Random inspection report
Care homes for older people
Name: Address: Englewood Care Home 42-44 Egerton Park Rock Ferry Birkenhead Wirral CH42 4QZ one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Paul Kenyon Date: 2 5 0 1 2 0 1 0 Information about the care home
Name of care home: Address: Englewood Care Home 42-44 Egerton Park Rock Ferry Birkenhead Wirral CH42 4QZ 01516455064 01516455069 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Englewood Care Limited care home 24 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 24 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 24 Date of last inspection Brief description of the care home Englewood provides personal care and support for up to 24 older people who have dementia. The home is situated in a quiet residential area of Rock Ferry in Wirral. Accommodation is on three floors which are served by a passenger lift. The bedrooms are single and all but one of them have en-suite facilities. There is one double bedroom available for people who choose to share, such as married couples or partners. On the ground floor there is a lounge and at the rear of the building a large dining roomlounge overlooking the spacious garden. The home has a call system and mobility aids. There
Care Homes for Older People Page 2 of 16 Brief description of the care home is a large car park at the front. When we visited, the weekly fees for the home were between 395.22 and 458.63 pounds. Additional charges are made for hairdressing, newspapers, clothing, medical requisites other than prescribed medications items of a luxury nature and chiropody. Care Homes for Older People Page 3 of 16 What we found:
This was an unannounced visit to Englewood. For the purposes of this visit, we invited an expert by experience to accompany us. An expert by experience is a member of the public whose role is to provide information to us on their views about the quality of care being provided in the service. Their observations are included within this report. In addition to this, we involved a pharmacy inspector to assess the management of medication in the service and to review progress in the requirements raised in respect of medication during our last visit. This inspection lasted six hours and took place during the morning and afternoon periods. During this time we toured the building, spoke to the people who use the service and observed the care provided. We also looked at a number of records relating to the care provided as well as having discussions with staff, the Acting Manager and the Owner of the service. The nature of the disability of the people who live at Englewood is such that it is not always possible to gain a direct view of their experiences but we were able to observe the care they receive to gain an indication of this. At the time of our visit there were six people living at Englewood. One person remained in hospital and it was uncertain at the time whether this person would come back to live at Englewood. We looked at care plans. We found that two care plans were not available having been taken from the premises by other authorities for the purposes of an investigation. The service had not commenced any temporary care plans to replace these and as a result, the needs of the two people concerned could not be met by the lack of any care plan documentation. The care plans that were available outlined how staff could meet the needs of people in each area of their daily lives and had been reviewed by the service on a monthly basis. As stated that nature of the disability of people is that it would be difficult for them to confirm the contents of care plans. There was no evidence that any families had been involved in agreeing the contents of their relations care plans. We looked at the health needs of people and how the service met these. We found documents to suggest that the health needs of people had been assessed in a number of ways including assessments in relation to continence needs, their daily functioning, their susceptibility of developing pressure sores, their nutritional needs and the monitoring of their weight. We also noted that records suggested that when people had a health problem, the service ensured that they had access to a health professional such as a District Nurse or a Doctor. Contained within care plans is information about how staff should support people in respect of oral care and other health needs. The service assesses people in respect of hazards that they may face in their daily lives which could affect their well being. One involves an assessment of falls. These had been completed for most people with the exception of two which had not been completed by the service. As a result, it was unclear whether these individuals were more or less likely to experience a fall. One of these records related to a person who did have a fall resulting in this person being hospitalised. We looked at the management of medication given that there were a number of
Care Homes for Older People Page 4 of 16 requirements raised during our last visit to the service. We found that the requirements raised at out last visit in relation to medication had not been addressed. There were still issues in relation to the recording of medication receipt, administration and disposal. The service had not addressed training for people administering medication and medications were not being given as prescribed. There remain issues with the auditing of medication. All these remain as requirements in this report and means that the management of medication does not promote the health and wellbeing of the people who use the service. We looked at how the service promotes the privacy and dignity of those who use the service. We noted that staff interacted with people in a positive manner which was dignified. We noted that when individuals needed medication consultations in their rooms, that steps were taken to ensure that this was achieved. We did notice that staff discussed the outcome of a doctors visit one individual had had and medication in the dining room