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Inspection on 24/09/07 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 24th September 2007.

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

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

Erskine Hall provides a comfortable and attractive environment for people who live or work in the home. There is a generally high level of satisfaction expressed by people living in the home about the standard of care they receive. There is a strong management and administration team in the home and care staff say that they feel well supported by the training and supervision they receive.

What has improved since the last inspection?

The introduction of the new Quest format for care plans has significantly improved the standard of care plans in the home. This will benefit both staff and the people they care for by providing key information in a clear and accessible format with provision for a constant process of review clearly recorded.

What the care home could do better:

The manager has not yet completed the process of registration with the CSCI and this must be done. Although generally safe and accurate there are some parts of the storage, administration and recording of medication that require tightening up. Again, although people are generally quite satisfied with the catering arrangements in the home, over-large portions were mentioned as a concern by a number of people living in the home spoken to during this inspection visit.

CARE HOMES FOR OLDER PEOPLE Erskine Hall Care Centre Watford Road Northwood Middlesex HA6 3PA Lead Inspector Jeffrey Orange Key Unannounced Inspection 24th September 2007 08:30 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.V351508.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. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 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 erskinehallall@bupa.com BUPA Care Homes (AKW) Ltd Manager post vacant 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.V351508.R01.S.doc Version 5.2 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. 19th December 2006 Date of last inspection 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 extensive grounds, with good parking facilities. Accommodation is arranged on three floors, each with a day room and served by a passenger lift. All rooms exceed 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. The home’s statement of purpose, service user guide and previous CSCI inspection reports are available in the home. The current fee range for this service is £513 to £1,039 per week. (Confirmed at 24/09/07). BUPA’s terms and conditions of residence clearly set out what is included in the weekly fee and what is available at additional charge, for example hairdressing, private healthcare treatments, escort duties and personal purchases such as newspapers and toiletries. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place over approximately 6 hours starting as people living in the home were being assisted to get ready for the day and having their breakfasts and continued until after lunch when the afternoon activities were taking place. As well as observing the care experience in the home discussions were held with people living in the home, visitors and relatives and with healthcare professionals associated with the home. Members of the staff team on duty were also spoken to and key records, including care plans, staff recruitment files and medication records were examined. Discussions were also held with the Deputy Manager and her administrative team supported the inspection process. This report also takes account of any service user surveys received and information received from the home in the Annual Quality Assurance Assessment (AQAA) submitted to the Commission for Social Care Inspection. The AQAA is a self-assessment and dataset that is filled in once a year by all care providers which gives details of how they are meeting care outcomes for people using their service as well as providing the CSCI with statistical information about the service. This report also takes into account any information received by the CSCI about Erskine Hall since the last key inspection that took place between December 2006 and January 2007. What the service does well: Erskine Hall provides a comfortable and attractive environment for people who live or work in the home. There is a generally high level of satisfaction expressed by people living in the home about the standard of care they receive. There is a strong management and administration team in the home and care staff say that they feel well supported by the training and supervision they receive. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 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.V351508.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 3 5 (Standard 6 does not apply to Erskine Hall) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a thorough system of pre-admission assessment in place that should ensure that only those people whose needs can be appropriately met are admitted into the home. There is a range of clear and detailed information provided about the terms and conditions that will apply to a persons stay in Erskine Hall, including what is included in the weekly fee and what is available at additional cost. This should ensure that people know what they will have to pay and what they will get for their money. Pre-admission visits either by the person considering Erskine Hall as their home or by those responsible for them are encouraged and facilitated, this should enable them to decide if they think that they will be happy there and that the home will provide them with what they want and need. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 9 EVIDENCE: It has been established from talking to people living in the home and to those responsible for them, that visits to the home to look at rooms and services were encouraged prior to admission. Copies of a range of documentation including the “Terms and Conditions of Residence” and “Paying for a care Home”, together with the homes’ Statement of Purpose and Service Users’ Guide were seen and are available in the home. These can be provided to any person considering Erskine Hall as their home or as a home for someone they are responsible for. Pre-admission assessments for several recently admitted people living in the home were seen and contained full assessments of their needs and how they were to be met. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 10 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 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal, social and healthcare needs are clearly recorded in a personal care plan that provides the basis for the delivery and review of care, involves the person concerned and is kept up to date. People living at Erskine Hall have access to the specialist and community healthcare services they require. Self-medication is encouraged on a risk- assessed basis, which preserves the independence of people living in the home in respect of their own medication. There are some areas of the home’s medication practice that need to be more closely monitored in order to fully protect those whose medication is administered or stored on their behalf by the home. EVIDENCE: A sample of care plans were seen, these were in the new Quest format and were clear, comprehensive and well-completed, this should provide care staff with the information they need in order to accurately determine the care needs of people living in the home and to effectively meet them. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 11 During this visit a dentist was visiting one person in the home, a G.P discussed the effective relationship that exists with the home and the ambulance service attended to one person who was being taken to hospital, care plans contain details of the involvement of a range of healthcare professionals with people who live in the home. Several people are or have been self-medicating whilst at Erskine Hall, this demonstrates that those who are capable of doing so and wish to do so are able to retain responsibility for their own medication. Although the overall standard of medication practice was satisfactory some medication was being stored at inappropriate temperatures, some variable dosages of medication were not always being accurately recorded and it was not possible to reconcile those medications where totals had not been brought forward from the previous recording period. People living in the home were generally very positive about and supportive of staff and the way that they provided care for them. “They are wonderful you know” was one typical comment. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 12 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): Standards 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Erskine Hall have the opportunity to develop and maintain important personal and family relationships. There are a range of activities available and activities staff attempt to take account of individual needs and preferences when developing the activities programme for the home. People living in Erskine Hall are given opportunities through meetings and surveys and through one to one contact with the manager and staff to affect and influence the daily routines of the home. The home’s menu is varied, with a number of choices, including healthy options, it is drawn up in consultation with people living in the home and seeks to respond positively to views about food expressed to the chef and his staff. Some people living in the home find the size of portions intimidating. EVIDENCE: The activities programme was seen and activities were observed during this visit. People who had been taking part told the inspector that they had enjoyed them and that “It is good for us to do exercises like this” Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 13 A brief discussion was held with the activities organiser, who confirmed that he seeks to take account of people specific interests when drawing up the programme and that, with other staff he tries to offer some level of one to one activity to those people living in the home who cannot access the lounges for group activities. The chef discussed the process of meal planning, including the provision of “night bites” between the hours of 6.30 pm and 6.30 am for those who want a hot snack at those times. The overall feedback from people living in the home was very positive, the one area where several people had a concern was the size of portions, which some found over-large and off-putting. There is to be a relatives and residents meeting on the 4th October, and notices were prominent throughout the home advertising this. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 14 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): Standard 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a comprehensive complaints policy and procedure in place and staff are provided with training that should enable them to recognise abuse if it is seen or expected and to take the appropriate action to safeguard people living in the home. EVIDENCE: Staff training records were seen to include evidence of training being undertaken in safeguarding and issues around the potential abuse of vulnerable adults and what to do if it seen or suspected. Complaints are recorded and responded to in line with the BUPA complaints policy, which includes a timescale for formal responses to any complaint made. This policy is publicised in the home and in literature provided to people living in the home. The manager chose not to complete the section of the AQAA relating to complaints. There have not been any complaints received about Erskine Hall by the CSCI since the last key inspection ended in January 2007. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 15 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): Standard 19 24 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Erskine Hall offers a pleasant, comfortable and generally safe environment for those people who live or work there, however there were some potentially significant failures in good health and safety practice found which detracted from what would otherwise have been a good outcome. EVIDENCE: The home was clean, free of clutter and appeared well maintained on the day of the inspection. Furniture and décor is of a high standard and peoples’ own rooms are comfortable and pleasant, with considerable scope offered for personalisation with items of furniture, pictures and ornaments. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 16 Two linen storage doors, although marked fire doors keep locked shut, were open for a considerable period during this inspection. The laundry fire door was propped open during this inspection, other similar wedges were seen for example in medication storage areas although not in use during this inspection. A medication storage area where oxygen cylinders are stored did not have the appropriate signage on the exterior door. The staff rest room floor was very dirty and untidy and there was cardboard stacked under the sink unit right up against an electric socket, which could potentially be a fire risk. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 17 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): Standards 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are available in the numbers and with the skills and experience required to adequately meet the needs of people living in the home. Staff are supported with training and supervision to help them develop their skills and to address any areas where their performance could be improved. The home has a robust system of recruitment in place that should ensure that only those suitable to do so are employed to provide care for people living in the home. EVIDENCE: “I respect the carers”, “The staff are very good” were some of the many positive comments made about the staff team throughout this inspection. The standard of care seen was good, from the early morning when staff were greeting people as they helped them to get up and provided them with their breakfasts and throughout the day during meal times and activities. Training records were seen and although these were not always fully completed and up to date, staff spoken too and those records seen provide adequate evidence of a good training programme in place including for NVQ. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 18 Recruitment files were seen for recently recruited staff and these contained evidence of the necessary checks to protect people living in the home from the employment of unsuitable people to care for them. New staff are now being required to pay for their own CRB checks despite the home facing some difficulty in recruiting staff, for whom this will be an additional cost. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 19 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): Standards 31 33 35 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The fitness of the home’s manager has not yet been established through the registration process with the CSCI. The home has a well- developed system of quality assurance that seeks to obtain the views of people living in the home, those responsible for them and health and social care professionals associated with the home. People living in the home’s financial interests are protected by the systems in place for the recording of financial transactions made on their behalf. There were a number of health and safety issues which, although relatively minor, could nonetheless potentially have serious adverse effects on people living and working in the home. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 20 EVIDENCE: At the time of writing this report, no application for registration as manager had been received by the CSCI in respect of Erskine Hall. (The registration process is the way that a managers’ fitness is initially established by the CSCI.) There were some significant areas of the AQAA that were not completed, for example section 16 (Complaints) and section 17 (Contracts) Errors in medication storage and administration, the use of door wedges and failure to keep fire doors closed, the storage of combustible materials near a potential ignition source and the lack of correct signage for oxygen storage facilities are all potential hazards for people living and working in the home. Although the manager may not be personally responsible for any of these she is responsible for putting in place and monitoring robust systems to ensure they do not take place and if and when they do, as manager must take responsibility for them and for addressing them. The quality assurance and financial systems in use in the home have previously been inspected and found to be satisfactory. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 21 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 2 Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Requirement All medication must be stored within the manufacturer’s recommended temperature range for it. Where any medication is prescribed in variable dosages, the exact dose administered on each occasion must be recorded. To facilitate the accurate audit of medication, totals must be brought forward from one administration period to the next. Fire doors must not be propped open or left open and unlocked. Combustible materials must not be stored where they represent a risk to people living or working in the home for example by being adjacent to an obvious ignition source. Appropriate signage must be used to inform people that oxygen is being stored in those rooms/storage areas where that is the case. A fit person must be registered as manager for the home with the CSCI. This requirement has DS0000019345.V351508.R01.S.doc Timescale for action 24/09/07 2. OP9 13(2) 24/09/07 3. OP9 13(2) 24/09/07 4. 5. OP19 OP19 13(4) 23(4) 24/09/07 24/09/07 6. OP19 23(4) 24/09/07 7. OP31 8(1) 31/10/07 Erskine Hall Care Centre Version 5.2 Page 23 been brought forward from the previous report and must be complied with within the revised timescale. 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 OP9 OP15 OP15 OP29 Good Practice Recommendations The Manager should look into the possibility of obtaining supplies of Lactulose in a formulation that can be stored safely at temperatures not exceeding 25°C. The home should obtain a copy of the CSCI report “Highlight of the Day” and should make use of it, as it feels appropriate. Staff should offer each service user the opportunity to have the size portion they prefer at each meal. The manager should review the practice of requiring new staff to pay for their own CRB checks if it appears that this is adversely affecting recruitment of staff. Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Erskine Hall Care Centre DS0000019345.V351508.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!