Inspection on 06/04/05 for Esher House

This inspection was carried out on 6th April 2005.

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.

Other inspections for this house

Esher House 11/02/09

Esher House 17/08/07

Esher House 29/06/06

Esher House 26/09/05

Esher House 09/11/04

Esher House 05/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Esher House 16 Cabbell Road Cromer Norfolk NR27 9HU Lead Inspector Dot Binns Unannounced 6 April 2005 11.00am 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Esher House Version 1.10 Page 3 SERVICE INFORMATION Name of service Esher House Address 16 Cabbell Road, Cromer, Norfolk, NR27 9HU 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) 01263 512533 01263 512533 Prime Life Limited A new manager is in process of applying to be registered. Care Home 13 Category(ies) of MD Mental Disorder (13) registration, with number MD(E) Mental Disorder - over 65 (1) of places Esher House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9 November 2005 Brief Description of the Service: Esher House provides accommodation for up to 13 adults with mental health problems. The philosophy of the home is centred on helping service users to regain/develop social skills with a view to ‘moving on’ if this is possible. All service users have their own room to which they can retire at any time. Communal accommodation is spacious and one lounge is designated a ‘smoking room.’ Service users private rooms are located on the first, second and third floors.Service users are encouraged to participate in all aspects of the life of the home and to develop links with the local community if they wish. In this respect the home is well situated: both the town centre and the seafront are just a few minutes walk away. Maintaining and developing contacts with family and friends is seen to be an important aspect of the service users overall pattern of care and at their invitation family members and friends are welcome at all times. The home does not provide accommodation for highly dependent service users and all those in residence have to be fully ambulant as there is no lift. Esher House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection lasting three hours from 11am to 2pm. It was undertaken as part of the routine inspections of the Home but also because the registered person had left the home and a new manager had taken up post. The new manager is applying for registration. Much of the inspection was spent discussing the staffing situation with the manager when it was discovered that she was on duty alone in the Home. The serving of dinner was observed and service users were seen and chatted to in the dining room. Two service users were seen in private. In view of complaints made by the service users, an inspection was carried out of the bathrooms and the water temperatures tested. Samples of care records were read and requirements made at the last inspection were discussed and examined. What the service does well: What has improved since the last inspection? Service users receive better support during the late evening as the manager confirmed that one staff did now work every day till 10pm instead of the sleeping in staff starting at 8pm with no other staff on the premises. The Home has had the upheaval of a change of manager and other improvements are yet to be made. Esher House Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Esher House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Esher House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were looked at EVIDENCE: Esher House Version 1.10 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7 Records regarding the care of the service users were in place with appropriate information about the needs and lives of the service users. More information about personal interests and goals could be recorded. EVIDENCE: Two care records were examined and found to contain a lot of information about the varying needs of the service users to help the staff to look after them. Care plans are in the process of being reviewed and changed by the new manager so not all have been made as comprehensive as the new format. However the manager confirmed that this process was underway. Risk assessments were also seen, for example on risk of falling. Most of the service users can go out and confirmed that they did go out to shops and centres in the community and were able to make those decisions themselves. Daily notes were written by staff demonstrating that staff were monitoring the welfare and health of the service users. Esher House Version 1.10 Page 10 Where the care plans could be improved is in reflecting the personal goals of the service users in terms of their development and the steps taken by staff to help them achieve those goals. This needs more focus. Motivation is difficult with this client group but one to one attention to personal interests and goals was not apparent and service users do seem to sit around the home with little to do. Esher House Version 1.10 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 Service users enjoy their meals and thought the food was good in the home. EVIDENCE: A choice of chicken curry or sausage or egg and mash was offered at the main meal on the day of the inspection. A choice was also offered for dessert. Eight service users were seen in the dining room and they said the food was “very nice” and “had no complaints at all”. One service user was heard to say to staff how much he liked the dessert. The inspector had reservations about the food offered as there were no vegetables apart from the potato, and the chicken curry was pre packed. However the