CARE HOMES FOR OLDER PEOPLE
Erskine Hall Care Centre Watford Road Northwood Middlesex HA6 3PA Lead Inspector
Jeffrey Orange Unnnounced 25 May 2005 & 6 June 2005 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 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 I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Erskine Hall Care Centre Address Watford Road Northwood Middlesex HA6 3PA 01923 842702 01923 842703 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited Elaine Flanagan Care Home 85 Category(ies) of OP 85 registration, with number of places TI(E) 10 Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: This home may accommodate one person aged 50 years or over who requires nursing care. Date of last inspection 15 October 2005 Brief Description of the Service: Erskine Hall Care Centre is part of BUPA Care Homes Limited and is registered to provide nuring 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 over the age of 65. Erskine Hall is a purpose built nursing home, set back from the road in very pleasant grounds, with ample parking facilities. Accommodation is aranged 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 situted for North West London and South West Hertfordshire with good access to public transport. Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two visits, one of which started at 7.40 am and another which was in the afternoon. Two inspectors took part in the first visit. Residents and staff were spoken with and their views obtained about the experience of living and working in Erskine Hall. With the permission of the residents concerned, inspectors looked at resident’s accommodation as well as the home’s communal areas, kitchen and laundry. Medication records and practice were checked together with records relating to care and staffing, health and safety and administration. As part of this inspection process contact has been made with the home’s doctor and those responsible for the referral of residents into the home’s palliative care beds, to obtain their view on the standard of clinical and nursing practice in Erskine Hall. A series of meetings, held since the previous inspection, involving BUPA, Hertfordshire County Council the CSCI and other interested parties, considered some specific areas of concern and resulted in the implementation of an agreed action plan by BUPA, which has satisfactorily addressed them. What the service does well: What has improved since the last inspection?
Appropriate action has been taken to address those concerns about the laundry, kitchen risk assessments and minor environmental issues that gave rise to recommendations following the inspection of the home in October 2004.
Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 Page 6 The home has recently been successful in recruiting an additional member of the management team with particular responsibility for the performance and quality monitoring of clinical and medication practice in the home. This should improve consistency, which will in turn benefit residents by ensuring that they experience a satisfactory standard of care at all times. The home now enjoys a settled GP service and has also benefited from the involvement of a Nurse Practitioner with the home on a pilot basis. 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 I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 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 standard(s) 1,2,3,4,5,6 Procedures are in place to ensure that both prospective residents and the home have adequate information to enable them to be able to make a wellinformed judgement about the home’s ability to meet a prospective residents’ needs. EVIDENCE: Records show that the home undertakes a rigorous process of assessment to make sure that they are able to offer the care and services that people considering becoming residents need. The Service User’s Guide and Statement of Purpose, together with contracts and other documentation available were seen to include the required information. They could however be further enhanced in the case of the palliative care services offered by the home to give further details of the philosophy of care, equipment and specialist training provided for example (See recommendations) “I have everything I need here, I am well taken care of” was a very typical comment by one resident.
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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 standard(s) 7,8,9,10 Whilst in general the standard of care is good, there were sufficient concerns raised during this inspection to suggest that the home needs to closely monitor and quality assess its medication practice, care planning documentation and staff awareness of issues around dignity. This will ensure that residents receive appropriate care to meet their recorded needs at all times. EVIDENCE: Immediate requirements were made during this inspection in respect of serious concerns associated with the administration of medication. See requirements. (An action plan has already been received to address the issues identified) Some inconsistencies within individual care plans were brought to the attention of the manager. (See recommendations) One resident was seen to be lying on his bed in an undignified position and state of undress, in clear view of people passing his room. “I was marooned in my wheelchair” was a comment made by one resident. (See requirements) Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 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 standard(s) 12,13,14,15 The home provides a range of activities, choices of menu and alternative relaxation areas and encourages participation in and by the community. EVIDENCE: There was a steady stream of visitors into the home and residents leaving with friends or family for days out during both visits by the inspectors. The Manager, Activities Organiser and Inspector had a very informative exchange of views and information on the provision of activities in the home and it was obvious that time and resources are being made available to develop a person centred, imaginative and varied range of activities both for individuals and for groups. ”I would like lectures once a week” was a comment, made by a resident, which was responded to very positively by the Activities Organiser. Resident’s views are sought on a routine basis by the catering staff and residents confirmed this. Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 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 standard(s) 16,17,18 The home provides a safe and responsive environment of care in which residents can feel secure and confident. EVIDENCE: Policies and procedures were seen to be in place to protect residents and to provide opportunity for them to bring any concerns to the attention of the local or regional management of BUPA or to the CSCI. Age Concern Advocacy services are publicised throughout the home. Recent complaints about potential abuse have been thoroughly investigated and dealt with to the satisfaction of the appropriate authorities and action plans, drawn up with the participation of the local and regional management of BUPA, have been put in place to address any areas of concern. Staff training has been seen to include issues and practice around adult abuse. Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 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 standard(s) 19,20,21,22,23,24,25,26. The home is comfortable, well furnished and provides a safe and pleasant environment for its residents. EVIDENCE: The standard of cleanliness throughout the home was very good. Domestic staff spoken to were found to be enthusiastic, committed and well trained and took an evident pride in their work. Residents’ rooms were seen to be full of personal effects and ornaments to give a very personal and individual feel to each room. Residents expressed a high degree of satisfaction with the physical environment of the home; “ I am very comfortable, I have everything I could possibly want” said one gentleman. Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 There appear to be an adequate number of staff, with the appropriate skills, to meet current residents’ needs. EVIDENCE: Staff rotas were available and provided for staffing at the level previously agreed as adequate. Residents expressed a broad acceptance that the level of staffing in the home was realistic, although some concern was expressed about some response times; “They don’t always answer” One inspector went to the assistance of a resident whose peg feed alarm had been activated but not yet answered and who was in some distress. Staff were then alerted to deal with the incident. It was noted that the medication round took a considerable time to complete, although this may have been due to the day being the start of the medication changeover. (See recommendations) There has been a noticeable strengthening in the specialist training in palliative care provided for staff, including some members of staff being supported to undertake degree level qualifications. Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37,38 The home is well managed by an experienced and dedicated team who are accessible and responsive to residents. EVIDENCE: The registered manager has both nursing and management qualifications and considerable experience in residential/nursing settings. A Clinical Quality Manager has recently been appointed to provide additional management resources. Staff and residents were supportive of the management team and throughout the inspection there was a very positive interaction observed between visitors to the home, residents and the manager and her team. Financial records held on behalf of residents were checked and found to be well maintained and accurate.
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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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 2 3 Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 Page 17 No 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 The manager must ensure that at all times acceptable standards are achieved in respect of the recording and safe administration of medication in the home. The manager must ensure that at all times staff respect the dignity of residents. Timescale for action From 25.5.05 and thereafter. From 25.5.05 and thereafter 2. OP10 12(4)(a) 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 OP1 Good Practice Recommendations The home should consider reviewing the Service Users Guide and Statement of Purpose to provide fuller details of the services,equipment and training provided specifically in respect of those residents admitted into any of the palliative care beds. When reviewing care plans care should be taken to ensure that they are consistent and up to date. The manager should review staffing levels at peak times of activity during the day to ensure that they are adequate. 2. 3. OP7 OP27.4 Erskine Hall Care Centre I52_s19345_Erskine Hall_v229010_250505 stage 2.doc Version 1.30 Page 18 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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