helpline. Otherwise staff, Kent County Council (acting in its capacity as Power of Attorney) or the residents’ families and friends are relied upon to raise issues and represent the interests of the less able residents. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 17 The home’s complaints recording systems were redesigned before the last inspection (December 2005) and its register is being used to record critical information about all the complaints and the action and timeframes taken to resolve them. It properly makes cross-references to files where the detail is kept separately. An examination of the complaints showed a realistic range of issues raised. The home has a policy on abuse, which usefully provides a definition of its scope and action to take (preventative as well as reactive). And this is underpinned by staff training. All the residents spoken to on this occasion said they felt safe at this home and staff confirmed their commitment to challenge and report bad practice, should it occur. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 18 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, 21, 22, 23, 24, 25, 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. 19, 25, 26. The layout of this home is generally suitable for its stated purpose, and its features are attractively presented, safe and comfortable. All areas inspected were free from any unpleasant odours. Records confirm it is being maintained and regularly inspected for safety. 20. Residents have a choice of communal areas, and furnishings tend to be domestic in character. There are homely touches throughout. 21. Lavatories and washing facilities are generally accessible to bedrooms and communal areas, and are suitably adapted. 22. There is a range of equipment and adaptations to support residents and staff in safety in their daily routines and to maximise residents’ independence. 23, 24. Most residents have access to the privacy of their own bedrooms and most rooms have en-suite facilities. All rooms inspected have been personalised. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 19 EVIDENCE: The layout of this home is generally very suitable for its stated purpose and it has been very well maintained and decorated. As reported in previous inspections, each floor (including all the bedrooms on it) is characterised by its own colour scheme - pink, apricot, or yellow. While this may assist residents recognise their floor, it does give bedrooms a hotel atmosphere, and the colours of bedrooms may not always be gender appropriate. However, one relative showed how she had introduced bed linen and cushions to co-ordinate with the home’s décor to better suit her father. The floors are linked by two shaft lifts and four stairways. The corridors are wide but handrails have in most areas only been installed down one side, which could disadvantage anyone reliant on the strength of only one arm. Upstairs bedroom windows all have restrictors. All areas are linked with a call bell system and there is adequate specialist equipment and adaptation. There are 49 single bedrooms which have en-suite facilities, and six which do not. There are also eight double rooms, all of which have en-suite facilities. Only two of the bedrooms are slightly undersize, but in one case, this is compensated for by the provision of an en-suite WC and basin. Many bedrooms far exceed the National Minimum spatial standard, and a number of locks have been replaced to meet the National Minimum Standards. However, the provision of a second comfortable chair in each room is not standard provision – a notice in the lobby states this is available on request The home provides adequate communal space for each resident. There are five lounge areas (including a library on the ground floor and a quiet room on the 1st floor) as well as a choice of dining areas. All furnishings within the communal areas are domestic in character and of good quality, suitable for the service users needs. All areas seen were clean, well maintained and in satisfactory decorative order. There are five bathrooms (two of which have Parker baths) with WCs, a shower room with a WC and six WCs i.e. convenient to bedrooms and communal areas. Decorative pelmets over the top sections of obscure glass windows in some bathrooms may not, however, offer sufficient privacy. Blinds or curtains are recommended. Two WCs were judged in need of descaling and some doors were scuffed, but facilities were otherwise judged in good order, clean and odourfree. One of the bathrooms, which was not in practice being used, has been converted into a medication room, which (along with the acquisition of a second medication trolley) has obtained more satisfactory standards of storage Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 20 and administration. A few matters were raised for attention, to further improve the facility. The home’s laundry has been re-vamped and the home has an industrial washing machine with a sluice cycle and two dryers. Clinical waste is appropriately managed. There were no unpleasant odours in any of the areas visited in this inspection, and comfortable temperatures and lighting levels were maintained throughout. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 21 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 adequate. This judgment has been made using available evidence including a visit to this service. 27, 28. Work has been done to increase and redeploy staff to better address the needs of the residents and the size and layout of this home. And the manager is open to making further adjustments. But staff turnover is an issue. 29. The home has a systematic recruitment process, to safeguard practice and service delivery. 30. There has been further investment in staff training, to ensure compliance with accredited standards, with more in prospect. EVIDENCE: The waking / working day is currently calculated on the basis of a 14-hour period from 7.15 till 9pm. The manager said the home aims to have the following staffing arrangements when the home is up to full occupancy: in such circumstances, there should be: • eight care staff in the mornings (i.e. from 7.15am till 2pm); • six care staff in the afternoons (i.e. from 2pm till 6pm); • five from 6-9pm and • four overnight (9pm till 7.30am). Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 22 The home would also aim to have 3-4 domestic staff and one laundry person from 8am till 2pm. The home has a cook from 7am till 3pm and an assistant cook; plus a member of staff from 9am till 12pm to assist in the dining room. Staffing rotas, in their planning, generally appear to take into account peak times. Feedback on the day of this site visit indicates a generally sound level of satisfaction with the level of care given by staff. But an analysis of staffing rotas for a three week period (14 August to 3 September) showed there were six mornings when the staffing levels dropped by one, and a number of sources (residents and complaints register, relatives, staff and visiting professionals) there are said to be times during the day or even night shifts when staff appear to be stretched to their limit. Further adjustments are, therefore, indicated. Staff and records confirmed a systematic recruitment process, designed for consistency, and recruitment was invariably subject to satisfactory references, identification and CRB checks, to protect the residents. Since the last inspection, however, four staff were identified