Inspection on 01/02/06 for Elliscombe House Nursing Home

This inspection was carried out on 1st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Elliscombe House Nursing Home 15/11/06

Elliscombe House Nursing Home 04/08/05

Elliscombe House Nursing Home 23/02/05

Elliscombe House Nursing Home 08/09/04

Elliscombe House Nursing Home 26/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Elliscombe House Nursing Home Higher Holton Wincanton Somerset BA9 8EA Lead Inspector Shelagh Laver Unannounced Inspection 1st February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elliscombe House Nursing Home Address Higher Holton Wincanton Somerset BA9 8EA 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) 01963 33370 Park Healthcare Limited Mrs Melanie Jane Smith Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Elderly persons of either sex, not les than 60 years, who require general nursing care Two persons of either sex, between the age of 30-60 years, who require convalescent or respite care. The Registered Manager will work a minimum of 25 hours per week to undertake the management role and in addition to the nursing staff on duty. Staffing levels detailed in the provider letter of 25/05/05 will be the minimum levels of staff on duty. The staffing levels will be reviewed with CSCI if a new Registered Manager is appointed. 4th August 2005 Date of last inspection Brief Description of the Service: Elliscombe House is a residential care home for 41 older people who require nursing care. The registration also allows for up to two people between the ages of 30 and 60 years for convalescent or respite care. The home is set in open countryside, near the village of Holton, about 3 miles from the town of Wincanton. The ground floor has recently been extended and now offers a small lounge and a further large lounge and dining room with views over the countryside. Bedrooms are situated on both the ground floor and frist floor which can be reached by stairs or lift. Also on the first floor is an office suite. The old part of the house retains many of its original features and there are large grounds leading onto open countryside. The grounds are being developed following the completion of the extension to allow wheelchair access. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out as part of the planned annual programme of inspections. One inspector carried out this unannounced inspection over one day. The last inspection was announced and took place on 4th August 2005. Mrs Melanie Smith, Registered Manager, was present throughout the inspection. There was a registered nurse and an enrolled nurse on duty on the morning shift. The home has completed a ground floor extension and converted a former office to a bedroom to be available as an overnight room for relatives. These rooms are now established and comfortable. This has increased the registered beds at the home to 41 and provided another lounge, large dining room and quiet seating area. The communal rooms overlook the open countryside and lead onto the gardens through patio doors. 41 people were living in the home on the day of the inspection. There is a short waiting list. The initial impression was that the home was welcoming, smart and calm. All service users spoken to, and who were able, told the inspector that they were very satisfied with their care. One person said “We are very well looked after.” Another “staff are well…marvellous.” Staff and service users were very positive about the service at Elliscombe House. A tour of the premises was made, care in the home observed and a range of records was inspected, including care records. 15 service users, 5 staff and 2 visitors were spoken to. All spoke highly of the home. What the service does well: Service users benefit from good quality, homely surroundings. They are treated with respect and given suitable privacy for all care interventions. The home has thorough pre-admission arrangements that also provide good opportunities for the service user to make a decision about moving in. The home offers a varied menu of home cooked and nutritional meals. The home offers a varied activity programme, including regular trips. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 6 Service users benefit from an enthusiastic staff team and opportunities to express their views and make choices. Service users nursing needs are met supported by visiting health professionals. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. Standard 6 does not apply. The home has thorough pre-admission arrangements that also provide good opportunities for the service user to make a decision about moving in. EVIDENCE: The Statement of Purpose has been updated to reflect the new rooms and a copy was obtained. Fees charged range from £450-£685 per week, with additional charges for hairdressing, chiropody, physiotherapy and personal items. The manager completes a pre-admission assessment for all prospective service users. Service users and their families are invited to visit and view the home before making a decision to move in. A new service user confirmed that they were satisfied with the arrangements made. The home is staffed by at least one Registered Nurse 24 hours a day. Two nurses are on duty as agreed by CSCI staffing requirements following the Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 9 expansion of the home. The home has been suitably adapted to provide for the nursing needs of older people. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 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. The care planning system has been further development to ensure that all service user needs are addressed. The home has good systems and links with other health professionals to enable service user health needs to be met. Personal support is offered in such a way as to maintain the privacy and dignity of service users. The management of medicines is satisfactory; the use of creams is not consistent with best practice. EVIDENCE: Four service user plans were examined. The manager reported that she was pleased with the way care plans had developed. The home has an adequate documentation system that provides for comprehensive assessment of service user needs. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 11 Attention to detail in the care plans is still needed in some areas. For example bed rail documentation must be signed. Wound care records must be regular and should continue until the wound is healed. Similarly when a care intervention is changed this must be clear on the care plan. There is much detail in the daily records showing that care is taking place but this is not clear from the care plan. Assessments were reviewed regularly and the plan was reviewed each month and signed by either the service user or their representative. Plans detailed evidence of a monthly review and visits by the GP. Health needs were supported by the district nurse, chiropodist and dentist. It was clear in one plan that there was a great deal of regular consultation with a service user and their family to ensure satisfactory care at the end of the service users’ life. Staff were observed offering prompt and discreet support to people at all times. The management of medicines is satisfactory and storage and documentation was inspected. The manager carries out a monthly audit against the National Minimum Standards. Any guidance written on MAR sheet should be signed. The inspector found in service users’ bathroom cupboards a small number of old creams which need to be disposed of. The manager is required to ensure that a review of all creams in the home is undertaken by staff. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Service users are supported to lead the lifestyle they wish and have opportunities to participate in leisure activities. Visitors are made welcome at any time. The meals in the home are good offering choice and variety and taking account of personal preference. EVIDENCE: Service users spoken to all confirmed that they could spend the day as they choose and were very happy at Elliscombe House. They all appreciated the activities available. One service user said “We had a lovely Christmas here.” The home has an activities organiser who arranges a varied programme, including one-to-one opportunities for those who are unable or do not wish to be part of a group. The programme for February was observed and included Scrabble, arts and crafts and bingo. A “gents coffee morning” is organised and there are trips for shopping and lunch. The garden is accessible and service users were observed walking there during the inspection. Visitors spoken to confirmed that they are made welcome at any time. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 13 Lunch was not seen as part of the inspection however it was observed at the last inspection when it was appetising and plentiful. The menu was seen to be imaginative and offers plenty of choice. Service users spoken to were very happy with the meals provided and knew that the cook kept a list of their dietary needs. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. The home has a satisfactory complaints procedure that enables action to be taken. The home’s recruitment procedures endeavour to protect service users from the potential risk of harm and abuse. EVIDENCE: The home has a complaints procedure that is made available and a clear format for the manager to follow in response to any complaints. No complaints have been received since the last inspection. Three staff recruitment files were examined. All of the files contained evidence of POVA First and Enhanced CRB checks received by the home. References were received prior to commencement of work. Staff have received recent training in preventing abuse and those staff spoken to were clear about the action they would take if they were concerned. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. Service users’ benefit from comfortable, homely, well maintained surroundings. Bedrooms are personalised according to service user preferences. All areas of the home are kept clean and tidy. EVIDENCE: A tour of the premises was made and found all areas clean and tidy. The home has a range of equipment and adaptations that are suitable for the service users accommodated. The home has adjustable beds suitable for those who require assistance in bed; the manager has assessed the need for these and keeps this under review. Service user bedrooms seen were comfortable and personalised with their own belongings. A number have an outlook onto the garden and open countryside. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 16 One service user discussed the pleasure gained by watching birds in the gardens. There are adequate toilet and bathing facilities for the current service users. The manager confirmed on previous inspections that everybody is able to take a bath when they wish. There are en-suite facilities in most rooms and in all the new bedrooms. These were clean and tidy. A new nurse call system has been installed and service users are also able to have a pendant when sitting in the lounges or outside. It was noted during the inspection that there were times when service users would not be able to summon assistance from the small sitting room and this must be addressed. The home was clean throughout and control of infection measures were satisfactory and minimised any risk of cross infection. The laundry facilities were finished prior to the last inspection and