Inspection on 17/08/05 for Elliott House

This inspection was carried out on 17th August 2005.

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

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

Other inspections for this house

Elliott House 23/10/08

Elliott House 14/09/06

Elliott House 13/12/05

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 Announced 17-19/08/05 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 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 H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Elliott House Address 22 Reculver Road, Beltinge, Herne Bay, Kent, CT6 6NA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01227 374084 01227 740750 Mr Ian George Nicoll Mrs Linda Valerie Elks Registered Care Home 71 Category(ies) of Care Home for Older People of which 1 place is registration, with number for a service user with a Physical Disability of places Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1) People with a physical disability is restricted to 1 person whose date of birth is 18/06/37 2) Registration is restricted to 1 person with a date of birth of 03/12/16 Date of last inspection 04/01/05 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 ensuite 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. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which was used to introduce the new inspector to residents and the staff; to check progress with matters raised from the last inspection (January 2005); and to reach a preliminary view on other aspects of the day-to day running of the home. The inspection process took just over seventeen hours, spread over two and a half days, and involved meetings with seven residents (including a group of three over lunch), three relatives and one visiting friend, six staff (representing the direct care side, housekeeping, laundry and catering), the deputy manager and the manager. The inspection also involved an examination of comment cards from six residents, four relatives and one visiting healthcare professional, a range of records and the selection of two residents’ case files, to track their care. Seven bedrooms, selected at random, were inspected for compliance with the National Minimum Standards, and the inspector also checked some communal areas. Interactions between staff and residents were observed throughout the day. What the service does well: What has improved since the last inspection? Only two matters were raised for attention by the last inspection. One was found to have been met, and progress had been made with the other. Staff present as generally very self-motivated, notwithstanding the extra pressures attributed to providing cover while recruitment checks await completion. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 6 Information collected for individual “family trees” and in discussions with staff indicated a resolve to make care planning more holistic. 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 H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4, 5, 6 1. The home has a Statement of Purpose, which includes some elements of a Service User Guide but it does not provide residents and prospective Service Users with all the information they need to make a decision about moving into the home. 2. There are contracts governing each placement between the home, but they do not contain all the required elements. 3, 4. 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. The home does not provide intermediate care. EVIDENCE: Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 9 There is a Statement of Purpose, which usefully describes the facilities, services and principles of care but there was no Service User Guide available. Some elements of the Service User Guide have been incorporated into the Statement of Purpose but a number of elements listed by this standard for either document were not there. A number of elements were, moreover, dispersed throughout the document without an indexing system or page numbers to assist the reader’s understanding. Feedback on the day of this inspection indicated that the decision to apply to this home was influenced more by its locality (i.e. close to where the resident or their friends or relatives lived) and by personal recommendation, or through having visited other people there, than by any public information produced by the home itself. The home carries out a preadmission assessment, which has a standard format to ensure a consistent approach. This assessment tends to concentrate on personal and healthcare needs, although it also starts to take social care needs into account. The prospective resident or representative is invited to visit the home, and meet the staff and residents. None of the residents spoken to on this occasion was able to confirm this process as described, as they had entrusted the choice of home to the judgement of their representatives. Each resident is offered a month’s trial stay, and residents and relatives confirmed this was the practice, although this was not required in one case. On their admission, the home carries out further assessments and risk assessments. There are contracts governing each placement. Although these documents are written in plain English, and are generally compliant with the elements of this standard, they do not, crucially, identify which bedroom has been allocated; the fees payable, or who is responsible for the payment of fees as required (resident, local or health authority, relative or another). These elements are required. The manager said the home does not provide intermediate care. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, 10 7. The assessment and care planning processes cover a wide range of health and personal care needs, as well as some social care needs 8. The home is served by a range of healthcare professionals, to promote good health and has adequate facilities for privacy. 9. A separate review of medication handling was undertaken by a CSCI pharmacist inspector who concluded that the manager and staff are striving to attain good medicine standards but are hampered by the lack of sufficient provision for a) handling and storing medicine and b) for transporting medicine safely to service users. This situation required staff to work round the present system but if it were to continue could compromise the health and safety of the service users. 