Inspection on 16/02/09 for Elsdon Mews (26)

This inspection was carried out on 16th February 2009.

CSCI found this care home to be providing an Good service.

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

Elsdon Mews (26) 15/02/08

Elsdon Mews (26) 16/02/07

Elsdon Mews (26) 21/06/05

Elsdon Mews (26) 09/03/05

Elsdon Mews (26) 07/09/04

Elsdon Mews (26) 16/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Elsdon Mews (26) Elsdon Mews (26) Hebburn Tyne And Wear NE31 1RE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Allan Helmrich     Date: 1 8 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Elsdon Mews (26) Elsdon Mews (26) Hebburn Tyne And Wear NE31 1RE 01914833936 01914839747 ntawnt.elsdon@nhs.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Northumberland, Tyne & Wear NHS Trust Name of registered manager (if applicable) Lynne Mullen Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability Code LD, maximum number of places: 8 Date of last inspection Brief description of the care home 26 Elsdon Mews provides ordinary housing for people with learning disabilities, many of who were formally resident in long stay hospitals. Elsdon Mews can provide personal care for up to eight people. The service cannot provide nursing care. The home is a purpose built bungalow and due to its design and layout it blends in well with other properties in the community. The house has two dining room/lounges, a kitchen/dining area, and eight single bedrooms. There is a garden at the back of the Care Homes for Adults (18-65 years) Page 4 of 29 care home 8 Over 65 0 8 Brief description of the care home home which service users can use safely. The home has wide passageways and is suitable for people who use wheelchairs. There are separate laundry and storage facilities. The home is situated close to the town centres of Hebburn and Jarrow and within close proximity to a range of local amenities and facilities. There are bus stops nearby which link with the main regional centres and the home has its own transport. The weekly fees payable are 980.91 pounds. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The Visit: Care Homes for Adults (18-65 years) Page 6 of 29 The inspection was unannounced and was undertaken by the link inspector for the service over two days. The inspection started at 10:00am and lasted 8.5hrs. During the visit we: Spent time in the company of people who use the service. Talked with the home manager and staff on duty. Looked at information about the people who use the service and how well their needs are met. Looked at case records for three residents and other records that must be kept, including medication. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to assess if it was clean, safe and comfortable. Checked what improvements had been made since the last visit. Also surveys were sent to residents and staff. Responses were received from three residents supported by staff in the home, three staff members and a visitor. Information from these sources is used in this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has sufficient information on the needs of the people who live there and access to appropriate services to enable their needs to be met. Evidence: There is a Statement of Purpose and a Service User Guide which set out the aims and objectives of the home. These documents have been reviewed and amended to provide up to date information about the service. They are written in plain English and pictures and symbols are used to help people understand them. Although there have been no new admissions to the service since the home first opened some years ago there is a clear admission policy and procedure in place. This includes obtaining an up-to-date care management assessment as well as offering trial visits. We looked at the care plans and information for three of the seven people who live in the home. An evaluation of each persons care needs has been completed since our last Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: visit to the home. This provides comprehensive information on their history and up to date information on their interests and needs. The evaluation of needs provides the basis of each persons care plan and provides good information for the staff so that they know how to support each person appropriately. These plans could be further developed and written with more detail (see Personal and Health care Support). A copy of the contract is available in each persons file. The support staff who we spoke to said that the care plans contain sufficient information so that they can meet each persons needs and the staff have had training to improve their skills. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are involved in their own care planning and are consulted on their lives in the home. Evidence: Everyone living in the home has limited verbal skills. However much interaction was seen between them and the staff team. People were also seen freely moving around the home without restriction. The care plans reviewed were person centred and used pictures to involve the individual in developing their goals. One goal detailed was for someone to move to another home. Staff stated this was no longer an issue as following a reduction in people from eight to seven last year this person is now more settled. These details were not recorded in the individual plan. A section of the plan also described identified risks and how these are reduced to Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: enable the person to be more independent. Risks identified for one person who has no concept of danger included; front door security, kitchen safety, exposure to sun and traffic awareness. One visitor spoken to briefly who was attending her relatives review meeting stated she was very happy with the support provided in the home. One of the care plans reviewed did not contain a current review. The manager stated these are currently being brought up to date. Three surveys were returned from residents who were supported by staff to complete them. However all were content that they choose what to do and they are consulted about their needs. The personal finance records for two people were reviewed and found to be in order. Each transaction was evidenced by two people, items purchased were described and receipts are retained. People living in the home have purchased household items and the manager did not make it clear that she is aware of who has responsibility for replacement items. