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Inspection on 20/03/08 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 20th March 2008.

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 no outstanding requirements from the previous inspection report, but made 7 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

Elsenham House has a homely feel that is promoted by the staff. Good assessments are made before people are admitted to the home. People`s health, personal and mental health needs are met and their privacy and dignity are upheld. The home continues to encourage the people who use the service to move towards greater independence. Meals at the home provide choice for the service users and are well balanced and nutritious. Activities are managed well. A robust system is in place for recruitment.

What has improved since the last inspection?

The service user care plans now have evidence of their involvement in the care planning process. Some areas of the home have been refurbished.

What the care home could do better:

Record all medicines that enter the home. Keep the environment free from hazards internally and externally. Manage the administration and handling of medicines more thoroughly. Non-use of `tippex` on medicine record charts. Record all complaints and how they are dealt with. Deal with offensive odours. All residents must have care plans for all aspects of care. Inform the Commission of all incidents.Make sure all residents who self medicate have appropriate locking facilities in their rooms.

CARE HOME ADULTS 18-65 Elsenham House Nursing Home 49-53, 57 Station Road Cromer Norfolk NR27 0DX Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 20th March 2008 10:00 Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 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 Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 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 Adults 18-65. 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. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elsenham House Nursing Home Address 49-53, 57 Station Road Cromer Norfolk NR27 0DX 01263 513564 01263 511511 elsenhamhouse@hotmail.co.uk 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) Elsenham House Ltd John Dupuis Care Home 31 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (31) of places Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user over the age of 65 may be accommodated. Date of last inspection 7th September 2006 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 DS0000053608.V362400.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. This was an unannounced inspection that took place over seven and a half hours. Opportunity was taken to tour the premises, look at care records and policies and procedures and communicate with the home’s service users and also the staff and management. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the provider/manager, the clinical manager some residents, staff and other people who visit the home. This report gives a brief overview of the current judgements for each outcome group. What the service does well: What has improved since the last inspection? What they could do better: Record all medicines that enter the home. Keep the environment free from hazards internally and externally. Manage the administration and handling of medicines more thoroughly. Non-use of ‘tippex’ on medicine record charts. Record all complaints and how they are dealt with. Deal with offensive odours. All residents must have care plans for all aspects of care. Inform the Commission of all incidents. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 6 Make sure all residents who self medicate have appropriate locking facilities in their rooms. 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. The summary of this inspection report can be made available in other formats on request. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Persons who use the service have an appropriate assessment before admission to the home, this means that their diverse needs are identified and planned for before they move into the home. EVIDENCE: We examined the assessment records for those service users that had been admitted since the last key inspection. These were found to be good and assessed all elements of need in relation to each individual. Prospective service users are assessed over a period of time which gives them the opportunity to ‘test drive’ the home and also allows the home to decide if their needs can be met. Newly admitted service users confirmed that this had been the practice before their admission to the home. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system and the delivery of care means that all service users have their personal and mental health needs met. EVIDENCE: We examined six care plans that had been formulated using the assessment process. The care plans were detailed and covered all aspects of care including therapeutic intervention. The care plans showed evidence of service user involvement and those service users we spoke with confirmed that they were included in all aspects of their care. Risk assessments were in place for most of the service users, however we did note that some needed risk assessments for certain identified behaviour. A number of service users are prescribed Clozaril and Warfarin but did not have any care plans in place for this to ensure that all care is given in relation to this medicine and symptoms that may occur. Care plans that we looked at had evidence of continued evaluation of care and changes in care as the need arose. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 10 It was evident from case tracking that individuals are encouraged to risk take in relation to developing their independence. We noted that there were very detailed daily notes. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are actively supported and encouraged to integrate within the local community and access a variety of social situations. EVIDENCE: Discussion with the clinical manager, members of staff and residents and recording on file evidenced that the home offers service users numerous positive opportunities for education and socialisation within the home and the wider community friends and family. The staff team are aware of the need to promote individuals confidence and self esteem to ensure that they do not become too dependent on the service that is offered by the home. The routine of the home is organised to promote the inclusion of all service users whilst also recognising their need for privacy and freedom of choice within their lifestyle. The home has a facility for those service users who are increasing their move towards living more independently where the residents are encouraged to shop for food and then under supervision prepare and cook it. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 12 There were impressive care plans in place for this activity and notes on service user involvement. The service user we spoke with said that they enjoyed doing this and felt that they were increasing their move towards more independence. The resident also explained to us that they were responsible for ensuring that their flat was kept clean and had a rota for all domestic activities. The meals continue to be well managed and the menus are well balanced and nutritious, those residents we spoke with all stated that they felt that the food was good. Those residents that we spoke with confirmed that they were given ample opportunities to participate in many activities. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive a good level of support from a dedicated staff team. People who use this service are being placed at risk by unsafe management of medication. EVIDENCE: Comments from residents confirmed that staff are always available to support them in how they manage their illness and assist them to develop coping strategies to deal with their behaviour. We were unable to do a spot check for medication to ensure that the amount tallied with that, that had been recorded as given, not given or destroyed, this was because the home does not audit any medication that enters the home. The medication records varied in their quality; there were a number of gaps on the charts with no explanation of why a medication had not been given. We also noted that ‘tippex’ had been used on a medication record this is bad practice and must be avoided. Those service users who have prn (as required) medication prescribed must have care plans in place to justify the continued use of the medication. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 14 Those people who ‘self medicate’ must have locked facilities in their rooms to store the medication safely. The policies and procedure for medication needs to be updated to ensure that the administration and handling of medication is appropriately managed. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are listened to and the staff are aware of issues related to safeguarding adults. EVIDENCE: The home has an adequate complaints procedure that is contained in the service user guide. Those residents we spoke with said that they knew who to go to if they had any concerns and felt that they were listened to. Although the home’s annual quality assessment document stated that they recorded all concerns and complaints this was found not to be so. We were aware of at least one complaint in relation to an allegation of theft from a resident, however we could find no record of how this was dealt with and what action was taken. The home has appropriate procedures in place with regard to safeguarding adults and whistle-blowing, those staff we spoke with were aware of issues relating to safeguarding adults and confirmed that they had had training in this area. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of maintenance to the stair carpets means that the people who use the service could be potentially at risk. Lack of appropriate ventilation of the smoke room can place service users who do not smoke at risk. EVIDENCE: As part of the inspection a complete tour of the premises was undertaken with the exception of those rooms that were occupied. Whilst we acknowledge some areas have been refurbished we found some areas that were in need of immediate attention. The smoke room needs to be better ventilated as smoke was permeating into the next room; the carpet on the three steps leading into this room was in need of replacement and constituted a hazard. The carpet on one flight of stairs was very threadbare and in need of replacement as it also constituted a hazard. Room eighteen strongly smelt of urine. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 17 We noted that there was no current risk assessment in place for the environment. The area in the back garden was littered with unused furniture and poses a hazard for those service users who use the garden. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 18 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The appointment of a clinical manager does not seem to have had a negative effect on the staff. A robust system is in place for recruitment. Service users benefit from the clarity of staff roles, they also benefit from a cohesive team. EVIDENCE: Discussion with staff members confirmed that they felt very well supported especially by the clinical manager. They did not feel that the changes in management had impacted in any way on them or the service users. The staff did feel that since the introduction of the ‘key worker’ system they were more aware of their roles; they also felt that there was a “lovely” atmosphere and that the team was cohesive. The staff confirmed that they felt they could approach anyone with their concerns. Those staff seen by us felt that they had the necessary skills to meet the needs of the service users and that regular training continues to take place and records were seen for this. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 19 Records for newly appointed staff were examined and were seen to reflect a robust checking system. All new staff have an induction and one new member of staff confirmed this. Examination of duty rosters confirmed that staffing was adequate to meet the needs of the service users. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 20 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new management arrangements are meeting the needs of the service users. Notice must be given to the Commission without delay of any incidents that have occurred in the home. EVIDENCE: Since the last key inspection the provider has been registered as the manager and a clinical manager has been appointed. The inspection process, discussion with staff and service users led us to form the opinion that the home is well run and that the clinical manager is developing his skills in this role, he is also doing NVQ level 4 in management although the new registered manager is not. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 21 During examination of resident’s records we noted that some incidents had taken place that we were not notified about, the home must ensure that they keep the Commission informed of all incidents that occur in the home. The service users and staff appear to be benefiting from the leadership in the clinical area and the team seem to be working well together. We were unable to examine any records to evaluate if the quality assurance systems are in place or effective. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 3 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 2 2 3 2 3 Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 23 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 YA39 Regulation 24 (1) (a) (b) (2) Requirement The registered person shall establish and maintain a formal system for reviewing and monitoring and improving the quality of care and supply the commission with a report in respect of any review. This is a repeated requirement When medication is administered to people who use the service it must be clearly recorded. This will ensure that people receive the correct levels of medication. All medicines that enter the home must be recorded, this will ensure that audit trails may be carried out. All parts of the home to which service users have access must be reasonably free from hazards, this will maintain the safety of those people who work and use the service. The home must instigate a system for monitoring the quality of the services it provides to ensure that the home is run in the best interests of the people who use the service. DS0000053608.V362400.R01.S.doc Timescale for action 20/08/08 2. YA20 13 (2) 20/03/08 3. YA20 13 (2) 20/04/08 4. YA24 13 (4) (a) (c) 20/03/08 5. YA39 24 20/07/08 Elsenham House Nursing Home Version 5.2 Page 24 6. YA37 37 7. YA20 13 (2) The home must ensure that it informs the Commission of any significant events, this will ensure that the home complies with the Care Standards Act and Regulations. People who use the service who are prescribed prn (as required) medication must have care plans in place to justify continued use of the medicine. 20/03/08 20/04/08 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. 4. 5. 6. 7. Refer to Standard YA20 YA6 YA37 YA20 YA22 YA24 YA37 Good Practice Recommendations All service users who self medicate must be given suitable lockable facilities for storing their medication. All service users who are prescribed Warfarin and Clozaril Should have care plans to monitor the symptoms of these medicines and prevent any side effects. It is recommended that the registered manager has a level 4 NVQ in management. To ensure best practice it is advisable not to use tippex on the medicine record charts, this will also prevent mistakes being made. Records should be kept of all complaints and how they have been dealt with. It is recommended that the risk assessment of the environment is appropriately maintained. Review of the policies and procedures is necessary to ensure practice is up to date and meets current legislation. Elsenham House Nursing Home DS0000053608.V362400.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000053608.V362400.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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