Inspection on 26/10/07 for Ersham House Nursing Home

This inspection was carried out on 26th October 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ersham House Nursing Home 23/10/08

Ersham House Nursing Home 03/11/06

Ersham House Nursing Home 13/01/06

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 Nursing Home Ersham Road Hailsham East Sussex BN27 3PN Lead Inspector Debbie Calveley Key Unannounced Inspection 08:30 26th October 2007 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 Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 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 Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ersham House Nursing Home 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 Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 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). 3rd November 2006 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 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. Copies of inspection reports and the homes Statement of Purpose are made available on request. Fees charged as from 1 April 2006 range from £490 to £790, which does not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Intermediate care is not provided. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 5 Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Ersham house will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 26 October 2007. There were forty- one residents living in the home on the day, of which five were case tracked and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Seven members of care staff and the cook were spoken with in addition to discussion with the Registered Manager and the Registered Provider. Telephone contact was made with visiting professionals following the visit and two relatives were spoken with during the inspection visit. The information received from eight surveys and from personal contact has been incorporated into this report. An Annual Quality Assurance Assessment was received from Registered Manager completed in full prior to this key inspection. What the service does well: The atmosphere in Ersham House was relaxed, with communication between staff, residents and visitors being positive open and friendly. Comments received included: ‘Gives residents not only the medical attention they need, but the comfort of a loving warm home by attention seldom found in nursing homes’ ‘Values her independence which they respect’ ‘Since I have been visiting the home they have maintained the high standard I recognise, when I made the decision it was the right home for our needs’ ‘Thorough reliability- I can trust them to tell me of any change or need for mum, though I visit weekly providing a clean fresh and safe environment, Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 7 always a cheerful welcome to visitors and a friendly and gentle approach for residents’. The home provides prospective residents and their families, with a good level of information about what services are provided at the home. All parts of the home were clean, comfortable and well maintained. All residents, relatives, visitors and visiting professionals contacted as part of the inspection process confirmed a satisfaction with the home and its services, one resident saying ‘I am very well cared for the staff are nice it’s a lovely home and has good food’ Another said ‘This nursing home looks after all their patients very well, I have no complaints at all’. The quality and choice of meals remain good and all residents spoken with were complimentary about the food. The training for staff is comprehensive, and covers a wide variety of resident related conditions, which give the staff an understanding of the residents needs. There is a robust recruitment process in place, which protects the well being and safety of the residents. What has improved since the last inspection? What they could do better: The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. The care documentation including individualised care plans and risk assessments need to be improved to ensure residents receive appropriate and person centred care that meets their assessed needs and to minimise any risks. The call bell facility needs to be accessible to all residents so they can call for assistance when required. The staffing levels and deployment of staff need to be reviewed to ensure that the residents’ needs are consistently met. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 8 Information received from outside sources indicate that the home runs well when the Registered Manager is on duty, but changes are noted when she is not available, this was acknowledged and will be investigated. 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. The summary of this inspection report can be made available in other formats on request. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. Whilst the admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, more information needs to be documented to ensure their needs can be met. EVIDENCE: There is a range of well-documented information about the home and the services it provides. This includes a Statement of Purpose and a Service User Guide. Copies of these are available on request from the receptionist. The Service User Guide is in need of updating in respect of the CSCI address. It was also discussed that it would benefit residents if it was more user friendly in its appearance, e.g larger font and colour. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 11 Two residents were able to confirm that the contract arrangements were clear and understood. Five recent admissions to the home were identified and included the latest respite admission and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed on all long -term admissions and provide an assessment of prospective residents care needs, some however were found to be fairly minimal and were not dated and signed. The respite admission did not have a pre admission completed and the home relied on the letter of needs from the hospice. It was discussed that they need to also perform an assessment to ensure that they can meet the prospective needs. The assessments are completed by the Registered Manager or the deputy manager and discussion with the Registered Manager confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff, equipment and environment to meet their care needs. Prospective residents’ are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. A Social care professional spoken with confirmed that pre admission assessments are always completed and that these were usually completed promptly and efficiently. It was however noted that the home does not confirm having regard to the assessment that the home can meet the assessed needs of the prospective resident. This was discussed with the Registered Manager who was advised that this should be completed in writing in accordance with the required documentation. The Registered Manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and ensures that the Registered Nurses employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits/respite visits to the home can be arranged. It was confirmed that self-funding residents are invited to a trial period to ensure suitability of the home; this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst care documentation provides a framework for the delivery of care, it needs to be developed to provide clear guidance to care staff on all the care needs of the residents, along with robust systems for risk assessment to ensure individual person centred care is delivered. The homes practice ensure resident’s medicines are stored and administered safely and residents are treated with respect and have their privacy and dignity maintained. EVIDENCE: The care documentation pertaining to five residents were reviewed as part of the inspection process. These were found to include plans of care, nutritional assessments, personal histories and risk assessments. On the whole the care documentation demonstrated that the care was reviewed and evaluated, however it was noted that not all the plans of care Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 13 highlighted all the care needs of residents and some long term residents care plans did not reflect the changes to their needs. For example one resident who has communication problems did not have any guidance in the documentation to facilitate this vital need, another who is blind had little guidance in the care plans for staff to follow and there were no care plans for the wound care delivered for the residents on the ground floor. One residents care plan still reflected her needs from admission and had not been updated to incorporate her deteriorating health. It was also found that social histories and social care plans are not completed on all residents. The respite resident’s care plan had little documented as to his care needs and the care to be given by staff and this was acknowledged by the Registered Manager. During the inspection it was found again that fluid charts were not being filled in accurately or continuously, this was discussed with the Registered Manager during the inspection, this has been previously identified at the last two inspections. It was also noted that the use of risk assessment was very limited; for example ‘bed rails’ were in use without appropriate risk assessment, the use of call bells are not documented and a resident administering his own medicines did not have a risk assessment. Those risk assessment completed for nutritional screening, falls and moving and handling need to be based on clear criteria and followed up within the care documentation. Records indicated that local Doctors are called regularly and are involved in the care of residents and specialist advice is sought when required. Staff spoken with confirmed that they receive a full report on each resident daily and that they read the care documentation that is kept in the main office when possible. They felt that their views were taken into account when planning resident’s care. All feedback received from residents, relatives and visiting professionals confirmed a satisfaction with the care provided and comments included ‘Every thing has been absolutely fine’ ‘ I Feel they look after mum well and choices are given around daily life’. Staff were observed when administering medicines and they were seen to be working safely. The records seen were found to be accurate and the storage areas were found to be appropriate and well managed. Recommendations of good practice were discussed. As mentioned previously, residents that are selfadministrating some of their medication need to be appropriately risk assessed and safe practices endorsed by staff. Staff were seen to be kind and pleasant to residents and a good rapport was noted between them one staff member said’ she thought of many of the residents as friends’ and one resident said ‘Staff are good to me and I am able to have some fun’. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 14 Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Social activities and meals continue to be creative and provide daily variation and interest for people living in the home. Residents are able to make a range of choices about their lives as well as maintaining links with friends and relatives. EVIDENCE: The activities provided in Ersham House are enjoyed by many of the residents that were spoken to. One resident said that she enjoyed the range of activities and felt that they were lucky to live in Ersham. Staff confirmed that the activities in the home have been a great benefit to residents and that celebrations are held regularly for special occasions including birthdays. The home was celebrating Halloween and had decorated the home with pumpkin flower arrangements. Discussions with residents confirmed that they joined in activities only if they chose to do so; some residents prefer their own company and often spent their time in their own rooms. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 16 Resident’s rooms were found to be individual and personalised and each resident has their preferred term of address recorded in their care documentation and this preference was respected. Residents were seen to have their choices respected through out the day with decisions being responded to. Visitors spoken to were all happy with the visiting arrangements and how staff who were said to be ‘very welcoming’ received them. During the inspection visit it was noted that the reception area was always manned during the day and visitors were greeted with assistance being provided if needed. The atmosphere in the home is positive and welcoming. The breakfast service and the mid day meal was observed and was seen to be organised and well managed ensuring that those residents needing assistance were given time and able to have the assistance that they needed in an unrushed manner. It was confirmed that residents had a choice at lunchtime, which included a vegetarian choice. The menus were discussed and it was confirmed that they are being reviewed by the new chef. Those residents saying they did not like the main choice were seen to have alternatives provided that they did want. Menus are used and circulated on the day prior to the meals being provided and records are kept on what food is eaten by each resident. All feedback about the food was complimentary and comments included ‘good food’ ‘I have choices in the meals and the meals are good’. The dining area is pleasant and well furnished with natural light. The kitchen was inspected in June 2007 and the report was complimentary in the main with a recommendation of re- decorating which has been done. Staff were seen to be following good practice when serving and distributing the meals. The meals provided looked appetising and were served in a manner that ensured it looked attractive. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive appropriate training to protect residents from abuse. EVIDENCE: The home has a written complaints procedure and this is displayed in the home and provided within the Service Users Guide. The procedure followed on receipt of a complaint evidenced the investigation undertaken with an outcome recorded and the action taken. All records were clear and kept in a way that promotes peoples confidentiality. A formal complaint has been dealt with by the home and although this complaint has been resolved the records held did not clearly record what and how the complaint was received how it was investigated and responded to. Relatives and visiting professionals said that they were confident that the management of the home would respond positively to any concern raised. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 18 Everyone spoken to confirmed that if they had any concerns or complaints they would not hesitate in talking to either the Registered Manager or a senior staff member of the home. Although the home has the local guidelines on safeguarding vulnerable adults it does not have a home policy or procedure and this needs to be provided and supported with appropriate training on this subject for all staff working in the home. Records indicated that staff have received appropriate training on safeguarding adults and the home has a whistle blowing procedure. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Ersham House provides a comfortable, clean and safe environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. EVIDENCE: The tour of the premises demonstrated that all parts of the home continue to be well maintained and well furnished with good quality co-ordinated furniture. There is an on-going maintenance programme that ensures that the home is maintained to a high standard, carpets have been identified for replacement. The residents are encouraged and enabled to personalise their rooms with furniture and pictures. All personal items are listed in the individual care plans. Residents are offered the choice of having a lock and key for their bedroom, risk assessments are in place for this. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 20 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. There are adequate communal bathrooms and shower rooms in the home with specialist equipment, which enables frail residents and those with a physical disability to enjoy the facilities available. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms, hoists, wheelchairs and lifts to all areas of the home. Whilst call bells are provided in all areas, the access to call bells in communal areas needs to be addressed and supported by individual risk assessments. The home provides adequate attractive communal space. A recent addition of a water feature on the patio area has proven to be enjoyed by the residents. 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 that leads in to the garden. There is also an activity room on the ground floor for the residents use. On the day of the inspection the home was found to be warm and comfortable, with good levels of natural 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, and the home have an appropriate policy in place. On the day of the inspection the home was in the main found to be clean and free from offensive odours. Two bedrooms were identified as having an offensive odour, of which the Registered Manager was aware and had arranged to be deep cleaned. 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. Wheelchairs and hoists need to be cleaned regularly and included in the cleaning rota. 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 Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst residents are protected by the home’s recruitment policy and practices and from the training and induction programme, the staffing arrangements at the present time do not ensure the needs of the residents living in the home are satisfactorily met. EVIDENCE: The staffing rota was viewed and for the 41 residents living in the home at present, there are ten carers and two Registered Nurses (RN’s) in the morning, and five carers and two RN’s in the afternoon, and one RN and four carers at night. Feedback from residents, staff and surveys indicate that there are insufficient staff in the afternoon to meet the needs of the residents, in particular at suppertime due to a large amount of residents requiring assistance and putting residents to bed. It was discussed that the staffing levels and deployment of staff at key times needs to be reviewed. The Registered Manager confirmed that that there is flexibility of the staffing levels and they are adjusted according to the changing needs of the residents, for example an extra carer is coming in the morning 6am – 12 midday to help with bathing and getting residents up, this needs to be extended to the afternoon – evening shift. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 22 Staff spoken to say that the levels of staff on duty were sufficient to give the care required in the morning, but afternoons are a struggle with the amount of feeds and this impacts on the time spent positively with residents. One survey stated ‘The time taken to answer a call bell can be lengthy at times’, another stated ‘ Very busy, staff seem to be rushing’. Five staff recruitment files were viewed and evidenced that the home management team follow robust procedures when employing staff. The required information is collected before employment; it was discussed that the application form be enlarged to evidence the prospective employees past work history and their reasons for wishing to become a carer. The induction training is very thorough and staff are supervised closely during this period to ensure they are competent for job they are to undertake in the home. Staff interviewed confirmed a high satisfaction with the training provided and stated that recent training was interesting and informative. Staff and records seen confirmed that they had undertaken compulsory training such as manual handling, adult protection, first aid, and food hygiene, fire safety and Infection control. In addition specialist training in understanding dementia, challenging behaviour, palliative care, wound care and catheter care updates are also provided. Ersham House is OCN Registered and is an accredited Approved Training Centre able to award a Vocational Qualification Level 2 Direct Care Award NVQ At present 70 of staff have an NVQ qualification. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The overall management of this home is good with effective systems in place to protect residents EVIDENCE: The Registered Manager is a Qualified Registered General Nurse. The management structure of the home is strong, competent and has clear lines of accountability. The feedback from residents, relatives and staff indicated that they felt supported and were able to approach the management team at any time. The ethos of the home is to focus on the residents and the staff were observed doing this and interaction was positive. Regular staff meetings are held but Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 24 attendance by staff has dropped recently, The staff spoken with mentioned the staff meetings and that not many staff attended Resident/relative meetings are held and records of the meetings are kept. These form part of the quality assurance systems in the home. There are systems in place to monitor the quality in the home and include the use of questionnaires. The Registered Manager confirmed that the surveys are audited, reported on and responded to. It was recommended that the use of questionnaires is expanded to staff and visiting professionals. Residents’ financial interests are safeguarded by the homes policies and procedures and records are kept and maintained. The residents spoken with said they had no worries regarding their financial status, and felt they were supported in managing their affairs efficiently. All staff receive regular formal supervision, the Registered Manager confirmed that supervision has been allocated out to other staff, these staff would benefit from appropriate training so as to ensure that all staff benefit from the supervision sessions. Ersham House looked well maintained and systems are in place to report any problems to the maintenance person that need attention. Certificates relating to Health and Safety in the home were reviewed and found on the whole to be full. Some concerns have been raised regarding poor moving and handling practices and unexplained bruising, these are to be investigated by the Registered Manager. The accident records were viewed and it was discussed that the accidents/incidents need to be audited and action points recorded. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 25 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 2 3 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14(1) Requirement That the registered Person ensures that the pre-admission assessment contains enough information to ensure that the home can meet the prospective residents identified needs. That the registered person confirms in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. That the registered Person ensures that all documentation relating to the service users specific needs are recorded accurately and reviewed regularly. In particular fluid charts, wound care, communication and maintaining/encouraging independence care plans. (Timescale of 31/01/07 not met.) That the registered Person ensures that the respite care plans fully demonstrate the reasons for admission and the Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 27 Timescale for action 02/01/08 2. OP7 12(1)(a) (b) 02/01/08 3. OP8 14 (1) (2) (a) (b) care needs. That suitable risk assessments are completed in all areas of risk and cover the use of bedrails, wound care, self-medication and risk of falls to promote resident safety. (Timescale of 31/01/07 not met.) That appropriate risk assessments are in place with an action plan for those residents that do not have the capacity to ring the call bell. That a call bell facility or a system of supervision on residents is available for the communal areas. (Timescale of 03/12/06 not met.) That the Registered Person ensures that there are sufficient staff on duty at all times to meet the needs of the service users. 02/01/08 4. OP22 OP38 13(4c) 23(2n) 02/01/08 5. OP27 18 (1) (a) 02/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP26 Good Practice Recommendations That a medication audit continues to ensure good practice. That identified rooms are deep cleaned to eradicate the offensive odours. Ersham House Nursing Home DS0000013983.V346936.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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