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are encouraged to make choices for their activities, and the staff support them to develop their skills for independence. Evidence: One person attends a day service during the week. Enablers who have worked with people living in the home for a long time supplement the work done by support staff. Everyone has a programme of daily activities and an enabler said that these activities are regularly reviewed. People involved with new activities are given time to ensure they are comfortable with an activity before it is rejected. One person had to stop attending horse riding as she was not comfortable being hoisted. Everyone has access to community activities and the previous weeks activity record Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: showed that people went personal shopping, to lunch, to a movie and to the swimming pool. Other activities recorded were visits to places of local interest such as; Stephenson Railway Museum, Seaburn Walk and Bedes World. Some people have a bubble bath and pamper and visit a Leisure Centre. Following each activity notes are kept recording the level of enjoyment gained. No one attends college or any other form of education. The care plans include a section called all about me detailing any independent living skills, and people are asked what they would like to do using using pictures to aid decision making. Another section called what is important to me identifies things staff must take account of when planning activities of daily living. Everyone is encouraged to keep in touch with their families. A section of the care plan identifies who is involved in care and support and friends and family contact information. A four week menu that promotes healthy eating is displayed. There is a fruit bowl available to people in the home also to promote good health. The main meal is in the evening and during the inspection this meal containing appropriate vegetables was being prepared. The person preparing the meal did not use a kitchen audit to promote good practice. The manager said that she had a copy of Safer Food Better Business but that this had not been provided to the staff team. The kitchen was however clean and organised. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and health care support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff support people to maintain their health needs and to consult other medical professionals. Evidence: The care plans reviewed provide a good basis for the provision of care. There is an essential life plan with pictures that shows staff the things necessary to support the person correctly and in a way they prefer. The plans identify who is involved in care and support and how to keep the individual healthy. Support plans were seen for many areas of support including; exercises, skin care, getting dressed, using the toilet unaided and sleeping. These plans however included statements such as; adequate, regularly, suitable and sufficient. The plans could be improved by providing more specific information to the staff team regarding how support is provided. Also up until several months ago, key workers provided a monthly holistic assessment of the person looking at aspects of; health, social life, activities, relationships and progress towards goals. This has lapsed and a good resource has been lost. The health care records seen included references to hospital visits, and contact with Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: GPs and other health professionals such as psychiatrist, psychologist, occupational and speech therapists. The home regularly weighs people to monitor there health and siton scales have been purchased to aid this process. The home has systems in place to manage peoples medication safely. However not all staff have been assessed as competent by the manager to ensure a good standard is maintained. The medication records were checked and one medicine was found that had not been signed for. Also staff providing subsequent medications had not identified and followed up the error to ensure the person was safe. A max-min thermometer was not used to monitor the temperature at which medicines are stored. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is written in a format that the people who live in the home can understand and follow. This means that they may be confident that their concerns will listened to. People are also supported by a caring staff team who are aware of how to protect vulnerable people. Evidence: There is a complaints procedure. This is provided in pictures and symbols to assist those people who have verbal communication difficulties. A copy of the complaints procedure is available in the Service User Guide The complaints record confirmed that there have been no complaints since the last inspection. The home has its own policy and procedure documents relating to abuse which are available to staff to guide them if they have any concerns in this area. There has been no safeguarding adult referrals made since the last inspection. The manager has done safeguarding training and is to do further training for managers in the near future. Also a system is in place to ensure all staff are appropriately trained. Care Homes for Adults (18-65 years) Page 18 of 29 Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and well maintained environment for the people who live there and the staff maintain a good standard of cleanliness and hygiene that protects people from the risks of the spread of infection. Evidence: Elsdon Street is a detached bungalow in keeping with other properties in the area. It is within walking distance of local shops and services and is not far away from Hebburn and Jarrow town centres. Peoples bedrooms are individual in style, containing many personal items. There are two lounges although everyone appeared to congregate in the large one. The home was clean and well maintained. The kitchen was well fitted out and can be used by residents with supervision. The laundry contains suitable equipment, including a washing machine with a sluice programme. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: Liquid soap and paper towels are provided in all communal toilets and bathrooms to prevent the risks of spread of infection. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are supported by a stable staff team whose training needs are being met to provide them with sufficient skills to understand and meet their needs. Evidence: The usual staffing levels in the home are; four support workers between 8:00am and 8:00pm then two support staff until 11:00pm then one waking and one sleep in through the night. In addition the home employs two enablers whose job it is to take people out through the day to places of their choosing. It has been agreed with us that staff recruitment records can be held centrally by the organisation and therefore are not available in the home for inspection. However, the manager confirmed that she is involved in the recruitment process. Staff are only employed in the home after sufficient background checks have been carried out to help determine their suitability to carry out their role. These checks include the receipt of a Criminal Records Bureau (CRB) checks, two written references, and confirmation of physical fitness. The manager is aware of the requirement from the last inspection to improve staff Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: training and this is in progress. A training plan was produced to ensure staff have the skills to provide good support to people who live in the home and a new plan is being prepared for this year. Any new staff receive an induction that must be forwarded to the company within two weeks and an interim review of ability is carried out by the manager between six and twelve weeks after starting work in the home. Information provided by the manager before the inspection stated that 16 of the 19 support staff have a National Vocational Qualification (NVQ) in care. Staff commented that they are well supported and each of the three surveys returned by staff were positive about training provision. Staff said; we get mandatory training, safeguarding and equality and diversity. Regular support is provided either in supervision or issues can be discussed privately. Training in Person Centred Planning has provided me with a fuller understanding of my role. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interest of the people who live there. Management systems are in place to monitor and improve the support provided and to ensure people are safe. Evidence: The manager is a registered nurse for learning disability and has a number of years experience in a management role. She has only been in post since October 2007 yet in this short period of time she has addressed many of the issues identified at the last inspection. Staff said that she is good at her job and that she has changed things for the better. The views of service users and their families have not been formally sought. Regular visits by company manager take place to assess the care provided and quality reviews are ongoing. There is a rolling programme of training for staff in health and safety matters and staff confirmed that this training has been kept up-to-date. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Appropriate records are maintained of accidents and incidents. Periodic fire checks are done and some fire instruction for staff is in place. The manager is reminded that instruction should be twice yearly for daytime workers and four times a year for staff working through the night. Staff should also sign to confirm they have received the training. The fire risk assessment of the building is also due for review to ensure the home is safe for people who live and work their. Maintenance certificates were checked for the internal wiring of the building, the gas heating system and for small portable appliances. All were in order. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 42 23(4)(e) The manager must implement the system, as planned, to make sure that all staff receive regular fire instruction and drill. 30/04/2008 Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 6 6 7 Ensure all care reviews are brought up to date and that a system is in place to ensure these are maintained. Ensure that goals are regularly followed up and any changes are recorded. The manager should ensure she is aware of who is responsible for replacement items such as bedroom furniture and bedding. This should be made clear in the homes documentation. The manager must introduce the kitchen audit Safer Food Better Business (SFBB) to the staff team to promote good kitchen practice. Improve the quality of information in plans of care by being more specific about how care and support are delivered. Re introduce the key worker system of producing a monthly holistic assessment of care provided. Ensure people are safe in the home by carrying out an assessment of staffs ability to follow the company medication processes. Make staff aware of their responsibility to ensure Medical Administration Record (MAR) Charts are accurate. Provide a Max-Min thermometer to better monitor the Page 27 of 29 4 17 5 18 6 20 Care Homes for Adults (18-65 years) temperature at which medicines are stored. 7 42 The manager should review the system for ensuring fire safety. Review the fire risk assessment each year. Ensure staff fire instruction is regular and that staff sign to confirm they have received the instruction. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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