Inspection on 20/01/09 for Mount Ephraim House

This inspection was carried out on 20th January 2009.

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

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

Mount Ephraim House 28/01/08

Mount Ephraim House 26/07/06

Mount Ephraim House 20/12/05

Mount Ephraim House 21/06/05

Mount Ephraim House 08/02/05

Mount Ephraim House 02/11/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mount Ephraim House Mount Ephraim Tunbridge Wells Kent TN4 8BU     The quality rating for this care home is:   two star good 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: Gary Bartlett     Date: 2 0 0 1 2 0 0 9 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. the things that people have said are important to them: They reflect 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 26 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Mount Ephraim House Mount Ephraim Tunbridge Wells Kent TN4 8BU 01892520316 01892523180 mountephraim.house@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Karen Patricia Cooper Type of registration: Number of places registered: Greensleeves Homes Trust care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 38. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Mount Ephraim House provides 24 hour personal care and accommodation for up to thirty-eight older people. Greensleeves Homes Trust, a charitable organisation, owns the home. Mount Ephraim House is located in a residential area of Tunbridge Wells. The nearest shops and other usual town amenities are approximately a half-mile away. The home was first registered on 8th March 1991. It consists of a semi-detached property with large secluded gardens to the sides of the premises. There are limited car parking facilities to the front and side of the house. Accommodation currently Care Homes for Older People Page 4 of 26 Over 65 38 0 Brief description of the care home includes thirty-seven rooms for single occupancy, six of which have shower and WC en-suite facilities. Thirteen of the bedrooms are located on the ground floor; separate facilities can be made available for guests to stay. There are two shaft lifts in the main house enabling wheelchair access to the upper floors in the main house and a stair lift in the annex. There is a staff call system and television points in all the bedrooms. A number of residents have their own phone lines installed. The home employs care, administrative and ancillary staff. Current fees range from £460 to £575 per week for private placements. Care Homes for Older People Page 5 of 26 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: two star good 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: This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Mount Ephraim House on 20th January 2008 from 9.15 am until 4.10 pm. Judgements about quality of life and choices were taken from direct observation and by discussion with the residents, staff, and visitors. Some records and parts of the building and grounds were inspected. The Manager had completed an Annual Quality Assurance Assessment, from which information was used to inform the inspection process. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as service users. People Care Homes for Older People Page 6 of 26 living at Mount Ephraim House prefer to be referred to as residents. Accordingly this shall be done in the text of this report. The Inspector would like to thank everyone involved for their contribution to the inspection. What the care home does well: What has improved since the last inspection? What they could do better: How residents care needs are being met would be better identified through further improvements to care planning and recording. There are plans to improve the kitchen area and bathrooms. This is important to make for a more pleasant environment and to promote infection control. The Manager acknowledges the training matrix needs updating to give a management overview of staff training needs. Care Homes for Older People Page 8 of 26 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 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 26 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 can be confident that they are appropriately placed due to good preadmission assessments and benefit from being able to visit the home prior to admission. Evidence: The Manager described how a pre-admission assessment is made of each prospective resident to ensure the home can meet his or her needs. If practical, a member of the senior team visits the prospective resident in their home or hospital to ensure the necessary information is current and accurate. Records show that prospective residents, their families, advocates, and relevant health care professionals are involved in the assessment process. Specialist advice is sought from external sources where required. Residents said they or their families had been able to visit Mount Ephraim House Care Homes for Older People Page 11 of 26 Evidence: before moving in. Residents visitors confirmed this and said staff are very helpful in assisting new residents to settle in. Mount Ephraim House does not provide intermediate care. Care Homes for Older People Page 12 of 26 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 care and health needs are well met in a dignified and appropriate manner. A further improvement to care plans and daily records would better evidence how they are met. Evidence: The judgment for this outcome group has taken into account the quality of life for the residents. It includes an assessment of the level of knowledge and understanding displayed by staff when providing both personal and health care. Comments