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Inspection on 18/06/05 for Elsenham House Nursing Home

Also see our care home review for Elsenham House Nursing Home for more information

This inspection was carried out on 18th June 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff are keen to move forward and adhere to regulatory activities. The staff are anxious to ensure the safety of the service users.

What has improved since the last inspection?

What the care home could do better:

The home needs to retain qualified members of staff - especially managers - as this would also encourage a more cohesive team. The provider needs to ensure that all staff members have clear job descriptions and that they understand the roles for which they have been employed. The service needs to improve the provision of activities especially at the weekends when the residents are not attending their various jobs and attending further education courses. The home must consider an on call system where said members of the staff team are nominated to be on call: not the hit and miss system that is in place at the moment where someone who lives close to the home might be available. The service must consider a more appropriate place to store the Nomad Medicine cassettes, as they are left on the desk in the office at the moment: although the office is locked, a constant stream of residents access this office thus presenting a safety hazard in relation to the storage of these medicines.

CARE HOME ADULTS 18-65 Elsenham House Nursing Home 49-53, 57 Station Road Cromer Norfolk NR27 0DX Lead Inspector Marilyn Fellingham Unannounced 18 June 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Elsenham House Nursing Home Address 49-53, 57 Station Road Cromer Norfolk NR27 0DX 01263 513564 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) jdupuis@elsenhamhouse.freeserve.co.uk Elsenham House Ltd Anthony Lee Care Home 31 Category(ies) of Mental Disorder (31) registration, with number of places Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: One named service user over the age of 65 may be accommodated. Date of last inspection 27 January 2005 Brief Description of the Service: Elsenham House is situated in an urban location, on the outskirts of Cromer and comprises of four properties, divided by one house in between. The first three properties were built in approximately 1890, they have small rear gardens where there are lawned areas and patios for Service Users use. Public transport services include a bus service every 15 minutes and a train service from Cromer every 20 minutes. Fifty-seven Station Road, Cromer, the fourth property, is intended as a unit where Service Users are encouraged to develop their skills and become more independent, prior to moving back into the community. Many of the Service Users are encouraged to promote as much independence as is possible and are facilitated to continue to engage in outside the Home activities and work experience. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection in response to the Commission’s concern for staffing levels in the home and other issues that were identified at the last inspection. The inspection took place over 2 hours. One Registered Mental Health nurse was on duty with five carers, one of these cares was on duty in number 53, one was on duty in number 57 and three were on duty in the main house along with the registered nurse. One Service User was on holiday and three were on weekend leave, leaving a total of 22 Service Users scattered around the home. One resident was out shopping with a carer and the rest were sitting around the house and on the steps outside the entrance to the home. The Inspector spoke with six of the Service Users and four members of staff. One Service User was being particularly noisy at the time of inspection. What the service does well: What has improved since the last inspection? The residents now have a better choice of food and less restrictions are in place. The Inspector was very encouraged by the decision of the Proprietor – subsequent to this inspection – to fully implement the Requirement on additional staffing in order to minimise risk overnight and at weekends. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 6 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. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare 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) Scoring of Standards Statutory Requirements Identified During the Inspection Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) no standards inspected. EVIDENCE: Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 Not all Service User’s personal goals are reflected in the plan of care. Although in some cases the service users make decisions about their lives, it is apparent that this does not happen consistently. In some instances there is no evidence of service users being allowed to take risks as part of an independent lifestyle. EVIDENCE: The Inspector gained the impression that some residents are unable to manage or access their own money when they wanted to; it would appear that in some cases a daily allowance is allocated. However this was not reflected in plans of care with nothing recorded to signify that this action was carried out in the best interests of the client or with their consent. The lack of care planning also reflects that the residents are not being consulted or encouraged to take risks as part of an independent life style. The Inspector was unable to see records of how residents’ money was handled as she was informed by the nurse in charge that it was dealt with by the administrator. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14, 17 The provision of social activities is not managed in a way which ensures service users are offered choices throughout the week. The service users are given a healthy diet with choices available. EVIDENCE: There was very little activity going on within the home and many of the residents were observed by the Inspector to be sitting around the home in a lethargic way. One resident was being particularly noisy and when the nurse who was in charge was asked by the Inspector for the diagnosis she could not provide an accurate one as indicated in the notes. There was no visible timetable for weekend activities and when questioned the residents had no idea what might be available for them to engage in. Examination of the care plans did not reveal any related information about activities or involvement of the residents. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 11 The Inspector gained the impression after discussion with some residents and the two members of kitchen staff that the meals had improved greatly and that there was a good choice available each meal time. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 It was a judgement of some of the service users (which the inspector was not able to corroborate) that the administration of medication was sometimes carried out at a time reflecting the needs of the staff rather than the needs of the service users. More secure storage of medication is recommended – out of sight of the service users. EVIDENCE: The Inspector was led to believe after discussion with some service users that they do not always get their medication at the time it is due; they felt that the ‘hand overs’ sometimes take too long and some staff spend a lot of time shut in the office. There were no records in care plans of residents becoming anxious that they had not received their medication, however the inspector gained the impression that delayed administration of the medication made some of the residents very anxious thus producing a potentially unstable environment. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 13 The cassettes containing the residents medication are kept in the nurses office on the desk. The office is locked at all times when empty, however there is always a constant stream of residents going into the office to seek counsel with the trained members of staff and could lead to the medication being misappropriated. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) no standards inspected EVIDENCE: Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) no standards inspected EVIDENCE: Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36 The deployment and number of qualified staff on duty at weekends is not sufficient to meet the stated purpose of the home and the assessed needs of the people who live it. EVIDENCE: The Inspector gained the impression during her visit that there was lack of clarity of roles within the home that led to confusion amongst the staff and service users; she also gained the impression that the staff did not work as an effective cohesive team and that there was a great deal of dissension amongst them. Some members of staff still do not have contracts in place. There is no ‘on call’ system in place whereby members of staff are delegated to come on duty in times of an emergency; this is of particular importance when only one qualified member of staff is on duty at the weekends. The overall impression gained after discussion with staff and residents is that the service users could be better supported by well supervised and adequate staff. Examination of the duty rosters once again indicated only one nurse on duty at the weekends and one ‘sleeping’ nurse on night duty. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,43 There is contradictory leadership within the home, this leads to the residents not always being in receipt of a consistent quality of care. Service users do not at the moment benefit from a common ethos or management approach. EVIDENCE: The home has undergone major changes in management over the past year with the resignation of two managers and some qualified staff. The impression gained on the day of inspection was that there was still much controversy amongst the staff in relation to the roles of the clinicians vis-à-vis the management. As already mentioned in evidence for other standards, many of the issues surrounding the management of the home are staff related and the absence of clearly defined roles for the provider, manager and staff. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x x 2 x x 3 Standard No 31 32 33 34 35 36 Score 2 2 2 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Elsenham House Nursing Home Score x x 2 x Standard No 37 38 39 40 41 42 43 Score 2 2 x x x x 2 I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 19 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 YA32 and 33 Regulation 18 Requirement The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This relates to the need to have two qualified staff on duty over weekends and a waking qualified staff member overnight. The registered person shall ensure that the home is conducted so as to promote and make proper provision for the health and welfare of the service users. Timescale for action Immediate and on going 2. YA 42 12 Immediate and on going RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA12 YA14 Good Practice Recommendations It is recommended that activities are better organised. It is recommended that more outings are offered for the residents to engage in and also short holidays. I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 20 Elsenham House Nursing Home 3. YA37 It is recommended that all staff have clear lines of accountability and clinical leadership is introduced. Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF 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 Elsenham House Nursing Home I55 S53608 Elsenham House V233794 180605 Stage 4.doc Version 1.30 Page 22 - 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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