CARE HOMES FOR OLDER PEOPLE
Erith House Lower Erith Road Torquay Devon TQ1 2PX Lead Inspector
Sharon Goldsworthy Announced 23 August 2005 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. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Erith House Address Lower Erith Road Torquay Devon TQ1 2PX 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) Erith House Management Committee 01803 293736 01803 211311 Mrs Jane Hannaby CRH 20 Category(ies) of Old age not falling within any other category(20) registration, with number Physical Disability over 65 Years (20) of places Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th January 2005 Brief Description of the Service: Erith House provides residential care for up to twenty older people, who may have physical disabilities. The house was purpose built in Victorian times, and was solidly built, with gothic archways and fine windows. It is set in a large attractive garden in a quiet residential area in Wellswood, between Torquay and Babbacombe. There is level access throughout, with a shaft lift, and wide doors and corridors. Flagstones have been laid along the garden paths to make walking easier. There are raised toilet seats and a Parker bath. As well as a large lounge and dining room there is a library and a kitchenette for the use of service users. All bedrooms are single, with en-suite facilities. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on the 23rd August at 9.15am for the duration of 5.5 hours. A tour of the premises was conducted. Discussions were held with committee members, the Manager and a sample of seven residents. A sample of records was also viewed and discussed with the committee members and Manager. The Manager completed pre-inspection documentation and one resident and one relative completed pre-inspection questionnaires. What the service does well: What has improved since the last inspection?
The Manager has addressed and met the vast majority of the Requirements and Recommendations made at the last inspection. In particular she has implemented new care plans for all residents, has written a comprehensive employee handbook that is now ready to be implemented, has implemented and recorded regular staff meetings and staff supervision meetings and arranged several staff training events, that have either been completed or are due to take place in the next few months. This level of enthusiasm, confidence and drive should be commended and encouraged and will be to the benefit of all concerned, in particular the residents and to staff morale.
Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 6 As mentioned above, the home have recently employed a Registered Nurse who supports the Manager in overseeing the resident’s health care needs. It is felt by all concerned that this level of support is still required and should continue. 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. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 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 Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 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) 3 Residents can be assured of a full assessment of their needs for suitability before being offered a place at Erith House. EVIDENCE: Resident’s files sampled, evidenced that the home had received social services and completed their own needs assessments prior to service users being admitted. The home’s needs assessment includes personal care and physical well-being, diet and dietary preferences, mobility, history of falls, continence, medication, mental state, social interests, religious and cultural needs, risk assessment and carer and family involvement. Residents spoken with confirmed that the Manager did meet with them at their previous address and that they were able to visit the home and meet with the Manager and staff prior to a decision being made to move into the home. This process allows the Manager to make a decision as to whether the home can meet the needs of the individual and for the individual to make a decision about whether they would like to live in the home and feel that their individual needs and preferences could be met at the home. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 The resident’s health, personal and social care needs are set out in the individual plan of care. There is good multidisciplinary input and working with this home to ensure residents health care needs are being met. EVIDENCE: The Manager has recently introduced a new care planning document for all residents. She has now taken responsibility for maintaining the care plans. They are comprehensive and have been signed by the service user and have been reviewed monthly. Detailed daily records and daily handover records are completed for all residents. Residents spoken to confirmed that they were aware of these records and had read them through at some point and signed them. Residents confirmed that they have access to health care services as required, and care records also evidence this to be the case. The home has recently employed a Registered Nurse for two mornings a week, to oversee the resident’s health care needs. This is seen as beneficial by residents and they have taken to this new role positively. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 10 All residents spoken with felt that they were treated with respect and afforded dignity. They confirmed that staff allow them time in their rooms undisturbed if requested and that staff always knock on doors before entering. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14. 15 Residents feel that their lifestyle experienced in the home matches their expectations and preferences, with the ability to exercise choice and control over their lives. Dietary needs are well catered for, with a balanced and varied selection of food. EVIDENCE: Most residents in the home are independent and self-caring. It is reported that most residents maintain control over their own finances. A number of residents were observed leaving the home independently to visit friends or go to local shops. Residents are very much encouraged to voice an opinion and make suggestions on how the home is run through meetings with committee members, quality questionnaires and a suggestions box recently introduced. There are regular activities and events in the home. These are advertised on a notice board in the main hallway. All but one of the residents spoken with confirmed that they attend most of the social events held in the home and looked forward to them. All residents spoken with stated that the food in the home was of a good standard. Some stated that food is served promptly, is well presented and plentiful. Meals are set, although alternatives are offered when required. Residents have an open choice of evening meals or snacks. Regular beverages are offered throughout the day, and some residents partake in a glass of
Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 12 sherry together before lunch. More regular monitoring and giving of fluids was seen to be in place for two residents who are in need of more care. These particular residents took their meals in the lounge, and were assisted by staff with feeding and encouragements. This was done sensitively and with dignity. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Complaints and concerns are listened to and complaints are dealt with satisfactorily. Staff have limited knowledge and understanding of Adult Protection issues, which are in place to protect residents from harm or abuse. EVIDENCE: The home has a clear complaints procedure in place. This is displayed on the resident’s notice board and is contained in the Service User Guide. The home has a complaints/comments log and has recently introduced a suggestions box in the main hallway. This was seen to be in use, with a few suggestions already put in by residents. The residents also have the opportunity to meet with committee members who visit the home at least once a week and make themselves available to speak with residents. Residents confirmed that they do see the committee members regularly and have had meetings with them or spoken with them individually. In March 2005, the CSCI received an anonymous complaint about the conduct of the Manager at Erith House. A complaint investigation was carried out by the CSCI, which involved the interviewing of all staff and all residents. The complaints were partly upheld and the results given to the committee. The Manager has continued to work in the home with support from a Registered Nurse and regular supervision from the committee. At this inspection visit, the committee reported that they have been pleased with the Managers performance and increased confidence and intend to continue to support her in this role. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 14 The home has a copy of the local Protection of Vulnerable Adults from Abuse procedures and guidance notes. The Manager has yet to complete the home’s own Adult Protection policy and staff have yet to attend training on this topic. The Manager confirmed that all staff are booked to attend this training in January and February 2006 and that the policy will be completed in the next few weeks. It is vital that staff receive this training to ensure that they have a full understanding of the local policies in relation to the Protection of Vulnerable Adults, so as residents are no placed at harm from abuse and to ensure that staff have a full understanding of the policies should an incident be reported to them. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 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, 21, 26 The overall quality of décor and furnishings is of a high quality and the home is clean and hygienic. EVIDENCE: All bedrooms are en-suite, with toilet seats and grab rails being provided according to assessed need. There is a Parker bath, and two showers with seats. The downstairs bathroom has an ordinary bath, and also the sluice is sited here. The committee have now obtained professional advice, from an Occupational Therapist, in order to redesign this bathroom, and make it accessible and have stated their intention to address this when funds allow. To meet this standard, the sluice is also to be moved out of the bathroom. All bedrooms are well decorated, with attractive soft furnishings, and good lighting including table lamps and wall lights. Each room is individual, with many pieces of furniture and other belongings brought in by the occupant. Each room has sufficient electrical sockets, and many have facilities for making drinks. Service users have been provided with lockable storage space and although the majority of bedroom doors can only be locked from the outside, as rooms are vacated new suitable locking devices are being fitted. Existing
Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 16 service users have been asked if they also wish to have the new type of lock and all have stated that they do not. These written comments were seen. One bedroom door has recently been fitted with a new door lock. The Manager stated her intention to fit new door locks to all bedroom doors as they become vacant and before a new resident is admitted. The committee confirmed their support for this. The home remains clean and free from odour throughout. The laundry floor has a good surface, and the walls are washable. There are two washing machines, and a tumble drier. Disposable gloves and aprons are provided and the manager has further implemented more ways of reducing the risk from the spread of infection i.e. staff routinely carry soap free hand cleaner that they are encouraged to use between attending to individual service users. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 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 There are sufficient levels of staff to meet the needs of the current resident group. Residents are not fully protected by the home’s recruitment process. Not all staff are fully trained or competent to do their jobs. EVIDENCE: Staff rotas supplied by the Manager on the day of this inspection visit show four members of care staff on duty in a morning, four in the afternoon and one waking and one sleeping in at nights. In addition, the Manager is present for five days a week and a Registered Nurse is present for two mornings a week. Care staff are supported by two general assistants (three on a Monday, Wednesday and Friday), a cook, a kitchen assistant and a kitchen domestic to wash up following teas. The home currently has a vacancy for one night staff and one part time day carer. These shifts, as well as sickness and annual leave are covered mostly by existing staff. Where this is not possible, the Manager obtains agency staff. The Manager has reviewed the home’s policy on recruitment of staff and has recently obtained two written references for all staff where there were shortfalls. All staff files now contain the required documentation with the exception of evidence that POVA checks have been received for all staff employed after July 2004, and before they start work. All staff must be checked with the Department of Health’s Protection of Vulnerable Adults list, before being employed in the home to ensure that residents are protected and not placed at risk of harm.
Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 18 Since the last inspection, the Manager has booked a number of training courses for staff that were outstanding or where refresher training is required. All staff are booked to attend training on Protection of Vulnerable Adults from Abuse in January and February 2006. For all who are still requiring it Food Hygiene is booked for September 2005. Eight staff attended medication awareness training in April 2005, all staff attended fire safety training in July 2005, five attended Manual handling training in June 2005, twelve attended infection control training in March 2005 and five have attendee first aid training. The Manager stated her intention to seek further training and book courses for those staff still to complete the above statutory training. In addition to the above, one member of staff is just finishing an NVQ Level 3 and is going on to do an NVQ at level 4. One member of staff is doing an NVQ Level 3 and one is doing an NVQ Level 2. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 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) 31, 33, 35, 36, 38 The home is run and managed by persons who are fit to be in charge, and able to discharge their responsibilities fully. Staff are appropriately supervised. The health, safety and welfare of the residents and staff are promoted and protected with some minor improvements required. EVIDENCE: Erith House is a registered charity, first established in 1854. It is managed by a Committee, most of whom have been on the committee for some years now. Two were present on the day of this inspection and are present in the home for at least one day a week. The Registered Manager has been in post for approximately four years. In addition, since the last inspection, the home has now employed a Registered Nurse to support the Manager initially for three days a week, although this has recently been two days a week. At this inspection visit, the committee reported that they have been pleased with the
Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 20 Managers performance and increased confidence recently and intend to continue to offer regular supervision sessions and support her in this role. There is no formal quality assurance system although feedback is gathered in various ways, and acted upon as soon as possible. There are two Residents’ Meetings held each year, with Committee members attending and taking minutes. Committee members visit regularly, and speak to individual service users. There is a newly implemented suggestions box in the main hallway, which residents were seen to be using. The committee have distributed questionnaires to visitors to the home. The home does have an annual development/business plan in place and this was seen at this visit. A discussion was held with the Manager and committee members about the need to collate and analyse this data and look to producing a set of aims and objectives and a report that can be made available alongside the Statement of Purpose. It is reported that all residents manage their own monies independently or with the assistance of a family member or representative. The home does not currently hold monies for any residents. The Manager has recently implemented supervision for care staff. She was able to evidence some records for these meetings and stated her intention to have these typed up, so as the staff member could have a copy. The home’s health and safety records were inspected and found to be comprehensive and up to date with the exception of hot water temperature valve checks that had not been completed since January 2004. All hot water outlets are fitted with thermostatic valves. However, these still need to be monitored regularly to ensure they continue to be in working order. This ensures that resident’s are protected from the risk of scalding. All electrical appliances are tested yearly. Records of the most recent testing (July 2005) were seen. There were some appliances that failed the safety inspection or recommendations were made to make them safe. The Manager was advised to review this document and make a report of her follow up action to evidence that she has addressed these issues. Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 x 3 x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 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 3 x 2 x 3 3 x 2 Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 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. 2. Standard 18 29 Regulation 13(6) 13(6) Requirement All staff must receive training in the Protection of Vulnerable from Abuse POVA first checks must be completed and evidenced that they have been obtained before any new member of staff starts work. All staff must receive training in First Aid, Fire Safety, Manual Handling, Health and Safety, Food Hygiene, COSHH, Protection of Vulnerable Adults from Abuse and care of elderly Ensure that all hot water temperature valves are checked regularly Timescale for action 38/02/06 immediatel y 3. 30 18(1) 31/03/06 4. 38 13(4) 30/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 18 21 Good Practice Recommendations Complete and make available to staff the homes own Protection of Vulnerable from Abuse policy. Refurbish the ground floor bathroom as planned when funds allow and resite the sluice.
D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 23 Erith House 3. 4. 5. 6. 7. 24 30 33 36 38 Continue to replace all bedroom doors locks as the rooms become vacant. 50 of care staff must be trained to NVQ Level 2 at end of 2005. If this is not met within this timescale this will become a Requirement Further develop the quality assurance system in line with the NMS 33. All staff should receive supervision at least six times a year and signed records are given to the staff member and one kept for inspection Where recommendations have been made following health and safety checks, the manager is to evidence what action has been taken Erith House D54-D07 S18351 Erith House V222537 230805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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