Inspection on 19/11/08 for Ernest Dene Residential Care Home

This inspection was carried out on 19th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ernest Dene Residential Care Home 8-12 Donovan Avenue Muswell Hill London N10 2JX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Ray     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Ernest Dene Residential Care Home 8-12 Donovan Avenue Muswell Hill London N10 2JX 02088834901 02088834531 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Brownlow Properties Limited Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose pimary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE Mental Disorder, excluding Learning Disability or Dementia - Code MD The maximum number of service users who can be accommodated is: 33 Date of last inspection Brief description of the care home Ernest Dene is made up of 3 double fronted houses that have been adapted for use as a residential home by being linked together. A new registered provider is responsible for the home called Brownlow Properties Ltd and the applicant for registered manager Care Homes for Older People Page 4 of 36 Over 65 0 0 33 33 33 0 Brief description of the care home is Damien Heneghan. Ernest Dene is registered to provide care and support for 33 older people with dementia. On the day of the inspection there were 32 residents living in the home. The home is situated in a quiet residential area of Muswell Hill. There are bedrooms on all floors and a lift to all floors. Ernest Dene is not a purpose built establishment and as such there are limitations on the number of people with mobility problems that the home can support. There are 15 single rooms and 9 double rooms. The aims of the service are to “provide a safe and homely environment where the unique needs of each individual are recognised and skilled staff are available to provide care and support in a way that encourages self determination and enables each person to achieve their best possible quality of life”. The current weekly fees are between 441 to 598 pounds, for each placement, and people are expected to pay separately for items such as hairdressing and private chiropody. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place on the 19 November 2008 and was unannounced. The inspection lasted for ten hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. Two inspectors Jane Ray and David Hastings carried out the inspection. They were able to observe the support given to the current residents and also spend time talking to them. The inspectors were also able to spend time talking to the manager, head of care, one senior carer and two carers as well as the two night care staff who were working at the start of the inspection. Care Homes for Older People Page 6 of 36 The inspectors did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home provided the inspector with detailed written information on how they had progressed in meeting the requirements and recommendations from the previous inspection. The inspector also spoke to five relatives who visit the home regularly either during or after the inspection visit. The inspector would like to thank the residents and staff for their assistance with the inspection process. What the care home does well: What has improved since the last inspection? The home has worked had to complete or start working towards meeting the requirements and recommendations from the last inspection. This included providing residents with a new contract between themselves and the new home owner. Complaints are now being appropriately recorded and addressed. Quality assurance questionnaires have been sent out seeking the views of relatives, staff and care professionals in addition to the previous resident questionnaires. Care for the residents has improved by ensuring they are not woken up earlier in the morning than they wish. Pressure relieving equipment has been obtained through the district nursing service where this is needed for specific residents. The home has accessed input from a dental service and a continence advisor for the residents. A dramatherapy service has been provided once a week in the home to specifically stimulate the residents with dementia. Where restrictions need to be placed on the residents, such as holding their cigarettes, this is recorded in their care plan and risk assessment. Medication requirements made at the last inspection to provide guidelines for medication given as required and to risk assess any self administered medication has also been completed. Ongoing work to improve the environment of the home has also been undertaken including the refurbishment of two bathrooms. Staffing issues have also been addressed including the provision of new contracts of employment for the staff, enrolling more staff for the NVQ qualification and providing individual supervision. The English language being spoken by the staff has also improved, which had enhanced communication with the residents. Residents are no longer being asked to pay a set amount each month to cover hairdressing and chiropody costs and other items, but are instead paying according to the services they use. Care Homes for Older People Page 8 of 36 Health and safety in the home is improving by providing a revised fire safety risk assessment and an ongoing programme of appropriate training. What they could do better: There are a number of areas for improvement identified at this inspection. The staff team needs to all be offered training in dementia and mental health so they can understand the needs of the residents and how to support them most appropriately. Residents also need to be offered a wider range of activites and opportunities to go out, especially those with dementia. The manager should also consider whether charging for a therapeutic activity for a group a residents is appropriate as this is part of the homes main purpose. The food provided in the home must be more varied through the