CARE HOMES FOR OLDER PEOPLE
Emsworth House Emsworth House Close Havant Road Emsworth Hampshire PO10 7JR Lead Inspector
Gina Pickering Unannounced Inspection 27th September 2005 09:30 X10015.doc Version 1.40 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 Emsworth House DS0000037245.V255215.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 Older People. 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. Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Emsworth House Address Emsworth House Close Havant Road Emsworth Hampshire PO10 7JR 01243 373016 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) Hampshire County Council Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Old age, registration, with number not falling within any other category (36) of places Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th May 2005 Brief Description of the Service: Emsworth House is a care home registered to provide personal care for up to 36 service users over 65 years of age. At present building work is in progress to extend the home to provide 40 nursing beds. As a result of the work the home is at present accommodating no more than 28 residents. The home is registered to provide care for residents with a diagnosis of dementia as well as for the older person. However again due to the building work in progress the management team have made an assessment that at the moment the home is not a suitable environment to deliver care to residents with dementia type illnesses. An acting unit manager with the support of an assistant manager team is managing the home. A new manager has been appointed and is undertaking and induction process whilst awaiting completion of the manager registration process by CSCI. The home is situated in a residential area of Emsworth within easy access of local community facilities and local health acre facilities. Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over five hours on 27th September 2005. as part of the inspection process the inspector spoke with the acting manager, the assistant managers, six staff members, one visitor and ten residents as well inspecting a sample of documents and touring the environment. For the purpose of this report the acting unit manager and the assistant managers shall be referred to as the management team. Discussion with staff at the home evidenced that those who live at the home like to be called residents, this shall be reflected throughout this report. Residents offered such comments as ‘ it’s wonderful’, and ‘every one is very helpful’. Many residents stated that they had no complaints. Staff commented that they are fully supported by the management team to fulfil their roles. What the service does well: What has improved since the last inspection?
Following the last inspection medication administration records are documented correctly indicating any reason for residents not receiving their medications. Medication fridge temperatures are now recorded in the correct manner assuring the effectiveness of medications stored there. The practice of
Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 6 the building workmen entering the home via the laundry area has ceased which reduces the risk of cross infection. The implementation of new care planning systems with training and support for staff should improve the welfare of residents by staff having more information about the needs of the residents. By all staff attending the planned training sessions booked for October will improve the good protection of residents from the effects of abuse offered by the home. 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. Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed and met at the previous inspection dated 24/05/05. EVIDENCE: Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 New care planning systems being implemented should result in detailed information being available of resident’s health, personal and social needs. Evidence is available of good multidisciplinary involvement to ensure the health and wellbeing of the residents. The poor practice of not labelling individual resident’s lotions and ointments poses a risk to the wellbeing and health of the residents. EVIDENCE: Care plans detail the actions to be taken to meet the resident’s personal, health and social care needs. Some care plans contain more detailed information that others. This was discussed with the acting manager who agreed that it was part of staff development to give staff the training to enable them to produce more comprehensive care plans. The home is to implement a
Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 10 new care-planning document that has been developed by Hampshire county council to be used in all local authority care homes. This should provide opportunity for the plan of care to be more comprehensive providing staff receive the appropriate training and support to enable them use the plans effectively. Resident’s health needs are monitored by the use of the care planning system. A local GP visits the home on a weekly basis to address any health care issues that clients have. Conversation with care workers evidenced that there is a process in which GP’s are called out to see clients that are not well. Care workers also confirmed that all clients have access to domiciliary visits from chiropodists, dentists, and opticians. District nurses provide any nursing care input required. Following several requirements from the previous inspection the storage and recording of medications was inspected again. All medication administration charts are completed accurately. The medication fridge temperatures are monitored correctly ensuring the stability of medications stored there. However some lotions and eye drops still do not have the opening dates on or the name of the resident they are for written on the tube. A second requirement has been made about this. Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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 & 14 The home provides stimulating and varied activities to enrich the life of the residents, with staff at the home acknowledging the interests and social needs of the resident group. The ethos and philosophy of the home creates an environment in which clients are able to exercise choice and control within their daily life, and are encouraged and supported to maintain links with the local community. EVIDENCE: Care plans give a description of the resident including their family and social history and their hobbies and interests. A comprehensive entertainment programme is arranged for the year that incorporates sing a longs, plays, and games. The home has been developing activities on a one to one basis or in small groups. This can include manicures, games, flower arranging, arts and crafts, knitting and trips to the beach or into the town. residents voiced their appreciation of both the arranged visiting entertainers and the house arranged entertainment. All activities are monitored and documented including the aims of the activity and the outcome of the activity. These are used as part of the quality monitoring of the home to improve the service provided.
Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 12 The home encourages and supports residents to maintain contact with their family and friends. Discussion with residents evidenced that they are able to retain control oven their daily activities, such as being able to make the choice whether to join in with activities or not, where to take their meals, and for those able to whether to access the community independently or with support. Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 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 Residents are protected from abuse by staff who have a clear understanding of the issues surrounding the protection of vulnerable adults. EVIDENCE: Following a recommendation made from the previous inspection all staff are due to attend formal training about the protection of vulnerable adults. This will enhance their knowledge and further protect residents from the effects of abuse. Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 A well maintained and hygienic environment promote the welfare and safety of the people living at the home. EVIDENCE: Both these standards were fully assessed at the previous inspection on 24th May 2005. However the inspector assessed the home to evidence that the building work taking place is not affecting residents. At the time of the inspection there was no evidence of the building works affecting the environment of the home. All areas were clean and tidy. No hazards to the well being of the clients were noted. All areas are accessible to the residents with the exception of some areas of the garden that have been closed off due to the building works. However there is still a substantial garden area that can be accessed by the residents. The previous inspection had noted that workmen were accessing the home through the laundry area. This practice no longer happens. Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Resident’s well-being is protected by the robust recruitment practices employed at the home. EVIDENCE: The home utilises Hampshire County Council’s recruitment policies and procedures. Inspecting a sample of staff files evidenced that this policy is adhered to ensuring that prior to commencing employment two satisfactory written references are obtained, CRB and POVA clearance is obtained as well as details of the applicants relevant qualifications and evidence of their identity. Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 Good practices ensure that residents’ finical interests are safe guarded. EVIDENCE: The inspector discussed residents’ finances with the home’s administrator. Only one resident is able to manage her own finances, all other residents have family or advocates that manage their finances. The home will keep residents ‘spending money’ on site. This is kept in a safe within the administrator’s office. Records of this money were inspected evidencing that individuals residents money is kept in individual wallets, all receipts for money received and spent are kept. And accurate record of residents’ monies is recorded on individual sheets that are backed up by information on the computor system. Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X X Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? yes 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 OP9 Regulation 13(2) Requirement The registered person must ensure that all tubes of ointment and creams have the opening date written on them. THIS REQUIREMENT HAS PREVIOUSLY BEEN MADE ON THE 24/05/05. The name of the client that the ointment or cream is prescribed for must be on the container. Timescale for action 14/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Emsworth House DS0000037245.V255215.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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