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Inspection on 19/04/06 for St Elizabeths Care Home with Nursing

Also see our care home review for St Elizabeths Care Home with Nursing for more information

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The inspection main finding is that all of the Standards assessed, bar 3, are either met or in a number of cases, exceeded. The staff teams including management continue to demonstrate their openness and positive response to requirements, recommendations and suggestions made by the Commission. They are to be commended for the way they continually strive to maintain and further improve the services offered. Prospective service users, significant others and potential placing authorities are provided with relevant information about services and encouraged to visit the Centre. The assessment and admission process is robust, which ensures that the needs of the new resident are well known and care is planned accordingly. The management team were able to demonstrate how care is planned and reviewed to address the needs of individuals who require complex health and social care services. The approach involves the service user and significant others, in order to ensure the needs, wishes and aspiration of the individual are at the centre of service planning and delivery. The ethos of the Organisation continues to be evident as you go around and speak with residents, staff and observe care practices. There is a strong sense of care and compassion, which permeates through everything you see. Work, learning and leisure activities continue to be given a high profile; service users have a wide range of meaningful activities chosen by them to reflect their wishes and needs. Service users expressed a high level of satisfaction regarding the services they receive at St Elizabeths Centre. The environment is well maintained and all 15 homes are refurbished regularly. A high standard of cleanliness was evident throughout those areas viewed. The Centre benefits from extensive grounds, which are well utilised by service users. The systems in operation including complaint and adult protection should offer adequate protection to a service user. Staffing arrangements remain satisfactory; Staff training continues to be given a high priority. The Centre is registered to assess staff in NVQ Level 2 and 3. The Registered Manager is known as the Director of Care. She continues to provide evidence that demonstrates her abilities to manage and further develop this large and complex Care Home with nursing. The Director`s leadership clearly generates confidence to others.

What has improved since the last inspection?

There was 1 requirement and 2 recommendations made in the last inspection report dated 24.01.06; these have been achieved bar 1 recommendation, which is being progressed. The use of DATIX has significantly improved the risk management of the establishment. Reports generated clearly demonstrate what incidents have occurred and these are used to learn from events, and remedial action taken if any. The Organisation has implemented "Training for Change"; this course enables service users to become trainers in their own right. Some of them are already involved in some aspect of the mandatory training and interview panels for key personnel. The Centre employs a Learning Manager with an education background in training individuals who have a learning disability. The Learning Manager is also responsible for ensuring that service users have opportunities to engage in community workshops for example, First Aid and volunteering in local environmental activities. The continuous improvements in service development are fine examples, which demonstrate the commitment and innovative approach of the Senior Management Team.

What the care home could do better:

There are 1 requirement and 3 recommendations (1 previous) arising from this report that need addressing. The draft placement contract/terms and conditions should be updated, finalised and used for new service users. Whilst good effort has been made, furtherimprovement is needed so that care plans reflect the signature of the service user and next of kin where appropriate; this would demonstrate transparency to their participation in the care planning process. Similarly, the Director should demonstrate more clearly that the service user is being informed about their rights to confidentiality and access to records retained about them. All staff members must participate in at least one fire drill annually, at minimum.