as working illegally at this home. Immigration Officers have attributed no fault to the manager or recruitment practices. Records confirm that five staff have received induction, which is based on the TOPSS model. And personnel files routinely confirm the issue of copies of GSCC Code of Conduct and Practice. The manager recognises the importance of training and maintains a matrix of mandatory training on a range of issues such as manual handling, first aid, fire safety, health and safety, infection control, medication and adult protection etc. And there was also evidence of training in some specialisms such as loss and bereavement, challenging behaviour, nutrition, dementia, and insulin. At the time of these site visits, and taking into account staff turnover, six staff have obtained NVQ level 3, four staff have obtained NVQ Level 2, and three others are currently working towards their NVQ Level 2 accreditation, obtaining an overall 46 of the staff team i.e. just short of the National Minimum Standard. Additional training is planned in key planning. Catering for dementia has also been identified as another training need. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36, 37, 38 Quality in this outcome area is Adequate. This judgment has been made using available evidence including a visit to this service. 31, 32. The home has generally been able to demonstrate good use of the inspection and regulatory processes. 32, 33. The manager is engaging in a formal dialogue with residents and their relatives to maintain an open and inclusive ethos; and to ensure the home is run in their best interests. But this needs to link conspicuously with an annual development plan. 35. There are robust procedures in place for accounting for and safeguarding residents’ finances. 36. Staff who give direct care are given supervision, but not to comply with the elements of this standard. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 24 38. All property maintenance records and health and safety checks seen were judged well maintained. And there was good evidence of risk assessments (individuals, activities and environment). EVIDENCE: The registered manager is judged qualified, competent and experienced to run the home. She has responded positively to matters raised at previous inspections, and there have been a number of promising developments, which are detailed throughout this report. This is judged a good use of the inspection and regulatory processes. There are clear lines of accountability within the home and with the more senior management Care staff have previously been able to confirm having received supervision from line management, generally every two to three months. The standard for care staff is at least six times a year. These sessions were said to usefully review performance since the last session; and were also used to discuss operational matters as well as identify training and support needs. Supervision for support and ancillary staff involves a more needs led approach as part of continuous management – the only formal meeting cited being annual appraisals. All staff said they found line management approachable on a dayto-day basis. There was good evidence of residents’ participation in decisions about the running of the home through group meetings – and of the manager’s response to issues raised for her attention. Records show a range of matters under consideration in each case – premises, meals, activities, and day-to-day concerns. Residents said they were confident that any concerns they had would be listened to and responded to. And the manager ensured there was good access to the inspector. This is judged an inclusive approach. There was better evidence of visits by a representative of the proprietor, usually monthly but there were some lapses more recently in the records seen, which will require further attention. There was, however, no annual development plan for the current year available for inspection. The reader is advised that this is required and that it should show a systematic cycle of planning – action – review, and reflecting in each case the aims and outcomes for service users (residents, relatives and visiting professionals). The registered manager ensures that residents have good control over their own money except where they state that they do not wish to or they are risk assessed to lack capacity to do so. And safeguards are in place to protect the Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 25 interests of the service user – appropriate written records of all transactions are maintained; allowances are not pooled; and the facilities for the safekeeping of money and valuables on behalf of the residents are judged secure. The manager does not, moreover, act as Appointee for any residents. Records confirm that the registered manager has made good provision for the health and safety of people who live and work at Elliott House. All maintenance records seen were up to date and filed systematically. There are policies and procedures governing practice, and these are usefully underpinned by staff training. Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X 3 Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Medication Room. The following matters are raised for attention: • Windows required cleaning • Festoon blinds must be replaced by more hygienic coverings • Drug fridge – Strongly recommend abbreviated signatures as per MAR charts • Strongly recommend either wrist or elbow mixer taps Action plan to be submitted Visits by a representative of the proprietor must comply with al elements of Regulation 26 There needs to be an annual development plan, based on a systematic cycle of planning, action, and review – reflecting aims and objectives for residents Care staff need to receive formal supervision at least six times a year Timescale for action 31/10/06 2 3 OP33 OP33 26 24 31/10/06 31/12/06 4 OP36 18(2) 31/10/06 Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 28 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 OP1 Good Practice Recommendations Given the generally poor recall of some residents, the inspector would recommend that the admission checklist include the issue of the Statement of Purpose, and Service User Guide and whether other formats were warranted. The manager should persist with staff training in key working The manager should give consideration to the purchase or hire of an adapted minibus for outings into the local community, to preserve their links. Training in catering for the elderly and for special needs (e.g. dementia) should be introduced for all staff involved in the preparation and delivery of meals, to ensure practice complies with best practice Decorative pelmet over the top section of obscure glass windows in bathrooms may not offer sufficient privacy. Blinds or curtains are recommended. The manager should persist with NVQ accreditation for staff, notwithstanding staffing turnover Catering for dementia has been identified as a training need by one member of the catering staff The annual development plan should maintain a conspicuous link with a qualified assurance framework placing residents and their relatives and representatives at the centre. Regulation 26 reports will need to fully comply with the provisions of 26(4)(a)(b) 2 3 4 OP7 OP13 OP15 5 6 7 8 OP21 OP30 OP30 OP33 Elliott House DS0000023385.V314101.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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