Inspection on 09/12/08 for Etheldred House

This inspection was carried out on 9th December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Etheldred House 27/02/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Etheldred House Clay Street Histon Cambridge CB24 9EY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janie Buchanan     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Etheldred House Clay Street Histon Cambridge CB24 9EY 01223236079 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): santall.steytler@excelcareholdings.com Excelcare Holdings Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 80 Number of places (if applicable): Under 65 Over 65 0 80 dementia old age, not falling within any other category Additional conditions: 80 0 The maximum number of service users who can be accommodated is 80 The registered person may provide the following categories of service: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Older People, not falling within any other category - Code OP Date of last inspection Brief description of the care home Etheldred House is a large new purpose built care home, providing nursing and residential care to 80 older people. The home is divided into 4 units Apple, Pear, Cherry and Strawberry each with its own communal lounge, dining area bedrooms, kitchenette and bathroom facilities. The home has 3 secure garden areas that are accessible to residents. The home is situated in the village of Histon with good access to local shops and a library. Cambridge City Centre is about 4 miles away. The Care Homes for Older People Page 4 of 28 Brief description of the care home registered provider of the home is Etheldred Healthcare Limited, which is a subsidiary company of Excelcare Holdings Ltd. 18 of the beds are contracted to the local Primary Care Trust at their benchmark cost, with the rest being available to people self-funding their own care. Weekly charges vary between £630 and £790 per week depending upon the peoples needs Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: For this inspection we (The Commission for Social Care Inspection) looked at all the information that we have received about the home. This included the annual quality assurance assessments (AQAA) that was sent to us. The AQAA is a self assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information. We received a number of surveys from residents, their advocates and and staff working at the home. We spoke with four residents, three members of staff and the manager, and looked at a range of documents and policies. We undertook a brief tour of the home to check the environment and took lunch with the residents to check on the quality of food and to observe how staff interacted with residents. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Pre-admission assessments for prospective residents need to be much more thorough and accurate to ensure they are admitted to the correct unit where their needs can be best met and to ensure they are not moved around the home once they have moved in. Food and fluid charts for residents need to be completed much more thoroughly to ensure an accurate and up to date record is kept of what they have actually consumed. This is vital if their health is to be monitored meaningfully. Staff should spend more time actually with residents during the mealtimes, to encourage and prompt them to eat more. Long and uninteresting corridors give the home a rather institutional and hotel like feel and much more could be done to make these areas more homely, attractive and Care Homes for Older People Page 8 of 28 stimulating for residents. Likewise in the garden: familiar objects such as a green house, washing line, a vegetable patch or even a car could be included so that it resembles the garden of a domestic setting and also give residents the opportunity to hang out washing, weed, clean the car, sweep the patio etc. There should be a range of strongly coloured and smelling plants to stimulate the senses and raised beds so that residents can see, touch and feel plants without having to bend down. A covered area should also be provided so that residents can access this area even when its raining. Supervision for staff needs to be more frequent to ensure their working practices are monitored, their training needs identified and so they have a chance to raise any concerns. We raised this at the last inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have information about the home to help them choose if it is the right place for them. They have their needs assessed and a contact that gives details of the service they will receive. Evidence: The home has a statement of purpose and service users guide, copies of which are made available to each resident. They contain good information about the facilities of the home, its philosophy of care and staffs qualifications. The documents have been updated since the last inspection to include information about how the home will meet the specific needs of people with dementia living there. One resident told us an illustrative brochure was available, which was fairly comprehensive and accurate. Each resident is also issued with a contract that states the terms and conditions of their stay at the home, the fees payable, the care and support services offered and Care Homes for Older People Page 11 of 28 Evidence: details about terminating the contract. We saw signed copies of this contract on the residents files that we checked. All residents health and personal care needs are fully assessed before they are admitted to the home to ensure their needs can be met there. However, we have received concerns from local social workers that sometimes the home has placed people inappropriately in its units where their needs cannot be properly met. One told us: I just get the feeling they dont understand the difference between residential and nursing dementia care. This concern was also raised by the homes local GP who felt that: one or two patients have been misplaced. However the manager is well aware of this problem and is working hard to ensure that current residents are placed correctly. