Inspection on 09/01/06 for Homelea Residential Care Home

This inspection was carried out on 9th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Homelea Residential Care Home 25/04/07

Homelea Residential Care Home 10/08/05

Homelea Residential Care Home 01/02/05

Homelea Residential Care Home 02/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Homelea 15-17 Lewes Road Eastbourne East Sussex BN21 2BY Lead Inspector Gwyneth Bryant Announced Inspection 9th January 2006 08:30 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 Homelea DS0000021142.V263445.R01.S.doc Version 5.1 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. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Homelea Address 15-17 Lewes Road Eastbourne East Sussex BN21 2BY 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) 01323 722046 01323 460808 Nifinara Limited Dr Nina Patel Care Home 27 Category(ies) of Dementia (27) registration, with number of places Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty- seven (27). Service users must be older people aged sixty-five (65) years or over on admission. Service users with a dementia type illness only to be accommodated. Date of last inspection 10th August 2005 Brief Description of the Service: Homelea is registered to provide care and accommodation for up to twentyseven people with a dementia -type illness. The home is close to Eastbourne town centre and a short car journey from the seafront. It is comprised of three buildings combined into a large detached house with a small front garden and a large rear garden and car park. There is level access to all parts of the garden and seating is provided for residents. The home is owned by two medical doctors, one of whom is also the registered manager. They are experienced and committed to providing a high level of care to their residents. The home aims to provide a safe homely environment in which residents are able to lead satisfying lives, retain dignity, privacy and exercise choice. Regular social activities within the home and outings are arranged. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001 uses the term ‘service users’ to describe those living in care home settings. For the purpose of this report, those living at Homelea will be referred to as ’residents’. This was an announced inspection and took place over 5.75 hours. The purpose of the inspection was to check compliance with the recommendations made at the last inspection and inspect additional standards. There were twenty-six residents in residence on the day. Discussion with two members of staff, the Registered Managers/ Providers and two relatives took place. A range of documentation was viewed including care plans, personnel and medication records. Comment cards were received from twenty-seven relatives/representatives and eight from residents whose key workers assisted them to complete the cards. Only one comment card included a negative comment and this related to an isolated incident. This was discussed, anonymously, with the Registered Providers who said no such incident had been reported to staff and if it had it would have been addressed immediately. The discussions and comment cards were used to inform the inspection process. Five residents were awaiting a GP visit on the day therefore a tour of the premises was not carried out in the interests of infection control. This is the second inspection of this year and therefore this report should be read in conjunction with the report from the unannounced inspection carried out on 10 August 2005 What the service does well: Those residents, who were able to express an opinion, said they were happy; the food was good and the staff very kind. Relatives spoken with re-iterated this and they commented on the welcome they received from staff and how much they appreciated the management ensuring they were informed on all aspects of care given to their relative. Staff were observed throughout the inspection, to treat residents with care and respect and it was evident that they had built a good rapport with residents. The staff are knowledgeable about residents and their needs and one said ‘We work as a team and we are all respected by the management’. The ethos of the home is that consultation with residents and the offering of choice is paramount. Staff and visitors stated that the Registered Providers and all staff are approachable and have an ‘open door’ policy. Record keeping is good and are accurate, up-to-date and regularly reviewed. Due to the highly complimentary statements in the comment cards received from relatives it was felt they should be included. Statements made included the following: Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 6 “… the care, consideration and love received by the owners, carers and all staff is exceptional…” “ I am very pleased with the care given to my father and kindness shown both to myself and my father by all staff…” “Homelea provides a kind and caring environment where my mother is extremely well looked after”. “ Very pleased with the care my mother has received and the friendly approachability of the management and staff”. “The care and affection shown to all residents is second to none”. “ I find the staff looking after her are very kind and keep me informed”. 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. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 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 Homelea DS0000021142.V263445.R01.S.doc Version 5.1 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): 2 and 4. Standard 6 is not applicable. Residents’ contracts ensure their legal rights are protected. Satisfactory pre-admission assessments are carried out at the time of admission to ensure the home can meet residents’ needs. EVIDENCE: A sample residents contract was viewed and they are based on the Office of Fair Trading guidance and include the information as required under the Standard therefore residents’ legal rights and their representatives are protected. Pre-admission documents for recent admissions were viewed and it is evident that these documents are used effectively to ensure the home is able to meet the needs of prospective residents. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 9 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, 8 9 and 11 The care planning system is clear and consistent and provides staff with the information they need to satisfactorily meet residents’ needs. Residents are protected by satisfactory systems for the recording, handling and storing of medication. Residents’ healthcare needs are fully met and their privacy and dignity is protected. EVIDENCE: Care planning documents were inspected and found to be comprehensive and include detailed information on all aspects of residents social, personal and healthcare needs. Detailed risk assessments in respect of residents’ environment and individual disabilities are carried out and regularly reviewed. The home has developed a care audit trail, which consists of daily notes that are used to develop the continuous evaluation sheet, and this sheet is the basis for residents’ daily living needs record; thus information is available to guide staff on how best to meet residents’ daily care needs. The Manager and staff have a good understanding of residents’ preferences and care needs. Those residents, who were able to do so, mentioned the care and kindness of staff and that they felt all their needs were met. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 10 Monthly review sheets are added to residents’ files so their progress can be tracked over time. Where no significant changes have been noted, a summary of relevant events is created. The home has a key worker system to ensure continuity of care for residents. Residents’ representatives are invited to the monthly care plan reviews and provided with a written summary as part of their involvement in residents care and to inform the quality assurance systems. Residents are registered with GP’s and can access allied health professionals as required, including, optician, chiropodist and dentist. The care planning systems exceed the required standard. Policies and procedures for the receipt, storage and administration of medicines are in place and the procedures are put into practice. Medication is stored in a secure area on the ground floor and medication administration forms are signed when medication is given to residents. All staff who administer medication have received satisfactory training. Staff were observed to treat residents with respect and it was evident that staff and residents are comfortable with each other. Staff spoken with demonstrated their knowledge of how to provide palliative care when required to ensure that residents and their relatives are treated with sensitivity and respect at all times. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 11 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 The routines of the home enable residents to exercise choice and control over their daily lives. The meals in Homelea are good offering both choice and variety and catering for special dietary needs. EVIDENCE: The home has policies and procedures on maximising residents’ autonomy and residents are encouraged to remain independent for as long as possible and exercise choice over all aspects of their daily lives. Residents care plans clearly demonstrate that they have been consulted over their preferences in their daily routines. Throughout the inspection it was evident that residents were able to spend their time in either of the lounges, in their rooms or wander about the home. Choices are offered at each meal, residents were positive and complementary about the food. Relatives spoken with confirmed that they were happy with the meals given to residents and residents’ care plans showed that most had put on weight since being admitted to the home. The lunchtime meal was found to be attractively presented and residents seen to enjoy it. To ensure residents’ nutritional needs are fully met a record of their daily food intake in respect of both the quantity and type of meal is maintained. Residents’ are encouraged to feed themselves but it was noted that staff offer discrete Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 12 assistance when required. Drinks are given every two hours and all meals are tailored to individual preferences. The home aims to provide at least five pieces of fruit and vegetables, each day, in line with government guidance. For those residents’ whose appetite is poor, vitamin and food supplements are provided to ensure optimum health is maintained. These additional dietary measures demonstrate that the standard is exceeded. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 13 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 The home has a satisfactory complaints procedure with evidence that residents’ views are listened to and acted upon. EVIDENCE: The complaints book was viewed and no complaints had been made. Comment cards received showed that none of the respondents had needed to make a complaint at any time. Relatives spoken with said they would talk to the owner if they had any concerns. A summary of the homes’ complaints procedure is displayed in the homes hallway. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 14 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 and 25 The standard of decor within the home is generally good, providing a homely, comfortable and safe environment for residents. EVIDENCE: As stated earlier in the report a full tour of the premises was not carried out to ensure infection controls are maintained. The communal areas were seen to be clean and well maintained and there were no offensive odours. It was recommended at the last inspection that external and internal paintwork be attended to, a small area of tiling in one bathroom and a door handle in another also required attention. These had been addressed, as had the recommendation in respect of adjusting a fire door. In addition carpets in hallways had been replaced and non-slip edging fitted to internal steps. Water delivery temperatures are regularly tested to ensure they remain with safe limits and all radiators have guards fitted or have low temperature surfaces. Call bells are provided in all areas to which residents have access. Floor pressure pads are provided for those residents who have a tendency to wander Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 15 at night to ensure that staff are alerted. These measures ensure residents are safe and able to call for help when necessary. