CARE HOMES FOR OLDER PEOPLE
Eshcol House 12 Clifton Terrace Portscatho Truro TR2 5HR Lead Inspector
Lowenna Harty Unannounced 26 July 2005 10:00 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. Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Eshcol House Address 12 Clifton Terrace Portscatho Truro Cornwall TR2 5HR 01872 580291 01872 580291 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) Mr Mark Fairhurst Mrs Gillian Fairhurst Care Home 31 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (14), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (4), Old age, not falling within any other category (31), Physical disability (4), Terminally ill (4) Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1) Up to 1 service user with dementia aged 50 - 60 years may be admitted. Date of last inspection 10 February 2005 Brief Description of the Service: Eschcol House provides accomodation, personal and nursing care for up to 31 older people. Four of these may have a physical disability; Four may be terminally ill, Four may have a mental illness, up to fourteen may have dementia and one adult aged 50-60 years may have dementia. The registered providers are Mark and Gillian Fairhurst. They are actively involved in the business on a day-to-day basis and employ a manager and a team of staff to assist them. There is always a qualified nurse on duty at the home. The home is located in the village of Portscatho on the Roseland Peninsula. It overlooks the sea and several rooms have spectacular sea views. The home is accessible by road and the village is within walking distance. The home has three storeys. The upper floors are accessible by a serviced lift, stairs and stair lift. There are two lounges on the ground floor and a separate dining room. Most of the bedrooms provide en suite facilities. The home is set in its own attractive grounds with parking space at the front of the building. There is level access to all communal parts of the building and the grounds and suitable facilities for people with physical disabilities to enter the building independently. Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection as part of the home’s annual inspection programme, which took place on 26 July 2005. Two inspectors spent approximately five hours in the home and between them they undertook the following activities: 1. Inspection of records, including assessment information and care plans 2. Discussion with the manager and senior staff on how it operates on a dayto-day basis 3. Inspection of the premises 4. Interview with a member of staff 5. Interviews with three residents held in private with them 6. Observation of daily life in the home. The Principle method of inspection was “case-tracking”, whereby a selection of residents’ records (in this case, three) are chosen and reviewed in detail. This is followed up by discussions with staff working with them and the residents themselves. This provides a useful impression of how the service operates on a day-to-day basis. Overall the home provides residents with a good standard of care in a warm and homely environment. The inspectors would like to thank the registered provider, manager, staff, residents and all those who contributed for their kind assistance in the conduct of this inspection. What the service does well:
Residents are assessed before they are admitted to the home so that the home’s manager can decide if their needs can be met there. Assessment information includes consideration of prospective residents’ personal, health and social care needs, including their preferences and their religious and cultural backgrounds. Trained and qualified staff meet residents’ healthcare needs. There is always a qualified nurse on duty and residents are assisted to access specialist healthcare workers who visit the home, according to their individual needs. Residents are able to receive visitors in the privacy of their rooms or in the communal lounges and there were plenty of visitors coming
Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 6 and going from the home at the time of the inspection. Residents are able to choose who they see and do not see and when. They are able to have private telephone lines installed in their rooms if they wish, so that they can keep in touch with relatives and friends. The home has a formal written complaints procedure and this is provided to residents in the information that tells them about the home. The home is comfortable, warm, safe and homely. It is well maintained and tastefully furnished and decorated. Several rooms, including the two lounges, have spectacular sea views. The home was clean, tidy and hygienic throughout at the time of the unannounced inspection and there are suitable systems in place to protect residents from the risk of infection. There are staff employed in a variety of different capacities, including nursing, caring, domestic, administrative and maintenance roles to ensure that the home is well run for the benefit of residents. Staff are employed on the basis of fair, safe and effective recruitment and selection practices to ensure that they are suitable to work in the home. Most of the care staff are qualified to at least NVQ level 2 and they have good access to ongoing training and development. The home has formal systems in place to monitor the quality of the service it provides. This includes residents’ satisfaction questionnaires, residents’ meetings and questionnaires sent to relatives and professionals who regularly visit the home. The home’s annual quality review is available to residents and their representatives. Health and safety in the home is maintained through regular risk assessments, equipment tests and checks, written procedures for staff and staff training. This includes fire safety. What has improved since the last inspection? What they could do better:
Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 7 At this inspection, the home was compliant with most of the regulations and achieved most of the national minimum standards that were checked. There are generally good outcomes for most residents. The new manager plans to review the home’s care planning systems and this should lead to improvements. Staff would benefit from clearer written direction and guidance so that they can be surer that residents’ needs are fully met. If residents are admitted to the home with an expectation of their being rehabilitated back to their own homes, following an illness or admission to hospital, they would benefit from improved facilities to help them to practice independent living. Otherwise, there should be a clear statement in the home’s statement of purpose to ensure that prospective residents and their relatives are very clear about the extent to which they can be supported in this respect. Some improvements to the way the home manages medicines are needed, to fully protect residents. This includes making sure that medicine pots are washed up in the kitchen, rather than in the area where staff wash their hands, for hygiene reasons. Record keeping is mainly satisfactory, but some improvement are needed to protect residents from medication errors. This only relates to isolated records, reviewed at the inspection and not to usual practice in the home. 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. Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 6 Residents’ needs are fully assessed before they move into the home to ensure they can be met. Facilities for people who are admitted for rehabilitation should be improved. EVIDENCE: The home’s assessment format is detailed and thorough and covers all aspects of residents’ needs. This includes their health, personal and social care needs, considers their preferences, likes and dislikes and religious and cultural backgrounds. Residents are sent a self-assessment form to complete, which provides good evidence that they are involved in the assessment process. Upon their admission to the home there are more detailed, specialist assessments, including assessments of risk to ensure that residents’ plans of care reflect all their healthcare needs properly. Of the three residents’ whose assessments were reviewed, most of their assessments were fully completed and their files contained evidence of their involvement in this, either through completed self-assessment forms or their signatures. Where this was not possible, there was an explanation on the form, for example one contained a note to say that the assessment had been completed via telephone. The
Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 10 assessment form for one resident had not been fully completed, but they were admitted several years ago and standards have improved since then. The home does not have dedicated facilities for people who are admitted for intermediate care. There are visiting professionals, such as physiotherapists and social workers, who visit the home to provide intense physical rehabilitation and assistance to help some residents to return to their own homes when they are admitted for short periods following accidents or specific illnesses. The home’s manager said that some staff have had training in rehabilitation care but there is a lack of equipment, for example to promote activities of daily living such as food preparation, in the home. Some residents may benefit from improved facilities in this respect, otherwise there should be a clear statement in the home’s statement of purpose about the extent that rehabilitation can be supported so that service users and their relatives are clear about this before they are admitted. Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 9 Residents would benefit from improved care planning arrangements. Their healthcare needs are met well. Some improvements are needed to ensure medicines are managed safely in the home. EVIDENCE: Each of the residents whose care plans were reviewed had written care plans. These were detailed and covered most of their health and social care needs. There was clear written permission sought in situations where residents may require the use of cot sides on their beds or other equipment designed to protect them or alert staff if they require assistance, but which may also be deemed restrictive. The home has a new manager and she is planning to improve care-planning arrangements to ensure that there is a clearer separation of care plans and assessment information and this would be an improvement. Care plans were not fully completed in every case and hopefully this will improve once the new system is implemented. There is always a trained nurse on duty in the home and residents’ healthcare needs are thoroughly assessed and well met. The home has good relations with external professionals and specialists who visit the home on a regular basis, including GPs, physiotherapists and other healthcare professionals. The
Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 12 home has good links with local community nurses. There are full records of residents’ healthcare needs on their files and detailed daily care records but care plans should provide more clear direction and guidance for staff. The home has clear written guidelines for staff handling residents’ medicines and this includes guidelines for residents who prefer to retain and manage their own medicines. Staff handling medicines receive training and storage facilities are appropriate to ensure that residents are mainly protected from medication errors. Some aspects of practice need improvement, for example medicine pots need to be washed and dried in the kitchen, away from the staff hand washing area for hygiene reasons. Recording needs some improvement to ensure that all transcribing of medicines is backed up by two signatures. Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 Residents’ wishes with regard to contact with visitors from outside of the home are respected. EVIDENCE: There are no unnecessary restrictions on visitors to the home and several residents had visits from relatives during the inspection. One of the residents said that there are plenty of people coming in and out of the home and there is a well-used visitors’ book. Residents’ files contain details of their family members and instructions in respect of visitors, where relevant. Their wishes and preferences are respected. Residents are able pay for telephones to be installed in their rooms so that they can maintain contact with family and friends. Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents are able to make formal complaints and there are good systems in place to help them make their views known. EVIDENCE: The home has a written complaints procedure, which is supplied to residents. There are formal systems in place to monitor the quality of care and services provided by the home with satisfaction questionnaires that are sent to residents and professionals from outside of the home. There are records of residents’ meetings and the home has an annual quality report, which is available to residents and their representatives. Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The home is safe, comfortable and well maintained and residents are protected by systems in place to make sure it is clean and hygienic. EVIDENCE: At the unannounced inspection, the home was warm, clean and tidy. It was pleasant and airy and residents benefit from plenty of natural light and spectacular sea views from several rooms. The home employs a maintenance manager, who keeps clear records of work that is done and plans for work that needs to be completed. There was evidence of maintenance work in progress at the time of the inspection. The home was well decorated and tastefully furnished throughout. There is ample storage space and necessary disability equipment does not intrude on the home’s environment, which has a homely, non-institutional feel. There are records of all health and safety checks, staff induction and training, fire safety and environmental risk assessments. These are all up-to-date. The home has written policies and procedures to instruct staff on how to prevent the spread of infection in the home. They are supplied with suitable equipment and there are suitable facilities for hand washing in the home. The home has a new sluice to improve hygiene in the home.
Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 16 Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 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 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 are sufficient staff in a variety of capacities to meet residents’ needs. Residents are protected by fair, safe and effective recruitment and selection of staff. Staff are well trained to meet residents’ needs. EVIDENCE: Staff duty records show that there is always a qualified nurse on duty. There are care staff, including senior carers, domestic, maintenance and administrative staff. A care staff member said that she has enough time to undertake both the care work and spend time with residents during her working day. There is a low staff turnover and the business has the Investors in People award. Staff files provide evidence of sound recruitment and selection practices. All have completed application forms, checks necessary to protect residents are undertaken in every case and interview records are retained. There are records of induction training for new staff and most of the care staff are qualified to at least NVQ level 2. There are records of staff training and qualifications and there is a clear commitment to ongoing staff training with a staff-training calendar with booked training for the whole year. Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 18 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) 33 & 38 The home is run for the benefit of service users. It is a safe place for them to live in and for staff to work in. EVIDENCE: There is a formal quality assurance system in place, including anonymous questionnaires sent to residents and their relatives and to professionals from outside of the home who visit it regularly. Copies of letters of thanks and appreciation are retained. There are minutes of residents’ meetings and the registered provider has produced an annual quality report, which is available to residents and their representatives. The home’s maintenance manager is responsible for ensuring that the home’s environment is kept safe. There are written risk assessments covering the home’s environment and fire safety and records of all necessary equipment tests and checks. There are records of staff training and they are provided with written policies and procedures to guide them in their work. Residents’ records
Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 19 reviewed at this inspection showed clear written risk assessments for service users to ensure their individual needs are met and they are safe. Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 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 x x x x 3 x x x x 3 Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 21 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 9 Regulation 13(2), 13(3) 13(2) Requirement There must be suitable arrangements for the washing and drying of individual medicine pots. Medication records must be made in accordance with written policy and good practice in every case. Timescale for action 01/09/05 2. 9 01/09/05 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 6 Good Practice Recommendations Residents admited for short periods following an illness or accident with a view to returning to their own homes would benefit from improved rehabilitation facilities. Otherwise the homes statement of purpose should provide very clear information on the extent that rehabilitation can be supported by the home. Plans to improve care planning systems in the home should be implemented so that there is a clearer distinction between assessment records and care planning and staff are provided with clearer written direction and guidance. 2. 7 Eshcol House D52-D04 S9264 Eshcol House V239815 260705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection John keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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