CARE HOMES FOR OLDER PEOPLE
Ennis House 59-61 Enys Road Eastbourne East Sussex BN21 2DN Lead Inspector
Lucy Green Unannounced Inspection 1st December 2005 08:45 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 Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 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. Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ennis House Address 59-61 Enys Road Eastbourne East Sussex BN21 2DN 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) 01323 720719 Mr Michael Baldry Mr Michael Baldry Care Home 40 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (40), Old age, not falling within any of places other category (40) Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is forty (40). Service users must be older people aged sixty-five (65) years and over on admission. A maximum of twenty service users at any one time may be aged between fifty (50) and sixty-four (64) years. This includes one named service user aged forty-nine (49) years on admission. Service users with a primary diagnosis of past or present mental illness only to be accommodated. 18th April 2005 4. Date of last inspection Brief Description of the Service: Ennis House is registered to provide long-term residential care for up to forty older people with either a past or present mental disorder. This service does not provide intermediate care. The home is a large property, which has been created by adapting and linking three terraced houses. The home is situated in a residential area of Eastbourne, close to the town centre. Service user accommodation is provided in single rooms, many of which have ensuite facilities. Communal space is provided by a number of lounges and a dining room - which offer both smoking and non-smoking facilities. The home has sufficient toilets and bathrooms. A passenger lift provides partial access to the upstairs of the home. Two spacious gardens are situated to the rear of the property. Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Ennis House have requested to be referred to as ‘residents’. This unannounced inspection took place over five hours on 1st December 2005. Due to the size of the home, two Inspectors undertook this inspection. This is the second inspection of this year and therefore this report should be read in conjunction with the report from the announced inspection carried out on 18th April 2005. The purpose of this inspection was to assess compliance with the requirements of the previous inspection and to generally monitor care practices at the home. A tour of the premises took place, care, medication and recruitment records were inspected. The Inspectors met with eight residents. The Manager, four staff, and three visitors were also spoken with during the inspection. What the service does well:
The home has an experienced team of staff who enjoy their work and have a good understanding of the needs of the people living at the home. Residents spoke highly of the support received by staff and positive relationships between staff and residents were observed. The environment is relaxed and friendly and residents have use of a range of communal areas in addition to their individual rooms. Residents are supported with their personal routines and this support was seen to be offered and carried out with dignity and respect. Residents are offered choice about all aspects of their lives and it was evident from discussions with staff, that consultation and the offering of choice is automatic at Ennis House. Staff had made preparations for Christmas and the Registered Provider/Manager had bought presents for every resident to be opened together on Christmas day. This highlights the sense of community spirit which is prevalent at the home. The home has to manage a lot of resident medication and there are robust systems in place to ensure that this is managed well.
Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 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 Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 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): 1,2 , 3, 4 & 5 Residents benefit from accessible information that outlines the rights and responsibilities attached to a placement at Ennis House. Residents benefit from the opportunity to assess the suitability of the home prior to admission. Residents would be better protected if pre-admission assessments were thoroughly documented. EVIDENCE: The home has complied with requirements of previous inspections and produced an up to date Statement of Purpose and Service User Guide. These documents provide accessible information about the services offered at Ennis House. A written contract is now in place which outlines the terms and conditions attached to a placement at Ennis House.
Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 9 Prospective residents are encouraged to visit the home prior to admission to assess the suitability of the placement. There was evidence that for the most recent admission, the home had confirmed in writing that the trial period had expired and that the home could meet the individual’s needs. The assessment information however, does not contain sufficient information to provide documentary evidence that a thorough assessment has been conducted. Consequently, it is not possible to judge whether all assessed needs are being met. In order to fully meet Standards 3 and 4, the home must ensure that a comprehensive pre-admission assessment is carried out for all potential admissions and provide the documentation in care plans to support this. Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 10 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, 10 & 11 Staff practice continues to reflect a good understanding of residents’ personal healthcare needs. The documentation in place does not fully reflect the level of care provided. Residents are protected by the way medication is managed. EVIDENCE: Staff practices observed throughout the inspection, demonstrated a good understanding of the residents and their needs. Discussion with staff produced evidence that staff have the knowledge required to provide appropriate personal and healthcare support to the residents at Ennis House. A sample of care plans were viewed and it was evident that continued improvements have been made in this area. However, it was again noted that the positive outcomes observed for residents at this time are still dependent upon staff knowledge and memories, rather than full and detailed recording systems. The home has recently employed one member of staff to concentrate on reviewing and updating care plans. It is vital that this person liaises closely with those staff providing the direct care as there is still work to be done to
Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 11 ensure all care plans provide a comprehensive plan of how residents should be supported. Risk assessments still need additional detail. It is required that where risks are identified, they are followed through with an assessment of the controls in place to minimise those risks. This is particularly important in respect of residents who may go out independently, or who smoke in their bedrooms. The home has a good system in place for managing the large amount of medication that has to be administered each day. Records were clear and it was possible to track changes of medication. The home has taken on board requirements from the last inspection and introduced a system for the correct handling of prn medication (prescribed as necessary). Several staff have undertaken relevant medication training and a further three staff are booked on a course for February 2006. The Head of Care reported that only staff who have been appropriately supervises handle medication. Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 12 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 Residents benefit from an inclusive and sociable environment, where choice is offered as a matter of instinct. EVIDENCE: The home has made a significant improvement in respect of producing a programme of fulfilling activities for residents. A social profile has been compiled for each resident which provides a synopsis of information about the social likes and dislikes of each resident. The activity timetable commenced the week prior to inspection and from the evaluation sheets in place, there was evidence that residents had engaged in arts and craft sessions and worked on a jigsaw puzzle together. The home has purchased a number of items to enable these activities to happen. Leading up to Christmas, residents had begun making festive crackers with gifts that could be given to relatives and friends. Carol singers were booked to come into the home the following weekend. Some residents are able to go out independently, for others support is required. The Head of Care reported that the home was in the process of licensing a vehicle to enable more trips outside the home to occur.
Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 13 During the inspection, several visitors were observed ‘popping in’ to visit their friends or relatives. It was evident that Ennis House has an open culture, where visitors feel free to drop by at any time. One visitor thanked staff “for the way they had looked after her friend and for the happy memories she has now had”. Throughout the inspection it was evident that residents at Ennis House have a lot of choice and control over their lives. Staff were observed offering choice about drink and meals. Mail is given unopened to residents and privacy is respected at all times. Conversations with staff highlighted that choice is something they do automatically. The home does however, need to improve its systems for evidencing this choice, as the care plans do not reflect the hard work that goes on. Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 14 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): These standards were not assessed at this inspection, please refer to inspection report from 18 April 2005. EVIDENCE: Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 15 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 Residents benefit from an environment which provides choice of space and privacy, however, a number of maintenance issues impact on both safety and homeliness. EVIDENCE: Ennis House is a large property, which in addition to single bedroom accommodation, offers a range of communal areas. The home is divided into two areas; one of which provides level access by way of a passenger lift, the other a stair lift. The stair lift is not currently in operation and the Manager reported that this is being removed. The residents accommodated in this part of the house must therefore, be fully ambulant. During a tour of the building, the Inspectors again noted a large number of maintenance issues which require attention. For example, the carpet in a number of areas is frayed, which not only looks worn, but also poses a trip hazard. Two window panes were found to be cracked and in need of repair, one of the corridors upstairs is being used as a general storage area and for reasons of fire safety, this area should be clear. Fibre glass is also exposed
Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 16 and needs to be sealed. Door locks had been adjusted on a number of communal doors, but part of the lock is protruding through the doors and these need to be removed to prevent injury. A number of bedrooms were found to be malodorous and the continence issues for these residents needs to be managed more effectively. The Manager has therefore been required to undertake a full maintenance audit of the home to ensure the above, and any other issues are addressed. Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 17 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): 27, 28, 29 & 30 Residents are supported by a dedicated team of staff who are knowledgeable about their needs. Greater protection is afforded to residents by the improved recruitment procedures now in place. Residents would further benefit if staff received training which is specific to some of their complex needs. EVIDENCE: On the day of inspection, there were sufficient staff to support the needs of residents as detailed in the care plans. Staff spoken with again confirmed that staffing levels were adequate at this time. The residents who spoke with the Inspectors commented how nice staff were and how they felt relaxed and happy to ask for help. The Inspectors observed lots of positive interaction between residents and staff. Staff training is ongoing, two staff have completed and several staff are working towards National Vocational Qualifications (NVQ). Ten staff are undertaking an induction in line with the National Training Organisation through an outside training body. Once the induction training has been completed, these people will then move on to NVQ’s. Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 18 The home has a training matrix in place and recent updates in manual handling and first aid have just been held. It was however identified that staff would benefit from some specific training in supporting people with mental health needs and managing challenging behaviour. It was a requirement of the last inspection that the home take urgent steps to improve the recruitment practices within the home. It was pleasing to note that significant improvements in this area had been made. The staff files for three recently recruited staff were inspected. References, details of any working permits and appropriate checks by the Criminal Records Bureau are now in place. It was identified that a full employment history and copies of relevant qualifications, had not been obtained in all cases and therefore this area now needs to be concentrated on. Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 19 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): 31, 32, 33 & 38 Residents benefit from living in a home that is run for their best interests. Residents’ would be better consulted if formal systems for quality assurance were in place. Residents would be better protected if the identified health and safety issues were addressed. EVIDENCE: The management team at Ennis House, ensure that the home is run in the best interests of the people who live at the home. The Registered Owner/Manager has been in post for eighteen years and has a wealth of experience in this field. That being said, he does not have either the care or management qualifications required by the National Minimum Standards. The Head of Care and a senior carer are both working towards NVQ 4 and therefore the management team
Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 20 collectively have the skills. A future discussion will need to be had with the Registered Manager about how these standards can be fully met. The outcome for residents and staff is that Ennis House is an open and inclusive environment where they feel valued and listened to. That being said, there are no formal systems in place for monitoring quality assurance. This is another area where working practices are good, but the lack of recording lets the home down. Steps have been taken since the last inspection to improve the fire safety at Ennis House. Those maintenance issues previously identified, do however need to be addressed at they impose on the general health and safety of the home. Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 21 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 3 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 3 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 X 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X X X X 2 Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement That a full pre-admission assessment is carried out on each prospective resident. (Previous timescales of 5 November 2004 and 18/04/05 not met). Comprehensive risk assessments are carried out in respect of all areas of residents lives and the controls in place evaluated. (Previous timescale of 01/07/05 not met) That the homes care planning system to effectively monitor residents health and welfare needs. (Previous timescales of 31 March 2005 and 01/09/05 not met). The adult protection policy to be updated to include details of POVA. (Previous timescale of 01/07/05 not met) The maintenance issues identified at the time of the inspection are attended to. Action is taken to effectively manage the continence needs of service users and ensure the home is free from offensive
DS0000021096.V249344.R01.S.doc Timescale for action 01/01/06 2. OP7 13(4) 01/03/06 3. OP7 15(2) 01/04/06 4. OP18 13(6) 01/03/06 5. 6. OP19 OP26 23 16(2)(k) 10/01/06 01/02/06 Ennis House Version 5.1 Page 23 7. OP29 19 & Sch 2 8. OP30 18(1)(c)(i ) 24 23(2&4) 9. 10. OP33 OP38 odours. The home obtain a full employment history and copy of any certificates of all new staff. (Previous timescale of 18/04/05 not met) Staff receive training in managing challenging behaviour and supporting people with mental health needs. A formal system of monitoring quality assurance to be put in place. The broken glass panes in the windows identified be repaired or replaced. . 10/01/06 01/05/06 01/03/06 10/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ennis House DS0000021096.V249344.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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