Inspection on 04/08/05 for Elliscombe House Nursing Home

This inspection was carried out on 4th August 2005.

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

Other inspections for this house

Elliscombe House Nursing Home 15/11/06

Elliscombe House Nursing Home 01/02/06

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 BA9 8EA Lead Inspector Sue Burn Announced 4 August, 2005 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. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Elliscombe House Nursing Home Address Higher Holton, Wincanton, Somerset, BA9 8EA 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) 01963 33370 Park Healthcare Limited Mrs Melanie Jane Smith Care Home with nursing 41 Category(ies) of Old age (41) registration, with number of places Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elderly persons of either sex, not less than 60 years, who require general nursing care. 2. Two persons of either sex, between the age of 30-60 years, who require convalescent or respite care. 3. 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 4. Staffing levels detailed in the provider letter of 25/05/05 will be the minmum of staff on duty. 5. The staffing levels will be reviewed with CSCI if a new Registered Manager is appointed. Date of last inspection 23 February, 2005 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 D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 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 announced inspection over one day. The last inspection was unannounced and took place on 24 February 2005. Mrs Melanie Smith, Registered Manager, was present throughout the inspection and working as nurse-in-charge for the morning shift. Since the last inspection the home has completed a ground floor extension and converted a former office to a bedroom. 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. Some existing service users took the opportunity to move into the new bedrooms. 40 people were living in the home on the day of the inspection. All service users spoken to, and who were able, told the inspector that they were very satisfied with their care and one person said she would ‘recommend the home’. Mrs Smith had arranged a coffee morning for service users to meet the inspector and discuss the home and all very enthusiastic about the service they receive 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. 16 service users, 9 staff and 3 visitors were spoken to. All spoke highly of the home. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? At the last inspection 2 requirements were raised. One related to the guarding of hot radiator surfaces and the manager has taken satisfactory action to rectify this. The other r4equirement related to obtaining satisfactory preemployment checks. This had not been actioned to comply with legislation and an Immediate Requirement was issued at the end of this inspection. The dining arrangements for service users has improved as a dining room has been provided in the new extension, all service users who wish to can now eat in sociable and pleasant communal surroundings. Lounge areas have improved with the provision of a small seating area and a large comfortable lounge in the new extension overlooking the garden and open countryside. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 7 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 D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 8 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 Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 9 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) 3, 4, 5 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 but was not examined on this occassion. 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 and visitor confirmed that they were satisfied with the arrangements made and found any ‘movingin’ problems were dealt with promptly. A sample of 2 pre-admission assessments was seen and contained sufficient information. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 10 The home is staffed by at least one Registered Nurse 24 hours a day and the home has been suitably adapted to provide for the nursing needs of older people. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 11 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 The care planning system is in need of 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: Six service user plans were examined. The manager reported that she was aware that the care plans needed further development and this was to be addressed now that the extension works were complete. The home has an adequate documentation system that provides for comprehensive assessment of service user needs. Each of the plans examined had an aspect of service user need that had not been addressed although generally the care plans detailed clear actions for staff to follow in most areas. The manager needs to Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 12 ensure that wound care plans are followed or reviewed to reflect changes made or observed. One care plans did not detail the prevention of infection measures that were observed to be in place and another for a recurrent problem that was being monitored but did not detail how staff should manage the situation when it occurred. The inspector also observed one incident of moving and handling a service user that was not consistent with their plan or best practice. It is required that all aspects of service user needs are thoroughly assessed and that plans detail all the necessary information to enable staff to provide the care and support required by individuals. 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 by the GP and support from the district nurse, chiropodist and dentist. It was clear in one plan that a service user was being supported to maintain their independence to manage their own personal care needs. 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. The home has taken action to address issues raised at the last pharmacy inspection. The inspector found a number of creams in use that were not being used appropriately. The manager is required to ensure that creams are signed for on the MAR chart and only used by the individual for whom they are prescribed. They should also be dated when opened to ensure that they are used by the expiry date. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 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 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. All were consulted about the new extension and were well informed about the changes and how the staff were organised. Service users had been offered the opportunity to move into one of the new bedrooms and chose their own décor. Service users had also been consulted about the décor for the new communal rooms. 