Inspection on 20/06/05 for Excelsior

This inspection was carried out on 20th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 10/11/05

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 Lynda Mosling Unannounced 20th 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. Excelsior H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 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 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 excelsior@wightbiz.com Arthur Leighton Lawence and 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 H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10/2/2005 Brief Description of the Service: Excelsior is a 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 has applied to become registered manager of 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 H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken by one inspector during the afternoon. Three residents were seen privately in their rooms and a group of residents in the lounge/dining area were also spoken to. Records seen included care plans, risk assessments, quality assurance questionnaires, recruitment and training files. Three members of staff and the proprietors were spoken to as part of the inspection. What the service does well: Thorough pre-placement assessment and care planning ensures the home can meet the needs of the residents. The interactions between the staff and the residents are sensitive and take account of the residents’ individual preferences. There is a lively atmosphere within the home and residents are provided with a range of activities to suit their individual interests. A member of staff is specifically employed to arrange activities. The home provides good quality accommodation and residents’ rooms are designed to take account of the individual’s needs. They are comfortable and attractive. Recruitment and training of staff is a particular strength and staff confirmed that they are encouraged, and rewarded, to undertake training. The staff group have grown in their confidence as result of this encouragement. There is a well developed quality assurance system based on feedback from the residents. Residents feel consulted and listened to. Records kept within the home are very detailed and evidence the service provided to residents. The residents said they are well cared for and feel fortunate to be living in the home. Excelsior H55H04_S41267_Excelsior_V216942_200605.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. Excelsior H55H04_S41267_Excelsior_V216942_200605.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 Excelsior H55H04_S41267_Excelsior_V216942_200605.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) 3 and 5. Prospective residents are assessed by the senior staff prior to being offered a placement to ensure the home can meet their needs. Residents and friends have an opportunity to visit the home and meet the staff and residents before deciding to move in. EVIDENCE: The home receives referrals from private individuals, district nurses and care managers. In each case an assessment is undertaken to ensure the home can meet the needs of the resident. The assessment includes information about health needs, mobility, social needs and personal care needs. In addition, the staff consider how the resident will fit in with the current resident group and whether the staff have the correct skills to manage them. Assessments of four residents were seen. Two of the new residents were spoken to. They confirmed that they had seen the manager prior to coming to the home and had been involved in discussion about how their needs would be met. One resident had come from another residential home and explained that this helped him know what he was looking for. He said, ‘I knew that this was going to be the place for me’. Excelsior H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 Page 9 The residents confirmed that they were able to visit prior to placement and one of the residents made the decision that he wanted to stay within a week of being at the home even though he was ‘supposed to be trying it out’. The proprietors explained that they can offer day care, respite and a range of trial periods for residents prior to a longer placement being agreed. Staff spoken to said they get information about the prospective resident following the first assessment and have an input into whether they can meet the resident’s needs. Records regarding declined prospective residents and/or those who have decided not to stay are kept for future reference. All placements are reviewed after four weeks. Copies of the reviews were seen on residents’ files. Excelsior H55H04_S41267_Excelsior_V216942_200605.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 and 10. Care plans are thorough and agreed by the resident and/or representative. They clearly outline how the care should be delivered. Health care needs are met by the home in conjuction with specialist services. Residents say they are treated with respect and have their privacy protected. 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 the 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 discussion about their care plans and were clear about what to expect from the home. The proprietors have made changes to the home 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 i.e. Sound Advice and Sight Concern. This has led to a range of aids and adaptations being provided, as well as the decoration of the rooms being designed to help the visually impaired. Excelsior H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 Page 11 Health care needs are met in conjunction with medical specialists. District nurses, GPs etc. visit regularly and records are kept of these visits on the residents’ files. All contact with medical professions is recorded, particularly where there has been some conflict i.e. if the “Out of Hours” medical service refuse to do a visit to a resident. Residents are always escorted to hospital for appointments or trips to the Accident and Emergency department. An admission pack for the hospital is sent with the resident. This was seen to provide information about a resident to assist the ambulance and/or hospital staff. Dentists, opticians, chiropodists and hairdressers visit the home, but residents can also access their own choice of provider. All providers of services visiting the home are CRB checked. The home has a clear 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 ‘friendly and professional’. There was also a lot of humour observed between the staff and the residents and staff spoke of ‘enjoying the company of the residents’. Residents confirmed that they are able to keep their affairs private and staff are careful not to discuss residents in front of others. Excelsior H55H04_S41267_Excelsior_V216942_200605.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 and 13. Residents enjoy a variety of activities and are encouraged to pursue their own interests. Visitors are encouraged and are able to spend time with the residents in private. EVIDENCE: The proprietor has recruited someone specifically to provide activities to the residents. He is employed for three hours each afternoon and will do activities with groups of residents and/or individuals. The activities offered include bingo, quizzes, ball games, reminiscence therapy and board games. On the day of inspection there were three residents enjoying a game of Ludo. This proved to be noisy, in a good humoured way. One resident said she enjoyed ‘taking the mickey and cheating’ whilst playing games. Lively interchange between the staff and the residents was observed and was being enjoyed by the residents. In addition a student comes into the home to engage residents in arts and craft activities. There is a mini-bus and driver available to arrange trips out. However, some residents choose to remain in their own rooms and this is accepted too. One resident had spent the day in his room as he was feeling ‘a bit below par’, but said he usually likes to be in the lounge socialising with staff and other residents. Visitors of relatives and friends are encouraged, with the permission of the resident. They can share meals with the residents. Residents spoken to said Excelsior H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 Page 13 their visitors can come and ‘stay as long as they wish’. Some residents go out with friends and others are taken to coffee mornings, clubs etc. Different religious interests are catered for with visits from local ministers. Excelsior H55H04_S41267_Excelsior_V216942_200605.