Inspection on 28/06/05 for Esther House

This inspection was carried out on 28th June 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

Esther House 21/11/07

Esther House 14/08/06

Esther House 01/11/05

Esther House 14/12/04

Esther House 30/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Esther House 34 Mauldeth Road Heaton Mersey Stockport SK4 3ND Lead Inspector Kath Oldham Announced 28 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. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Esther House Address 34 Mauldeth Road, Heaton Mersey, Stockport SK4 3ND 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) 0161-432-0826 0161-947-9439 Mr P J Kelly CRH Care Home 15 Category(ies) of OP Old Age registration, with number of places Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 15 OP. Date of last inspection 14 December 2004 Brief Description of the Service: Esther House is a small home situated in the Heaton Mersey area of Stockport, close to local shops and amenities. It is a large detached house set in its own grounds. Esther House is registered to take people whose primary need for care is due to old age. At any one time, a minority of service users may suffer from shortterm memory loss. The majority of service users have care needs which are relatively uncomplicated, i.e., help with washing, dressing/undressing, assistance with toilet, administration of medication, acquisition of medical treatment, as and when necessary. The home does not offer care for people who have high dependency needs A member of staff is employed to co-ordinate an activities programme for service users three times weekly. This includes light exercise, manicures and pedicures. Eight bedrooms have en-suite toilets. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and took place in June 2005. Time was spent in conversation with residents and visitors, observing staff practice and routines. A sample of records maintained for the purpose of regulation were examined. An inspection of the premises was also included. Comment cards were sent out to visiting health professionals and residents prior to the actual inspection. The comments received are included in this report. Action had been taken in relation the requirements made as a result of previous inspections. Some had been carried out in full, but others needed more work to meet the Regulations and National Minimum Standards. Verbal feedback of the findings of the inspection was given to the owner and the manager at the end of the inspection. What the service does well: The atmosphere in the home is warm and friendly. Staff take a pride in their work and work as part of a team; all staff members assisting one another in differing tasks. Service users’ activities were said to be enjoyed and service users were occupied in everyday occupations, as they would be in their own home. Service users appear happy in the home and ask about one another and show a genuine concern for their friends at the home. The owners and manager were described as easy to approach with one visitor saying they look after the residents as they would their own mother. Residents enjoyed the food. The atmosphere in the dining room was sociable with residents catching up with one another and sharing what they had done in the day and what they intended to do. Residents were interested to take part in the inspection and wanted to share their views about the home. Staff were patient, friendly and sensitive and spent time with individual residents. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 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. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.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 Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.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 & 5 Residents are provided with the information they need prior to moving into the home. EVIDENCE: Residents said they were told about the home before they came and had a service user guide in their bedroom. One resident said she has a contract with the home that is on file. Examination of the contracts identified that they needed to provide more information about which room the resident is to occupy and how much care costs when residents were in hospital. One service user said they were not aware that the bedroom number should be included in the contract but understood how sensible that would be. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 9 Residents said they looked round the home before coming to stay. Another resident said she stayed for a couple of weeks before making the decision to stay. The acting manager carries out an assessment of the resident and their needs to see if the home can look after the resident. Examination of a sample of residents’ records confirmed an assessment was in place. Relatives said they were shown around the home before their cared for resident came to stay. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Service users’ health, personal and social care needs are provided for at Esther House. The lack of detail recorded in the care plan has the potential for care needs not to be addressed. EVIDENCE: Doctors, dentists and chiropodists attend the home to provide health care to residents. One resident said the chiropodist did wonders for her feet. One resident said that they were relieved, knowing they were taken care of. A visitor said she would recommend the home to anyone and would be happy for her own mother to live at the home. Doctors were seen to have consultations with residents in the privacy of their bedrooms. Staff were observed respecting residents’ privacy by knocking on doors before entering. One GP’s comment card said the home “always has the best interests of residents in mind in terms of their healthcare”. Another said they had “no concerns whatsoever; very caring home I think, with happy residents.” A further GP said that Esther House is “one of the best residential homes I have dealings with.” Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 11 Residents said they were treated with the utmost respect and felt at ease with staff at the home. One resident said they “felt looked after” and they were “happy with their life.” Residents said their care needs are met by staff who know them well. Staff said they were aware of residents’ needs through conversation with residents and others involved in their care, in addition to the assessment. Examination of the care records identified that not all the care needs were recorded. Residents said they get their medication when they should which helps them to stay well. The storage of medication needs to be improved, as it is stored in an unlocked cupboard, which is not in keeping with safe storage guidelines. Residents are able to self medicate; an assessment is made by the home to see if this is practicable and appropriate for the individual. There is a medication policy in place which needs to be amended to ensure that it complies with regulations and staff are familiar with it. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Residents were, in the main, able to make their own day to day decisions and choices; their independence was promoted as were their privacy and dignity. EVIDENCE: Residents said they could do what they want when they wanted. One resident said she uses the home as a base and continues with activity as she did before she came to stay at the home. Another resident said she always stays busy and enjoys the ideas of the activities co-ordinator. One relative said they love coming to visit the home. A number of residents visit church weekly and attend meetings outside the home. Visitors said they have peace of mind that their cared for relative was well looked after. Residents said that their visitors come when they want. One resident said they go out most days, as the mood takes them and just lets the home know. Visitors were seen coming in and out of the home during the day of the inspection. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 13 An activities co-ordinator is employed at the home, whose hours have been increased. Residents said they looked forward to her coming on duty. Previous inspections have reported residents to say that when the activities coordinator is off, the staff don’t have time to work with them in activities. The acting manager stated there had been changes in the staff team and it was hoped now they were a bit more organised, staff would support residents in more activities. In the main, residents choose to have their breakfast in their bedroom and the remainder of their meals in the dining room. One resident spends most of the day in her room, coming down for meals, which suits her lifestyle. A number of service users use their rooms as bed-sits and call on their neighbour for chats. Residents were complimentary about the meals, they said they were “lovely” and “cooked well”. The records did not detail individual diets, as they need to do in line with regulations. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 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 & 18 The complaints procedure ensured that all interested parties were aware of how to complain and the process that would be undertaken. Limited staff training could lead to staff not recognising some types of abuse. EVIDENCE: Esther House has a complaints procedure that was included in the service user guide which every resident has a copy of. Residents and visitors said they were aware of what to do if they had a complaint. One resident said they tell the home what they think and if there is any need for change or improvement. Examination of the complaints record detailed comments and complaints received. One relative said “they always have time for you and respond quickly to requests/comments”. Residents and visitors expressed a high level of confidence that they could talk to any member of staff if they had a complaint. Two staff have received training in the identification of abuse and what action to take. The rest of the staff need to attend this training to ensure they are able to recognise and describe signs of potential abuse to safeguard residents. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 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, 20, 23, 24, 25 & 26 Esther House has created a warm and friendly atmosphere where residents feel safe, comfortable and well looked after. EVIDENCE: Examination of records identified that electrical and gas service checks were carried out to maintain the equipment in the home safely. Service users said they felt safe and secure. The home was very clean and tidy. Service users said it was always this way. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 16 The home has a large lounge which the majority of residents use at some time during the day. A smaller lounge is also available that residents were seen to use for quieter time or to chat with their visitors. The main lounge has had an additional call point installed, which was said to be better for residents to call for help or assistance. A new television cabinet has also been purchased which lifts the television screen higher so residents can see it easily. Residents said watching the television was now a lot better. There is a dining room on the ground floor with tables set with crockery; tablecloths and flowers, which provides a welcoming feel to the room. One resident said “the tables are always set beautifully”. Radiators at the home are now guarded which reduces the risk of scalding. One service user was observed to use the radiator cover to steady her when leaving the lounge. The home has had some problems with the heating system with a number of the radiators in residents’ bedrooms being too hot or too cold. Individual valves have been installed on those radiators, which enable residents to control the temperature in their bedroom. Inspection of the bedrooms identified that service users are not provided with a lockable drawer or cupboard where they can keep private items secure. A number of residents don’t have keys to their bedroom doors. It is the home’s intention to try and promote residents’ privacy and personal space more by including in the procedure for admitting new residents the giving of their bedroom door key. One bedroom had been redecorated and new carpeting had been purchased which brightened the room. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 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, 28, 29 & 30 Staff were in sufficient numbers to meet the needs of residents, they were skilled and experienced to undertake the work they are employed to do. The training provided was not sufficient for the protection of staff and service users. EVIDENCE: In an effort to protect service users the home has a thorough recruitment and selection procedure. Service users said staff appeared to know what they were doing and were instructed by the owner. Staff have been allocated to a number of residents to whom they provide care and support. Service users said they liked their “key worker” and have a special relationship with them. A comment card said that they were “very impressed with staff, very caring, professional, good management of problems.” Two staff have obtained NVQ level 2 training, a further two have commenced and two staff are studying for NVQ level 3. Additional training needs to be undertaken in moving and handling to ensure the practice which is being used by staff is in keeping with health and safety guidelines. The manager said that it was her intention to put together a training plan to keep on top of the training which needs to completed by staff. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 18 Service users would benefit from staff receiving updates in training in moving and handling and adult protection procedures. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 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 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, 36 & 38 Esther House is a well managed home. Practices in the home ensure that the health and safety of residents and staff are promoted and protected. EVIDENCE: Since the last inspection the deputy manager has been promoted to acting manager. It is the owners’ intention to nominate her to the commission for consideration for registration as manager. Staff appeared confident in the acting manager’s abilities and said she was helpful and did her best to sort out any problems. The manager has commenced studying for NVQ level 4, which she will need as part of her registration. The manager does not currently receive formal, structured supervision to assist in her personal and professional development. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 20 The owners visit the home regularly and spend time in conversation with service users to see if the care that they receive is what they need. Residents said they always had time to chat with them and see how they were. Residents were confident that if they needed anything all they had to do was ask. Service users and staff meetings are not routinely arranged which would provide them with an opportunity to influence how the home is run and contribute to the effectiveness of the home Formal supervision was not being provided for staff. The manager said that she planned to implement a system of formal supervision in the months following the inspection. Records showed that not all staff had taken part in fire drills at the regularity requested by the fire authority, which has the potential to put staff and residents at risk in an emergency situation. Accident records were completed correctly and action taken in an attempt to minimise the number of accidents experienced by residents. Procedures for handling money for residents were satisfactory. Residents said staff purchased toiletries and such like on their behalf and obtained receipts. Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 3 3 x x 3 2 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 2 3 x x 2 x 3 Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 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 The registered person must provide alternative locked storage for all medication in the home. The registered person must develop a record of food served to detail meals for individual service users to enable anyone inspecting the record to judge whether the diet is satisfactory in terms of nutrition and otherwise. (Previous timescales of 31/07/04 and 31/01/05 not met). The registered person must provide staff with external training in the definitions of abuse and how to recognise abuse within care home settings. (Previous timescale of 31/02/05 not met). The registered person must ensure that all staff receive updates to the moving and handling training annually. The registered person must ensure that all staff receive fire drill training and practice at a minimum of twice yearly. Timescale for action 31/08/05 2. OP15 17(2) Schedule 4 30/09/05 3. OP18 13(6) 30/10/05 4. OP30 13(5) Ongoing 5. OP38 23(4) Immediate & ongoing Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 23 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 OP2 Good Practice Recommendations The registered person should amend the present contract to contain information regarding which room is to be occupied and charges applicable should a resident be admitted to hospital. The registered person should continue to develop the care staff team to facilitate their completion of the care plans and the daily reports. The registered person should research and compare the homes medication policy and procedure with the Royal Pharmaceutical Societys guidelines ensuring compliance and familiarity with them. The registered person should include a photograph of individual service users within the medication administration records. The registered person should provide service users with activity and stimulation as a matter of routine and not be dependent on the hours of the activity co-ordinator. The registered person should provide, in all service users bedrooms, lockable storage space for medication, money and valuables and provide a key which can be retained by the service user. The registered person should further promote the homes key holding policy to include routine provision of keys to bedroom doors to service users on admission. The registered person should produce a staff training and development programme. The registered person should obtain for the acting manager regular, formal supervision to assist in the development of her role and abilities. The registered person should arrange for service user meetings at the home to discuss areas of interest at intervals appropriate to their needs. The registered person should record the notes/minutes of the meeting. The registered person should arrange formal regular staff meetings, the details of which should be recorded. 2. 3. OP7 OP9 4. 5. 6. OP9 OP12 OP24 7. 8. 9. 10. OP24 OP30 OP31 OP32 11. OP33 Esther House F54 F04 esther house A s8554 v225688 280605 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 2nd Floor Heritage Wharf Portland Place Ashton under Lyne, OL7 0QD 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. 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