Inspection on 10/11/05 for Excelsior

This inspection was carried out on 10th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Excelsior 08/05/07

Excelsior 20/06/05

Excelsior 10/02/05

Excelsior 22/07/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Excelsior 74/76 Mitchell Avenue Ventnor Isle of Wight PO38 1DS Lead Inspector Janet Ktomi Unannounced Inspection 10th November 2005 12.00 X10015.doc Version 1.40 Page 1 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 Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 2 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. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Excelsior Address 74/76 Mitchell Avenue Ventnor Isle of Wight PO38 1DS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01983 854737 Mr Arthur Leighton Lawrence Mrs Shushma Lawrence Mrs Shushma Lawrence Care Home 19 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (19), of places Physical disability over 65 years of age (1) Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 2005 Brief Description of the Service: Excelsior is an extended large detached house in a residential area of Ventnor and is close to all amenities. It is a registered care home for a total of 19 people over the age of 65 years. The home is privately owned by Mr and Mrs Lawrence who live, with their family, above the home. Mrs Lawrence is the registered manager for the home. There is a parking area in front of the house and gardens to the front and rear. All rooms are single, are en-suite and have attractive views over the surrounding countryside and/or sea. The home has a stair lift to access the upstairs level. Day placements are available by arrangement (up to 2 places daily). Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second unannounced inspection of this inspection year. Core standards not assessed during the first inspection were assessed along with additional core and non-core standards. The inspection lasted four and a half hours during which a tour of the building was undertaken. Discussions were held with residents, care staff, the Registered Manager/proprietors. Many of the people living within the home were met during the inspection and gave the inspector their views about the service. All the residents stated that they enjoyed living at the home; the food was good and they liked the staff and proprietors. Care and other records and documentation identified in the report were viewed. What the service does well: What has improved since the last inspection? The home continues to provide an excellent service to residents. There is an ongoing maintenance programme with several rooms having been redecorated and new carpets provided since the previous inspection. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 6 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. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3 and 4. Standard 6 is not applicable to the service provided a t Excelsior. The home provides all prospective and existing residents with information about the home and services they can expect to receive. Prospective residents are fully assessed to ensure that their needs can be fully met by the home. EVIDENCE: The home has a residents’ guide and statement of purpose, which is provided to all prospective residents, with a copy available in all bedrooms. These were seen during the inspection. The home accommodates both social services funded and privately funded residents. A contract is provided for privately funded residents with a sample being seen. This contained all the required contractual information in a clear concise comprehensible written format. The home receives referrals from private individuals and care managers. The manager confirmed that in all cases an assessment that includes information about health, mobility, social and personal care needs is completed. A completed pre-admission assessment for a recently admitted resident was seen during the inspection. The manager stated that she also considers where in the home the vacant bedroom is located, how the prospective resident will Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 9 fit in with the existing residents and whether the staff have the necessary skills to care for the new person. Residents the inspector was able to speak with confirmed that they were aware of the services they were entitled to receive at the home. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 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 the following standard(s): 7 and 9 Care plans, containing specific risk assessments, are thorough and clearly outline the care that should be delivered. The home has appropriate policies for the safe storage and administration of medication. The controlled medications record must be signed at the time of administration by the two carers who undertake and witness the medication being administered. EVIDENCE: A sample of residents’ care plans was seen. There is a copy, agreed by the resident, on file and a daily care plan is kept in the resident’s room so that it can be easily accessed by the staff providing care. The care plans are detailed to ensure any new staff could follow the instructions. The residents spoken to said they had been involved in discussions about their care plans and were clear about how their care needs would be met. The home has made changes in order to meet individual needs, for example, installing ceiling track systems in two bedrooms and a bathroom. Advice is taken from appropriate sources to meet the needs of residents such as sound advice and sight concern. This has led to a range of aids and adaptations being Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 11 provided, as well the decoration of the rooms being designed to help the visually impaired. During the unannounced inspection the inspector met a carer who was escorting a service user for a hospital out patient appointment. This carer was in addition to the three carers on shift. The home has a policy about respect for residents and covers this in all staff induction. The staff were observed to be respectful to residents and those spoken to felt the staff were polite, friendly and helpful. The arrangements in respect of medication administration were reviewed. The home has appropriate storage facilities for all medication located within the basement of the home. Medications are stored within a locked cupboard, with individual residents’ medications kept together in plastic containers and predispensed system. The home has a separate secure storage facility within the locked medications room for the storage of controlled medications. All medications received into the home are recorded and the inspector was shown the returns ledger that is counter signed by the pharmacist. The home has copies of medications/pharmacy books and has a folder containing information about medications prescribed for individual residents. Staff who administer medication have all received training and been deemed competent by the manager. The Medication Administration records were viewed and these were fully recorded on appropriate forms. The administration of controlled medications is also recorded in the controlled medications register. This was viewed and found to contain several gaps were the second carer who witnessed the administration had not signed the book. Both carers must sign this at the time of administration. The remaining core standards were fully assessed during the previous unannounced inspection. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 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 the following standard(s): 14 and 15 Residents’ capacity to exercise personal choice and control over their lives is promoted. A varied, nutritious diet is provided which meets individual residents’ likes and special needs. EVIDENCE: During the tour of the building a number of residents’ bedrooms were seen. These contained personal possessions of the resident with those spoken with confirming that they had been able to bring items of furniture as well as ornaments and pictures with them into the home. The arrangements in respect of residents’ personal finances were reviewed during the previous unannounced inspection and found to be appropriate. Residents spoken with during the inspection confirmed that they are able to make many choices about aspects of their lives. Residents confirmed that they are able to choose whether to join in activities and where they spend their time. Residents were seen both within their own rooms and sitting within the lounge. Residents stated that they have choice about their meals, where they eat them and about what time they get up or go to bed. Discussions with care staff and the proprietors indicated that they respect service users’ decisions. Service users are provided with aids for communication such as specialist equipment for one man with hearing loss to enable him to express his opinions Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 13 and care staff to keep him informed of options available. The home provides independent advocacy for service users via Care Aware. Care Aware is an independent organisation with information for service users available within the home and via a twenty-four hour help line. All existing and prospective service users are assessed using the advocacy questionnaire to ensure they are receiving all the relevant benefits and have information about their entitlement to financial support from social services. The inspector was able to meet the home’s cook and observed the main lunchtime meal being served. The menus seen indicated that a varied and nutritious diet is provided with the manager stating that menus are changed if residents suggest different meals during resident meetings. Residents spoken with confirmed that they have choice about their meals and are able to request alternatives if they do not fancy what is offered. The main meal is served at lunchtime and the food looked appetising and portion sizes appropriate. The cook has a list of individual residents’ likes and dislikes within the kitchen and a record of food eaten by residents is kept within the staff room. Choice is also provided during the evening meal. Residents confirmed that hot and cold drinks are available throughout the day. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 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 the following standard(s): 16 Residents or their representatives are able to complain if they are unhappy with the service provided at the home. EVIDENCE: The home provides residents with information as to how to make a complaint within the residents’ information guide. The home’s complaints policy and procedure fully complies with the requirements of the National Minimum Standards. Information as to how to complain via the Commission for Social Care Inspection is included in the residents’ information. The home maintains a record of complaints. Discussions with residents indicated that they felt able to complain and indicated that they would do so to either of the proprietors. Care staff spoken with during the inspection were aware of what they should do if a resident or relative wished to complain. At the time of the unannounced inspection residents had no complaints. It is the inspector’s opinion that residents would be able to complain if they had any concerns and that the proprietors would take appropriate action to satisfactorily resolve any issues. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 23, 24, 25 and 26 The home provides a safe, attractive homely environment for residents. Residents’ rooms and communal areas provide appropriate equipment to meet residents’ individual needs. The home is clean, tidy and well maintained. EVIDENCE: Since taking over the home in 2003 the proprietors have made numerous improvements to the environment. All rooms are redecorated once they become vacant, the rooms are en-suite and the proprietors have taken advice from Sight Concern and Sound Advice to ensure rooms are decorated and arranged to the best advantage of the residents. New carpets have been laid which are bleach-proof and stain resistant. The proprietors intend to replace the remaining carpets around the home in the future with similar high quality floor coverings. The home has a stair lift to the first floor with four bedrooms being then accessed by a short flight of four stairs. Residents of these rooms are fully mobile and should the need arise would be offered a room elsewhere in the home if they were no longer able to safely manage these stairs. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 16 The home is registered for up to nineteen people. The proprietors have decided to use rooms registered as twin for only one person. Therefore the home was full at the time of the unannounced inspection with seventeen residents. The proprietor is in the process of drawing up plans as to how space within the home can be used more effectively and provide an additional single bedroom and improved en-suite and space within another room. The plans would also provide a separate sluice facility (currently located within a bathroom) and improved staff room with covered external smoking area. Once plans are completed the proprietor is to forward a copy to the Commission. The home provides pleasant communal space within a lounge/dining room and conservatory with access onto a decked patio that has extensive sea views. There is also an area of lawned garden with new fencing to ensure safety and privacy for residents. The home provides three assisted bathrooms and one walk in shower room. All bedrooms have en-suite facilities with a separate WC located close to the lounge/dining room. Bedrooms are individually and naturally ventilated with radiators covered and having individual thermostatic controls. One resident stated that she could ask care staff to change the setting on her radiator to ensure her bedroom was heated to her individual needs. There are dedicated cleaners employed daily that are responsible for the cleaning within the home, including the residents’ bedrooms. At the time of the unannounced inspection the home was found to be clean, tidy and free from offensive odours. Residents confirmed that this was always the case. Supplies of liquid soap, paper towels and disposable gloves were seen around the home. The laundry facilities were not inspected and will be during the next unannounced inspection. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. The home provides suitably trained care and ancillary staff in numbers appropriate to meet the residents’ needs. 58 of the care staff are qualified to at least NVQ level 2 with all staff undertaking mandatory and specific training to meet the needs of the residents. EVIDENCE: The duty rotas were seen during the unannounced inspection and corresponded to the numbers of care and ancillary staff on duty. Three care staff are provided throughout the day with one awake and two sleep-in staff at night. In addition to care staff the home employs a cook and dedicated housekeeping staff. An additional person is employed for two hours each morning to encourage exercises for the residents and another person for two hours in the afternoon for activities, for groups or individual residents. Maintenance, cooks and garden staff are also available. The manager/proprietor, Mrs Shushma Lawrence and proprietor Mr Arthur Lawrence, are also present within the home. Residents stated that they felt there were sufficient staff to meet their needs with one confirming that two staff are available at night if she needed attention requiring two carers. Care staff stated that they felt that they were able to meet residents’ needs. On the day of the unannounced inspection an additional carer had been provided by the home to escort one resident to a hospital out patient appointment. Care staff confirmed the manager’s statement that they do not use agency staff but cover holidays and sickness with the home’s existing care staff. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 18 The home has fourteen care staff, eight of which have at least NVQ level 2 in care. This equates to 58 with additional care staff identified to commence this qualification when places are available. One carer is undertaking NVQ level 3 and another is to commence level 3 training. The home actively supports NVQ training and pays care staff two hours per fortnight for coursework allowing them to use the home’s computers to complete work. Care staff stated they are encouraged to undertake training and supported to do so. The home has purchased a variety of in house training packages including dementia, adult protection, infection control, food hygiene, challenging behaviour, health and safety, supervision and appraisals, medication, fire awareness and first aid. The manager is a manual handling trainer and undertakes manual handling assessments and training. Additional training sessions are provided to meet individual residents’ needs such as Parkinson’s, schizophrenia, depression and Alzheimer’s. The manager stated that she would arrange specific training as required to ensure that residents’ needs are understood and met by staff. The care staff on duty were observed providing sensitive and competent care to the residents. Staff stated they enjoyed working at the home and all worked together as a team. Care staff stated that they felt able to talk with the proprietors and were confident that they would resolve any concerns. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 36 and 37. The registered manager is competent to run the home. The management approach of the home creates an open, positive and inclusive atmosphere. EVIDENCE: One of the joint proprietors, Mrs Shushma Lawrence, is now the home’s registered manager. Mrs Lawrence informed the inspector that she has recently completed NVQ level 4 in care and has two units to complete to achieve the Registered Manager’s Award. The manager has completed Manual Handling trainers training and confirmed that she undertakes updates for mandatory and resident specific training. The manager has contact with other home managers from whom she is able to access advice if required. Residents and care staff were clear about the management arrangements within the home and all described the proprietors as approachable and available. The management approach of the home creates an open, positive and inclusive atmosphere. Regular staff and resident meetings are held. Residents stated Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 20 that they would be happy to identify any concerns to the proprietors and were confident that the proprietors would resolve any issues. The home would appear to be financially viable, being fully occupied at the time of the inspection, the proprietors stating that they had a waiting list of potential residents. Appropriate insurance certificates were seen displayed on the hallway. Discussions with the proprietors indicated that they had a longterm business plan and plans for continuing updating and refurbishment of the home. Care staff receive recorded supervision both on a regular and ad hoc basis by a member of the management or senior staff. The home has purchased an in house training package in respect of supervision and appraisals. Care staff also receive an annual appraisal during which specific training needs and goals are identified. The proprietors spend a considerable amount of time in the home and therefore are able to observe, support and supervise staff on an ongoing basis in addition to the formal arrangements. During the unannounced inspection a variety of records was viewed within the home. These included care plans, risk assessments, Medication Administration Records, Controlled Medications book, menus, residents’ contracts and staff duty rotas. All were found to be appropriately stored and maintained with the exception of the controlled medications record book. As previously mentioned this contained several gaps where the second carer, acting as witness, had not signed the record book. The second carer must observe the dispensing and administration of controlled medication and sign the book to confirm this at the time the resident receives the medication. At the time of the unannounced inspection the home appeared safe for residents, visitors and staff. This standard was fully assessed during the previous inspection. Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 4 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 4 3 X 4 4 3 3 STAFFING Standard No Score 27 4 28 3 29 X 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 X 3 X 3 2 X Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP9OP37 Regulation 13 (2) Requirement Both carers must sign the controlled medications record at the time the controlled medication is administered. Timescale for action 10/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Excelsior DS0000041267.V249322.R01.S.doc Version 5.0 Page 24 - 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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