CARE HOME ADULTS 18-65 St Elizabeths Care Home with Nursing South End Much Hadham Hertfordshire SG10 6EW Lead Inspector Mr Neil Fernando Unannounced Inspection 19th April 2006 10:15 St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 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 St Elizabeths Care Home with Nursing DS0000019542.V291472.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 Adults 18-65. 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. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Elizabeths Care Home with Nursing Address South End Much Hadham Hertfordshire SG10 6EW 01279 843451 01279 842918 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) The Congregation of the Daughters of the Cross of Liege Mrs Johanna Elizabeth Coughlan Care Home 104 Category(ies) of Learning disability (104), Learning disability registration, with number over 65 years of age (104), Physical disability of places (104), Physical disability over 65 years of age (104) St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This home may accommodate 104 people (18-65 years and above 65 years) with physical disability who require personal care. This home may accommodate 104 people (18-65 years and above 65 years) with learning disabilities who require personal care. This home may accommodate 7 people (for reason of epilepsy) with learning disability and physical disability who require nursing care. 24th January 2006 Date of last inspection Brief Description of the Service: St Elizabeth Centre for adults is set in acres of grounds in the rural village of Much Hadham. Service users are accommodated in 15 buildings according to their care needs. These are: Hume House-8 adults with moderate learning disability; Vaughan House-8 adults with moderate learning disability; Lewis House-8 elderly persons with physical disability, Vincent House-8 adults with special needs and profound communication difficulties; Hood House-8 adults, some with challenging behaviour; Corum Villa & extension-7 adults with moderate learning disability and some with challenging behaviour; Jeanne Haze House-8 adults with moderate learning disability; Villa Maria-8 adults with physical and communication difficulties; Elena House-9 elderly persons with high care needs; St Gabriels House-10 adults with challenging behaviour; Kelly & Kearney House-10 adults with moderate learning disability; Loretto Cottage5 adults with moderate learning disability; St Josephs Cottage-5 adults with moderate learning disability. The Emilie Schneider Centre is a 7-bedded nursing wing, where nursing care is provided on a temporary basis for the service users as required. This unit offers 2 single bedrooms and a 5-bedded room with curtain dividers. The accommodation with the exception of Loretto and St Josephs Cottages are single storey building. Loretto Cottage and St Josephs Cottage are 2 semi-detached double storey properties. Kelly & Kearney House is the most recent purpose built property. Each building is selfcontained with assisted bathrooms and/or showers and/or assisted toilets. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection for the year 2006/07. The last inspection was undertaken on 24.01.06. St Elizabeths is a residential care home, which is registered to accommodate a maximum of 104 younger and older people with learning disabilities, of both genders, that may have an associated physical disability. It also offers 7 nursing care places to its service users when and as required. At the time of the inspection, there were 101 service users in residence. The inspection lasted for over 6.5 hours. During this time, 14 service users, 9 staff including an Assistant Director and the Director of Care were spoken to, in order to seek their views regarding the quality of service offered at this establishment. Also records were examined and a brief tour of 3 of the homes was undertaken. What the service does well: The inspection main finding is that all of the Standards assessed, bar 3, are either met or in a number of cases, exceeded. The staff teams including management continue to demonstrate their openness and positive response to requirements, recommendations and suggestions made by the Commission. They are to be commended for the way they continually strive to maintain and further improve the services offered. Prospective service users, significant others and potential placing authorities are provided with relevant information about services and encouraged to visit the Centre. The assessment and admission process is robust, which ensures that the needs of the new resident are well known and care is planned accordingly. The management team were able to demonstrate how care is planned and reviewed to address the needs of individuals who require complex health and social care services. The approach involves the service user and significant others, in order to ensure the needs, wishes and aspiration of the individual are at the centre of service planning and delivery. The ethos of the Organisation continues to be evident as you go around and speak with residents, staff and observe care practices. There is a strong sense of care and compassion, which permeates through everything you see. Work, learning and leisure activities continue to be given a high profile; service users have a wide range of meaningful activities chosen by them to reflect their wishes and needs. Service users expressed a high level of satisfaction regarding the services they receive at St Elizabeths Centre. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 6 The environment is well maintained and all 15 homes are refurbished regularly. A high standard of cleanliness was evident throughout those areas viewed. The Centre benefits from extensive grounds, which are well utilised by service users. The systems in operation including complaint and adult protection should offer adequate protection to a service user. Staffing arrangements remain satisfactory; Staff training continues to be given a high priority. The Centre is registered to assess staff in NVQ Level 2 and 3. The Registered Manager is known as the Director of Care. She continues to provide evidence that demonstrates her abilities to manage and further develop this large and complex Care Home with nursing. The Director’s leadership clearly generates confidence to others. What has improved since the last inspection? What they could do better: There are 1 requirement and 3 recommendations (1 previous) arising from this report that need addressing. The draft placement contract/terms and conditions should be updated, finalised and used for new service users. Whilst good effort has been made, further St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 7 improvement is needed so that care plans reflect the signature of the service user and next of kin where appropriate; this would demonstrate transparency to their participation in the care planning process. Similarly, the Director should demonstrate more clearly that the service user is being informed about their rights to confidentiality and access to records retained about them. All staff members must participate in at least one fire drill annually, at minimum. 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. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5. Prospective service users, their relatives/friends and significant others are given full support to able them to make an informed decision about the facilities offered at St Elizabeths. The opportunity to visit and “test drive” the home clearly demonstrates that the participation of service users and their relatives are central to the decision-making process. The draft placement contract/terms and conditions should be updated and finalised. EVIDENCE: Records examined and information gained from staff members and service users demonstrate that normally service users admitted to the home are under a Care Management arrangement and have a full assessment of needs by their respective Social Worker, prior to admission to the home. A senior staff member from each home is involved in the pre-admission assessments, as well as professional assessments from referring agencies. Self-funding service users also have a pre-admission assessment. The establishment considers it to be “very essential” that the involvement of the prospective resident, family/relatives and significant others is central to the assessment process. Assessment records are noted to be very comprehensive. Evidence available shows that standard 3 has been exceeded. Members of staff including senior Managers reported and service users confirmed that prospective residents, their relatives/friends are always encouraged to visit and to “test drive the home. The opportunity to meet with residents and staff members, have a meal, overnight stay if necessary and St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 10 seek clarification, appear to be a routine part of the admission process at St Elizabeths. If a placement is offered and accepted, the initial visits to the home is followed by a trial period to allow for staff to carry out a full assessment of needs. At the end of the trial period, a review meeting is held with all concerned, in order to consider if a long term placement is appropriate or not. Overall, evidence indicates that standard 4 has been exceeded. A signed copy of the contract agreement from the placing authority is retained centrally. Discussion with the contract Manager, Director of Finance and Director of Care indicates that St Elizabeths has produced a new draft contract/terms and conditions and consultation with relevant parties is currently in progress; it is expected that this would be finalised by July 2006. The contract/terms and conditions should be updated, in order to include the stated details in standard 5 of the National Minimum Standards. The Commission notes that this recommendation remains outstanding following the implementation of the NMS from April 2002. The Director of Care is aware that this shortfall needs remedial action. Given the severe learning disabilities of many of the service users, it is not appropriate for them to sign and retain a copy of the existing contract. It is however positive to note that the signature of the relative/next of kin and/or Care Manager from the placing authority is being obtained as appropriate. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 10. The care planning process and review system is robust enough to ensure that service users’ identified needs are addressed and unmet needs, closely monitored. Care plans are comprehensive and well maintained, and the quality of care provided by the staff teams remains consistent. Informing residents of their rights to confidentiality and access to records retained about them would further empower them. EVIDENCE: Consistent with the previous two inspection reports, information gathered demonstrates that the service user’s care plan is drawn up from a range of assessment of needs including Social Worker’s reports, input from family representatives, staff’s on going assessment during the trial period and contributions from any other professional as appropriate. Very good details are maintained of all visits from visiting professionals. A random sample of care plans for twelve service users including a recently admitted resident were examined. These are noted to be very well written and reflect the identified needs/requirements of each service user. Whilst good evidence is available to show that Standard 6 of the National Minimum Standards has been met, 5 of the care plans viewed did not include the signature of the service users and next of kin, as appropriate. This is a minor but important issue; obtaining the