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Inspection on 10/01/06 for Erskine Hall Care Centre

Also see our care home review for Erskine Hall Care Centre for more information

This inspection was carried out on 10th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The standard of care observed was good and this was supported by comments made by residents. "Service is very good" was the view of one of those residents spoken with. Staff training is good and provides staff with the necessary skills to meet the care needs of the home`s residents. Staff feel well supported by the management team of the home.

What has improved since the last inspection?

Specialist palliative care training has continued to be rolled out amongst the staff team. (See below) Additional residents` groups are being held as part of the activities programme for the home.

What the care home could do better:

The standard of staff meal and rest provision is not adequate and does not present a positive view of how staff are valued. Palliative care training should be provided for all care staff, both care and nurse qualified as soon as possible. Communication with residents when details of meal provision has to be altered at short notice should be improved out of respect for the residents and to prevent care staff having to bear the brunt of residents` dissatisfaction.

CARE HOMES FOR OLDER PEOPLE Erskine Hall Care Centre Watford Road Northwood Middlesex HA6 3PA Lead Inspector Jeffrey Orange Unannounced Inspection 10th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Erskine Hall Care Centre Address Watford Road Northwood Middlesex HA6 3PA 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) 01923 842 702 01923 842 703 BUPA Care Homes (AKW) Ltd Ms Elaine Flanagan Care Home 85 Category(ies) of Old age, not falling within any other category registration, with number (85), Terminally ill over 65 years of age (10) of places Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home may accommodate one person aged 50 years or over who requires nursing care. To admit (within the current registration limit of TI category) three terminally ill persons between the age of 18 to 65 years. 25th May 2005, 6th June 2005 & 9th December 2005 Date of last inspections Brief Description of the Service: Erskine Hall Care Centre is part of BUPA Care Homes Limited and is registered to provide nursing care and accommodation for up to 85 older people. Within that number the home is registered to provide terminal care for up to 10 persons, of whom up to 3 may be between the ages of 18-65 yrs of age. Erskine Hall is a purpose built nursing home, set back from the road in very pleasant grounds, with ample parking facilities. Accommodation is arranged on three floors, each with a day room and served by a passenger lift. All rooms are above the minimum size required by the National Minimum Standards and have en-suite facilities. Catering and laundry facilities for the home are situated in the basement along with a hairdressing room. Erskine Hall is situated in Northwood, Middlesex, conveniently situated for North West London and South West Hertfordshire, with good access to public transport. Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 5 hours. It provided an opportunity to speak to the home’s deputy manager and quality manager, following the recent departure of the registered manager to take up a senior healthcare post. A number of residents were also spoken to as well as several members of the staff team. Medication, recruitment and care plan records were also inspected. There have been a series of additional visits since the last inspections of May and June 2005. The latest of these was on the 9th December, conducted by the lead inspector for the home and a nursing qualified inspector. That visit focussed on the palliative care provision in the home, and informed consideration of an application for a variation in the home’s registration conditions, to enable them, subject to assessment, to admit up to three persons for palliative care aged between the ages of 18-65 yrs. That variation was subsequently approved. As all of the key standards have already been assessed prior to this current inspection, many of them have not been inspected again on this occasion. For details of the previous assessment please refer to the report of the inspections of the 25th May and the 6th June 2005 and to the report of the additional visit carried out on the 9th December 2005. The overall result of this inspection was very positive. Residents were supportive of the home and the way they were treated and the standard of care that they receive. Staff felt that they were encouraged to and enabled to acquire and update the training that they need to provide care for the residents. What the service does well: The standard of care observed was good and this was supported by comments made by residents. “Service is very good” was the view of one of those residents spoken with. Staff training is good and provides staff with the necessary skills to meet the care needs of the home’s residents. Staff feel well supported by the management team of the home. Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 6 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 contacting your local CSCI office. Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were all assessed during the previous series of inspection. For full details please see the reports for the inspections dated 25th May and 6th June 2005 and the additional visit of the 9th December 2005. EVIDENCE: Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 9 10 Those care plans seen provided up to date information on the care needs of residents and how they were to be met. Although medication processes are in general robust and include a structured monitoring process, this requires constant vigilance to ensure that the highest standards possible are maintained at all times, to provide for the safety and wellbeing of residents. Residents are treated with dignity and respect and their right to privacy is observed. EVIDENCE: Those care plans that were inspected were found to be well completed and in good order. There were two gaps in the medication records seen and the system of recording medication into and out of the home when resident’s leave for short periods was not sufficiently robust to allow for a proper audit. Those resident’s spoken to during this inspection all spoke positively about the way that the care they receive was given. “ The staff are very kind and caring” was one comment made. Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 10 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 15 The home’s activities organiser continues to develop a varied programme, based upon residents’ individual needs and preferences. The quality and consistency of the home’s catering has given rise to some dissatisfaction amongst residents. EVIDENCE: Residents were consulted and provided very positive feed back on the home’s activities. Details of individual activity assessments were seen. A discussion with the activity organiser was an opportunity to discuss future plans and developments. Several residents were dissatisfied with the recent standard of catering in the home, especially when changes were made without consultation or prior notice. This was discussed with the quality manager, who was already aware of these concerns and has put in place procedures to improve this aspect of the home’s operation. Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 11 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): These standards were all assessed during the previous series of inspection. For full details please see the reports for the inspections dated 25th May and 6th June 2005 and the additional visit of the 9th December 2005. There have not been any complaints made to the CSCI since then. EVIDENCE: Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 12 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 The provision of rest and mealtime accommodation for staff is not of a satisfactory standard or condition and does not reflect the value that the home says it places on its staff. The ground floor residents’ lounge requires attention to make it of an acceptable standard of decorative order. EVIDENCE: The basement area includes some seating and dining provision, this is however poorly decorated and furnished. The ground floor residents’ lounge has areas affected by damp with wall-paper needing replacement. Electric light fittings are missing and/or in need of maintenance. Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 13 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): 29 30 The home operates a robust recruitment process, which should offer adequate protection to its residents. Training overall is good. As all staff may provide care to those in the palliative care category, the specific training in this discipline that has already been provided for some staff, should be made available to all care staff at the earliest possible opportunity. EVIDENCE: Files for recently recruited members of staff were inspected and found to be robust and complete. Not all staff spoken to had yet received specific palliative care training, although they would all be expected to provide care to this category of residents. Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 14 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 36 The management team currently responsible for the home provide clear and effective leadership. Supervision is provided to all staff in an appropriate form and at required intervals. EVIDENCE: Residents and staff spoken to were all supportive and appreciative of the efforts being made by the Deputy Manager and Quality Manager in managing the home following the departure of the previous registered manager to take up a senior healthcare post. Staff spoken to and sample records seen provide evidence that meaningful supervision takes place in order to support staff in their roles. Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 15 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 Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 16 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X 3 X X Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13(2) Requirement Timescale for action 10/01/05 2 OP19 23(3) The manager must ensure that it is possible to audit all medication that leaves the home with service users for short periods and to ensure that any gaps in medication records are identified and investigated at the earliest possible opportunity. The standard of staff rest and 30/06/06 meal accommodation must be improved to an acceptable standard. The resident’s ground floor lounge must be brought up to an acceptable level of repair and decorative order. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP30 Good Practice Recommendations Specific palliative care training should be provided for all staff called upon to provide care to this service user group as a matter of priority. DS0000019345.V276833.R01.S.doc Version 5.1 Page 18 Erskine Hall Care Centre Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 19 Erskine Hall Care Centre DS0000019345.V276833.R01.S.doc Version 5.1 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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