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Inspection on 07/09/06 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 7th September 2006.

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 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 Home has a staff group that appear committed to providing good care to service users. The Home maintains a homely atmosphere that allows the service users to personalise their rooms and make decisions every day in relation to their lifestyles, acre and assessed needs. The Home is exceptionally good at encouraging independence and providing opportunities for service users to move on, socialise and pursue their educational objectives. The overall management of the home is good. The management of activities for the service users is exceptionally good. A robust system is in place for recruitment.

What has improved since the last inspection?

The system for service users who self medicate has improved with risk assessments in place for those who do. A formal supervision system is in place for all staff members. Good records are now kept for all service user involvement in activities. Overall staffing has greatly improved with new staff being recently inducted.

What the care home could do better:

The staff need to ensure that there is recorded service user involvement when compiling the plans of care. The home could have a more fully developed quality monitoring system in place.

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 7th September 2006 11:00 Elsenham House Nursing Home DS0000053608.V312066.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.V312066.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.V312066.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 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 Mrs Patricia Margaret Taylor Care Home 31 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (31) of places Elsenham House Nursing Home DS0000053608.V312066.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 20th September 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.V312066.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over five and a half hours. Opportunity was taken to tour the premises, look at care records and policies and procedures, and communicate with the service users in addition to a visiting professional. Opportunity was also taken to speak with staff members the provider and manager. The inspection report reflects changes that have taken place since the last inspection along with evidence from inspection of Key Standards. Only one comment card was received from a relative prior to the inspection taking place. What the service does well: What has improved since the last inspection? The system for service users who self medicate has improved with risk assessments in place for those who do. A formal supervision system is in place for all staff members. Good records are now kept for all service user involvement in activities. Overall staffing has greatly improved with new staff being recently inducted. Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 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 DS0000053608.V312066.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.V312066.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality outcome for this group is good. This judgement is made using available evidence during the inspection process. Persons who use the service have adequate information to make an informed decision about admission to the Home. Prospective service users or their advocates are informed by written confirmation whether their needs can be met. EVIDENCE: Case tracking of four service users confirmed good practice and that time was taken to ensure that the service users were assessed adequately and that their needs could be met. Service users that were spoken to agreed that they were given sufficient information before admission to the home that allowed them to make an informed choice. They also confirmed that they visited the home on a number of occasions thus giving them the opportunity to ‘test drive’ it first. Contracts were seen for all new admissions. Elsenham House Nursing Home DS0000053608.V312066.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. Quality outcome for this group is good. This judgement has been made using available evidence, the inspection process and discussion with service users and other professionals. Service users are encouraged to lead independent lifestyles. EVIDENCE: The Inspector examined four care plans; the assessment process had been used to formulate a plan of care that also included therapeutic intervention. The care plans were detailed and related to the assessed needs of the service users. It was noted that there had been continued evaluation of care and records of multidisciplinary intervention and review. There were very detailed daily notes and some data had been entered on the care plans when appropriate. There was no evidence of service user involvement in the care planning process and a recommendation is made. Risk assessments were in place and service users are encouraged to take responsible risks; however it is required that all service users who participate in activities and outings have risk assessments in place for these activities. It Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 Page 10 is also required that a policy is put in place for all service users who go on holiday and if travelling abroad. Those service users spoken to indicated in their conversations with the Inspector that they were encouraged to take risks in their daily lives and towards more independence. Elsenham House Nursing Home DS0000053608.V312066.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17. Quality outcome for this group is excellent. This judgement has been made using available evidence, discussion with service users. Activities and meals are managed well. The service users are encouraged to be in control of their own lives and enhance their social skills whilst also developing personally and meeting their educational objectives. EVIDENCE: Examination of care plans revealed that service users attend consultation meetings and in discussion with them the Inspector was able to ascertain that they contributed to the running of the Home. Discussion with the service users confirmed that opportunities were given to encourage them in their personal development and educational needs; various care plans indicated involvement in learning opportunities and leisure activities. Activity programmes were seen and these indicated many activities and visits that have been made and also that have been arranged to take place. One service user enthused about a visit to see the group Motor Head and others had enjoyed a visit to the Mickleborough Collection. Many of the service users now swim twice a week and appear to enjoy this activity. One of the night nurses does some art and craft sessions with the service users. Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 Page 12 Two service users discussed with the Inspector their impending holidays others talked about the various activities they had participated in. On the whole the service users felt that the meals had improved and that they were given a number of choices for each meal. It was noted that the service users are offered a wide variety of food that appears nutritious; fresh fruit is always available and the inspector noted that a number of bowls of fruit were dotted around the home. Elsenham House Nursing Home DS0000053608.V312066.