made by residents, their relatives and observation during the day of the site visit all indicate the standard of care provided is good. Residents say that staff are fully aware of their needs. Staff are aware of far more information than is recorded in care plans and daily records. A lot of information is shared verbally. Each resident has a care plan and four were inspected in detail. The writing of the care plans is much improved and they are more person centred and directive as to how needs are to be met. However, further work is needed so every resident has a Care Homes for Older People Page 13 of 26 Evidence: cohesive plan of care. It is very clear that the Manager is aware some care plans and daily records are not consistently detailed or specific as they should be and is addressing this by regularly monitoring them and providing training to staff. Residents consider their health needs are well met. References were made to a wide variety of healthcare professionals including local doctors, the community mental health team, chiropodists and hospital specialists. Staff spoken with generally have a good understanding of getting a balance between perceived risks and promoting independence. There have been improvements to the risk assessments, but as with the care plans, further work is required for them to more fully encompass activities undertaken by residents. The room used for the storage of medicines is adequately maintained and medicines are only administered by staff that have been trained. The majority of care staff have been trained. The Medication Record Administration Record (MAR) sheets inspected were correctly completed. Residents feel that staff are kind and gentle, this was confirmed by observation and discussion with visitors. Staff are considerate of the age and dignity of residents and treat them with courtesy. Care Homes for Older People Page 14 of 26 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. The home offers activities and outings to provide interest and stimulation for the people who live there. Families and friends are made welcome. Residents enjoy good quality meals. Evidence: A new Activities Coordinator has been employed at the home since early December 2008 for 20 hours per week. She works this flexibly, depending on the innovative programme of activities that she has introduced. Residents speak highly of the activities being provided, having recently enjoyed a very successful Christmas party, a trip to a pantomime and two concerts by visiting musicians. They are looking forward to two tea outings that are arranged, monthly talks by someone from the Tunbridge Wells museum and a Valentines masked ball, for which some residents are making the masks. Residents interests are recorded in their care plans and the Activities Coordinator fully understands the need to promote these on an individual basis. She is also aware that some residents might like to participate in some meaningful daily tasks Care Homes for Older People Page 15 of 26 Evidence: around the home, such as preparation for meal times. Most people living at Mount Ephraim House are largely self-caring and some go out regularly and independently. Some like to visit friends, use the local shopping facilities and attend church. Some residents have strong spiritual beliefs and the home supports them in meeting these. There is assistance for those who wish to go to church and others may attend a religious service conducted by a visiting Minister. Family and friends feel very welcome and know they can visit at any reasonable time. During the inspection a number of visitors were seen in the home and the visitors book records regular visits by families, friends and others. The design of Mount Ephraim House provides seating areas within the communal areas where residents can entertain their visitors, in addition to the privacy of their own room. Residents are encouraged to personalise their rooms with their own possessions if they wish. Most residents have brought items of furniture and plenty of personal effects with them. As rooms are differently shaped and sized this leads to very individual environments. Residents said they like the food and think it is well cooked. There is a planned menu and an alternative is offered to the main course. Staff have a good knowledge of residents individual tastes and these are catered for. Mealtimes are relaxed, staff are patient and helpful and allow residents the time they need to finish their meal comfortably. The minutes of a recent Residents Meeting indicate it is important to them for staff to have a high standard of table etiquette. The Manager described how she is addressing this. The need to do so was demonstrated by the observation of the untidy manner in which the vegetable curry had been presented on some of the plates. The Hot and cold drinks and snacks are available through out the day. Care Homes for Older People Page 16 of 26 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 and their relatives know their complaints are listened to and acted on. There are systems to protect residents from abuse. Evidence: The complaints procedure is readily available to residents and their relatives. They say they feel confident they are listened to and any necessary action is taken. The home keeps a record is of all complaints received by them, the result of the investigation and how the complaint has been resolved. The Annual Quality Assurance Assessment completed by the Manager indicates there have been 8 complaints recorded in last 12 months, one of which was upheld. The Commission has not received any information regarding complaints about the home in that time. There are procedures