service users were enthusiastic about the food. Service users confirmed they helped themselves to breakfast and had access to fresh orange juice in the fridge and to cereals and toast. The fridge and toaster and kettle were seen in the dining room. They also said that the teatime meal was good and usually a hot snack but there were also salads. Esher House Version 1.10 Page 12 One service user seen in private said he thought the food was very good and the helpings were generous. The main meal was being served at 12 noon though some service users came later and there was some coming and going at the tables. Two service users were out and their meal was being kept for them. This showed some flexibility in the system. Esher House Version 1.10 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 The healthcare needs of the service users are being assessed and monitored by the staff with appropriate access to healthcare facilities. Service users are able to control their own medication where appropriate but the homes procedures were not tight enough to ensure safe storage and handling of medication. EVIDENCE: Two samples of care plans were examined. There were separate sections showing what health services the service user had received and these confirmed that GPs, district nurses, and community psychiatric nurses had all been in attendance. Hospital appointments and eye clinics were also attended. Daily progress notes written by staff confirmed that staff were monitoring how service users were feeling and advising them about their health. The drug cupboard was seen by the inspector on arrival to be open and unattended with medication left out. The room where the drugs were stored was accessible and not locked providing opportunities for theft or mistakes. Esher House Version 1.10 Page 14 The daily administration record was examined and although much had been completed correctly there were gaps in the signatures on several days. The bubble packs containing the tablets was examined and the medication had gone. This did not give enough reassurance that the medication had been given to the person and much stricter recording procedures are necessary. There was evidence from the medication records that service users if able could self medicate and were given their own medication to take on a weekly basis. Esher House Version 1.10 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected EVIDENCE: Esher House Version 1.10 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,27,28 Service users live in a homely and comfortable environment with a variety of shared spaces and with privacy in their own rooms. Hot water is not being provided consistently to all of the service users. EVIDENCE: On arrival at the Home, the inspector was immediately approached by a service user regarding the problem with the hot water. Another service user asked to see the inspector in private and highlighted the same problem. They complained about lack of hot water and their inability to have a bath. One person said they had only managed to have one bath in two weeks. They had tried to have their baths at different times accepting that sometimes too many people were using water at the same time but still the water was cold. One also said that two people were not able to get into a bath and needed to have use of the shower, but had found it difficult to obtain hot water. “You need to have a shower don’t you” said one. One service user said the water in his room was “hot one minute, cold the next”. Esher House Version 1.10 Page 17 The baths and showers were all inspected and the water allowed to run for a short time in each to test the temperature of the water. The baths and shower on the first and third floors were running hot but the water on the second floor from both the shower and the bath was cold. A problem with hot water has been highlighted before in this home and clearly something is not right with the hot water system. This needs to be remedied and the service users’ concerns addressed. The Home does have a variety of spaces for service users to sit. There is a front smoking room, a back lounge, and a conservatory which joins up with the dining room. All have comfortable chairs and bright surroundings. In addition all of the service users have single rooms and although only two or three were visited, these were seen to be homely and fitted with a lock for privacy. Service users themselves said they felt very comfortable in the Home. Esher House Version 1.10 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Service users are not supported by an effective staff team. The staffing was so poor on the day of the inspection that an immediate requirement was made to rectify the situation and make safe the Home. Staffing overall was considered to be ineffective and not organised in a way which promoted the welfare of the service users. EVIDENCE: The manager was on duty alone when the inspector arrived. No other staff were on the premises. This was considered unsafe practice with 11 service uses on the premises. One care staff was on duty on the rota but had taken two service users to a hospital appointment. She was out of the building for three hours leaving the manager on their own for this time. Esher House Version 1.10 Page 19 The manager was trying to cook the main meal in the kitchen, attend to service users and see visitors at the same time. She had to leave the kitchen with foodstuffs cooking to attend to service users which may have been unsafe. The drug cupboard had been left open in the office, free for anyone to take the drugs. The lounge was in need of a clean. There was clearly too much for the manager