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) 18. The policies, procedures and practices within the home are designed to protect the residents from abuse. EVIDENCE: The recruitment of new staff puts the safety of residents first. All necessary references are taken up and all providers within the home i.e. chiropodists have CRB checks taken out. The induction of staff includes information about whistle blowing, abuse and how to recognise it and the procedures to be used if there are suspicions and/or allegations. The staff have undertaken training in adult abuse and follow the locally agreed procedures. Staff spoken to were aware of their responsibility to protect the residents. The proprietors take all matters of likely abuse seriously and have appropriately used the systems in place to check out concerns about residents. The residents spoken to were sure that they had not seen anything of concern within the home regarding abuse or unkind treatment. They confirmed that they would ‘soon shout’ if they did. Excelsior H55H04_S41267_Excelsior_V216942_200605.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, 23 and 26. The home provides safe and attractive accommodation. Residents rooms provide the appropriate equipment to meet their needs. The home is clean, tidy and has no offensive odour. EVIDENCE: Since taking over the home in 2003 the proprietors have made numerous improvements to the environment. All rooms are re-decorated once they become vacant, the rooms are en-suite and advice has been taken from Sound Advice and Sight Concern to arrange the rooms to the best advantage of the residents. New carpets have been laid which are bleach proof and stain resistant. This has helped deal with the consequences of spillages and prevents the problem of odours within the home. The home currently does not have a passenger lift but this is in the business plan. There is a stair lift for the use of residents. The residents spoken to were very pleased with their rooms and said they had everything they wanted. One resident with partial sight and hearing loss had Excelsior H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 Page 16 devices to help him communicate, including a hand held microphone with headphones which he can control in order to speak with people. Two bedrooms have tracking for hoists to ensure safe lifting and transfer. All rooms are en-suite and are attractive and comfortable. Residents are able to bring their own furniture into the home, by arrangement. There are dedicated cleaners employed daily. They are responsible for the cleaning within the home, including the residents’ rooms. However, they involve the resident in the cleaning of their rooms if that is what they wish. Excelsior H55H04_S41267_Excelsior_V216942_200605.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) 29 and 30. The recruitment of staff is safe and places the protection of residents first. There are good training systems in place to ensure the competence of the staff. EVIDENCE: The recruitment process ensures that all the necessary references are taken up. The records were seen and showed that written references are received and verbal follow up is made prior to a job being offered. The six week induction of staff meets the requirements of TOPPS. New staff shadow experienced staff until they are judged competent to be placed on the rota. There was evidence on the day of the inspection that any concerns about new staff and/or students are appropriately taken up to ensure the safety of residents and to provide a consistent service. New staff spoken to said that the staff and proprietors were really helpful. One said ‘I can always ask for help if I am unsure – they would rather I do that’. Staff have a training audit as part of their annual appraisal. Copies of these were available at the inspection, including a spreadsheet that enables a quick look at the overall qualifications/training of the staff. This is used to target training provision. Updates on the basic training is ongoing. The home has bought in training providers to provide distance learning packages. These have proved quite popular with staff who can see their relevance to the working environment. NVQ training is encouraged and staff are supported by Excelsior H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 Page 18 being given paid time to study. Staff spoken to confirmed that training is encouraged. One said ‘If we want anything special to help with our job they will arrange it’. The staff spoken to were enjoying NVQ training even though they said they hadn’t expected to. The proprietors felt that training had an overall positive effect on the performance of staff within the home as it raises all staff’s awareness of issues. The staff on duty were observed providing sensitive and competent care to the residents. Several staff talked of their pleasure in working with the residents. Excelsior H55H04_S41267_Excelsior_V216942_200605.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) 33, 35 and 38. The home involves the residents in all major decisions and is run in the best interests of the residents. The home ensures the residents financial affairs are safeguarded. The health and safety of residents is promoted by clear policies and procedures. EVIDENCE: The home has developed a system of quality assurance that actively seeks the views of residents and their relatives/friends. The result of the feedback is used to make changes/improvements in the running of the home. There is a self-monitoring process that looks at all standards and highlights any necessary changes. Questionnaires to residents covering themes i.e. food and catering, personal care and support, daily living etc. are given to residents to complete on a regular basis. This demonstrates the home’s desire to provide a service that meets the standards and the expectations of the residents. Copies of the feedback were shared at the inspection. Two new residents spoken to Excelsior H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 Page 20 confirmed that they had been asked about their experience of moving into the home. They felt ‘important’ as a result of being asked their views. Residents are in control of their own money. There is a locked provision in the office where residents can keep their weekly allowance and all spending is accounted for. There is a spreadsheet – password protected - that shows the money belonging to the residents and when it has been accessed, and by whom. Relatives generally arrange for the purchase of clothes or any other items for the residents. The home keeps records of all checks on fire equipment, COSHH analysis, risk assessments etc. They were made available at the inspection and showed an impressive attention to detail. Each member of staff has a responsibility for the health and safety of the residents. There is a health and safety manual and all staff have signed to say they have read it and will use it. Risk assessments on residents are often undertaken in conjunction with relatives, GPs and other interested parties to ensure a collective understanding and acceptance of calculated risk. Excelsior H55H04_S41267_Excelsior_V216942_200605.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 x x 4 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 x 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x 4 x x 3 STAFFING Standard No Score 27 x 28 x 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 4 x 3 x x 4 Excelsior H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action 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 Good Practice Recommendations Excelsior H55H04_S41267_Excelsior_V216942_200605.doc Version 1.30 Page 23 Commission for Social Care Inspection Mill Court Furrlongs Newport 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. 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