Inspection on 24/01/08 for Englewood Care Home

This inspection was carried out on 24th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Englewood Care Home 25/01/10

Englewood Care Home 06/04/09

Englewood Care Home 30/04/08

Englewood Care Home 14/08/07

Englewood Care Home 21/11/06

Englewood Care Home 25/05/06

Englewood Care Home 26/01/06

Englewood Care Home 04/05/05

Englewood Care Home 20/12/04

Englewood Care Home 18/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Englewood Care Home 42-44 Egerton Park Rock Ferry Birkenhead Wirral CH42 4QZ Lead Inspector Beate Field Key Unannounced Inspection 24th January 2008 10:30 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 Englewood Care Home DS0000054702.V358858.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 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. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Englewood Care Home Address 42-44 Egerton Park Rock Ferry Birkenhead Wirral CH42 4QZ 0151 645 5064 0151 6455069 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) Englewood Care Limited Post Vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 24 service users to include:* Up to 24 service users in the category of DE (E) (Dementia over the age of 65 years). Date of last inspection 12th October 2007 Brief Description of the Service: Englewood care home provides personal care and support for 24 older people, both male and female over the age of 65, who have dementia. The home is situated in a residential area. Accommodation is provided on three floors, which are accessible by a passenger lift. The bedrooms are single with most having en-suite facilities. There is one double bedroom. The home has two communal areas on the ground floor. There is a lounge and a large dining room and conservatory to the rear of the building overlooking the garden. The home has a call system and mobility aids. Ample car parking is available. At the time of this inspection, the weekly fees for the home were £406.84. Additional charges are made for hairdressing, newspapers, clothing, medical requisites (other than prescribed medications) items of a luxury nature and chiropody. A service user guide and a statement of purpose, which describe the services offered is available to new residents, their relatives and professionals before a resident comes to live at the home. A copy of the most recent inspection report can be obtained from the manager. Englewood Care Home DS0000054702.V358858.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 the people who use this service experience adequate quality outcomes. This inspection is based on a site visit to the home by two inspectors over a 5.5-hour period and is also informed by information received about the service since the last inspection and by questionnaires completed by relatives and staff. During the site visit to the home time was spent in the office looking at a sample of records and policies and procedures and talking to the manager. A tour of the home was undertaken. The inspectors spoke with residents, relatives and staff and made observations of the care given by staff. What the service does well: The assessment of new residents ensures that a service is only offered to people whose needs can be met. Residents and their relatives benefit from being able to visit the home to see if it is right for them before moving in. Visitors are encouraged to visit the home. Appealing and well-balanced meals are provided. Relatives know how to complain and would feel comfortable about doing so. This ensures that they are able to make their views known and this protects the residents’ rights. A clean and homely environment is provided. Relatives made positive comments about the care and support provided by staff. Staff were observed to be friendly and polite towards residents. This creates a pleasant and relaxed atmosphere within the home. A number of the staff have worked at the home for over three years. This means that the residents are cared for by staff who are familiar to them and know their needs. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The residents’ care plans need to provide greater information for staff on the action they are to take to meet the residents health and social care needs and minimise the risk of falls. This information must be available to ensure that the wellbeing of the residents is promoted at all times. A programme of activities needs to be made available at the home following consultation with the residents and their relatives to ensure that residents receive appropriate stimulation in accordance with their wishes. Improvements need to be made to the home to ensure that residents enjoy a good standard of decoration and furnishings. A sufficient number of staff need to be available in the evenings and at the weekends in order to promote the well-being of the residents and promote their safety. Staff need to have access to the training they require to carry out their roles effectively. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 7 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. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 8 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 Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment of new residents ensures that a service is only offered to people whose needs can be met. Residents and their relatives benefit from being able to visit the home to see if it is right for them before moving in. EVIDENCE: Since the last inspection a manager has been appointed who has experience of assessing the needs of older people with dementia. Records showed that an assessment is undertaken before any resident moves to the home. The assessments of three new residents were seen. These assessments provided the basis from which a plan of care can be developed. Information is now recorded about the residents’ dementia and how this is presented and around the residents’ life before moving to the home. This Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 10 information is needed so that it can inform the residents care plan and ensure that staff have the information they need to fully support the residents. Care needs to be taken to ensure that the standard assessment tools used for nutrition and skin care clearly show what the result of the assessment is and the action that needs to be taken as a result. The manager and relatives confirmed that prospective residents and their relatives are able to visit the home before moving in. During these visits they can meet staff and current residents and view the home. Records showed that residents have a contract with the home that outlines what is covered by the fees and the rights of the home and the resident. Intermediate care is not provided at the home. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and social care needs of residents would be better met if the care plans and risk assessments contained more detailed information for staff to refer to. EVIDENCE: Six residents’ care plans were seen. There has been an improvement to the detail of information now available for staff to refer to. Social history has been recorded and provides basic information for staff around the residents’ lives before they came to live at the home and what is important to them. The care plans also provide some basic information about what residents can do for themselves. The manager has only been in post for 6 weeks and plans to build on this to provide more guidance to staff around the action they are to take to enable residents to maintain their independence, where this is appropriate. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 12 More information on how the residents’ dementia presents and how staff are to respond is now being recorded. The manager recognised that further information is needed and again said they will be building on this over the coming months. Support plans around meeting the needs of residents who can display aggressive behaviour have been developed and again provide information that the manager can expand upon to provide greater guidance for staff. Where residents have a specific illness such as dysphasia or Parkinson’s disease, there continues to be a need for clear written guidance to be available for staff to refer to on how these illnesses present themselves and the support staff are to provide the resident. Detailed risk assessments around how to safeguard a resident and minimise the risks of falls were not available. The assessments available do not provide sufficient guidance to staff on the actions to be taken to minimise the risk of falls. The assessments do not indicate how to make sure a safe environment is provided, how nutritional and medication factors may be significant. This needs to be addressed so as to provide detailed information on falls prevention. The manager recognised this and said that these assessments are to be reviewed as a matter of priority. Where residents are receiving support from the district nurse, the guidance from the district nurse to staff around how they are to support the residents is not recorded in the residents care plan for staff to refer to, for example around bathing, encouraging mobility and change of position. This information was recorded in the care plan completed by the district nurses. However, staff do not refer to the district nurses care plans. The daily records were very brief and need to be expanded upon to provide more information about a residents’ day-to-day well being at the home. Clear records have been made of visits to residents by any health care professionals and the outcome. Relatives and friends who returned surveys said that the care needs of their friend/relative are always or usually met. Some comments made were: “ The home is very good and all work in unison to help the residents.” “Absolutely wonderful.” Care needs are always met. “Home could do no better.” “The staff are always kind and caring to my relative. They like the sense of humour of the staff. They say they are happy and that’s what matters most.” Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 13 “They provide a caring environment. We are welcome to visit at any time and made welcome. All staff seem to care about and know who everyone is.” “They look after the people who need care and attention so that they can enjoy the life that is left to them.” Policies and procedures for handling and recording medication are available. A sample of the medicine administration record (MAR) sheets and corresponding medications were inspected and found to be correctly maintained. Staff who administer medication have undertaken training in the safe handling and administration of medication. It continues to be recommended that a record be made of the assessed competence of staff to administer medication. No residents manage their own medication. Some patient information leaflets were not available for some medications. These should be made available for all medications that are administered at the home. During lunch it was observed that medication was placed into a dispensing pot and left on the dining room table for a resident to take. There were other residents at the table having their lunch and the staff were not supervising. This is not a safe practice as other residents could have taken this medication. This was brought to the attention of the manager who dealt with this immediately. Staff were observed to treat residents with respect. Staff were observed to speak to residents in a respectful manner. The relatives who returned surveys said that the staff always or usually respect their relatives privacy. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A range of planned activities needs to made available to ensure that residents receive appropriate stimulation in accordance with their wishes. EVIDENCE: There is no longer an activities co-ordinator at the home. There was no programme of activities available for the residents at the time of the visit. Staff reported that they put music or a video on for residents and play games with the residents and paint the residents nails when there is time to allow this. However, staff reported that there is often little time to do this. 4 staff who returned questionnaires said that more activities are needed for the residents, some comments were: “We could do with more indoor and outdoor activities” “It would be good if we could take residents out more.” Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 15 “More activities are needed for the residents.” “We need more outings and activities.” Some relatives who returned questionnaires said that there are usually enough activities, however others commented that they would like to see more activities provided at the home. Some comments made were: “I hope they will continue with suitable activities as my relative has only mild dementia and can communicate quite well.” “Trips and entertainment are lacking.” Consultation needs to take place with residents, where appropriate and their relatives/advocates with a view to providing a range of activities that meet the preferences of the current residents. A discussion with staff indicated that the routines of daily living are flexible. Staff said residents make decisions about their day-to-day lives at the home, such as when they will get up and go to bed and what they will do each day. The manager is currently reviewing the residents care plans to provide greater information around the skills that the residents have. This will further assist residents to have their choices respected. The residents’ bedrooms that were seen had been personalised with items brought in from their own homes. The religion of residents is documented and it is understood that a minister from a local Church of England church and a priest from a Catholic church visit the home every Saturday. Visitors are welcome at the home and observations showed that visitors call to see their relatives throughout the day. Residents can see visitors in private in their bedrooms or in the dining room. The relatives who were spoken with said they are made to feel welcome when they visit. A four-week menu is in place. The menus showed that varied meals are provided that would meet the nutritional needs of residents. There is a choice of a cooked breakfast or cereal or toast and a choice of meals at teatime and for supper. At dinner time one main meal and pudding is provided. An alternative is made available for residents. The time for lunch is 12.30pm – 1.30pm and the evening meal is from 4.30pm – 5.30pm. The staff reported that they did not consider the meal times to be too close together as there was never any food left over and residents always seem to be asking when the evening meal is from around 4.00pm. The manager was asked to review the times that meals are provided to ensure that this meets the needs of the residents. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 16 Observations were made of the food provided at lunchtime. The food looked appealing and well balanced. All residents sat at the dining tables and none required assistance with eating. Residents said that they liked the food. It continues to be recommended that the cook be provided with training around meeting the dietary needs of individuals with dementia. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The wellbeing of residents is safeguarded by the procedures and practices for responding to complaints and adult protection matters. EVIDENCE: There is a complaints procedure available, which is displayed in the reception area of the home. Relatives who were spoken with and those who returned questionnaires said that they would know how to complain if they needed to and those who had raised any issues said they were always or usually given an appropriate response. No complaints had been recorded in the home’s records since the last inspection. The manager and staff interviewed were aware of the action to be taken should a complaint be made to them. The home has a copy of Wirral Borough Council’s adult protection procedures. No allegations of abuse have been made at the home over the past twelve months. The manager and staff interviewed were very well aware of the procedure to follow should they suspect abuse. Since the last inspection the majority of staff have received further training around safeguarding older people from abuse. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An adequate environment is provided with all areas being clean and odour free. Residents would benefit from the home environment being assessed to identify further ways of helping them to find their way around the home. EVIDENCE: The home was clean with no unpleasant smells. There was evidence of some decorative and maintenance works taking place since the last key visit to the service. Some bedroom carpets have been replaced; new beds, mattresses and bedding have been made available. As reported in the last key visit to the home, some of the furniture and furnishings in the communal rooms and bedrooms were showing signs of wear Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 19 and tear. Some of the chairs in the bedrooms did not appear clean due to staining. The dining room tables are sturdy but appear a little worn. The carpet on the landings was showing signs of wear. Some of the carpets in a sample of bedrooms seen showed staining due to wear. The manager reported that since being in post she has identified decorative and maintenance works that are needed. The manager reported that there are plans in place to replace carpet to the hall, landing and stairs. A programme of refurbishment for the home needs to be drawn up and forwarded to the CSCI. A sample of resident’s bedrooms seen had been personalised and were homely. Residents who are related are currently sharing a bedroom. It would be good practice to make a further room available for their use. There were sufficient toilets, showers and bathrooms to meet residents’ needs and there were aids such as hoists in the bathrooms to help staff assist residents to get in and out of the bath. The base of the shower has been leaking and repaired with a large amount of putty. The shower is used a great deal by the residents and the shower base should be replaced. Communal areas are provided in a dining room, which has a conservatory with seating areas and in a lounge. The home is registered for 24 people yet there are only 20 comfortable chairs available, 12 in the lounge and 8 in the conservatory. At present there are a sufficient number of chairs for the people living at the home, however further chairs will need to be made available when more than 20 people are living there. The lounge is a small room and some chairs do not enable the residents to see the television. The manager reported that the owner has plans to extend this room to make greater space available. Following the key visit the manager reported that the lounge, dining room and conservatory had been re-organised to allow greater sitting space for the residents and to ensure that each resident can watch a television. Relatives who returned questionnaires said that the home is clean. A tour of the home showed that in general a safe environment is maintained. Tests of hot water temperature are being recorded and show that water is being delivered at a safe temperature. Radiators have a low surface temperature and window restrictors are in place. One residents’ bed was against a radiator, although this has a controlled surface temperature, the pipes underneath the bed were very hot and present a risk to the residents safety. Following the key visit the manager reported that this bedroom had been re-organised and the exposed pipes covered. The manager also reported that all the bedrooms have been assessed for any similar risks. An assessment of the environment should take place by an individual with experience in dementia care with a view to making the home environment more accessible. At present photographs of residents have been placed next to their bedrooms. Further aids such as this should be made available. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 20 Residents currently have to go outside to smoke. A review of these arrangements should be made with a view to promoting a safe home and work environment and the rights of the resident. There is a private enclosed garden with seating areas for the residents and their visitors to use in the warmer weather. The garden had a variety of plants and bushes and a bird table as well as a paved path around the grass. The garden is secured by gates and lit by security lights. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A sufficient number of staff need to be available in the evenings and at the weekends in order to promote the well-being of the residents and promote their safety. EVIDENCE: There have been some improvements to the staffing levels at the home since the last key visit. The rota shows that during the week from 8am – 5pm there are either 3 or 4 care staff on duty with sufficient catering and domestic staff. During the evenings there are two care staff available and at the weekends there are 3 care staff available until either 1pm or 2pm, then there are 2 staff available. At the time of this visit there were 14 residents with dementia living at the home. 2 residents were in hospital and due to return and a further resident was due to move in to the home. Given the needs of the residents and that the home is a large building and has 3 floors two care staff are not sufficient. The manager recognised this and reported that further staff have been recruited and that inductions will be carried out next week. Sufficient staff need to be available at all times to meet the needs of the residents. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 22 The rota does not clearly reflect which staff are performing which roles. For example, where a care assistant also performs catering duties the times allocated to each role must be clearly indicated on the rota. Since the last visit to the home a more thorough induction, which meets the standards of Skills for Care has been introduced. There was evidence that the manager is working through these induction standards with a new member of staff. Records show training is provided to staff around health and safety matters such as first aid, infection control, food hygiene, fire awareness, moving and handling and whistle blowing. The staff training records showed that updates are needed in this training and that some staff have not had training in health and safety, first aid, moving and handling or infection control. The manager reported that she has identified that there are some training shortfalls and that this is being addressed. Staff are encouraged to undertake an NVQ in Care of the Elderly. It was reported that over 50 of staff have received this training. A sample of training certificates were seen. Staff have received a days training in caring for older people with dementia, since the last visit to the home. Staff reported that this did not provide a great deal of information on managing aggressive behaviour. At the last key inspection visit to the home and at this visit staff said that they need further, more detailed, training as they find some behaviours difficult to manage. It is important that staff receive this given the potential difficult behaviours some residents may display. Further, more detailed training in meeting the needs of older people with dementia needs to be planned. Staff interviewed said that they enjoy working at the home and are happy that a manager has been appointed. They said that they receive training that is relevant to the work they do and that they feel well supported. The views of staff were varied as to whether there are sufficient staff available at all times to meet the needs of the residents. Some said that there are always, some usually and some said more staff are needed at weekends and in the evenings. Relatives who returned questionnaires and those spoken with described staff as patient and caring. Some comments made were the staff are “always kind and caring,” “ the care staff are excellent and never seem to weaken they do everything well.” Two staff files were examined during the inspection. These were wellorganised and contained sufficient information. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has made improvements since being in post a short time, however a consistent manager needs to be in place for these improvements to be kept up and for further improvements to be achieved. EVIDENCE: Since the last key visit to the home a manager has been appointed who has experience of managing residential services for older people who have dementia. The manager holds a relevant qualification in care and has recently completed a management qualification. The manager is in the process of applying to the CSCI to be registered. The manager has been in post for 6 Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 24 weeks and has in this time identified what works well at the home and what improvements need to be made. As indicated in this report the manager has made some improvements since being in post a short time, however, improvements are still needed to care plans, the activities available for the residents, the home environment and the staffing available. There now needs to be consistency in the management arrangements at the home for these issues to be effectively addressed. The staff who returned questionnaires and those spoken said that they are pleased