10. Residents confirmed that staff treat them well, and that their privacy is respected. EVIDENCE: The preadmission assessment covers the residents’ most critical health and personal care needs. This is then developed into a care plan, which also addresses some social care needs, and is intended to be read in conjunction Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 11 with risk assessments and information on key personal / family history information. An examination of two residents’ files, followed through with discussions, generally confirmed the process as described. Records confirm that elements of the care plans are generally reviewed monthly. However, these reviews usually showed little or no change overall, and there were gaps in the records in respect of formal reviews and little or no follow up in respect of identified social care needs (interests, activities). The manager said there is no formal group review of care plans other than those led by care managers, and none of the residents or carers spoken to showed any recognition of an active care planning / review process. One or two did generally recall being asked questions about their care needs right at the start. And they also confirmed the manager’s own assertion that she was always available to residents or their relatives to discuss any issues or concerns. A separate inspection of the home’s medication arrangements found there were clear records to ensure an audit trail. Medicine storage was, however, unsatisfactory as medicine was not stored in separate medicine cupboards; there was no work surface or washing facilities; and some medicine had to be stored elsewhere. The drug trolley required refilling, demonstrating it was insufficient for the size of the home. The medicine round observed indicated that staff were not employing best practice in administration and this has been cause for separate complaints to the CSCI. It appeared that training in medicine handling was some time ago. 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 confirmed that their privacy was respected and that staff generally treated them well, though there have been occasional delays in answering call bells, attributed to what they perceived as staff shortages and competing pressures and priorities. The home accesses a range of healthcare professionals, but residents would need to pay for chiropody, physiotherapy of 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 home has yet to instigate a key worker system. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 12. Most residents are generally content with their lifestyles in this home, and the home has been able to match their expectations. This home offers a range of activities inside and outside the home, but is currently having to cover the work carried out by its activities co-ordinator following her abrupt departure. 13. There are open visiting arrangements, and the home is well placed for access to local shopping and seafront outlets. 14. There is choice and control over most aspects of daily routines. Personal care is offered in a way which protects residents’ privacy and dignity. 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. But there needs to be a more effective system to remind residents of menu options available to, or already made by them. EVIDENCE: The residents were not on this occasion 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, and relatives and staff were able to supply more examples. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 13 Examples include Bingo; films; Reminiscence; a regular Tuck Trolley; board games (snakes and ladders, Ludo, draughts). Musical events include Karaoke, guitar sessions and there are traditional celebrations include Valentines Day, VE Day, birthdays, Easter bonnets and Christmas. Famous Quotes are put on display on notice boards around the home as talking points. The communal events are rotated between different communal areas to encourage participation. Following the recent abrupt departure of its activities coordinator, the home has been trying to maintain the programme set up, to the credit of one member of staff in particular. Most residents indicated that they were generally content with their lifestyles in this home. The Statement of Purpose states that “visiting clergymen from all denominations call to administer care” but there was no information on the extent to which this actually applied in practice, what the local resources were, or how prospective residents would be supported to access other religious services. The home has open visiting arrangements, and meals can be provided for visitors if required at “reasonable” cost, though this did appear to the residents or relatives spoken to on this occasion. 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. Residents can choose where to take their meals (there is a choice of attractive dining facilities as well as bedrooms), and also have some choice over meal times. Almost all of them said they were satisfied with the meals. Less clear, however, was their understanding of the menu choices available to them. A member of staff was on each day of the inspection observed taking orders for the next day over the dining room tables. Some residents were clearly struggling to hear what was being said over the communal chatter, and appeared to be letting others choose for them or choosing options they could hear rather than making deliberated selections. There was, moreover, no system to remind them of the options selected. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 16. There is a complaints procedure readily available, though some versions require amending, and residents feel that any complaints they had would be listened to and acted on. There are no independent advocates. The home relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. The complaints register is not, however, being used as required. 18. Residents feel well cared for and safe there is a policy on adult protection. Staff expressed a commitment to protect residents from abuse 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 which needs to be aligned with the one on display to commit the home to timeframes for resolving complaints. Moreover, it only gives the Commission as an option if the complaint is not satisfactorily resolved. This is not a correct interpretation of the National Minimum Standard or Regulation 22. It also gives the outdated title of the CSCI, which is likely to be confusing to the reader. The residents and relatives confirmed that they would know who to talk to if they had a complaint and felt safe. The home does not use any independent advocacy services but relies on staff, or the residents’ families and friends to raise issues and represent the interests of the less able residents. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 15 However, the complaints register is not in use as required. The use of daily reports and/or the incidents file to log expressions of dissatisfaction is not judged inclusive enough. The register should provide a comprehensive record of all complaints and the action and timeframes taken to resolve them Previous inspections have established that there is a policy on abuse, and all the residents spoken to on this occasion said they felt safe at this home. Meetings with staff were used to ask them about the adult protection procedures and all showed a commitment to report any incidents should they occur. Less clear, however, was their understanding of the processes that flow on from adult protection issues, once reported, and the role of, and contact details for, the CSCI, to facilitate access. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 16 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26 19, 25. The layout of this home is generally suitable for its stated purpose, and residents confirm this is an attractive and homely place to live. 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. 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. Residents can personalise them with their own possessions and items of furniture 26. The home is generally well maintained and all areas inspected were free of any unpleasant odours. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 17 EVIDENCE: The layout of this home is generally suitable for its stated purpose and well maintained and decorated. Each floor (including all the bedrooms on it) is characterised by its own colour scheme - pink, apricot, 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. The floors are linked by two shaft lifts and four stairways. The corridors are wide but hand rails 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 but communal areas don’t. This is required. All areas are linked with a call bell system and there is adequate specialist equipment and adaptation. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 18 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. Seven bedrooms were selected at random for assessment against the National Minimum Standards and generally had all the furniture and fitments required. Three did not, however, have a second comfortable chair; one did not have a bedside cabinet; and one did not have a lockable facility – it is expected that nonprovision is in each case be justified by properly documented consultation or risk assessment. Each room had been personalised with the residents’ possessions and, in some cases, pieces of their own furniture and there were homely touches throughout. Several residents said they did not want to use the locks on their doors or lockable facilities. 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. The home has two commercial washing machines with sluice cycles, and two dryers (though one was out of action at the time of this inspection). A few residents are supported to do their own washing of small personal items if they wish. Clinical waste is appropriately managed. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 30 27. The home aims to meet the needs of the residents with its staffing arrangement, and this is a workforce which reports working flexibly and cooperatively to maintain the residents’ quality of life. However, persisting staffing shortages have been raised as a matter requiring resolution by residents, relatives and staff alike. This is judged a major shortfall. 28. To the credit of staff providing cover for shortfalls, residents generally feel safe and well cared for. There is a programme of mandatory health and safety training. Positive relationships have been formed between the staff and residents. However, medication arrangements will require attention to obtain required standards and protect residents. 29. There is a systematic recruitment process, which includes a range of checks, to protect residents. 30. Staff are multi skilled to ensure good quality care and support. EVIDENCE: The waking / working day is currently calculated on the basis of a 14-hour period from 7.15 till 9pm. The recommended waking / working day is, however, 15 hours (Ref. Residential Forum). 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 seven care staff in the mornings (i.e. from 7.15am till 2pm); five care staff in the afternoons (i.e. from 2pm till 9pm) and four overnight (9pm till Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 20 7.30am). The home would also aim to have 3-4 domestic staff and one laundry person from 8am till 2pm; and another laundry person working from 5-8pm. The home has a cook from 7am till 3pm; and an assistant cook and dining room assistant from 7am till 2-3pm and/or 12-6pm. In the light of eight vacancies and persisting staffing shortfalls (attributed to delays obtaining CRB checks), however, this arrangement has been dropped to six care staff in the mornings; five in the afternoons (till 6pm), thereafter four, including overnight. An examination of the duty rota for care staff for one week 4-10 July, generally confirmed this amended arrangement during week days. The night time staffing level was maintained throughout. However, the day time staffing levels dropped even further to five and even four during the day over the weekend. This is not an acceptable level of shortfall, and is judged likely to compromise the quality of life of residents and put an inordinate strain on staff trying to provide cover. Staffing shortages were raised as an issue of concern by residents, relatives and staff alike. At the same time, residents and relatives spoke fondly of the staff, and staff reported working flexibly and co-operatively to maintain the residents’ quality of life. The manager needs to be able to negotiate changes with the Registered Individual as necessary to maintain adequate staffing levels at all times. See standard 9 for findings in respect of the medication arrangements. There were observed and reported lapses in standards, which are judged likely to compromise the safety of residents. Staff confirmed a systematic recruitment process, designed for consistency, and their recruitment was invariably subject to satisfactory references, identification and CRB checks, to protect residents. All staff confirmed having received induction, which has more recently been based on the TOPSS model, and there is a matrix and cycle of mandatory training on issues such as manual handling, infection control, First Aid, health and safety, and fire safety training etc. NVQ training featured in 24/46 cases i.e. 52 of the team (including ancillary staff) though it was not clear from the matrix supplied whether accreditation was in each case in prospect or had been achieved. And there was evidence of training in a range of specialisms such as dementia, insulin, and challenging behaviour. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36 These standards were partially assessed on this occasion. 33. There is now an annual development plan in place for the home for the year 2005/6, but there needs to be 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) 36. There needs to be clearer evidence of formal supervision and appraisal systems to oversee and manage further skills development. EVIDENCE: The Statement of Purpose commits the home to regular reviews with individual residents, residents’ meetings every 4-6 weeks, questionnaires and surveys but this level of consultation is not currently the practice. There were only three residents’ meetings on record, representing the last three years. Care Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 22 planning reviews do not proactively demonstrate the participation of residents and/or their relatives. Records show that while Quality Assurance accreditation agencies have been discussed, the home has not yet embarked on any of these programmes. The manager has produced an annual development plan for home for the current financial year, which usefully commits the home to aims and vision statements; defines its customer base (current and projected); identifies its business objectives; and outlines its performance and projections. This is judged a good start. There needs to be a conspicuous link with a qualified assurance framework placing residents and their relatives and representatives at the centre. Regulation 26 reports were examined for the period March to July 2005. They did not show the level of detail to enable anyone authorised to inspect them to judge compliance with the provisions of this regulation. Only one report showed the time of the visit, and none identified the individuals the visiting officer met with or which records, parts of the home were seen. Staff said they felt well invested in and confirmed that their line managers were available for support and advice. However, they were not clear about the home’s level of compliance with Regulation 36.2 – formal, documented supervision sessions six times a year or formal annual appraisals. Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x 1 x x 2 x x Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 24 Yes Are there any outstanding requirements from the last inspection? 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 OP1 Regulation 4, 5, 6 & Schedule 1 Requirement The Statement of Purpose must be amended to comply with all the elements of National Minimum Standard 1, Regulation 4 and Schedule 1. If it is intended to also serve as the Service User Guide it must also be amemnded to include the elements identified by Regs 5,6 Medication policies and procedures must be updated Self administration of medication must be monitored and records kept as appropriate Medicine storage is reviewed and improved to meet the needs of the home The home needs to procure another drug trolley and repaint the existing one The Controlled Drugs cupboard is bolted to the wall The minimum and maximum temperature of the drug fridge must be recorded daily and action taken when outside normal limits Medicine is given at the manufacturer’s recommended time Staff training in medication Timescale for action 31 12 05 2. 3. 4. 5. 6. 7. OP9 OP9 OP9 OP9 OP9 OP9 13(2) 13(2) 13(2) 13(2) 13(2) 13(2) 31 12 05 15 10 05 30 11 05 31 12 05 15 10 05 15 10 05 8. 9. OP9 OP9 13(2) 18(1)(a) Immediate and ongoing 31 12 05 Page 25 Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 10. OP16 17(2) & Schedule 4(11) 11. 12. OP19 OP24 13(4) 16(2) 13. OP27 18(1) 14. OP33 26 15. OP36 18(2) administration must be updated and all staff follow the home’s procedures The complaints register must provide a comprehensive record of all complaints about the operation of the home and action / timeframes taken to resolve them All upstairs windows must have restrictors The provision of furniture and fittings needs to be assessed against the elements of standard 24. Non-provision must be justified by properly documented consultation or risk assessment. The manager must ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of the residents Reg 26 Visit reports must show the level of detail to enable anyone authorised to inspect them to judge compliance with the provisions of this regulation. Care staff must receive formal supervision in accordance with provisions of standard 36 Immediate and ongoing 31 12 05 31 12 05 Immediate and ongoing Immediate and ongoing Immediate and ongoing 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. 2. Refer to Standard OP9.3 OP12 Good Practice Recommendations All medicine is recorded on service user’s MAR charts to ensure a record of current medication Public information should include a directory of local religious resources were, and advice on how prospective residents would be supported to access other religious services. H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 26 Elliott House 3. OP15 4. OP16 5. 6. 7. 8. OP19 OP24 OP27 OP33 The home should look for other opportunities to establish individuals menu selections (i.e. less distracting environments) and should have a system to remind them of the options selected. Staff should show a better understanding the processes that flow on from adult protection issues, once reported, and the role of, and contact details for, the CSCI, to facilitate access. Consideration should be given to installing handrails on both sides of corridors, to maximise residents scope for moving around independently Consideration should be given to decorating bedrooms according to prospective residents individual choice of colours scheme The recommended waking / working day, for the purposes of staffing levels is 15 hours (Ref. Residential Forum). 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) Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elliott House H56-H05 S23385 Elliott House V234950 170805 Stage 4.doc Version 1.40 Page 28 - 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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