provision of a four week rolling menu, rather than the current one week menu. Some residents would appreciate being offered a cup and saucer rather than a mug and others would like toast instead of bread for their breakfast. It is also strongly recommended that the home does not have visiting hours to support relatives and friends who wish to visit the service. In terms of administration of medication, all control drugs that are administered must be properly recorded, the temperature at which medication is stored must be monitored and a record must be available on the medication administration records of any allergies. It is also recommended that for residents who have pain releif as required that pain indicators are recorded so staff know when to administer the medication. It is recommended that each residents care plan is reviewed each month to ensure it is up to date. It is also suggested that where a social worker has not arranged an annual review with the resident, that the home invites them to a review meeting. Where staff hold a residents cigarettes on their behalf there should be a clear record of when the cigarettes should given out to ensure all staff are being consistent. The manager should ensure that all the contracts between the home and the resident that have been sent to relatives to sign should be returned. The manager should also seek the input of the multi-professional team to support one resident who does not want their nails cut as this will lead to long term health problems if not addressed. The home needs to ensure there are screens available in all the shared bedrooms to ensure the residents privacy is maintained when personal care is being delivered. Paper hand towels need to be available in shared bathrooms to maintain standards of health and safety. It is recommended that the home completes the replacement of old bedding and disposes of the old bedding. In terms of staffing the manager should continue to monitor staffing levels to ensure there are enough care and support staff available to meet the needs of the residents. The manager must also ensure that staff do not start working unsupervised until they have received their CRB disclosure as this compromises the safety of the residents. The staff need to be supported to complete the Skills for Care Induction. They also should be paid the correct amount on an agreed date and if there is a problem with their pay this should be resolved by the manager as a high priority. A training overview needs to be prepared for the whole staff team so that training can be planned and booked. Senior staff need training on how to carry out supervision as a two way process and all Care Homes for Older People Page 9 of 36 staff need to be offered regular individual supervision. In terms of health and safety all the staff need to complete fire safety training and know what to do in the event of a fire. This is particularly urgent for the night staff. The manager needs to be clear about what hours he is working in the home and to record these hours on the rota so the staff know his whereabouts and when he will be available. He also needs to ensure he is supportive towards the staff team and addresses any concerns they might have. The results of the quality assurance excercise need to be collated and an action plan prepared to ensure any comments received are addressed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be assured that their individual needs will be assessed. New people moving to the service will be able to visit the home and have access to information in an appropriate format to tell them about the home. Contracts between the home and the resident are available and so there is clarity about what the home will provide. Some of the specific needs of the residents will not be fully met as most staff have not yet received training on supporting people who have dementia or a mental illness. Evidence: My mother has settled in quite well and hasnt raised any issues (Comment from a relative) Contracts have been sent to the relatives of the residents. (Extract from the information completed by the home) Care Homes for Older People Page 12 of 36 Evidence: The statement of purpose and service user guide, were inspected. Both of these documents are written as one document called Welcome to Ernest Dene. This document is clearly written, was accurate and contained all the necessary information. Four case notes for people who have moved to the home since the last inspection were inspected. All four had completed assessments. Two had a social service assessment as well as an assessment completed by the manager. One person who is privately placed only had an assessment prepared by the manager. The final person only had a social service assessment as they had been placed at the home as an emergency and the manager had not had time to do the assessment before they arrived. The assessments contained all the necessary information in sufficient detail to act as a good basis for the care plan. The manager explained that in most cases the relatives visit the home before the resident moves in. This is because many of the residents move to the home from hospital and are unable to make visits. Residents are offered a six-week trial period to enable them to decide about their long-term admission to the home. The inspectors discussed the current needs of the people living in the home with the care staff and manager as well as observing the care they were receiving. The staff felt confident that they were meeting the needs of most of the residents and this was reflected in the care that was observed. The staff records show that only one member of staff has received training on dementia and no staff have training in mental health. Only three of the fifteen staff are booked to attend training in dementia. One staff member who was interviewed, talked about how new staff may find it hard to be patient with the residents as they dont understand the dementia. Training on dementia and mental health is important to ensure staff have the skills and experience to effectively communicate with the residents. The manager explained that the comprehensive contracts seen at the last inspection have now been sent out for relatives to sign and are gradually being returned. This needs to be completed for all the residents in the home. Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported to access most of the healthcare treatment they need. Their plans of care are very person centred and reflect their individual needs. The system of medication administration needs some improvements to ensure it is used correctly at all times. Evidence: My relative gets support with her mental and physical health and the home contacts me when there is any issue. (Comment from a relative) Mum has been relatively well presented when I have visited. (Comment from a relative) Staff sometimes have to take decisions in respect of certain issues in respect of certain residents. This is because they lack the mental capacity to make an appropriate decision in their own interests, or if the benefits of a resident taking a decision for themselves are far outweighed in terms of the possible harmful impact that decision Care Homes for Older People Page 14 of 36 Evidence: will have on other residents or staff living and working at Ernest Dene. (Extract from the information completed by the home) The home feels more efficient and they were very careful about my mothers medication when she came to stay with us for the weekend. (Comment from a relative) The care plans for eight people living in the home were inspected. These documents covered all the areas where care and support were needed. They provided guidance to staff on what action they needed to take to meet each persons needs. The care plans were all up to date and were very person centred, recognising the importance of relationships and personal preferences. We asked about how the care plans were updated and the head of care explained that as a residents needs change the care plan is amended on the computer and a new copy is printed to go in their file. A system however needs to be developed to ensure the key workers check and update as needed the care plans on a monthly basis. The manager and head of care explained that review meetings are arranged annually by the residents care manager and that some review meetings have taken place since the last inspection. We did however recommend that a record is available of when each resident had their last review meeting and if it is almost a year since the last review or over a year, the home should take the initiative and invite the care manager to the meeting. The case notes that we inspected showed that areas of risk were assessed very thoroughly. These recognised not only physical risks but also emotional risk and areas of potential abuse. These records were a very high standard. At the last inspection we identified that restrictions are placed on some residents, such as holding their cigarettes on their behalf. In the case notes we inspected we saw that this is now recorded and explained in the residents care plans and risk assessments. It is recommended that these records clearly explain how the cigarettes will be distributed such as stating that a resident will be given one cigarette an hour. There should also be evidence that this practice has been discussed and agreed with relatives and care professionals where appropriate. The manager explained that at the time of the inspection two of the residents had pressure sores. We could see that they both had appropriate care plans in place and had the appropriate pressure relieving equipment. The manager explained that this equipment is obtained through a referral to the district nurse and is also used successfully in a preventative manner. Care Homes for Older People Page 15 of 36 Evidence: The case notes showed that the home has a separate record of healthcare appointments for each resident. These showed that the residents were receiving primary healthcare input and being referred for specialist input as needed. A private chiropodist comes to the home every month and treats residents as needed. The case notes also show that some residents are starting to receive a dental service. In addition a number of residents case notes showed they had received input from the continence advisor. It was however observed that one resident has very long nails and the staff explained that she is very unwilling to have either her hand or toe nails cut. This needs to be discussed with a multidisciplinary team to explore other ways of helping her to receive this input. Throughout the inspection the staff were observed supporting the people living in the home with their personal care, meals and moving around the home. This was done in a manner that respected the residents privacy and dignity. It was observed that the staff were very aware of the mood and comfort of the residents and responded to any sign of distress, including non verbal indications. The staff were observed to be communicating clearly with the residents and some staff who had previously struggled with speaking English, as they had recently come to live in the country had much improved. It was observed that the residents appeared adequately presented. Some staff told us that the hairdresser had not visited for a few weeks and her visits need to resume. Three relatives who were spoken to commented that clothing can go missing in the home, probably because it ends up in the wrong residents cupboard. At the last inspection we were concerned about the time residents were being woken in the morning and going to bed in the evening. We started the inspection at 6.30am. At this time 11 of the current 32 residents were already awake and sitting downstairs. The residents all said that they had made the choice to get up. The two night staff said, we only get people up if they want to, if not