staff confirmed that they are suitable for the needs of the home. It is strongly recommended that staff hand wash facilities be provided in the clinic room Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. The home is adequately staffed by suitably experienced staff. Staff induction and training are planned and ensure that staff receive the training they require. EVIDENCE: The manager had recruited additional staff prior to the new unit opening. New staffing arrangements have been agreed with CSCI and these were in operation on the morning of inspection. The manager keeps the provision of staff under review and assesses the dependency levels of service users regularly to ensure that the staffing levels are adequate. Rotas examined confirmed that the agreed levels have been adhered to. A Registered Nurse is on duty 24 hours a day with an additional nurse working from 8am-2pm. The manager has also introduced a social support worker to assist with meals, drinks and any additional needs that service users may have when in the lounges. The home continues to provide placements for nursing students and supervised practice/adaptation for overseas nurses approved by Bournemouth University. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 18 Staff spoken to confirmed that they receive an induction programme. This has been confirmed at previous inspections to comply with TOPSS standards. All staff work at least one supernumerary shift, dependant on their needs. Staff are supported to undertake NVQ training with 14 (58 ) having achieved NVQ2 in Care. A further 12 members of staff are undertaking training. All staff have recently been updated in Moving and Handling practices and a further member of staff is to be trained as a manual handling trainer. The manager has developed an annual training plan for the home and each member of staff has an individual training record. Since the last inspection training has been provided on a range of subjects including abuse awareness, oxygen therapies, malnutrition, care planning, catheter awareness and bereavement. All staff receive an annual appraisal. The three recruitment files examined contained evidence of pre-employment checks and references. There must be a formal record of interviews maintained. “To whom it may concern” references are not acceptable and will no longer be used. It was suggested that references are stamped with the date they arrive in the home. The manger agreed that the application form would be adapted at the next opportunity to include ten years of previous employment. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 & 38. The home is well managed and the manager promotes an accessible and open style of management. Health and safety arrangements ensure that staff and service users are protected in most areas. EVIDENCE: The home’s manager, Mrs Smith, was appointed in 2003. Mrs Smith has experience managing a care home for nursing. She is a Registered nurse and has completed the Registered Manager’s Award and additional qualifications. Staff and service users spoke very highly of the manager and feel she is approachable and will take action if any concerns are raised. There was clear Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 20 evidence of the targets and projects to be achieved during the coming year. Amongst the more usual targets is the development of a “pets corner”. Staff spoken to were clear about their roles and felt well supported. There was a team approach to supporting service users. Staff meetings are held and a newsletter published. Mrs Smith’s continues to work regular shifts ‘on the floor’ to work with staff and to supervise the care of the service users directly. She spoke of the positive effects this had for the service users, staff and also herself. A key worker system is in place. Tasks are delegated to senior staff to assist with the running of the home and this process should continue. The home does not manage any monies on behalf of service users. Records required for inspection were held appropriately, well managed and made available. A tour of the premises were made and all areas seen were free from hazards. The inspector observed that work was continuing to guard all hot surfaces and this is almost completed. Risk assessments are in place whilst this is being finished. All staff have received recent fire training. Accidents are recorded and the manager makes a thorough analysis of each one and takes any action necessary. A range of records was examined and were well maintained and ordered and demonstrated satisfactory checks are carried out, these included: • • • • Fire equipment and systems Water temperatures and showers Hoists Bed rails Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 22 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 38 Regulation 13 (4) Requirement The access to call pendants and other methods of summoning staff assistance in the small sitting room must be reviewed to ensure service user safety. An audit of all service user cupboards must be undertaken to remove out of date creams. Timescale for action 28/02/06 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 3 Refer to Standard OP 7 OP 29 OP 26 Good Practice Recommendations The audit and development of care plans should continue as discussed during the inspection and to reflect comments in the report. Records of interviews should be kept. “To whom it may concern” references should not be accepted. It is strongly recommended that staff hand washing facilities are provided in the clinic room. Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Elliscombe House Nursing Home DS0000003253.V281241.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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