CARE HOMES FOR OLDER PEOPLE
Erith House Lower Erith Road Torquay Devon TQ1 2PX Lead Inspector
Sharon Goldsworthy Unannounced Inspection 7th February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Erith House DS0000018351.V262960.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. Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Erith House Address Lower Erith Road Torquay Devon TQ1 2PX 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) 01803 293736 01803 211311 Erith House Management Committee Mrs Jane Hannaby Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability over 65 years of age of places (20) Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd August 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 DS0000018351.V262960.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and is the second inspection to take place. The Manager was present throughout this inspection. Time was spent with the nursing manager, staff on duty and the residents, as well as looking at some documentation and practices. The inspection took five hours in total. A complaint was received by the CSCI in November 2005 in relation to the circumstances in which an ex-resident moved from Erith House to another home. This complaint was partly upheld. What the service does well: What has improved since the last inspection?
The nursing post has been extended from two days to five days and a permanent contract has been issued for this post. This post supports the manager and specifically oversees the care needs of the residents on a daily basis. Staff training has continued since the last inspection and some further training is booked for the next few months. Care staff have been offered NVQ training to level 2, with a good proportion of staff having completed to this level. A further two locks have been purchased and are ready to be fitted to bedroom doors where these have become vacant in recent months. The staff supervision structure has recently been revised by the manager and it is hoped that this will be put into place in the next few weeks. Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 6 What they could do better:
The home’s Statement of Purpose and Service User’s Guide needs to be updated to include up to date information on the committee members and the staff team, so as the reader has all the information they need before making a decision about moving to the home and following a move to the home. The care plans and daily records are currently under review. Some need to contain much more detailed and specific records in relation to care needs, but also social and general wellbeing aspects of the residents’ lives. A number of errors were found in the medication system, in particular in its storage and administration practices. An immediate requirement was left for the Manager to address the areas of most concern and a referral has been made for the CSCI pharmacy inspector to visit the home to review, inspect and offer advice on the current medication system and practices, to ensure the residents safety. All complaints and comments (including positive comments) should be recorded in the logbook to evidence that the home is open to receiving complaints and deals with them effectively. All monies held on behalf of the residents must be signed for by a member of staff and the resident, or where the resident is unable, by two members of staff to ensure that both residents and staff members are protected. All staff supervision must be recorded and signed by both the supervisor and supervisee and a copy given to the supervisee. This ensures that there is an accurate record held of the meeting and that the supervisee agrees to any action plans formulated. Regular supervision allows staff to be monitored and care practice reviewed regularly, as well as allowing the member of staff time to reflect on their practice and to plan training needs. The home needs to respond to the fire officer’s recommendations in terms of updating the fire risk assessments and removing or replacing the sofa in the entrance hall, which currently presents as a fire risk. 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. Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Prospective and current residents have most of the information they need to make an informed choice about where they live. EVIDENCE: The home has a Statement of Purpose and Service User Guide in place that gives prospective residents details required for making a decision about moving into the home. There are some minor details that require some updating, mainly in relation to the management committee and staffing details. The Manager stated her intention to update this document. Erith House DS0000018351.V262960.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, 9 The resident’s health, personal and social care needs are set out in the individual plan of care. The systems for the administration of medication could potentially place residents at risk. EVIDENCE: The Manager has recently introduced a new care planning system, but is in the process of reviewing this and is thinking of replacing the current system to make it work for this home. Care plans and daily records are in place and complete, but would benefit from being much more detailed and specific in terms of care needs. Daily records need to record the residents general wellbeing and social care aspects of their daily lives. They are currently very task orientated records and do not give a full picture of the resident’s lives. The Manager agreed and felt that this could be addressed with her staff team. The medication system was observed in some detail at this inspection visit. The medication system in use is a monitored dosage system, although there are also bottles of liquids and tablets also. There were three boxes of medications that did not have labels on and so not identifiable as to whom they belonged to. A label had been put over the top of the original dispensing
Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 11 label to another box of medications and it was found that this medication was being given to the person for whom it was originally prescribed. The Manager explained that the one resident for whom it was being used, had run out of his or her own medications and so another’s was being used. This is unacceptable practice. The Manager was asked to obtain new labels for the abovementioned three boxes of medications and some more medication for the aforementioned resident. It was found that one bottle of Lactulose (being prescribed for one specific resident) was being used for all residents who are prescribed this medication. The Manager was informed that this practice does not allow for a safe audit of medications administered. A bottle of prescribed controlled medication was found in the main drugs trolley, rather than in the controlled drugs cupboard as required. However, all records were found to be up to date and complete, including controlled drugs records. The Manager and nurse manager agreed that they would benefit from advice and support of the CSCI pharmacy inspector and this has been arranged. A full inspection report from the pharmacy inspector can be obtained in addition to this report. The Manager and nurse manager have introduced two new books which record when blood or urine samples have been sent for testing to hospitals or GP’s, as a way of monitoring and auditing results. Another book is being used by District Nurses and GP’s to record their visits. This practice is commended. Erith House DS0000018351.V262960.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 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. Residents can maintain contact with family and friends and the local community facilities. EVIDENCE: Most residents in the home are independent and self-caring. 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. Most residents spoken with confirmed that they attend most of the social events held in the home and looked forward to them. Residents confirmed that their friends and family can and do visit the home regularly and can do so at any time they wish. Erith House DS0000018351.V262960.R01.S.doc Version 5.1 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 the following 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. The CSCI received a complaint from a relative of an ex resident in November 2005. The complaint was in relation to the circumstances leading up to the resident moving from Erith House to another home. The complaint was upheld in part, as the home could not evidence that they had taken an appropriate level of action to notify the family of their concerns at an earlier time. The Manager stated that she has learnt from this complaint and is intending to implement a system of more comprehensive records in relation to telephone calls, conversations with relatives and professionals and letters to follow up on such consultations.
Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 14 The home has a copy of the local Protection of Vulnerable Adults from Abuse procedures and guidance notes. The home has its own Adult Protection policy. Staff are booked to attend training on this topic 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 DS0000018351.V262960.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 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,
Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 16 as rooms are vacated new suitable locking devices are being fitted. Existing 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 have been seen. One bedroom door has recently been fitted with a new door lock and two others will be fitted shortly. 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 DS0000018351.V262960.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, 30 There are sufficient levels of staff to meet the needs of the current resident group. Not all staff are fully trained or competent to do their jobs. EVIDENCE: With the exception of one day in the last two weeks and the week of the inspection, rotas 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 State enrolled nurse is present for five mornings a week, with the occasional weekend and afternoon shift. Care staff are supported by two general assistants a cook, a kitchen assistant and a kitchen domestic to wash up following teas. The home currently has vacancies for both day and night shifts. 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. In the last year, staff have attended a number of training courses that were outstanding or where refresher training was required. All staff are booked to attend training on Protection of Vulnerable Adults from Abuse in February and March 2006. The Manager stated her intention to seek further training and book courses for those staff still to complete any outstanding statutory training. In addition to the above, NVQ training has been offered to all care staff. Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 18 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): 33, 35, 36, 38 The home is run in the best interest of the residents and their financial interests are safeguarded. Not all staff are appropriately supervised. The health, safety and welfare of the residents and staff are promoted and protected with some minor improvements required. EVIDENCE: 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 about the need to collate and analyse
Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 19 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. At the last inspection, it was reported that all residents manage their own monies independently or with the assistance of a family member or representative and that the home does not currently hold monies for any residents. The safe contents were viewed at this inspection visit and evidenced that the home is now handling monies and holding valuables for a small number of residents. Monies held are secure and records are kept accurately, with the exception of just one. The Manager was advised that two signatories must be obtained when handling any resident’s monies; ideally one must be from the resident themselves. Where this is not possible a second member of staff should be present and signing. There are a limited number staff that have access to the safe keys. 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. Not all staff have received supervision however. The Manager stated that she has reviewed the previous supervision process and is about to implement a new system. At the last inspection, 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 at the last inspection. 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. The local fire officer visited the home recently and has made two recommendations for action. The home’s fire risk assessments need to be updated and the manager stated her intention to do this very shortly. The second recommendation was in relation to concerns about the sofa at the bottom of the stairs in the entrance hall. This piece of furniture is not covered and protected with current fire safety standards and should be removed to ensure the complete safety of residents in the event of a fire. Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 20 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 2 X 2 Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3. 4. Standard OP7 OP9 OP18 OP30 Regulation 15(1) 13(2) 13(6) 18(1) Timescale for action Care plans and daily care records 31/03/06 need to be more detailed. See separate CSCI pharmacy 07/02/06 inspection report All staff must receive training in 28/02/06 the Protection of Vulnerable from Abuse All staff must receive training in 31/03/06 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 31/03/06 temperature valves are checked regularly Address the two issues raised by 31/03/06 the fire authority Requirement 5. 6. OP38 OP38 13(4) 23(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. Refer to Standard Good Practice Recommendations Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 22 1 2 3. 4. 5. 6. 7. 8 8. 9. OP1 OP16 OP18 OP21 OP24 OP30 OP33 OP35 OP36 OP38 The Statement of Purpose and Service User Guide needs to be reviewed and updated. Implement more detailed records of all complaints, comments and positive feedback received. 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. 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. Ensure that two signatories are recorded for all residents’ monies handled by the home. 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 DS0000018351.V262960.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Erith House DS0000018351.V262960.R01.S.doc Version 5.1 Page 24 - 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!