we leave them in bed. The time people like to get up or go to bed is reflected in their care plan and in a separate list of residents to bed and rising preferences. Those residents who were awake early were offered a cup of tea and a biscuit. The home keeps a record of when people have a bath, although staff said that residents can have a bath whenever they want or if this is necessary. The record showed that unless baths had been refused most residents were having baths. Individual preferences about bathing are also recorded in each persons care plan. The manager explained that three residents use bedrails at night to prevent them falling out of bed. These were observed during a tour of the home. The appropriate Care Homes for Older People Page 16 of 36 Evidence: assessment and care plan was in place. The medication was inspected. The medication is stored in two trolleys separate lounges. The medication is dispensed using a blister pack system. The medication storage temperature is recorded daily but in a storage cupboard in the office and not in the trolleys in the lounge. The temperature needs to be taken in the trolleys where most of the medication is stored. The medicines administration record (MAR) chart was inspected and had been completed correctly. Medication arriving in the home is recorded on the MAR sheet and medication being returned to the pharmacist is separately recorded. Some residents have some medication that is taken as required. This is mostly pain relief and the residents can ask for the medication, however for residents who cannot say it would be helpful to include indicators of when that resident might be in pain. Other as required medication has written guidance on place stating when it should be administered. One resident self administers an inhaler and a risk assessment has been completed. Two residents were prescribed Controlled Drugs (CD) within schedules 2 or 3 in the home. These are securely stored and a separate record is kept monitoring the number of items administered with two staff signatures when the medication is given. I member of staff realised she had administered a control drug and it had not been recorded in the control drug register and only on the MAR sheet. One resident in their care plan had a record of an allergy to a particular medication. This needs to be clearly recorded on their MAR sheet to remind staff to ensure this is not prescribed. If there are no known allergies this should also be noted on the MAR sheet. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to make choices in their daily lives. People who use the service do not have opportunities to go out other than with relatives but are offered a variety of activities in the home. The meals are balanced and nutritional and enjoyed by the people living in the home although some might like more choice or different presentation. Evidence: Taking residents out is not possible with the staff we have available, we are however able to offer a choice of activities in the home and we are able to make time for this. (Comment from a member of staff) They are all sitting like zombies as there are not enough activities. (Comment from a relative) Mum is very positive about the food. (Comment from a relative) They have taken away our cups and saucers and given us plastic mugs. (Comment from a resident) Care Homes for Older People Page 18 of 36 Evidence: The staff were observed supporting the people living in the home throughout the inspection. The staff were able to describe how they offer the residents some choices, including what activities they want to do and how they prefer their drinks. A residents meeting has not taken place since the last inspection, although one is planned. It is hoped this will provide opportunities for the residents to discuss things they would like to see happening in the home. The home arranges for an entertainer to visit the home on a fortnightly basis. The staff also have some games, puzzles and craft equipment available and they were observed sitting with the residents doing these activities. Since the last inspection the home has introduced a weekly drama therapy session for a group of eight residents with dementia. One relative we spoke to said their mother really enjoyed the session but also pointed out that the manager is charging the participants twenty pounds a week for this activity.This is not common practice as homes recognise that providing stimulating activities is part of their main purpose. There is scope to provide more meaningful activities for people with dementia, but this is linked closely to the staff needing training in this area so they know what would be most appropriate for the residents. The staff explained that the residents who practice their religion are all Christian. A catholic service takes place every fortnight in the home. The home also has links with a Church of England vicar who visits the home when requested. The manager and staff explained that a number of the residents have close contact with their relatives. A sign in the home suggests visiting times, which finish at 7pm. Two relatives we spoke to said that they did not follow these visiting times. At the previous inspection it was suggested that visitors are made welcome at any time and this recommendation still stands. The home has a cook available seven days a week and during the inspection breakfast and lunch was prepared. The home has just a one week menu. The manager did however show us the draft menus for another three weeks. On the day of the inspection there was porridge, cereals and bread and butter for breakfast. Some residents commented that they would have liked toast. At lunch there is a choice of two hot meals and the cook asks everyone what they want in the morning before the food is prepared. It was observed that there were plenty of fresh fruit and vegetables. The care staff said that the cook finishes working at 4pm and the carers have to serve up the