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 Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 14 be part of a group. There are fortnightly trips for those who are able to go, including people in wheelchairs. The garden is accessible and is to have additional paving laid to improve this. Visitors spoken to confirmed that they are made welcome at any time. Lunch was seen as part of the inspection and was appetising and plentiful. The menu is particularly imaginative and offers a choice of at least 2 main courses and 3 sweets. Service users were very happy with the meals provided and knew that the cook kept a list of their dietary needs. Service users were observed being offered the level of support and assistance they required and were able to take their meal where they wished. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 15 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 The home has a satisfactory complaints procedure that enables action to be taken. The home’s recruitment procedures not fully 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. Five staff recruitment files were examined. One of the files was for a member of staff who did not commence work at the home. None of the other files contained evidence that POVA First or Enhanced CRB checks had been received by the home prior to the employee starting work. References for one of these staff members was also not received until after they had started work. An Immediate Requirement was issued during the inspection requiring the manager to ensure that the home receives either an enhanced CRB or POVA First check and 2 satisfactory references before employees start work. Staff have received recent training in abuse and those staff spoken to were clear about the action they would take if the were concerned. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 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, 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 and free from any unpleasant odours. 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, having ordered 4 more since the last inspection. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 17 Service user bedrooms seen were comfortable and personalised with their own belongings. A number have an outlook onto the garden and open countryside. 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. 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. 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 D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 18 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 The home is adequately staffed by suitably experienced staff. The standard of recruitment practices is not adequate, with appropriate checks not been carried out promptly enough and potentially leaving service users at risk (see Complaints and Protection). Staff induction and training are planned and ensure that staff receive the training they require. EVIDENCE: The manager recruited additional staff prior to the new unit opening to ensure a smooth transition and allow staff to become familiar with the home. Staff reported that this had been very effective, they had managed the additional workload without being overstretched and felt that service users were now getting more attention. New staffing arrangements have been agreed with CSCI and, in part, form the conditions of registration for the home. 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. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 19 The home continues to provide placements for nursing students and supervised practice/adaptation for overseas nurses approved by Bournemouth University. 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 44 having achieved at least NVQ2 in Care. All staff have recently been updated in Moving and Handling practices. The manager has developed an annual training plan for the home and each member of staff has an individual training record. A range of training sessions has been provided including, dementia care, recognising abuse, nutrition and tissue viability. All staff receive an annual appraisal. Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 20 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) 31, 32, 35, 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. Staff and service users were kept fully informed about the new extension and have been Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 21 consulted about arrangements. Staff spoken to were clear about their roles and felt well supported. The team was described as happy, relaxed and professional. Staff meetings are held and a newsletter published. Mrs Smith’s approach is to work regular shifts ‘on the floor’ to work with staff and to supervise the care of the service users directly. Mrs Smith has implemented a key worker system, which all the staff spoken to understood and felt it was a positive development. Tasks are also being delegated to senior staff to assist with the running of the home. 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 manager has made arrangements to ensure that all unguarded hot surfaces will be guarded by the time the heating is switched on. Risk assessments have been completed whilst this is being arranged. 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 • Radiator risk assessments • Water temperatures and showers • Hoists • Bed rails Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 22 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 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 4 x x 3 x 3 3 Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 23 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 7 Regulation 15(1)(2) Requirement The manager must ensure that care plans detail all service user needs with clear strategies for staff to follow. Safe systems for the use of creams must be implemented as detailed in this report. The registered person must ensure that robust recruitment procedures are carried out for all staff, which meet with all the requirements set out in Schedule 2 and regulation 19 of the Care Home Regulations 2001. Staff must not start work until the home has received either an enhanced CRB or POVA First check and 2 satisfactory references. Timescale for action 30.9.05 2. 3. 9 18, 29 13(2) 19 31.9.05 Immediate Requireme nt 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 26 Good Practice Recommendations It is strongly recommended that staff handwashing facilities are provided in the clinic room. D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 24 Elliscombe House Nursing Home Elliscombe House Nursing Home D53 - D02 S3253 Elliscombe House V232441 040805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier 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. 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