for responding to suspicion or evidence of abuse or neglect to help ensure the safety and protection of residents. The Manager and other staff spoken with have a sound understanding of safeguarding procedures. There has been one safeguarding alert since the last inspection and this has been resolved. Care Homes for Older People Page 17 of 26 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. Improvements to the environment are giving residents a more homely and comfortable environment in which to live. Evidence: Mount Ephraim House is a large building close to Tunbridge Wells town centre and overlooking the Common. It is a grand building with some imposing rooms, such as the lounge, dining room and the entrance hall. Accommodation is on 3 floors and these are served by 2 shaft lifts. Due to the age of the building some areas and bedrooms can only be accessed via a step or a few extra stairs on landings. This can be a problem for those less mobile and the Manager takes account of this when assessing possible admissions to the home. The home is set within extensive, attractive grounds that residents enjoy to walk in. Residents say they find Mount Ephraim House to be a comfortable place in which to live. Since the last inspection, there has been some redecoration and refurbishment of parts of the building improving the quality of life for residents using these areas. The Manager stated that funding had been agreed in the new financial years budget for the refurbishment of all the bathrooms and the dishwasher room and the fitting of a new staff call system. It is important this is done, to improve the environment and to better promote infection control. There is also to be the redecoration of more Care Homes for Older People Page 18 of 26 Evidence: bedrooms and provision of new furniture. Care Homes for Older People Page 19 of 26 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 feel there are adequate numbers of staff on duty and that the staff are caring people. Evidence: Residents and their relatives speak very highly of the staff and of the care given. People applying to work at the home have to complete an application form, attend an interview, provide references and satisfactory POVA and Criminal Record Bureau (CRB) checks. The files of the most recently recruited staff show that appropriate checks were made prior to them commencing duties. The Manager was advised to obtain guidance about storing CRB checks from the CRB website. New staff are required to undertake an in-house induction programme. A new, more comprehensive induction programme has been introduced recently. The Manager said she is considering requiring all existing permanent staff to undertake this induction programme so she can be sure of their skills base. Agency staff are given an induction when they first work at the home. There is ongoing training for all staff and NVQ training is encouraged. Staff speak of regular training and there are certificates on their files. The Manager acknowledges the Care Homes for Older People Page 20 of 26 Evidence: training matrix needs updating to give a management overview of courses attended and those booked. Residents say there are enough staff available when needed. They like the staff and find them friendly, polite and kind. Some very good interaction between staff and residents was observed. Care Homes for Older People Page 21 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager is committed to providing a good service and the home is well run in the best interests of residents. There is an open and friendly atmosphere. Evidence: The Manager, Karen Cooper, has been in post since October 2007. She has extensive experience in residential care, having been a registered Manager at other homes, and is a Registered Nurse, has a Diploma in Management and a Certificate in Supervisory Management. The Manager speaks of a commitment to delivering a high quality service. There is a sound system of holding and recording residents cash, which is regularly checked by the Trust as part of their audit process. Residents and their representatives or relatives are regularly asked for their views about the quality of care provided. The results are used to improve the service as Care Homes for Older People Page 22 of 26 Evidence: necessary. The Manager is monitoring the quality of records made by staff with the aim of achieving a higher level of consistency. The standard of cleanliness in the kitchen surrounding area is satisfactory taking into account it is to be refurbished in the immediate future. The Manager says she is intending to introduce a new system of environmental monitoring records to help better safeguard everyone at the home. There are records of fire systems checks and fire drills and training. Staff spoken with have a good understanding of safety and emergency procedures. The Manager stated that records of maintenance and safety checks are in order. These were not inspected on this occasion. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 24 of 26 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 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 7 It is recommended the Manager proceeds with further improvements to care planning system. The system used should give clear evidence of how care and support needs are to be provided, an evaluation of the activities of daily living including how these link to care plan issues and responsive risk assessments that clearly state the manner in which the risk is to be reduced or removed. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 26 of 26 - 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. 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