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 16 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, 29 and 30 The number of staff and the skill mix is such that residents’ needs are met and consistent care is provided. The recruitment practice is robust and provides safeguards for the protection of residents. EVIDENCE: The home has at least four carers on duty at each shift and five on some days, with a senior carer on duty as well. The assistant manager and both owners, one of who is the registered manager also work full time at the home and are extra to the rota. Staff were observed not to have to rush tasks and relatives spoken with said staff were always available to discuss issues. All comment cards returned also stated that the respondent felt there was always sufficient staff on duty. Two waking night staff are on duty every night. In addition the home employs cooks, domestic /laundry staff, a gardener and a maintenance person. Most leisure activities are provided by outside contractors; therefore care staff only provide care. One cleaner is employed specifically to clean carpets to ensure the home remains odour free and reduce the risk of cross infection. Total care hours provided are 635; the Residential Care Forum guidance requires 605 care hours taking into consideration the need for extra care hours due to the lack of level access within the home. Therefore staffing levels exceed those required by the Standard. Recruitment records for three recently recruited staff were viewed and it was found that the practice is robust ensuring residents are protected. References, Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 17 details of any working permits and appropriate checks by the Criminal Records Bureau were in place and two written references were also obtained. Staff are provided with sufficient training to enable them to meet residents assessed needs. All staff have induction and foundation training that meets the Care Skills Sector specifications. Copies of the training documents were held with staff files. Supervision records showed that training needs are identified and staff spoken with confirmed this. All staff receive mandatory training in manual handling, fire safety and infection control. There is a qualified first aider on duty at each shift and there is a training programme in place to ensure staff are familiar with the needs of this client group. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 18 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, 35 and 38 The manager provides good leadership and direction to staff to ensure residents receive consistent care, thus residents benefit from a supported staff team. There are systems in place to ensure residents financial interests are protected. There are systems in place that safeguard all aspects of the health, safety and welfare of service users EVIDENCE: The Manager/Registered Provider has the required qualifications in care and management as does the other Registered Provider. The Registered Manager has recently undertaken training in Managing Stress and Dealing with Unacceptable Employee Behaviour. Staff and relatives confirmed that she is open and approachable and both staff and relatives were seen to consult with her during the inspection. There is a ‘hand over’ period at the end of each shift to ensure staff coming on duty are aware of residents’ needs at all times. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 19 Appropriate insurance cover is provided with a certificate on display. The standard relating to quality assurance was not fully inspected however, it was demonstrated that the recommendation for the last inspection asking that stakeholders be formally approached was addressed and a copy of the survey results sent to the CSCI. The home does not handle the financial affairs of any residents. Relatives and solicitors handle residents’ finances. The home does hold the personal allowances for some residents and detailed records maintained and receipts obtained for all items bought. The home maintains a records of all residents’ possessions bought into the home. Evidence was available to demonstrate that electrical and gas systems and appliances have been serviced and are safe. Documents relating to safe working practices and Health and Safety were available and found to be satisfactory as were accident records. Fire equipment is regularly serviced and all staff have been trained in fire safety procedures. Staff spoken with confirmed that fire safety is included in the induction process. Mandatory training is provided for all staff and includes moving and handling, infection control and first aid. Smoke alarms and emergency lighting are also tested regularly ensuring the safety of both residents and staff. Self-closing devices have been fitted to all fire doors to ensure the home meets the latest fire safety guidance. Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 20 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 X 3 X 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 3 X X X X X 3 x STAFFING Standard No Score 27 4 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 21 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. 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. Refer to Standard Good Practice Recommendations Homelea DS0000021142.V263445.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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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