supper. The manager explained that the catering assistant who was available at the previous inspection and worked to a later time is not working at present. It was observed that most of the drinks during the day were offered in a mug and some of these were plastic. We were offered a cup and saucer. Care Homes for Older People Page 19 of 36 Evidence: Care Homes for Older People Page 20 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home have access to an appropriate complaints procedure and feel able to raise any concerns. Staff demonstrate an understanding of how to safeguard vulnerable adults. Evidence: We want the service we provide to match your needs and your expectations, and we welcome any comments you may wish to make. (Extract from the homes complaints procedure) The manager seems very approachable we would go to him with issues. (Comment from a relative) The complaints procedure is available in the welcome to Ernest Dene guide and includes details of who complainants can contact. We looked at the record of complaints and a number of complaints had been recorded since the last inspection. These mainly related to items that have gone missing. It is hoped that relatives and residents feel able to approach staff with a wider range of concerns in the future. The staff were asked about how they would recognise abuse and what steps they would take if they felt abuse had possibly taken place. They all demonstrated a good knowledge in this area. There have been no safeguarding issues since the last Care Homes for Older People Page 21 of 36 Evidence: inspection. Care Homes for Older People Page 22 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home have access to an environment that is clean and homely. Considerable work has taken place to improve the building but more is planned to create an environment that meets the needs of the residents. Evidence: The home is always very clean and tidy when I visit (comment from a relative) Ernest Dene consists of three Victorian terraced houses that have been joined together. The home is on three floors, a basement, ground floor and first floor. Bedrooms are available on all of these floors and there are nine double and fifteen single rooms. The building has a lift. The homes interior is decorated in a Victorian style, which creates a homely atmosphere. The house does however have lots of stairs, including some bedrooms that are accessible by small flight of stairs. This makes the building very difficult to move around for people with limited mobility. The new provider has recognised this limitation and is no longer proposing to admit residents with a physical disability. The bedrooms are all different. Some residents have brought personal items with them into the home and other rooms were rather bare. Some shared bedrooms did not have a screen to maintain the privacy of the residents. Care Homes for Older People Page 23 of 36 Evidence: The home has an attractive garden at the rear, although on the days of the inspection it was cold and damp and it was not in use. The garden is accessed through the basement dining room and a small exit next to the managers office. Smoking is only permitted in the garden and a covered shelter has been built by the managers office. There are three lounges on the ground floor and they each have a television and music systems. The main dining area is in the basement and some people also eat in the middle lounge on the ground floor. The staff have a room in the basement, where there are lockers available to leave their belongings and where there is a fridge, microwave and kettle to prepare snacks. The new provider has added en-suite toilets and basins to most of the rooms, replaced a number of doors, provided magnetic catches to keep doors open, replaced the nurse call system, provided a new entry system on the front door, replaced the beds, replaced two baths and decorated. Since the previous inspection the new provider has upgraded two of the bathrooms and started to replace old bedding. It was observed during the inspection that the home was very clean and free from offensive odours. Hand sanitising gel is available throughout the building to prevent the spread of infection. It was however seen in the shared bathrooms that there were no paper hand towels available. One relative also commented that she often has to ask staff for a toilet roll for her relatives en suite bathroom. During the day there is one domestic assistant who also helps with laundry. The care staff who work at night also have cleaning duties. The day care staff said they do not do the cleaning. The manager said that when the cleaner has a holiday he will arrange for a cleaner to come from another home. The provider has stated their commitment to continuing improvements in the home including rebuilding windows and replacing equipment in the kitchen and laundry. Care Homes for Older People Page 24 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported by a caring and committed team of staff who are getting to know the residents well. There may not be enough staff available to provide the residents with the support they want. Training has improved, which helps to give the staff the skills they need to do their work. Evidence: The staff are always rushing around, they would have a chat if it was an emergency. (Comment from a resident) The three famous words used by staff are, Im too busy. (Comment from a resident) The staff are very helpful and they take an interest in the residents. (Comment from a relative) The staff are now more consistent. (Comment from a relative) Since the last inspection the staffing structure has changed. There is a manager, Head of Care, three seniors and a team of care staff. Two of the three senior carers have just been recruited and have not yet started working fully. The staff rota was inspected. This showed that during the day there are four or care staff working in the Care Homes for Older People Page 25 of 36 