St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 12 signature where appropriate on the care plan indicates to an extent, the involvement of the service user in the care planning process. Once this is achieved, this standard would be exceeded. An established system is in operation, in order to ensure that each service user has a formal review undertaken by their placing authorities six monthly. An internal monthly review for each resident is also carried out and details of the changing needs/requirements made, is of a commendable standard. Service users spoken with expressed a high level of satisfaction regarding the assistance they receive. It was not possible to gain any accurate view of some of the service users on the subject of care planning and review systems, given their level of learning disabilities. They however, appeared to be generally aware of what is happening in their lives. One of the stated principles underpinning this organisation is that service users would be given the opportunity to make choices about their lifestyles and to be treated as individuals. Staff members interviewed demonstrated a good knowledge of the needs of individuals. Care practice observed appear to empower service users and their rights to decision-making are also being proactively encouraged and upheld, as appropriate. Evidence gathered suggests that staff treat information given by service users and significant others in confidence. Records regarding the residents are compiled and stored in accordance with the Organisation’s written procedures and the Data Protection Act 1998, and in their best interests. A system should however be instituted, in order to demonstrate that the service user is being informed about these issues and their rights of access to records retained about them. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 17. The service users appeared to be well supported to enjoy a full and meaningful life. Consistent with the last inspection report, an excellent level and variety of social and recreational activities is being facilitated; this appears to assist in the development and promote the welfare of service users. Meals appeared to be appetising and nutritionally sound. EVIDENCE: St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 14 Consistent with the last inspection report, there continues to be an excellent range of social and recreational activities in place, based on the identified needs and abilities of the individual service user. Details of social history, previous interest and hobbies are clearly reflected in each person’s care plan. Those who are able are actively encouraged to continue with any activity or hobby they were involved in, prior to their admission to the home. This includes community based activities as well as support for service users attending the very effective on site day centre. Information gathered from service users shows that excellent assistance is available from staff members, in order to facilitate access to indoor and outdoor activities. The home has 7 vehicles and staff members and service users reported that this is an excellent resource to access a higher level and variety of outdoor activities for residents. A full time activities co-ordinator is in post. A monthly activity plan is sent to each unit. Outside entertainers are brought in frequently. Overall, good evidence is available to indicate that an amazing level and variety of social and recreational activities is facilitated to the satisfaction of the service users. Leisure interests take into account religious and cultural factors. Information gained from staff, service users and examination of care plans and menus indicates that service users and their relatives are consulted regarding residents’ culinary likes and dislikes. Service users are involved in menus planning; some service users are able to prepare snacks and hot drinks for themselves and others, with staff assistance. Menus lists viewed suggest that the variety and quality of food offered at this home is of a good standard. Service users expressed a good deal of satisfaction with respect to food available to them. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 21. Overall, information gathered from service users and staff members, and records examined indicate that the personal and health care needs of service users are being addressed well. Illness and death of a service user are dealt with great compassion and care. EVIDENCE: The dependency levels of the service users vary considerably. Some live quite independently with minimal staff assistance whereas others have physical and mental disabilities that necessitate continuous one to one attention with the tasks of daily living or to deal with their behavioural difficulties. Staff are aware that any restrictions on personal freedom must be fully justified on therapeutic grounds and agreed on a multi-disciplinary basis with other care/health professionals and relatives, and these would be documented in individual care plans. Service users generally choose their own clothes and are able to express their individuality. Technical aids and equipment needed to maximise the independence and/or care of service users are available as required. Any resident who becomes ill is transferred to the Emilie Schneider Centre nursing unit, where appropriate. A three monthly medical review is also carried out involving the GP, service user, key worker/link nurse and relatives, St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 16 whenever possible. The ordering, storage administration and disposal of medication remain satisfactory. Documentary evidence is available to indicate that service users are registered with a General Practitioner. Service users are able to see their doctor at their surgery but the doctor may visit a resident at the home in an emergency. Other professionals, residents have some contact