CARE HOMES FOR OLDER PEOPLE
Elizabeth House Dolbery Road Parkstone Poole BH12 4PX Lead Inspector
Trevor Julian Unannounced 12 July 2005 13:30 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. Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Elizabeth House Address Dolbery Road, Parkstone, Poole, Dorset, BH12 4PX 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) 01202 744545 01202 744545 Care South Mrs Christine Kerr Care Home only 42 Category(ies) of OP - 31 registration, with number DE(E) - 11 of places MD(E) - 11 Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: One named person (as known to CSCI) may be accommodated within the category of PD (Physical Disability) The person as referred to in condition (1) may be accommodated under the age of 65 (this condition will not apply after the persons 65th birthday) Date of last inspection 01 December 2004 Brief Description of the Service: Elizabeth House is a large, purpose built home in the Parkstone area of Poole. The building is leased from the Borough of Poole, and managed by Care South, a local non-profit making organisation that owns and manages various care homes and community services in Dorset and the South West. The home is registered with the Commission for Social Care Inspection to accommodate a maximum of 42 adults over the age of 65 years, with 11 of these places being registered to accommodate service users with specialist mental health needs, 11 with dementia related needs, and the remainder to accommodate service users with needs relating to old age. No nursing care is provided by the home. Accommodation is offered over two floors, accessed by a 6-person passenger lift. There are various communal areas, thirteen W.C.’s: seven on the ground floor and a further six upstairs. There are 6 bathroom facilities (with assisted baths) and all bedrooms are single. Two have en-suite facilities.There is a large conservatory and a secure garden and courtyard area, with further lawn and wooded garden areas. The home is close to many local amenities, and offers access to a main bus route serving nearby towns and villages.
Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 12th July 2005 13:30-17:50. The time taken for the report process including travelling time, preparation, site visit and report writing totalled 12 hours. During the visit information was gathered through discussion with the manager, residents, staff and visitors. Further evidence was obtained through a tour of the premises and a review of records and procedures. The deputy manager was on the premises throughout the visit. For the purpose of this report the terms resident and service user are interchangeable. What the service does well:
The home provided prospective residents and families with information about the services offered within the home. People were only admitted once the home had carried out an assessment to check that the identified needs could be met. Care plans were produced to inform care staff how those needs were to be met. Relatives confirmed they were involved in the assessment and review process although this was not always documented. Staff said that changes to care needs were discussed at shift handover and that they had access to the care records. Medical needs were met through the community healthcare nurses. Residents confirmed that the staff call for medical assistance as needed. Residents and visitors felt the staff treated people with dignity and respect. During the visit there was a relaxed and friendly atmosphere in the home with lots of visitors coming and going. The home’s activity organiser arranged a variety of pastimes for the residents with the programme displayed on notice boards around the home. Residents said they enjoyed the activities but their was no compulsion to attend or to join in. During the visit most of the residents were enjoying being entertained by a pianist in the dining room. Social and spiritual needs were considered in the admission process and there were weekly services held in the home. People felt they were given good levels of choice in their daily lives and there was good variety in the food offered. On the day of the inspection it was very warm and the staff were seen regularly providing refreshments.
Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 6 The premises were clean and well maintained. Laundry services were provided in house; residents and visitors said the system was good with only occasional problems with returned items. The home did not manage any of the residents’ finances although most residents deposited personal allowances with the home to cover the cost of hairdressing, chiropody and personal expenditure. A check of four records showed the balances held matched the transaction and receipt records. Health and safety procedure were in place to keep residents, staff and visitors safe. These included training in fire safety, moving and handling and regular checks of the premises and equipment. 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. Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.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 Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.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) 1 and 3. Intermediate care was not offered at the home and so Standard 6 was not applicable. Information about the services offered in the home allowed prospective residents and their carers to make informed decisions about the suitability of the placement. Residents were only admitted once an assessment of need had been completed and the home had confirmed it could meet those needs. EVIDENCE: During the visit the family of the newest resident were in the home. They had been given information and advice about the placement through the care manager and had also visited the home. Another recent admission said the family had been given information about the services provided and the resident had visited prior to admission. In both cases senior staff had completed the assessments. The files reviewed each contained an assessment of need carried out prior to admission.
Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10. Care plans were in place to inform staff how needs were to be met. Community health teams provide support to meet any healthcare needs. Medication systems were followed to ensure medicine was safely stored and administered. Residents were treated with dignity to respect their basic rights. EVIDENCE: The care records for four residents were checked. They contained care plans, risk assessments, social history and other information for the carers. Staff said that the care needs were discussed at shift changeover and that the records were accessible if they needed to refer to them. Some of the records did not show the involvement of the residents’ representative although visitors did confirm their involvement. The records showed referrals for healthcare support. Residents said that the staff call for GP and community nursing visits as requested. Residents at risk of pressure ulceration had pressure – relieving equipment and other specialist
Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 10 devices. Where people had mobility problems Occupational Therapist assessments were carried out and manual handling plans were developed. A review of the medication showed the items were correctly stored including temperature sensitive items held in a locked fridge with the max and min temperatures recorded. There were photographs of the residents available to assist staff to identify the correct resident. The records for a new resident showed the records sheets were handwritten by the care team manager, as there could be transcription errors it is recommended that amendments and additions to the medication are checked and countersigned by a second person. During the visit time was spent on the specialist care unit on the first floor, the area had a relaxed and informal atmosphere. There was good levels of interaction between the residents and the staff. Other residents said the staff treated them well and with kindness. Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15 Events and activities in the home were planned to support the social and spiritual needs of the residents. The home encourages links with residents’ family and friends to reduce the risk of isolation. Residents were encouraged to exercise as much choice as their circumstances allow helping them feel valued. Meals were provided in suitable surroundings, the menu offered good levels of choice and the food was appetising to encourage a healthy nutritional intake. EVIDENCE: During the visit most of the residents were enjoying a visit to the home by a pianist. One person said that the home often had entertainment and that the activity organiser also worked hard to provide suitable pastimes. The records showed that social and spiritual needs were considered during the admission process and at subsequent reviews. The home had weekly interdenominational services on Sunday mornings and monthly communion. Information about the activities were posted around the home including dates of the next mobile library visit. One resident said she had decided not to
Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 12 attend the entertainment as it was too hot; she said there was no compulsion to attend. The home benefits from having several lounge areas allowing residents to receive visitors in quiet areas. The gardens were accessible to residents and visitors. Visitors said they were welcomed into the home by the staff, they added that if refreshments were being served they were also offered drinks. The home had no set visiting times and visitors who said they visited at different times of the day confirmed this. Residents said they were able to have choice in their daily lives as an example they could get up and go to bed as they liked. The home did not manage finances for any of the residents except for personal allowances. Information was available in the home about independent advocacy services. Meals were served in the dining room, the specialist unit or in the bedrooms at the residents’ request. Residents said there was always a choice of two main dishes with salads also available. People described the food as very good with choices offered. Staff were seen prompting residents to drink plenty during the hot weather. Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 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 standard(s) Not assessed during this visit. EVIDENCE: Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 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 standard(s) 19 and 26. The premises were clean and well presented providing people with a safe and hygienic place to live. EVIDENCE: During the visit the home was clean the home was well aired to keep the place as cool as possible during the warm weather. There were no major alterations planned; two bedrooms had been refurbished as part of ongoing maintenance and repairs around the home. The rooms visited had been personalised by the occupants with pictures and ornaments etc. The laundry was sited away from food storage and preparation areas. The room was equipped with two commercial washers and tumble dryers all were working. Residents and visitors said the laundry system was good with only occasional problems with items not being returned correctly. Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 15 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) 27 and 29 The home was staffed appropriately to meet the needs of the residents. Procedures for staff recruitment helped to keep the residents safe. EVIDENCE: Records showed that the home’s reliance on agency staff to cover vacant care hours had reduced from 10 in December 2004 to under 5 at the time of the visit. A small sample showed new recruits were only employed once references and clearances had been obtained. References had been obtained from two sources including the previous employer. Copies of proof of identity were held. One recent recruit confirmed that she had not started until the clearances had been obtained. Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 16 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. Residents and visitors views were sought to assist the home to be run in their best interests. Procedures were in place to ensure that residents were protected from the risk of financial abuse within the home. Systems and procedures were in place to keep the environment safe for residents and staff. EVIDENCE: An independent quality assurance audit had been completed recently. The views of residents, visitors, staff and healthcare professionals had been sought. The results had been analysed and discussed at staff meetings. Residents were able to give their views in regular resident meetings, minutes of the meetings were produced. Staff said they had opportunity to give their opinion at supervision and staff meeting.
Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 17 The home did not assist any resident to manage their personal finances except for their personal allowances. One person said they managed all their own finances with some support from their family. A check of four personal allowances showed the balances held matched the transaction records and receipts. Approved contactors inspected and serviced the fire warning system. Staff also carried out routine testing. All staff received training in fire safety procedures. An induction was provided for all agency staff before they started their first shift. Staff were trained in safe moving and handling techniques with additional support from Occupational Therapists for residents with specific mobility needs. Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 18 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x 3 x x 3 Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 19 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 OP 9 Good Practice Recommendations When handwritten amendments are made to the medication administration record those changes should be checked by a second person to avoid the risk of transcription errors. Elizabeth House D55 S4045 Elizabeth House V233434 120705 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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