Evidence: home from 8am to 8pm. Previously the staff member who is Head of Care worked mainly providing direct care, but is now largely based in the office. This means that whilst resident numbers have increased direct care has reduced during the day and remained the same at night when there are two waking members of staff. Whilst there was no clear evidence that staffing levels were too low, as residents had received personal care, call bells were being answered promptly and there were no increases in accidents in the home, the staffing levels need to be kept under review. The manager was reminded of his responsibility to provide adequate numbers of staff based on the needs of the residents. The manager provided a list of the care staff who are enrolled to study for an NVQ in health and social care. This is now the majority of the staff team. Three staff records were inspected for the four new staff who had come into post since the last inspection. They had all completed the necessary recruitment checks including a CRB disclosure (criminal record bureau) two references and a copy of photo identification with permission to work in the country where needed. The forth member of staff did not have a record available. The manager spoke to the responsible person who explained that he had the record as she had a POVA check but he was chasing up her CRB disclosure. This member of staff had been working at night and we had met her at the start of the inspection. This did not allow her to be supervised. The manager stated that he would transfer her to work during the day until her CRB arrived. The manager explained that all the staff had been offered new contracts or had transferred from their old employer under TUPE regulations. The new staff files all contained contracts of employment. Only one member of staff said she did not have a contract. Since the last inspection we have been contacted by staff who explained that they still do not know exactly what date they will be paid. They also feel they have not been paid for all the hours they have worked and have had deductions from their pay that they do not understand. These concerns were reiterated by the staff who were interviewed. We could see that in some cases this was causing financial hardship and personal distress. Whilst we explained that we cannot address these issues and advised staff to seek assistance elsewhere, we were concerned that the manager had not resolved these issues which had also been raised at the previous inspection. We discussed the matter with the manager who said staff could use the complaints procedure. We explained that we felt resolving these issues was essential in having a happy staff team who would then work well with the residents. The staff who were interviewed were asked about their induction training. They Care Homes for Older People Page 26 of 36 Evidence: explained that they were introduced to the home and the residents by the senior carers and completed an induction checklist. They then worked for five days shadowing an existing staff member. The home now has a copy of the induction using the Skills for Care format. This should be rolled out for all staff. The staff training records for four members of staff were inspected. These records were all in place. The home would however benefit from having a chart that gives an overview of the training of the whole staff team, so that future training can be planned. Care Homes for Older People Page 27 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in this home benefit from having the home run by a manager who has improved the service, but he still needs to improve his staff management skills. Residents need to be safeguarded by further staff training to ensure fire safety. Evidence: The manager does his job well and takes good care of the home. (Comment from a member of staff) The manager is not always here and it can be difficult to speak to him. (Comment from a member of staff) The manager, Damien Henighan is currently undertaking the registration process for Ernest Dene and is waiting for his CRB disclosure to be completed. We observed that he is very organised and has led a great many improvements in the home. There are still however a number of issues in this report that reflect poorly on his management Care Homes for Older People Page 28 of 36 Evidence: ability such as a member of staff working at night without a CRB disclosure and his ongoing inability to resolve financial issues with the staff team. The manager explained that in the long term he would like to hand over the management of the home and have more of a corporate role. We explained that managing a home the size of Ernest Dene is a full time job. We asked him to record the hours he would be in the home on the rota so staff know when he would be available. We also suggested he help with management tasks such as staff supervision and chairing staff team meetings as the Head of Care needs time working directly with the residents. Since the previous key inspection the annual quality assurance exercise has been extended and questionnaires sent to relatives and care professionals. These are now being returned and the results need to be collated and an action plan prepared. The staff supervision records were inspected for four staff and these showed that they had all had one or two supervision sessions. The staff who were interviewed explained that they had been supervised by the Head of Care. This member of staff acknowledged that supervising the whole staff team was a huge job. The records of supervision showed that this was not really a two way process, with the staff not being encouraged to give their views. We recommended that once the seniors are in post they all assist with supervising carers and they all have training so they can perform this role adequately. The manager explained that they have stopped charging all the residents a fee of 40 pounds a month to cover the costs of