Inspection on 18/04/05 for Ennis House

This inspection was carried out on 18th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Ennis House 23/11/09

Ennis House 13/08/07

Ennis House 24/05/06

Ennis House 01/12/05

Ennis House 05/11/04

Ennis House 14/04/04

Ennis House 28/05/03

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

1 Marten Road

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Ennis House 59 - 61 Enys Road Eastbourne East Sussex BN21 2DN Lead Inspector Lucy Green Unannounced 18 April 2005 08:40 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Ennis House Address 59 - 61 Enys Road Eastbourne East Sussex BN21 2DN 01323 720719 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Michael Baldry Mr Michael Baldry Care Home 40 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) 40 of places Old age, not falling within any other category (OP) 40 Ennis House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 12 service users with past or present mental health needs aged between 50 and 64 may be accomodated. Date of last inspection 5 November 2004 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 an 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours on 18 April 2005. This is the first statutory inspection of this year. The purpose of this inspection was to assess compliance with the requirements of the last inspection and to generally monitor care practices. Due to the size of the home, two Inspectors undertook this inspection. A tour of the premises took place, rotas and care records were inspected. Thirteen of the residents, four staff and the Manager were spoken with. The Inspectors observed breakfast and the lunchtime meal being served. What the service does well: What has improved since the last inspection? Since the last inspection, the home has reviewed its system of care planning which when fully completed should identify residents’ needs and the individual support required to meet them. Each resident is now issued with a contract which outlines the terms and conditions of their stay at Ennis House. The Care Manager for the home has now introduced a system to provide one to one formal support for staff and induction training has commenced for new staff. Ennis House Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ennis House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Ennis House Version 1.10 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 standard(s) 1, 2, 3 & 5 The documentation available does not provide prospective residents’ with the information they need to make a choice about whether to live at Ennis House. The home is unable to demonstrate that residents’ needs will be met prior to admission. EVIDENCE: Despite being a requirement at previous inspections, the home is still required to update the Statement of Purpose and Service User Guide to provide current and prospective residents with information about the services that Ennis House purports to provide. Several residents’ contracts were viewed and found to contain the relevant terms and conditions affecting their stay at Ennis House. A sample of recent pre-admission assessments were viewed and found that whilst there was evidence that residents are involved in their assessments, they contained insufficient information about the care needs of those residents. The home is therefore required to ensure that they carry out a comprehensive assessment of all residents prior to offering them a place at the home. Ennis House Version 1.10 Page 9 There was evidence to demonstrate that residents are offered a trial period at the home, before a placement becomes permanent. This should be followed up by the home informing residents in writing that they are able to meet their needs at the end of the trial period. Ennis House Version 1.10 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 standard(s) 7, 8 & 9 Staff practice reflects a good understanding of residents’ healthcare needs. The documentation in place does not fully reflect the high level of care provided. Medication is generally managed well. EVIDENCE: A sample of care plans were viewed and significant improvement has been made in this area. However, it was 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. One member of staff in particular, has invested a lot of time reviewing and updating care plans. She acknowledges there is still work to be done and indeed it is required that all care plans provide a comprehensive plan of how residents should be supported. There was evidence that care plans are starting to be reviewed. The Inspector was informed that monthly in-house reviews would now be held and a full care review would be conducted every six months. The review notes for one resident included positive feedback from the relevant Social Worker which highlighted the progress that had been made in respect of her client’s care Ennis House Version 1.10 Page 11 plan. It was possible to audit how advice from a range of healthcare professionals had been incorporated into care notes. Risk assessments are currently inadequate. 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 the two residents who were found smoking in their bedrooms on the day of inspection. 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 is however, required to provide appropriate training for staff who handle medication and the way controlled medication is handled should be reviewed. It is also required that when medication is administered on a prn (prescribed as required) basis, the reverse of the MAR (Medication Administration Record) sheet is completed detailing the reason, time and how much medication was administered. This will enable symptoms to be tracked to ensure any change in health is swiftly noticed. Ennis House Version 1.10 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 standard(s) 12, 13, 14 & 15 Residents are encouraged to live healthy and fulfilling lives, although there is a lack of planned activities. EVIDENCE: Conversations with residents highlighted that community presence and participation in social activities was varied across the home. Some residents are able to go out independently and do so frequently. For others, staff support is required and the frequency of their outings is dependent upon staff availability. Two residents informed one of the Inspectors that an activity programme had previously been in operation, but was no longer in place. Music in care Homes and Parche visit each month, but staff confirmed that other activities were organised in an ad hoc basis. It was evident from the comments received that residents would benefit from a more robust plan of activities – which would take place both inside and outside the home. Ennis House promotes an open door policy during the day. Residents spoke of visitors they had received and the home maintains a record of the contact each resident has with his or her relatives and friends. Ennis House Version 1.10 Page 13 Both breakfast and the lunchtime meal were observed and it was evident that choice and flexibility are paramount. Residents are able to choose where to take their meals, but for many this is seen as a social time. The dining room is arranged into small groups and lots of positive interaction was noticed at this time. The food itself was appetising and nicely presented. All residents spoken with were highly complimentary of the meals at Ennis House. Ennis House Version 1.10 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 standard(s) 16 & 18 The home has a positive approach to the management of complaints and staff understand the vulnerability of residents. Correct recruitment processes must be followed to fully protect residents. EVIDENCE: The complaints book was viewed and this indicated that complaints are recorded, alongside outcomes and actions taken to resolve the complaint. During the inspection, one