in front of residents, other staff, the pharmacy inspector and the expert by experience. It is required that confidential information should be discussed in private with people or their families and not in front of others. We looked at the daily lives of people in respect of the activities they undertake on a daily basis. The service employs an activities co-ordinator who provides activities during each afternoon on weekdays. Records are maintained by the co-ordinator indicating what activities have been pursued by each person as well as whether the person wished to participate. A timetable of activities is on display as well as photographs of people pursuing such activities. This timetable is looked at by some people but not all, it was noted through discussions with the Acting Manager. It is recommended that the service looks at other ways in which this format could be made appropriate to other people so that they are aware of what activities are being provided to them. The expert by experience who accompanied us on our visit made the following observations: A young lady was employed as a activities co-ordinator and helped with some care work, she was well liked by the residents, and had a good entertainment program worked out for each day.With very little family contact this young ladies work is most important to maintain a community and caring feeling between the residents. She did seem to enjoy her work and had a lovely manner with the residents When it was time for me to leave, the residents and the co-ordinator were singing along to Max Bygraves video on the television We looked at how the service provides food to the people who use the service. The expert by experience made the following observations: Having lunch with the six residents I found the dinning room cold after the warm lounge. The food was well cooked and very nourishing, it could have been presented better with side plates for the bread and butter, with jugs of water on the table.The staff helped the one lady who had difficulty feeding herself. The kitchen was clean and tidy The stock room was well stocked and had plenty of food in the fridges. The dining room was missing some light bulbs, the menu board had last Thursdays menu printed on it . When I asked what was the meal for today, the menu board was brought up to date The menu board indicated that if alternatives were wanted, people could ask the cook before 10 am. It is recommended that the service should review this arrangement to
Care Homes for Older People Page 5 of 16 ensure that it is suitable for the people who use the service so that they can be provided with an alternative meal if they wish. We noted that the service assesses the nutritional needs of people and that these are reviewed monthly. Where further nourishment is needed for people, food supplement drinks have been provided. The kitchen is well equipped and had been the subject of an environmental health inspection in November 2009 with no issues needing to be addressed. We looked at how people who use the service are protected from abuse. An incident prior to our visit had involved the service conducting an investigation in response to an allegation of physical abuse and then reporting it to us. The service had not reported the incident to the Local Authority safeguarding team and when this incident was reported to them by us, they had had to take retrospective action to safeguard the person. In addition to this, the service has a copy of the safeguarding procedure, which although is out of date, provides a clear process for providers to report any concerns. The service has not provided information to staff members about action to take in the event of an allegation of abuse being made and staff do not have information on how to avoid being involved with wills, in receiving gifts or on how to report concerns using whistle blowing. Accident records noted that two people who use the service had been involved in a incident in November 2009 where both had inflicted minor injuries to each other. This was not reported to the safeguarding authority and we had not been made aware of the incident. We toured the premises. The expert by experience noted: I visited all six residents rooms they were tidy and decorated with many of their own belongings on view. The toilets and bath rooms were clean with a good stock of continence products I found the dinning room cold after the warm lounge The dining room was missing some light bulbs Three of the residents lived on the top floor and are escorted in the lift to their rooms by staff. The stairs were secured with wooden gates to prevent residents from their use The gardens at the side and rear of the building were tidy and well kept, with lawn seats at the rear for use in the summer We toured the building and included the lounge, dining room, kitchen, the exterior of the building and all bedrooms and bathrooms. No offensive odours were noted on the ground floor or upper floors but odours were present in two bedrooms. We noted that there were some decorative issues that needed to be addressed. In one bedroom the carpet appeared jaded and in need of replacement. All bedrooms we viewed were adequately decorated but overall was jaded in appearance. There were some areas that needed to have more attention paid to cleaning, for example, a light fitting in one bathroom contained dead insects and this was affecting the amount of light being provided in this area. In another bedroom there was excessive noise coming from Central heating boilers but we were assured by Acting Manager that this is not an issue during the night when the person is in their room. In another bedroom, a carpet was beginning to wear along the seam. Care Homes for Older People Page 6 of 16 We noted that the dining room was very dark given that some light bulbs were missing. There is access to the grounds to the rear of the building and ramps were available for access. Repairs records are available but only suggested activity up until 2008. The Owner stated that he conducts any repairs himself or