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health care needs are met at the home. Evidence: We checked four residents care plans and peoples needs were clearly identified with the action to be taken by staff to meet them recorded. Information in the plans was generally detailed: for example it stated in one plan; is able to dress himself but may ask for help with socks or bottoms. Likes to wear his jacket all day, giving staff good guidance of how he liked to be helped. Residents we spoke to told us they were happy with the way staff helped them, and received the care and support they needed. However one resident told us she would very much like a bath twice a week, rather than just once. We spoke to a GP who visits the home regularly. He told us that the quality of care his patients received was generally good and that the staff coped with very frail residents well. He described staff as caring and competent. One relative told us that her father has become very poorly but has been seen by the GP 3 times in the last week. Care Homes for Older People Page 13 of 28 Evidence: Peoples falls risk, pressure sore risk and nutrition are regularly monitored and food, fluid and turning charts are implemented for residents when needed. However, these charts were not very detailed and did not give a comprehensive picture of what food was eaten and amounts actually consumed were not added up each day to check the person was receiving enough. Fluid charts showed that one resident was only getting 400-600 mls of fluid a day which is not enough to keep an older person properly hydrated. Turning charts too had been completed erratically, showing that one resident had only been turned every 3-4 hours even though their care plan stated they should be turned every two hours. We checked medication storage and recording in two of the homes units. Records we viewed had been completed accurately, hand written additions to the MAR sheets had been signed and dated, and indicated clearly if one or two tablets had been given to residents when a variable dose medication was prescribed to them. All creams administered in residents bedrooms had been recorded and signed for. Fridge temperatures where medicines were stored had been recorded daily. The temperature for the medication storage area on Strawberry had not been recorded each day but we were assured by the Head of Care that a thermometer had just been purchased to do this. Only staff who have received appropriate training administer medication to residents. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to some activities to keep them stimulated and their families are kept up to date with what is happening in their lives. Evidence: The homes activities co-ordinator retired in the beginning of October and there has been a reduction in the amount of activities and events as a result. A new co-ordinator has recently been recruited however and is just awaiting CRB checks before she starts working at the home. Staff told us that activities such as ball games, armchair exercise, sensory stimulation and cinema afternoons take place regularly which many residents enjoy. One relative told us: they respect dads wishes not to join in with the others for activities. Staff did bring a chess board to his room instead, to try and encourage him to play. However one resident stated: I would like to go to church more to get the atmosphere, I used to go every Sunday before I moved in here, my church is just around the corner from the home. Visitors to the home are made to feel welcome and all five relatives who completed or survey told us they were kept up to date with important issues affecting their friend or relation. Care Homes for Older People Page 15 of 28 Evidence: We observed lunch being served to residents. This consisted of either chicken casserole or cauliflower cheese with potatoes and mushrooms, followed by pineapple upside down cake. The quality of the food was satisfactory and was well presented. However, staff spent a lot of time by the hot trolley and in the kitchen area rather than with residents themselves so they could encourage and prompt them to eat. They did respond quickly though when a resident started choking. Most residents told us the food was good and a meals survey carried out by the home also confirmed this. However one resident commented: there is a surfeit of chicken and cheese sandwiches. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to the homes complaints procedure and their concerns are investigated. Evidence: Residents who completed our survey stated that they knew how to make a complaint and there are posters with information about how to complain on display around the home. The home has received 6 complaints since it opened concerning amongst other things: the capability of the manager; residents wandering into other residents bedrooms; the lack of a lockable cabinet in a residents bedroom; a residents clothing not being changed frequently enough; a mix up over a hairdressing appointment and water being too cold. These complaints had been investigated and responded to, although not always within the homes own set timescales. The manager had trouble finding details of all the complaints received as these had not been properly kept and filed by the previous manager. Records showed that staff had received training in protecting vulnerable adults and they showed us good knowledge about what they would do if a resident alleged they had been abused. We have attended two strategy meetings held under adult protection guidelines in relation to the home: one concerning the poor quality of care received by a resident from staff an the home (allegations not upheld) and the other concerning a resident who had been inappropriately moved from one unit to another Care Homes for Older People Page 17 of 28 Evidence: without adequate consultation or assessment of their needs (allegation upheld). Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable environment. Evidence: The home has been purpose built to meet the needs of older people. It is spacious and has fixtures and fittings of a high standard. There is a comfortable reception area, visitors toilet and a reception desk that is staffed. Facilities for residents include a hairdressing and treatment room, a movie theatre, a smoking room and relatives meeting room. All bedrooms have en suite facilities (with level access shower), a TV, a telephone point and fully profiling beds. There are a number of secure garden areas, giving residents safe access to fresh air and light. Three of the homes units are for residents with dementia. These are rather large (18,20,22 beds respectively) for such residents. Corridors in these units are long, devoid of natural light and are very similar looking in beige paint. Bedroom doors are also very similar looking. This is potentially confusing for residents with cognitive impairments. However there has been some attempt since the last inspection to improve the signage and orientation aids and pictures of bathrooms and lounges have been placed around the home to help residents who are unfamiliar with their surroundings find their way about. We did not check the homes kitchen but it was awarded 4 stars following a visit from the environmental health officer, ensuring that residents receive food that has been Care Homes for Older People Page 19 of 28 Evidence: prepared in safe and hygienic way. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by competent staff in sufficient numbers to meet their needs. Evidence: Staffing levels vary depending on the unit. On the dementia nursing unit there is 1 nurse and four carers for 18 residents; on the nursing unit there is 1 nurse and 4 carers for 20 residents; on the residential unit there is one team leader and 3 carers for 20 residents and on the dementia residential unit there is 1 team leader and 3 staff for 22 residents. Residents who completed our survey told us that staff were available when needed and one person we talked to during our visit commented:I just put my hand up and someone comes straight away usually. Another: the home seems quite well staffed. Language problems can cause some difficulty- often some amusement. We monitored how long staff took to answer calls bells during and visit and all were answered within 1-3 minutes. The use of agency staff has dramatically reduced and none have been employed since July of this year. Staff told us they had plenty time to spend with residents. Residents told us staff treated them in a way that they liked and one commented:I have yet to find one who is stroppy. Another: the staff are very very nice, only young girls but helpful. Staff who completed our surveys told us they received training relevant to their role and which kept them up to date with new ways of working. Staff training files that we Care Homes for Older People Page 21 of 28 Evidence: checked further confirmed this. More than 50 of staff hold an NVQ level 2 in care, which is above the recommended minimum standard. We checked the personnel files for three recently appointed members of staff. These showed us that the home had undertaken all appropriate police checks and obtained satisfactory references for the person before they started working at the home. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff have not benefited from consistent and strong management since the home opened. Evidence: Management of the home has been erratic since it opened. The previous manager never fully registered with us and has now been moved on to manage another home. There have been two deputy managers employed since February both of whom have left. However an experienced and competent manager and Head of Care have now been employed which should bring much needed stability to the home. The new manager has been quick to identify problems and is clearly committed to sorting them out. Staff clearly rated her: one staff member wrote on our survey: she always come into the units to see if everything is alright and if we need support or if there are any problems she can help or advise on. We tend to see her several times a day, not like previous manager. The new managers office door is always open, so I feel I can go to see her. She always makes time for us. I feel more happy now and more valued. Care Homes for Older People Page 23 of 28 Evidence: Another told us: she is doing good, she is strict but fair and checks the units frequently. One relative told us; she is a breath of fresh air. There are regular meetings where staff can raise concerns and one relatives meeting has been held since the new manager took over. However, it was evident that some staff (in particular night staff) were not receiving formal supervision as frequently as recommended by the minimum standards. When the did receive it, staff clearly appreciated it. One member told us: supervision helps me sort out any problems I have with colleagues. Training records we viewed showed that staff had received training in health and safety, fire and moving and handling and the home is currently responding to a notice of deficiencies that was issued by the fire safety officer. No health and safety hazards were viewed during our inspection, apart from some fallen leaves on the garden areas that residents could slip on. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 36 18(2) Staff must receive supervision of their working practices 09/06/2008 Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Prospective residents must be thoroughly and accurately assessed to ensure that they are placed in the most appropriate unit to meet their needs 20/09/2009 2 8 12 Residents nutrition and fluid intake must be recorded accurately and monitored closely to ensure that they are receiving enough food and fluid 20/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 15 19 Staff should spend more time sitting with residents during mealtimes so they can encourage and prompt them to eat. More should be done to make parts of the home, such as long corridors and garden areas more stimulating and interesting for residents. Page 26 of 28 Care Homes for Older People Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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