resident repeated a previous complaint to a senior carer, who responded with knowledge and sensitivity – reminding the resident of the choices available to him. The staff interviewed were knowledgeable about the vulnerability of residents and the systems in place to protect them. Staff spoken with were less confident in describing the importance of the POVA (Protection of Vulnerable Adults) register introduced in July 2004. The Inspector has since forwarded a copy of the Department of Health guidance on this topic and it is expected that this will be incorporated into the home’s policies and discussed with staff. The Head of Care and a Senior Carer are booked to attend a training course on abuse, which they will then cascade to the rest of the team. The Inspectors highlighted that the steps taken within the home to promote the protection of vulnerable adults, is undermined by the lack of a robust recruitment process. Ennis House Version 1.10 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 standard(s) 19 & 22 Residents benefit from an environment which provides choice of space, however, a number of maintenance issues make some areas less homely and uninviting and inaccessible. EVIDENCE: Ennis House is a large property, which in addition to single bedroom accommodation, offers a range of communal areas. During a tour of the building, the Inspectors noted a large number of maintenance issues which require attention. For example, one lounge has been used as a storage area for items awaiting repair. This makes the room look untidy and uninviting and consequently is used by just one of the forty residents. Similarly, the bath panels in several bathrooms are broken and require repair. The carpet in a number of areas is frayed, which not only looks worn, but also poses a trip hazard. Ennis House Version 1.10 Page 16 The home is divided into two areas; one of which provides level access to by way of a passenger lift, the other a stair lift. It was identified at the last inspection that the stair lift was faulty and required repair. At this inspection, it was again found to be out of commission. One resident, is however now unable to leave the first floor where her room is situated as she is no longer able to manage the stairs. Whilst the Manager confirmed that this resident had been offered an alternative room, she had chosen not to move. The home must now balance meeting needs with offering choice, because in failing to repair the stair lift, it is denying one resident all social opportunities. Ennis House Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Residents are supported by a dedicated team of staff who are knowledgeable about their needs. The home fails to ensure residents are protected by a robust recruitment process. 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 confirmed that staffing levels were adequate at this time. The residents who spoke with the Inspector 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, with two staff having completed and three staff working towards National Vocational Qualifications. New staff undertake an induction in line with the National Training Organisation and it is required that the foundation standards are also completed. The recruitment process generated real concerns about how the home ensured that residents were only supported by people who had been appropriately vetted. The Inspectors viewed the recruitment files for three new staff and significant gaps in documentation were found throughout. Of particular concern was the lack of current mandatory checks from the Criminal Records Bureau. In addition these staff files did not contain two written references and an issue about suitable work permits was also identified. An immediate Ennis House Version 1.10 Page 18 requirement notice was issued at the time of inspection, which was followed up with a letter of serious concern. The Inspectors will be undertaking an additional monitoring inspection to ensure these matters have been rectified. Ennis House Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 & 38 Residents’ finances are handled appropriately. The fire safety systems do not safeguard residents and staff from the risk of fire. EVIDENCE: A sample of records pertaining to residents’ finances were viewed and found to be satisfactorily maintained. Throughout the inspection, a number issues in relation to fire safety were identified. These included, a requirement outstanding from the last inspection that the area at the bottom of the external fire escape be cleared to ensure accessibility of this escape route. A large number of fire doors, including the kitchen door were found to be propped open and the glass panes in the door of the quiet lounge were cracked and require replacing. Ennis House Version 1.10 Page 20 Two residents were also observed smoking in their bedrooms against the advice in policies and without a risk assessment in place to ensure the safety of this activity. Ennis House Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x 2 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x 2 x x x x STAFFING Standard No Score 27 3 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x 3 x x 2 Ennis House Version 1.10 Page 22 YES 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 1 Regulation 4&5 Requirement To send a copy of the homes Statement of Purpose and Service User Guide to the Inspector once it has been amended and contains the required information. (Previous timescale of 31 January 2005 not met). That a full pre-admission assessment is carried out on each prospective resident.(Previous timescale of 5 November 2004 not met). The Registered Person confirms in writing to the resident that the home is able to meet his/her needs. Comprehensive risk assessments are carried out in respect of all areas of residents lives and the controls in place evaluated. That the homes care planning system to effectively monitor residents health and welfare needs.(Previous timescale of 31 March 2005 not met). The Registered Person ensure correct medication procedures are followed at all times. The Registered Person consult with residents about a fulfilling Version 1.10 Timescale for action 01 July 2005 2. 3 14(1) 18 April 2005 3. 5 14(1)(d) 01 July 2005 01 July 2005 01 September 2005 18 April 2005 01 July 2005 Page 23 4. 7 13(4) 5. 7 15(2) 6. 7. 9 12 13(2) 16(2)(m) & (n) Ennis House programme of activities. 8. 9. 10. 18 19 22 13(6) 23 23(2)(n) The adult protection policy to be updated to include details of POVA. The maintenance issues identified at the time of the inspection are attended to. The home demonstrate how the resident who is unable to manage the stairs, will be supported if the stair lift is not operational. The home follow correct recruitment procedures to ensure the safety and protection of residents. New staff undertake the foundation training following completion of induction. That the garden at the bottom of the fire exit is tidied to ensure this area is fully accessible to service users and staff. (Previous timescale of 5 November 2004 not met). The practice of propping open fire doors ceases in line with latest guidance from the Fire Brigade. The broken pane of glass in the door of the quiet lounge is replaced. 01 July 2005 01 July 2005 01 June 2005 11. 29 12. 13. 30 38 19 & Schedule 2 as amended 18(1) 23(4)(b) 18 April 2005 01 July 2005 18 April 2005 14. 38 23(4) 18 April 2005 20 May 2005 15. 38 23(2) & (4) 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. Refer to Standard Good Practice Recommendations Ennis House Version 1.10 Page 24 Commission for Social Care Inspection 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 © 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 Ennis House Version 1.10 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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