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21. Quality outcome for this group is good. This judgement has been made after discussion with staff and service users. Service users are well supported by staff and the arrangements for administration of medication is handled well. EVIDENCE: Discussion with service users confirmed that they were well supported by all levels of staff and that they were encouraged to make decisions about their daily lives and chose where and when what they wanted to do. Risk assessments are now in place for those service users who self medicate, however there was no evidence of service user involvement or evaluation of their ability to continue this practice and a recommendation is made to ensure the service users compliance with this practice. Those service users spoken to stated that they now get their medication on time; the Inspector observed medication being administered and it appeared to be in a safe well-controlled way with appropriate records being made. Staff are aware of the policies and procedures for the handling and administration of medication. Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 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 the following standard(s): 22,23. Quality outcome in this group is good. This judgement has been made using available evidence, the inspection process and discussion with service users and staff. Arrangements for dealing with complaints are satisfactory. EVIDENCE: The inspector examined the records for complaints, these were detailed and contained notes on action taken. It was also noted that responses to complaints were made within 28 days according to the home’s policy and procedures for making complaints. The Commission has not received any complaints since the last inspection. Service users spoken to were aware of how to air their concerns and the procedure for making a complaint. Staff spoken with, were very aware of all issues relating to the protection of vulnerable adults and they confirmed that they had attended training sessions in relation to this; staff records verified this. A very recent allegation of theft that has come to light and has been handled in the appropriate way with all the necessary agencies being involved; records were seen for this. Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 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 the following standard(s): 24,25,26,30. Quality outcome for this group is good. This judgement has been made on observations made during a tour of the Home, available evidence and discussion with staff, service users and the manager. The overall appearance of the Home has been greatly enhanced. EVIDENCE: The Home was found to be clean and tidy and the service users whose rooms were inspected all said they were satisfied with their accommodation. The rooms were suitable for the clients who live in the Home and the Inspector noted that they had all been personalised to some extent and were very much individualised. One double room has been reduced to a single occupancy. Bathrooms have been re decorated, the nurse’s station and also the quiet room. The smoke room has been altered to provide an extra quiet room. The Manager explained that the next project is to enhance the main sitting room, making it more homely and lighter. Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 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 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. Quality outcome for this group is good. This judgement had been made by, examining records, discussion with staff and management. Much improvement has taken place. EVIDENCE: Discussion with staff members confirmed that they felt that they were well supported by the management and that they were clear about their roles within the Home. They also felt that staffing levels had improved greatly since the last inspection and the duty rosters that were examined confirmed this to be true. Records for newly appointed staff were examined and were seen to reflect a robust checking system before staff are employed. The staff records were also seen to contain appropriate proof of staff identity. The staff spoken to stated that they felt the provision of training opportunities in the home were good and training records indicated this. New staff members confirmed that they had been given an induction and records for these were also seen. Formal supervision has been initiated and records for this were seen; appraisal documentation was also inspected. It is recommended that the supervision records be expanded, to include identification of training needs and professional development so that these can be seen to tie in with the home’s philosophy. Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 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): 37,38,39,40,41,42,43. Quality outcome for this group is good. This judgement is made using information gained from service users, staff, and visiting professionals. Records were also checked to provide further information. Service users benefit from a well managed home and are safeguarded by its policies and procedures. A formal system for monitoring the service needs to be introduced. EVIDENCE: The inspection process, discussion with staff and service users led the inspector to form the opinion that the Home is well run, with the present manager continually developing her skills in relation to management of this type of home. Service users and staff have definitely benefited from the ethos and leadership of the manager who constantly strives to ensure that the Home meets the National Minimum Standards; she also ensures that the home promotes good safe working practices. The staff and service users generally feel that they are well managed and supported. Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 Page 18 Although a number of informal activities exist for monitoring care and the service provided a requirement is made to ensure that this system id formalised. Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 3 4 3 5 3 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 3 25 3 26 3 27 x 28 x 29 x 30 3 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 4 12 4 13 4 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 2 3 3 3 3 Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 Page 20 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. Timescale for action 09/11/06 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 YA20 YA6 Good Practice Recommendations The registered person must encourage records to be kept of service user involvement in self-medication. The registered person must encourage staff to ensure that care plans indicate service user involvement. Elsenham House Nursing Home DS0000053608.V312066.R01.S.doc Version 5.2 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 © 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.V312066.R01.S.doc Version 5.2 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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