CARE HOME ADULTS 18-65
Elsenham House Nursing Home 49-53, 57 Station Road Cromer Norfolk NR27 0DX Lead Inspector
Mrs Marilyn Fellingham Announced Inspection 20th September 2005 12:45 Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 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.V251814.R01.S.doc Version 5.0 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.V251814.R01.S.doc Version 5.0 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 jdupuis@elsenhamhouse.freeserve.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 Anthony Lee Care Home 31 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (31) of places Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named service user over the age of 65 may be accommodated. Date of last inspection 18th June 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 DS0000053608.V251814.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection that took place over five hours. Opportunity was taken to examine staff records and policies, communicate with both staff members and service users. The manager and administrator were both present for the inspection, the provider was away. What the service does well: What has improved since the last inspection?
Activities are now being organised continually with appropriate staff intervention, trips out take place once a week and are well organised in advance: it was also noted that efforts have been made to enable dedicated staff to undertake activities in a planned and structured manner. The staffing situation has improved with the addition of more qualified staff on duty to ensure service user’s needs are met. A waking registered mental health nurse is now on duty every night thus ensuring a safe environment at all times. Service users now benefit from the clarity of staff roles and responsibilities and the appointment of a competent manager. It is recognised that the home has endeavoured to respond to all the requirements made at the last inspection. All service users’ monies are now audited on a weekly basis within a strict accounting system; care plans have been introduced for residents to enable them to handle their monies in a safe and structured way. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 Page 6 There is now a large resource room that can be used for art and craft activities with service users, it is also used for service user reviews with the various agencies and affords for a better more private venue for this. The menus have undergone a big change with the introduction of fresh vegetables and home cooked food. The menus appeared to be varied and well balanced. 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 DS0000053608.V251814.R01.S.doc Version 5.0 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.V251814.R01.S.doc Version 5.0 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 the following standard(s): 2 Assessment prior to admission is good. EVIDENCE: Assessments of prospective service users are always carried out before admission. The paper work for this process was seen and found to be informative. The procedure for admission takes place in some cases over a number of weeks so that the home and service users can be absolutely sure that the home can meet their needs. Discussion with a recent admission confirmed this process for admission and he stated that he had many visits to the home before living there and also had spent an overnight stay as well. He felt that the admission process to the home was informative and allowed him time to make an informed decision. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 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 the following standard(s): 6 EVIDENCE: Examination of care plans indicate that the care planning system is clear and adequately provides staff with the information they need to meet the assessed and changing needs and personal goals of the residents. The plan also clearly indicates where risks are involved and individual procedures for those residents who exhibit self-harm or aggressive behaviour. It was also evident that the service users are involved with the care planning with the intervention of all appropriate agencies that are involved in the service users care. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 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 the following standard(s): 12,13,15,16,17 The home offers a range of suitable activities and outings. The home provides suitable and well-balanced meals. EVIDENCE: The management of activities has undergone an enormous change and now offers the service users a range of options to satisfy their social, cultural, recreational and educational needs. The Inspector saw a programme for these and it is produced each week. Over the past weeks there have been visits to local National Trust houses, Seal trips, Pensthorpe and a trip to a Science Museum is planned for later in the month. The service users commented that they are enjoying these visits and that they have been out and about a lot. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 Page 11 There was much evidence during the inspection of activities taking place and unlike in the past there were very few service users in evidence during the Inspectors visit. One service user was returning after a visit to her parents, another service user was attending a sports Btec course, whilst others were off to bowling. All activities undertaken by the service users are done so by choice and guidance from their nominated nurses and carers. It is recommended that these activities are recorded on care plans and notes made on resident’s interactive skills during these visits. Menus were examined by the Inspector and they appear to be well balanced and provide fresh fruit and vegetables. The service users spoken with stated that the meals were better and that choices were available, one vegetarian felt his diet was adequate. A new cook has recently been appointed but service users need to be encouraged to stay out of the kitchen and bad language kept to a minimum. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 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 the following standard(s): 18,20 Service users are supported by the staff. The administration of medication is mostly handled well. EVIDENCE: Discussion with service users confirmed that they felt that they were well supported by the staff in a way that they preferred and that they commented that it had improved since the appointment of the new manager. Some service users self medicate, however there were no risk assessments in place for this activity and a requirement is made to ensure safe practice of this procedure. It is also recommended that policies and procedures be put in place to encourage best practice for self-medication. It was a judgement by some service users that the administration of medication was late when the manager was not on duty sometimes when staff spend a lot of time in the office; reflecting the needs of the staff rather that meeting the needs of the residents. They did however say that they felt the timing of giving them their medication had improved. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 22,23 Arrangements for dealing with complaints are satisfactory. EVIDENCE: Service users spoken to indicate that they would speak with the manager, provider or associate nurse if they had a complaint or a concern. They also muted that they felt that they would be listened to. Information about how to make a complaint is readily available and given to each service user. One complaint made by a service user was being handled well and all appropriate measures taken to deal with it. The Inspector spoke at great length with this particular service user who felt that he had been listened to and that his complaint was being handled seriously. The Inspector also saw records made in relation to this complaint and it was apparent that a responses to complaints are provided within 28 days according to the home’s procedure. Staff have received adult protection training and records were seen for this, staff spoken to also confirmed that they had attended sessions relating to vulnerable adults. Staff when asked by the Inspector were aware of the Whistle Blowing procedure and stated that they would not hesitate to blow the whistle if they felt that a resident was being abused. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 Page 14 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 the following standard(s): No standards assessed EVIDENCE: Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 The deployment and number of qualified staff on duty at all times is sufficient to meet the stated purpose of the home and the assessed needs of the residents. EVIDENCE: It was evident during the inspection process and after discussion with staff and service users that there was a better understanding and clarity in relation to roles and responsibilities, and that it was having a direct impact on the both the staff and the residents in that there was a much more cohesive team of staff working in the home. New job descriptions have been issued, examples of these were seen and the staff also had new contracts. Those staff spoken with appear much happier and there is less sickness. Since the addition of the new manager staff have a clear direction and understand their roles and responsibilities, this was also commented upon by the residents living in the home and those relatives spoken to. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 Page 16 Examination of duty rosters revealed that the deployment of staff has improved and that there are appropriate, qualified and skilled staff to meet the assessed needs of the service users. Safety during shifts has also improved and one carer highlighted this by describing a scenario whereby a service user had a hypoglycaemic attack and there were two qualified nurses on duty, one able to deal with the service user and the other to continue giving medication to the other service users, thus avoiding any displays of agitation by those waiting to receive their tablets. Carers also stated that they felt more confident during their shifts and better supported by the management. Recruitment is on going and follows the protocol laid out in the standard; all new staff have a probationary period and service users are encouraged to participate informally in the selection process. Most of the carers are finishing their NVQ level 2 training and one is due to complete level 3. Staff training records were seen and training sessions are competently managed by the administrator who has endeavoured to ensure training is applicable to meeting the needs of the service users and the criteria of the standards. Informal staff support has improved greatly, however a system for formal supervision needs to be addressed and a requirement is made. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,42 Service users are benefiting from a better managed home; their safety is safeguarded by the homes policies and practices that are now being introduced. EVIDENCE: It would appear that the home is now managed well, the new manager is competent and experienced in mental health; she has already created what appears to be an open and inclusive atmosphere. One comment from a service user was that “it is better with the new manager” and “we are looked after well”; another service user commented that “I am looked after properly here, and I feel I can approach the management for help”. Other comments from service users and two relatives were that they hoped that the new manager was not going to leave. The home promotes safe working practices and sessions are being arranged to ensure staff are familiar with moving and handling, first aid and all aspects of food hygiene and infection control. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 Page 18 One new member of staff confirmed that she had all the relevant training in fire procedure, food hygiene and the care of vulnerable adults; she stated that she had and does feel very well supported by all members of the staff team. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 Page 19 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 3 X X x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X X x Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Elsenham House Nursing Home Score 3 X 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 X X X 3 x DS0000053608.V251814.R01.S.doc Version 5.0 Page 20 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 YA36 Regulation 18 (2) Requirement The registered person shall ensure that persons working at the care home are appropriately supervised. Timescale for action 20/09/05 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 YA20 Good Practice Recommendations The registered person must encourage the use of risk assessments for self-medication and make sure policies and procedures are in place for this activity, thus encouraging safe practice. Elsenham House Nursing Home DS0000053608.V251814.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Norfolk Area Office 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
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