hairdressing, chiropody and toiletries. They are now sending out invoices for items of expenditure. Two relatives said they had paid bills for their relatives but had not been offered any receipt. The manager explained that in terms of fire safety since the last inspection the home has reviewed the fire safety risk assessment and carried out a fire drill that included evacuating the residents. The staff explained that since the last inspection more in depth health and safety training has been provided including moving and handling, fire safety and infection control. Further training is also booked. At the previous inspection the night staff were very unclear about what action they would take in the event of a fire. The training records showed that two of the night staff had still not received fire safety training. Care Homes for Older People Page 29 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 4 18 The registered person must 31/12/2008 ensure that each staff member has received the training they need to meet the needs of the residents. This must include training on dementia and mental health. . 2 9 13 The registered person must 19/12/2008 ensure any allergies are recorded on the residents medication administration record. If it is not possible to establish if the resident has any allergies then it must be recorded that the allergies are not known. . 3 9 13 The registered person must ensure that any control medication that is administered is recorded in the control drug record to ensure it is appropriately given. 28/11/2008 Care Homes for Older People Page 31 of 36 . 4 9 13 The registered person must check the storage temperature of the medication held in the trolleys to ensure it is at an appropriate level. . 5 12 16 The registered person must 15/01/2009 ensure that the residents are offered a range of stimulating activities that meets everyones needs including people with dementia. The activities must offer opportunities to go into the local community. . 6 15 16 The registered person must ensure that varied food is provided in the home by completing more than a one week menu. . 7 24 12 The registered person must provide screens in the shared bedrooms to preserve the privacy of the residents. . 8 26 16 The registered person must 28/11/2008 provide paper hand towels in shared bathrooms to maintain standards of health and safety. . 19/12/2008 19/12/2008 19/12/2008 Care Homes for Older People Page 32 of 36 9 29 19 The registered person must ensure that staff who do not have a CRB disclosure do not work unsupervised to safeguard the residents in the home. . 28/11/2008 10 30 18 The registered person must ensure the staff have the training they need by completing the Skills for Care induction. . 30/01/2009 11 33 24 The registered person must collate the results of the quality assurance excercise and prepare an action plan. . 31/12/2008 12 38 23 The registered person must 19/12/2008 ensure all the staff have completed fire safety training and that night staff know what steps they need to take in the event of a fire. . Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The registered person should ensure that contracts between the home and service user have been signed and a copy placed in each residents file. The registered person should introduce a system for reviewing the care plans on a monthly basis. The registered person should invite the care managers to attend an annual review meeting, if they have not already arranged a date themselves. Page 33 of 36 2 3 7 7 Care Homes for Older People 4 7 The registered person should record for residents where staff hold their cigarettes on their behalf, how often the cigarettes should be given to each person and in what quantity to ensure all staff are taking a consistent approach. This should be agreed with the resident, care professionals and where appropriate their relatives. The registered person should seek the input of the multiprofessional team to support the resident who does not want the input of a chiropodist. The registered person should have a record of indicators of pain for people who take pain releif on an as required basis. The registered person should consider whether it is appropriate to charge for a therapeutic service, or whether this should be part of the homes core purpose. The registered person should remove the designated visiting times to facilitate visits from relatives who may not be able to come at the given times. The registered person should ensure that the catering arrangements provide adequate choices for the residents, such as offering mugs or cups and saucers, or a choice between bread or toast at breakfast time. The registered person should continue to provide new bedding in all the bedrooms and dispose of old bedding. The registered person should ensure that there are always enough care and support staff working in the home to meet the needs of the residents. The registered person should ensure the staff are paid correctly and on time. This is restated from the previous inspection. The registered person should prepare an overview of the staff training in the home so that training needs are identified and training booked. The registered person should ensure the manager records on the rota when he will be working in the home, so staff know his whereabouts and to ensure he is available for sufficient time to undertake his management role. The registered person should ensure the manager has open communication with the staff team and addresses their concerns in a timely manner. This is restated from the previous inspection. The registered person should ensure that there are adequate numbers of senior staff who are trained to supervise staff members. Supervision needs to take place Page 34 of 36 5 8 6 9 7 12 8 13 9 15 10 11 24 27 12 29 13 30 14 32 15 32 16 36 Care Homes for Older People for all staff on a regular basis. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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