uses outside contractors. We asked for refurbishment records but these were not available and it is recommended that these are produced. We looked at hygiene standards in the building. As mentioned previously, there were strong offensive odours in two bedrooms and also a light fitting need cleaning. We noted soap and towels were not available in a bathroom and lids were missing off bins.The service does not employ domestic staff but there is an expectation that care staff should perform the role of both domestic, catering and laundry staff. It is required that the service have at least have domestic support so that care staff can concentrate on their caring role. A laundry is available in basement area. No people who use the service can access this area on safety grounds. The laundry contains industrial appliances. We looked at staffing levels in the home and the roles of care staff. Staff rotas indicate that two members of staff are on duty during most of the day with an activities coordinator working during the afternoon. The service does not employ a cook, domestic staff or laundry assistant. Care staff are expected to perform these roles. It is required that the skill mix is improved so that care staff can concentrate on their roles. The service has an Acting Manager who is included in the rota as a carer as well as having to undertake the role of acting manager. A staff rota is available. There was no evidence that staff levels deviate from the two on duty and the activity co-ordinator during weekdays. There was some evidence in care plans that the dependency levels of people have been assessed in the past but this is not an ongoing exercise. It is recommended that this is re-introduced so that the care staffing levels can be linked to the dependency needs of individuals. We looked at how the service recruits new member of staff. We looked at information relating to two people who had come to work at Englewood since our last visit. In both cases, there was information to suggest that the service had conducted checks on the suitability of each person to work in the service. These checks included references, police checks and the obtaining of information confirming the identity of the staff members. We looked at how staff are trained to meet the needs of people. Some training certificates are on file but a training programme revealed gaps in mandatory training such as food hygiene, first aid, health and safety and infection control. The Acting Manager confirmed that some recent training had been undertaken in dementia awareness. It is required that training is brought up to date for mandatory topics. We looked at how the service is managed. The service has an Acting Manager. No candidate to become the registered manner has been forwarded to us and this is a requirement. The Owner of the service undertakes some administrative roles such as payroll and fees and Deputy takes lead in care plan reviews and other management tasks. We looked at how the health and safety of the people who use the service is promoted. Records relating to health and safety training is not consistent with gaps suggesting that staff had not consistently received updated training in mandatory topics such as infection control, food hygiene or first aid. This is raised as a requirement in this report.
Care Homes for Older People Page 7 of 16 There was no evidence that portable appliances had been tested. Fire extinguishers had been serviced in October 2009 and there was evidence that radiators were covered and that window restrictors were in place on windows in upper floors of the building. Accident records are maintained. Records suggested that one person had sustained thirty two accidents over a twelve month period. The same person had not had their risk assessment in relation to falls adequately completed as identified earlier in this report. We noted that accident records suggested that there had been an incident between two individuals where minor injuries had been sustained by both parties.This should have been the subject of a safeguarding referral but no referral had been made. There was no evidence that the service had informed us of this incident.The service had sent us details of other incidents that had adversely affected their well being of individuals but not in this case. This is raised as a requirement in this report. What the care home does well: What they could do better:
As well as issues that the service must address, good practice recommendations are raised in this report. The service must ensure that each person who uses the service has a care plan so that their needs can be met. The service must ensure that risk assessments relating to falls are completed and provide a clear indication of the likelihood that a person will be at risk from repeated falls. Records for the receipt, disposal and administration of medicines must be complete and accurate to reduce the risk of mistakes and to help ensure medicines are given properly. Medication must only be administered by staff who have undergone training and been assessed as competent to handle medicines safely in order to protect the health and wellbeing of people living in the home. Care Homes for Older People Page 8 of 16 Medication must be administered as prescribed and at the correct time with regards to food and drink, in order to ensure that the medicine works properly. The Registered Person must ensure that regular audits (checks) are undertaken on all aspects of medicines management within the service. Findings and actions taken as a result of these audits should be recorded. Confidential information should be discussed in private with people or their families and not in front of others. The service must refer any allegations of abuse to the appropriate authorities so that people are protected. The service must consistently provide safeguarding training to staff so they can serve the best interests of the people who use the service. The service must provide information to staff on the receipt of gifts and will and whistleblowing so that people can be protected from abuse. The service must ensure that offensive odours are eradicated from the two bedrooms identified during the visit so that individuals live in an hygienic environment. The service must ensure that there are ancillary staff employed to ensure that staff can concentrate on their roles as carers to ensure that the needs of people are met. The service must provide mandatory training to staff to ensure that the people who use the service have their health and safety promoted. The service must forward a candidate to become the registered manager for the service so that the individuals receive care which is accountable. The service must inform the Care Quality Commission of any incident that adversely affects the well being of the people who use the service so that their best interests are served. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 16 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 9 13 The Registered Person must 31/12/2009 ensure that regular audits (checks) are undertaken on all aspects of medicines management within the service. Findings and actions taken as a result of these audits should be recorded. 2 9 13(2) Records for the receipt, 31/12/2009 disposal and administration of medicines must be complete and accurate to reduce the risk of mistakes and to help ensure medicines are given properly. 3 9 13 Medication must only be 31/12/2009 administered by staff who have undergone training and been assessed as competent to handle medicines safely in order to protect the health and wellbeing of people living in the home. 4 9 13 Medication must be 31/12/2009 administered as prescribed and at the correct time with regards to food and drink, in order to ensure that the
Page 10 of 16 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action medicine works properly. 5 27 18 The registered person must 31/12/2009 ensure that there are sufficient staff available to meet the needs of the service users at all times, including cleaning, laundry and catering. An assessment must take place of the current staffing arrangements given the number and needs of the residents, size and layout of the home. This requirement was made at an earlier inspection and was to be met by 01/09/2009. 6 31 9 The registered person must 31/12/2009 ensure that there is an individual who is in full time day to day control of the home who has the experience and qualifications necessary to ensure that the home operates in the best interests of the residents. This requirement was made at an earlier inspection and was to be met by 01/09/2009. Care Homes for Older People Page 11 of 16 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 The service must ensure that 26/02/2010 each person who uses the service has a care plan so that their needs can be met. 2 8 12 The service must ensure that 26/02/2010 risk assessments relating to falls are completed and provide a clear indication of the likelihood that a person will be at risk from repeated falls. so that their health and safety is promoted 3 10 12 Confidential information must only be discussed in private with people or their families and not in front of others. So that there privacy and dignity is promoted 17/02/2010 4 18 13 The service must consistently 31/03/2010 provide safeguarding training to staff Care Homes for Older People Page 12 of 16 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action so they can serve the best interests of the people who use the service. 5 18 13 The service must provide information to staff on the receipt of gifts and will and whistleblowing so that people can be protected from abuse. 6 18 13 The service must refer any allegations of abuse to the appropriate authorities so that people are protected. 7 19 23 The service must review lighting levels and temperature in the dining room so that the people who use the service live in a comfortable environment 8 26 13 The service must ensure that 26/02/2010 offensive odours are eradicated from the two bedrooms identified during the visit so that individuals live in an hygienic environment. 9 27 18 The service must ensure that 31/03/2010 there are ancillary staff employed to ensure that staff can concentrate on their roles as carers and address the hygiene issues identified in this report. to ensure that the needs of
Care Homes for Older People Page 13 of 16 26/02/2010 17/02/2010 05/03/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action people are met. 10 30 12 The service must provide mandatory training to staff to ensure that the people who use the service have their health and safety promoted. 11 31 8 The service must appoint a candidate to become the registered manager for the service so that the individuals receive care which is accountable. The service must inform the Care Quality Commission of any incident that adversely affects the well being of the people who use the service so that their best interests are served. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 31/03/2010 31/03/2010 12 38 37 17/02/2010 1 7 The representatives of the people who use the service should been consulted in respect of the contents of their relations care plans so that the people who use the service have their best interests served The format of activities on offer should be reviewed to enable all people to be made aware of what activities are on offer. Details of asking for alternative meals should be reviewed
Page 14 of 16 2 12 3 15 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations in order to meet the communication needs of the people who use the service. 4 5 19 26 The service should provide a plan of proposed refurbishment The light fitting identified during the visit should be cleaned to ensure effective lighting is provided to that individual in the bathroom area. Portable appliances should be tested annually to ensure that the health and safety of people is promoted. 6 37 Care Homes for Older People Page 15 of 16 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 16 of 16 - 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!
