CARE HOMES FOR OLDER PEOPLE
Ernelesthorpe Manor & Lodge Cow House Lane Armthorpe Doncaster South Yorkshire DN3 3EE Lead Inspector
Ramchand Samachetty Unannounced Inspection 19th December 2005 11:00 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 Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 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. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ernelesthorpe Manor & Lodge Address Cow House Lane Armthorpe Doncaster South Yorkshire DN3 3EE 01302 834643 01302 830800 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) Yorkshire Property Investment Fund Ltd Mrs Irene Widdowson Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (65), Physical disability over 65 years of age of places (65) Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One specific service user under the age of 65, named on the variation dated 25 th May 2004, may reside at the home. One specific service user under the age of 65, named on the variation application dated 4th July 2005 be accommodated at the home 19th April 2005 Date of last inspection Brief Description of the Service: Ernelesthorpe Manor and Lodge is a 65 bedded Home offering social and nursing care for older people (65 years & over), including those with a physical disability. The Home is situated in a residential area in the village of Armthorpe in Doncaster. It is accessible by public transport and to local shops and other community facilities. The Home is designed as a bungalow and offers all its accommodation on the ground floor. Within the Home, there are two areas, the Manor and the Lodge, but there is no physical division between them. One of the Units accommodates residents who require personal care only. The other unit is for residents who have nursing needs. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out on 19 December 2005, starting at 11.00 hours and finished at 18.30 hours. The inspection included a tour of the premises, conversations with four relatives and five members of staff, examination of care records and other documents and observation of some aspects of care. Additional information was also gained from previous complaints investigation with regards to care at the Home. What the service does well: What has improved since the last inspection?
Some improvement has been made to the physical environment. An area of floor covering has been renewed. Seating arrangements in the dining room has been improved by reducing the use of wheelchairs for residents, at mealtimes. This has led to more space being made available and has eliminated the feeling of ‘overcrowding’. The ‘public’ telephone is being relocated to allow residents increased privacy and confidentiality in their access and use of this facility. Staff have started to improve the process and documentation of assessment of residents’ needs and the care planning process. A start has also been made to improve the social care needs of all residents and to record such needs for appropriate care planning. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 6 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. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 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 Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 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): 2 Residents are not being provided with statement of terms and conditions/contracts relating to their residence at the Home, in a timely fashion. This shortfall can lead to uncertainty about the rights and responsibilities of both the residents and the Home management. All residents must be provided with such documents as soon as possible after starting their occupancy. EVIDENCE: Records and documentation relating to four residents, who had been in the Home for some time, were checked. No contracts/ statements of terms and conditions between the Home and the residents or their next of kin, were evidenced. In one instance, a statement of terms and conditions for a resident was evidenced. The resident had signed it, but it did not specify the fees charged by the Home. That part of the document was left blank. In discussion, the registered manager acknowledged that not all residents had been provided with such documents. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 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 the following standard(s): 8, 9 and 10 The health care needs of individual residents appeared to be appropriately catered for. However, a recent complaint investigation had shown that there was a lack of timely action by nursing staff, to ensure that specialist and community health services were made available to residents as required. This shortfall in the management of health care had compromised the health and wellbeing of a resident. Although policies and procedures were in place for the management and audit of medicines at the Home, there were serious shortfalls in the way nursing staff were handling the receipt and management of medicines. These, on occasions led to the loss of accountability for medicines prescribed for individual service users. Remedial action is required to ensure that staff adhere to existing policies and procedures and to good practice. EVIDENCE: Residents and relatives, who spoke to the inspector, stated that staff made sure that their loved ones did not miss ‘their appointments’ at hospitals or with their GPs’. One relative stated that a carer was taking her mother to hospital for treatment, and she found that support of ‘great help’. Care records checked
Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 10 showed that residential clients were receiving help from the district nurses and other health care professionals like the dentist and chiropodist. A recent complaint investigation showed that there were delays in referring to and in acting on the advice of health professionals, such as the dietician. There was also lack of clarity in the way nursing staff communicated with GP’s. The receipt, handling and administration of medicines were checked for both sections of the Home. Personal items belonging to staff were found stored in one metal cabinet designed for controlled drugs. The receipt of several items of medicines was not appropriately recorded and this led to difficulties in accounting for their use. This included controlled drugs. Medicines administration records were not appropriately maintained and various unexplained and inconsistent coding were used. The dosage and frequency of medicines were altered without explanation or evidence of authorisation. Hand written changes on the records were not signed and dated. One resident was not given her medicines as prescribed. One resident who was selfadministering her medicines was not risk assessed for doing so. The registered manager stated that she carries out a regular audit of medicines administration at the Home. A copy of such an audit for the month of October 2005 was evidenced. It sampled the medication issues for six residents and found that not all medicines administered were signed for, and that there was no administration record sheet for one resident. The manager stated that she discussed these issues with her staff. However, there was no evidence of the action that was taken by the relevant staff to ensure that they would improve on their practice. In response to the comments made at the last inspection, by relatives, about access to the public `pay phone’ the registered manager acknowledged that the pay phone could be better situated to improve its access and use. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 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 the following standard(s): 13 and 14. Residents are encouraged and supported to maintain contact with their relatives and friends. This helps them to continue enjoying family life. Not all residents are able to exercise choice and control over the activities of daily living, and staff assist them in expressing their preferences in a few areas. EVIDENCE: Residents and relatives commented that they were satisfied with arrangements for visiting. Relatives felt they were always welcomed at the Home. Relatives were encouraged to get involved in some aspects of care planning and review of their loved ones. One resident said ‘ my daughter takes me to church service every week, and this keeps my faith alive’. Residents were able to make choices with regards to food, the way they dress and the time they get up and retire to bed. Residents, who were less able to do so, were assisted by staff to express their preferences on such matters. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 12 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): Addressed at the previous inspection. EVIDENCE: Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 13 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): 26 Good hygiene standards were maintained at the Home and this helped with the control of infection. The ventilation and smoke extraction with regards to a lounge used by smokers appeared to be ineffective. This led to unpleasant tobacco smoke to drift towards areas used by non-smokers. This problem should be rectified for the benefit of the resident group. EVIDENCE: The home was found to be clean and free form malodours. However, tobacco smoke from a lounge used by smokers, tended to drift along parts of the main corridor and the adjoining lounge. The extractor fan and the ventilation in the smokers’ lounge appeared ineffective in drawing out the smoke. Action should be taken to remedy this problem. The storage of equipment used for and by residents, continue to be problematic. A few hoists and linen trolleys were left along corridors after use by staff, thereby creating potential hazards for other residents and causing
Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 14 obstruction. Equipment must be stored as safely as possible and without affecting the use of residents’ communal or private spaces. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 15 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): 30. The Home is providing training for its staff in a number of areas, but more efforts must be made to identify the training needs of individual staff members and to plan such training over the year. This will allow for an effective monitoring and quality assurance of training provision. EVIDENCE: A number of care staff, who spoke to the inspector stated that they had received training in moving and handling of residents. This course is run by the Home training officer. Other training courses that care staff said they have been provided with, include, accredited training in medicines administration and fire safety. Four care staff had completed a course in ‘Induction Standards Framework’. Only 4 staff members, including the registered manager and the deputy manager had been trained on adult protection. A number of care staff had undertaken training in food hygiene and first-aid over two years ago and would now benefit from refresher courses. It was noted that one registered nurse had followed a course in wound care and another one had received some training on tissue viability. Twenty of the thirty-seven care staff employed at the Home have achieved their NVQ level 2 in Care. There was a record of training undertaken by staff dating from 2003. There was no evidence that staff training and development needs had been appropriately identified and planned.
Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 16 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, 33, 35 and 36. Staff and relatives are satisfied with the way the Home is run. However, the registered manager should improve the application of existing audit, monitoring and quality assurance tools, in order to improve the overall quality of the service. Procedures for the management of residents’ personal allowances are adequate, but must be adhered to at all times, to safeguard the interest of residents concerned. EVIDENCE: The registered manager is a first level registered nurse. She has just completed the ‘Registered Manager Award’. Staff and relatives, who spoke to the inspector, stated that they were satisfied with the running of the Home. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 17 The Home was managing the personal allowances of 38 of its residents. Records relating to residents’ finances were checked. The procedures for accounting income and expenditure appeared adequate. However, in a small number of cases, the procedures for a witness signature on money paid out from individual residents’ account were not followed. In one instance, one resident’s account was three pounds short, but the manager thought that the figures were wrongly carried over. She agreed to audit the account in order to bring it in balance. The registered manager carries out a regular audit of medicines administered at the Home and of accidents. The recording of accidents suffered by residents is not in line with the Data Protection guidelines. The methods used are recorded, but there was no evidence of action taken with regards to the findings. A residents/relatives satisfaction survey had been completed in October 2005, but the findings had not been analysed yet. In discussion with staff, it was noted that a number of them had not been provided with the supervision as advised by the national minimum standards. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 18 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 X 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 X X Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 19 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. Standard OP1 Regulation 4, 5 Requirement The Homes statement of purpose and service user guide must be improved to meet the Regulation. Copies of these documents must be made available to all interested parties. (Previous timescale of 20/06/05 not met.) All residents must be provided with statements of terms and conditions/ contracts as soon as possible after their admission. Timescale for action 20/02/06 2. OP2 5 20/02/06 3. OP8 12, 13 Timely action must be taken to 20/02/06 ensure that residents are appropriately referred to community and specialist health services and that their advice is also appropriately acted upon, as required. Action must be taken to ensure 20/02/06 that staff adhere correctly, to the policies and procedures relating to the administration of medicines. A review of the management of medicines at the Home is now required.
DS0000055879.V273184.R01.S.doc Version 5.0 Page 20 4. OP9 12,13, 17 Ernelesthorpe Manor & Lodge 5. OP26 12, 23 6. OP26 7. 8. OP30 OP35 9. 10. OP36 OP18 The extraction of tobacco smoke from and the ventilation in the identified lounge must be improved. 12,13, 23 Equipment must be stored as safely as possible and without affecting the use of residents’ communal and private spaces. 12, 13, 18 Staff training and development needs must be appropriately identified and planned. 12, 17 Staff must adhere at all times, to the existing procedures relating to the management of residents’ personal allowances. 18 Staff must be provided with supervision to the required frequency. 12, 13 The adult protection policy and procedures used at the Home must be improved to reflect guidance from the No Secrets document. (Previous timescale of 20/06/05 not met). 13, 18 Further training on adult protection issues, including the local multi-agency approach, must be provided to all care staff. (Previous timescale of 04/07/05 not met) The necessary repair must be carried out in the identified bathroom. (Previous timescale of 04/07/05 not met) Appropriate storage of equipment and other items must be provided at the Home. (Previous timescale of 04/07/05 not met) The recording of accidents and incidents must be improved to comply with the data protection guidance. 03/03/06 20/02/06 20/02/06 20/02/06 20/02/06 20/02/06 11. OP18 20/02/06 12. OP19 23 20/02/06 13. OP19 23 20/02/06 15. OP38 12, 13 20/02/06 Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 21 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 OP33 Good Practice Recommendations The registered manager should improve the application of existing audit, monitoring and quality assurance tools, in order to improve the overall quality of the service. Ernelesthorpe Manor & Lodge DS0000055879.V273184.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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