Inspection on 13/01/06 for Ersham House Nursing Home

This inspection was carried out on 13th January 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ersham House Nursing Home 23/10/08

Ersham House Nursing Home 26/10/07

Ersham House Nursing Home 03/11/06

Ersham House Nursing Home 19/09/05

Ersham House Nursing Home 06/02/05

Ersham House Nursing Home 09/07/04

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

CARE HOMES FOR OLDER PEOPLE Ersham House Ersham Road Hailsham East Sussex BN27 3PN Lead Inspector Debbie Calveley Unannounced Inspection 13th January 2006 12:00 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 Ersham House DS0000013983.V262174.R02.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. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ersham House Address Ersham Road Hailsham East Sussex BN27 3PN 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) 01323-442727 01323-849900 ershamnh@btconnect.com Lakeglide Limited Mrs Sharon Sugars Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (41), Terminally ill (4) of places Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is fortyone (41). Service users must be aged sixty-five (65) years and over on admission. Service users may have a physical disability and be aged forty-five (45) and over on admission. The maximum number of service users to be accommodated with a terminal illness is four (4). 19th September 2005 Date of last inspection Brief Description of the Service: Ersham House is registered to provide nursing and supporting care for fortyone service users who meet the registration category of elderly, terminally ill and physically disabled. It was opened fifteen years ago and is set in gardens of approximately one acre, on the rural outskirts of Hailsham, with extensive views to the South Downs. The accommodation offered is thirty-nine single rooms, twenty with ensuite facilities and one double room with an ensuite bathroom. The home have a contract with social services for ten booked beds. The home offers communal areas, which are light, homely and tastefully furnished throughout the home, there is the main lounge/dining area which is central in the home, two further small lounge areas on each floor and an activities room. The bedrooms have been designed and decorated to a high standard. Residents are encouraged to personalise their rooms with small pieces of furniture and pictures. There are ample bathing facilities available which have the necessary equipment to meet the needs of the residents living in the home. The lift ensures that there is level access to all parts of the home. There is a reception desk and office and receptionist that works full time Monday to Friday, thus releasing staff from answering phones and enabling them to concentrate on the needs of the service users. The gardens are rustic and well tended and easily accessed by the service users. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 13 January 2006. It commenced at 12.30 am, and took place over five hours. There were forty-one residents in the home at this time. A second visit was planned with the provider and the manager to meet with the night staff. The methodology of the inspection included a tour of the building, inspection of documentation and records, the delivery of care for twelve residents and informal interviews with fourteen residents, three relatives and eleven members of staff. Twenty service user and relative surveys were given out. At the time of writing this report eight relative responses have been received, the comments were complimentary regarding the care given. Three service users cards were received and the comments were again all complimentary, one though stated “I feel that the residents need more mental stimulation and hired entertainers who encourage audience participation, conversation and interaction. More green leafy vegetables would be good for the residents diets”. The overall quality of care provided at Ersham House was observed to be of a good standard and the outcome for residents living in the home is one of warmth and comfort. This is the second inspection of this year and therefore this report should be read in conjunction with the report from the unannounced inspection carried out on 19 September 2005. What the service does well: The comprehensive Statement of Purpose and Service Users Guide give prospective residents the information required enabling them to make an informed choice about where they live. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The residents are enabled to exercise choice and control of their every day life. The relatives and representatives are welcomed to the home and are kept informed of any changes and are complimentary about the service provided at Ersham House. There is a variety of good nutritious food offered and snacks are readily available. The home is clean, safe and well maintained, which is appreciated by the residents and their relatives. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 6 A stable staff team who provide a consistent level of care. The staff were approachable, friendly and professional and were observed to interact well with the residents. There are clear policies and procedures in place for dealing with complaints. What has improved since the last inspection? 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 Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 7 contacting your local CSCI office. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 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 Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 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, 2, 3, 4 and 5. The Statement of Purpose and Service Users Guide give prospective residents the information required enabling them to make an informed choice about where they live. A contract/statement of terms and conditions is given to all residents on admission, which confirms the facilities offered and care agreed. The home welcome and encourage prospective residents and their representatives to visit the home prior to admission to enable them to assess the suitability of the home and meet the staff and fellow residents. EVIDENCE: A Statement of Purpose and Service Users guide, which conforms to the Care Homes Regulations and National Minimum standards, is in place. It is available to all residents and their relatives and is written in a clear and user-friendly format. There is a comprehensive statement of terms and conditions, which includes the services covered by the fees and the room to be occupied. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 10 The pre-admission assessments of eight residents were viewed and were found to have been completed in full. The assessment takes place at the residents’ place of residence, and input from other relevant professionals is sought when required. The manager confirmed that they try to involve the family as much as possible, as they can add to the information received. Five of the residents spoken with were able to confirm that they were visited before admission whilst two could not remember being involved. The pre-admission assessment identifies any specific needs of the prospective resident and this informs the admission process. The home provides nursing care for elderly people and those suffering from a terminal illness, and the documentation available demonstrates that a full assessment of the resident’s specific needs is completed following admission to the home, and then reviewed on a regular basis. Trial visits can be arranged and residents and their representative can spend a day in the home prior to admission. This enables them to meet the staff and other residents, and sample the food and activities. There is a month’s trial either way to ensure that the home is suitable and the home can meet the needs of the resident. Unplanned/ emergency admissions are rare, but if they do occur, assessment and care planning takes place within twenty-four hours. Four residents spoken with said that they had chosen to live at Ersham, and had visited the home to have a look around with their family. One resident said she just arrived there from hospital, whilst another said her daughter had chosen the home. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 11 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, 8, 9 and 10. Residents’ benefit from a more comprehensive care planning system that guides staff in all aspects of personal and health care and that all risks are identified and planned for. The medication systems in place are well-managed, promoting good health and the safety of the residents. The residents are treated with respect and courtesy in all aspects of their care. EVIDENCE: A sample of care plans were viewed and found to be detailed and clearly identify resident’s care needs. It is evident that the pre-admission information is used effectively in the formation of care plans. The manager and staff have a good understanding of the residents needs and were able to discuss them and explain the support that is provided. The risk assessments in the care plans regarding nutrition, tissue viability, moving and handling and dependency rating were found up to date. Recommendations of good practice were made in respect of developing the moving and handling risk assessments to include the equipment used and size Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 12 of slings. During the inspection it was found that fluid charts in one part of the house were not filled in accurately, this was discussed with the manager at the time of the inspection. The new clinical room on the ground floor is now in use, it was found to be clean and tidy. In the upgrading of the room, the temperature recording has not been done recently and this needs to be recommenced to ensure the suitability of the temperature for storage of dressings and medications. The medication charts were seen on both floors and a few gaps were found, regarding entries, dates and signatures but there has been a significant improvement in the standard of documentation. Staff were observed to treat residents with care and respect and it was evident that staff and residents are comfortable with each other. Residents spoken with confirmed they are enabled to make choices about their daily lives. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 13 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, 14 and 15. The residents are enabled to exercise the choice and control of their every day life. The majority of residents benefit from a lifestyle that matches their expectations and preferences and the activity programme in place meets their social, religious and recreational needs. The dietary needs of residents are well catered for and offer a balanced and varied selection of food that has been updated in line with the personal likes and choices of residents. EVIDENCE: There has been an improvement in the level and range of leisure and social activities provided. An activities programme is displayed in the home, and all the residents spoken with said they were given a monthly schedule and then chose if they wanted to attend or not. One of the co-ordinators spoke in depth of the changes made since the last inspection; she also said that the programme is regularly going to be updated according to resident’s preference. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 14 Not many residents wanted to attend the planned activities on the afternoon of the inspection, and the co-ordinator was seen paying visits to individual residents, which enables the more isolated residents a chance to chat and share their news. An individual social assessment for each resident is complied and written on when they attend or the co-ordinator visits them. There is an open visiting policy and relatives and friends are made aware of this in the service users guide. Visitors can be received in private and service users may choose whom they wish or do not wish to see. There are various local community groups that visit the home, and ministers of different denominations also visit the home on a regular basis. The residents spoken with were able to confirm that they were allowed to choose their daily routine, and were asked their preferred times of getting up, where they eat, what they eat and when they go to bed. It was confirmed that the routines of daily living experienced by the residents have a degree of flexibility; individual residents can request meals at a different time if they are going out and in their preference for getting up and for going to bed. One resident said, “I am lucky to be here, its very nice and the staff are kind”. The feedback regarding the food at Ersham House continues to be complimentary, residents spoken with said, “ the food here is home cooked and always tasty”, “we get a choice and if we fancy something different we just ask”. There is a varied and nutritious menu, which is rotated on a four weekly basis and changed according to the seasons, and there are extra choices available. Any special diets for cultural and medical reasons can be catered for and snacks are available at any time. Advice is sought from the dietician and G.P when necessary. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 15 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 and 18. The complaint procedure is clearly detailed in the Statement of Purpose and Services Users guide and is available to residents and their families enabling them to share their concerns both formally and confidentially. Staff demonstrated a good understanding and knowledge of Adult Protection policies and procedures, which protect the residents from harm and abuse. EVIDENCE: There are appropriate policies and procedures in place and it was confirmed that these are followed when investigating any concerns raised at the home. The staff interviewed, were knowledgeable of the complaint procedure and of how to start the process if the manager is not available. The complaint book was viewed during the inspection. Five of the residents referred to the leaflet (service users guide) when asked if they knew how to make a complaint, whilst one resident said she didn’t know of a proper procedure, but would go the senior nurse and know that “it would be dealt with”. One relative said he was not sure of the complaint procedure but had total confidence in the staff to deal with any concerns he may have, and also that he had the copy of the service users guide. There have been no complaints received by the CSCI since the last inspection. The Adult Protection policy in the home was found to be up to date and staff interviewed were knowledgeable about the systems in place to protect vulnerable residents. There is on-going training for all staff in Adult Protection. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 16 Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 17 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, 20, 21, 22, 23, 24, 25 and 26. Service users benefit from a safe, attractive and well-maintained environment. Residents are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. There is specialist equipment in the home for residents’ use to maximise their independence. EVIDENCE: A tour of the premises was carried out, which demonstrated that all parts of the home are well-maintained and well furnished with good quality coordinated furniture, including the gardens. All repairs and maintenance is carried out promptly and satisfactorily. The residents are encouraged and enabled to personalise their rooms with furniture and pictures, and this was evident during the visit. One resident had just sold her home and she said that it meant a lot to her that she could bring some special bits of furniture in with her. All personal items are listed in the Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 18 individual care plans. Residents are offered the choice of having a lock and key for their bedroom, risk assessments are in place for this. It is demonstrated in the care plans and risk assessments that all service users are independently assessed for individual needs and the staff are aware of where to procure specialised equipment The home provides adequate attractive communal space. The communal rooms are well used and provide adequate communal space. There is a dining area/ lounge central in the home, which has become the centre of the home and was seen being used by many residents. Two smaller lounge areas also can be used as quiet areas, one on each floor, one which leads in to the garden. There is also an activity room for the residents use. On the day of the inspection the home was found to be warm and comfortable, with good levels of light and ventilation. Pre-set values regulate hot water supplies to areas accessible to residents. Outlets checked showed that hot water was delivered within the safe temperature range. Hot water is stored and distributed at temperatures that reduce the risk of Legionella On the day of the inspection the home was found to be clean and free from offensive odours. Staff ensure a high standard of hygiene and cleanliness and there are procedures in place to ensure that these standards are maintained throughout the home. Suitable laundry facilities are available which meet the required standard, all of which appeared in good working order. Adequate provisions of protective clothing are made available and suitable arrangements are in place for the disposal of clinical waste. There is written guidance for staff on control of infection. Staff consulted demonstrated a good and clear understanding of the risks associated with the spread of infections and diseases, and appeared knowledgeable in relation to how best to reduce such risks. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 19 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 and 30 There is a competent and effective staff team who work positively to ensure service users have a good quality of life. Staff are provided with training pertinent to meeting the needs of the residents and to do their jobs competently. EVIDENCE: The staffing rota was viewed. The rota showed that the morning shift comprises of two trained nurses and eight carers, which the staff say is sufficient to meet the needs of the residents. The afternoon shift comprises of two trained nurses and five carers, which was seen to be adequate at this time to meet the needs of the residents. The night shift was staffed by three carers and one trained nurse, this needs to be regularly reviewed and assessed as the needs of the residents change. Staff interviewed were able to discuss the training they had received whilst working in the home. They confirmed that they had had training in moving & handling, infection control, fire safety, and also study sessions on different illnesses that they care for in the home. A recommendation after talking to staff was that training for the more rare and complex conditions are undertaken before the admission of the resident to ensure the staff can competently support the resident with confidence. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 20 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): 32, 33, 35, 36 and 38. The ethos of the home is open and transparent enabling residents to participate in the running of the home, should they wish to. All aspects of resident’s health, safety and welfare are protected and promoted. EVIDENCE: The use of formal quality assurance and quality monitoring systems enable the provider to critically evaluate the service and ensure it is run in the resident’s best interests. The Registered Provider and Manager are both aware of what evidence needs to be gathered to evaluate the service and work is in place to collate this information. Surveys for residents and visitors have been created to inform the quality monitoring process. Staff supervision is now in place and will be on-going, there are still staff that have not yet received supervision, but the manager is working hard to catch Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 21 up. The staff that have received supervision said that they felt it was beneficial and it was evident that these sessions are used effectively to identify training needs and maintain good communication between staff and management. Documents relating to safe working practices and Health and Safety were available and found to be satisfactory as were accident records. A written risk assessment of the grounds and premises in respect of safe working practices has been undertaken, but needs to be updated regularly. Certificates to demonstrate that bath hoists, gas appliances and passenger lifts are safe were available. Smoke alarms and emergency lighting are also tested regularly ensuring the safety of both residents and staff. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 22 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 3 3 3 3 3 3 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 3 3 X 3 2 X 3 Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 12(1)(a) (b) 18(1)(2) (a)(c)(i) Requirement That all documentation relating to the service users specific needs are recorded accurately and reviewed regularly. That staff supervision is commenced for all staff. Timescale for action 13/01/06 2 OP36 13/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP8 OP9 OP9 OP9 Good Practice Recommendations That the risk assessments regarding moving and handling are developed. That a medication audit continues to ensure good practice. That the temperatures of the clinical rooms and fridges are recorded regularly. That the storage of diazepam is kept at the required temperature. Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ersham House DS0000013983.V262174.R02.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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