that a manager has been appointed. Relatives who returned surveys made similar comments, these included, “Management is a problem at the home. Managers do not stay long.” “Hopefully the new manager will stay so improvements can be seen to the end.” The manager has taken steps to put in place some systems for reviewing and improving the quality of care provided at the home. Supervision has been provided to all staff and a programme has been developed to ensure that staff receive regular supervision over the next 12 months. One staff meeting has been held and arrangements made for these to take place on a regular basis. Questionnaires have been sent to relatives in the past and there are plans to do this again. Questionnaires should also be sent to visiting professionals as to how the home is achieving goals for residents. There was evidence of other systems in place for quality assurance, which have been developed but not kept up to date. These systems should be revisited as they provide a good way of assessing the operation of the home. Further work should also take place around obtaining the views of the residents’ as there was little evidence available to show how this takes place. The home looks after monies deposited by relatives or advocates. The records of this were seen for 3 residents and were found to be in order. Residents are able to bring personal possessions to the home. A sample of safety certificates were seen. The electrical wiring certificate expired in November 2007. The fire alarm and the emergency lighting were also inspected as part of the inspection of the electrical wiring. Evidence that the electrical wiring and the fire alarm and the emergency lighting are working satisfactorily is to be forwarded to the CSCI. The records of staff checks of the fire alarm and emergency lighting showed that these are occurring at the recommended frequencies. A fire drill is due the last one took place in August 2007. Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 25 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X 3 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement Timescale for action 24/02/08 The registered person must ensure that the residents care plans contain clear information as to how staff are to meet the residents personal, social and health care needs. This includes providing sufficient information around how staff are to support residents who have specific medical conditions (this requirement remains outstanding from a previous inspection). The registered person must ensure that risk assessments in relation to falls are comprehensive in order to provide clear guidance to staff around what they need to do to prevent a fall (this requirement remains outstanding from a previous inspection). The registered person must ensure that the residents care plans contain clear information as to how staff are to support residents who have pressure sores (this requirement remains DS0000054702.V358858.R01.S.doc 2. OP7 15 24/02/08 3. OP7 14 24/02/08 Englewood Care Home Version 5.2 Page 27 outstanding from a previous inspection). 4. OP9 13 The registered person must ensure that medication is administered safely at all times. The registered person must consult residents about the programme of activities at the home and provide facilities for recreation having regard to the needs of the residents, activities in relation to recreation, fitness and training (this requirement remains outstanding from a previous inspection). The registered person must ensure that a rolling programme of refurbishment is continued to improve and enhance the premises for residents. A programme of refurbishment for the next 12 months is to be forwarded to the CSCI. The registered person must ensure that action is taken to address the risks presented by the hot exposed pipes running underneath a resident’s bed. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of residents, ensure that at all times suitably qualified, competent and experienced staff are working at the care home in such numbers as are appropriate for the health and welfare of the residents (this requirement remains outstanding from a previous inspection). The registered person must ensure that there is a clear DS0000054702.V358858.R01.S.doc 24/01/08 5. OP12 16 24/02/08 6. OP19 16 & 23 24/02/08 7. OP19 13 24/01/08 8. OP27 18 24/01/08 9. OP27 18 24/01/08 Englewood Care Home Version 5.2 Page 28 record of the duties to be carried out each week by the staff employed at the home (this requirement remains outstanding from a previous inspection). 10. OP27 18 The registered persons must ensure that all staff are provided with appropriate training for the work they perform. The registered persons must provide evidence that the fire alarm and emergency lighting are working satisfactorily. The registered persons must provide evidence that the electrical wiring of the home is safe. 24/04/08 11. OP38 23 24/02/08 12. OP38 23 24/02/08 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. Refer to Standard OP9 OP9 OP15 Good Practice Recommendations A record should be made of the assessed competence of staff to administer medication. Patient information leaflets should be made available for all medications that are administered at the home. The cook should be provided with training around meeting the nutritional needs of older people with dementia so that they have the information needed to meet the varying needs that will be presented. The manager should review the times that meals are provided to ensure that these times meet the needs of the residents. 4. OP15 Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 29 5. 6. OP19 OP19 Where residents are sharing a bedroom it would be good practice to make a further room available for their use. An assessment of the environment should take place by an individual with experience in dementia care with a view to making the home environment more accessible. A review of the smoking arrangements for residents should take place with a view to promoting both a safe home and work environment and the rights of the resident. The shower base should be replaced. Further work should take place around ways of obtaining the views of the residents. 7. OP19 8. 9. OP19 OP33 Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 Englewood Care Home DS0000054702.V358858.R01.S.doc Version 5.2 Page 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!