to contend with on her own. Having only one staff on was seen as unsafe and not meeting the requirements on staffing laid down by the Commission. The rota for the week of the inspection showed two staff on duty for most of the time, namely the manager on duty with only one care staff. On only one day was the manager on duty with two care staff, freeing her to get on with some of the management tasks required and potentially allowing one staff to leave the premises with service users if required. There were no catering or domestic hours provided on the day of the inspection and the manager said that no specific staff were recruited in these roles. Care staff complete all the cooking and cleaning of the house. The manager said that usually these hours are allocated as extra care hours and when this happens it means that three staff are on duty including the manager. However if only one care staff is on duty with the manager they are responsible for the catering and domestic tasks, for the most part taking them away from the service users as only one service user currently is involved in kitchen tasks and no staff are able to leave the premises with service users. It is accepted that this is a small home and that the manager is not expected to spend all her hours in management tasks. However there have to be management hours which are separate from the care hours so that the manager can ensure the good organisation of the Home. Staff also need to have the time to promote the welfare of and stimulate service users. The manager said that usually she is extra to the care hours for some of the time but was having particular difficulties with staffing at this time. A review as to how hours are distributed is recommended in order to allow the care staff to have the maximum amount of time supporting the service users in what they want to do and in allowing the manager to monitor the practices in the Home. In addition care staff are rostered to do 12 and up to 14 hour days which is considered to be far too long a shift. This is too tiring for staff and does not benefit the service users. On three occasions on the week of the inspection, one staff goes on to be the sleeping in person having done a 14 hour shift and then does a 12 hour shift the next day. It has been recommended in the past that this system is reviewed and shorter shifts brought in for the benefit of the service users. So far the home has not accepted this recommendation. The Commission continues to believe that this would be better practice and that currently the Home is being organised for the benefit of the staff rather than the service user. Esher House Version 1.10 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 41 The new manager is keen to do well but has yet to be registered. On the basis of this inspection, some difficulties are yet to be remedied especially regarding staffing. EVIDENCE: The manager is only just appointed and the service users and staff have undergone change through the loss of a manager and other staff. This inspection has shown flaws in the staffing arrangements which the manager will need to remedy. In terms of standard 41, a requirement had been made at the last inspection for regular and detailed reports on the Regulation 26 visits made by the provider or his representative. One recent visit record was seen though it was not as detailed as required by the legislation nor has a copy been sent to the Commission. Esher House Version 1.10 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 2 3 x x Standard No 11 12 13 14 15 Esher House x x x x x Standard No 31 32 33 34 35 36 Score x x 1 x x x Version 1.10 Page 22 16 17 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 1 x Standard No 37 38 39 40 41 42 43 Score 2 x x x 2 x x Esher House Version 1.10 Page 23 Yes 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 20 Regulation 13(2) Requirement The registered person must ensure that medication is safely kept in a locked facility at all times. The registered person must ensure that medication is correctly administered and recorded. Service users must have access to a hot water supply. The registered person must ensure that there are sufficient staff on duty in the home to ensure the safety of the service users. The registered person must ensure that the nominated person who carries out the Regulation 26 visit, does so in line with the duties as specified in Regulation 26 and sends a copy of the report to the Commission. (Previous timescale of 31.1.05 not met). Timescale for action Immediate and ongoing Immediate and ongoing 30th April 2005 An immediate requiremen t was made at the time of the inspection. 31st May 2005 2. 20 13(2) 3. 4. 27 33 23(2)(j) 18 5. 41 26 Esher House Version 1.10 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 33 33 Good Practice Recommendations Service user plans should be in sufficient detail to provide clear guidance for staff on the actions to be taken to meet the personal goals of the service users. A reorganisation of the staffing should take place to ensure that staff have time to spend with the service users in promoting their independence and interests as well as catering and cleaning and there is enough time for the manager to deal with the management tasks. It is recommended that the system of 12 and 14 hour shifts are reviewed and replaced with shorter shifts. 3. 33 Esher House Version 1.10 Page 25 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF 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 Esher House Version 1.10 Page 26 - 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. 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