with include Psychiatrist, Psychologist, Optician, Podiatrist, Hairdresser, Occupational and Speech Therapist, Dentist and Social Workers. A private Consultant Neurologist and a Consultant Psychiatrist for Learning Disability are also available. Evidence shows that when service users become terminally ill, they are cared by members of staff known to them, until such time they pass away. The care provided is supported by a range of significant others, including the family and individual of their cultural and religious backgrounds. Staff members have received in-house and external training on palliative care. The home also operates a nursing unit staffed by professionally qualified nurses including specialist nurses; service users therefore benefit from not having to leave their familiar surroundings where some (20 ) residents have made St Elizabeths their home for over 30 years. Staff members also undertake extensive outreach tasks for example when a service user is transferred to a hospital. Regular visiting pattern is established by staff known to that resident. Also the Organisation has its own chapel and can, if requested arrange the funeral service and burial on site. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The complaint procedures are well-publicised and service users and significant others should be adequately empowered to make a complaint. The systems in place are adequately robust to protect service users from harm. EVIDENCE: The policy and procedures on complaints have been recently updated in consultation with service users and significant others. Information on complaints is included in the service users’ guide and statement of purpose. The Director of Care reported that training on the new procedures for service users and staff teams is being planned for the near future. Residents spoken to said they are aware of how to go about making a complaint and expressed confidence in the likely positive response of the homes’ Managers and staff to any complaint made. The home maintains a record of complaints. No complaints have been received at the home or the Commission, since the last inspection in January 2006. The home has a copy of the Hertfordshire procedures on adult protection. Staff members spoken to confirmed that they are familiar with the procedures. Staff members have received training on the Protection of Vulnerable Adults. An element of adult protection is also covered in the induction programme for all new staff members and those people undertaking the NVQ assessment. There are currently three adult protection matters, which are being dealt with by the appropriate Adult Protection Team in Hertfordshire. Evidence demonstrates that staff members including senior Operational Managers have responded appropriately to the alleged incidents. There continues to be a St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 18 number of systems in operation, which should offer adequate protection to service users. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The premises provide a safe, comfortable and homely environment suitable for the needs of the service users. The standard of cleanliness was high and furnishings are suitable for the individual and collective needs of the resident group. EVIDENCE: The Inspector undertook a brief tour of three of the houses during this visit. These houses are well maintained and decorated, and furnished in a domestic style to provide a very homely, comfortable and safe environment. All bedrooms viewed are painted in different colours chosen by the residents where appropriate; they are thoroughly personalised to reflect the tastes and interests of the occupants, with mobiles, pictures and hobby materials. Staff members reported and service users spoken with confirmed that they are consulted about the décor and have keys to their rooms, as appropriate. Overall, all three houses and gardens are well maintained, which service users appear to appreciate very much. A high standard of cleanliness was evident throughout those areas viewed. There were no mal-odours present. Food items were appropriately stored in fridges and temperatures, recorded daily. The home has infection control policies and procedures in place and staff encourage residents to follow good St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 20 hygiene practice. Arrangements for the storage and disposal of domestic and clinical waste remain satisfactory. Staff members spoken to are conversant with infection control procedures. There were no health and safety hazards noted. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 36. The day and night staffing arrangements are deemed to be adequate. The needs of the current service users are being well met. Staff recruitment process is robust, which means that residents are in safe hands. Staff members receive training to enable them to deliver a good quality service to residents. EVIDENCE: Information gained from duty roster, staff members including the Director of Care provides evidence that the day and night staffing levels remain adequate to meet the needs of the resident group in each of the houses. In addition to the care staff team, the home has administration, maintenance, catering and ancillary staff members, and these arrangements are satisfactory. Staff members have the necessary skills and they receive appropriate training to meet the varying needs of the service users. Staff spoken with indicated that they have excellent opportunities for relevant training and this gives them greater confidence to do their jobs. It was evident during the inspection that they understand the different requirements and approaches appropriate for each resident. The procedures for the recruitment of staff was scrutinised and found to be robust. The recruitment files for 6 members who have been in post since the last inspection in January 2006 were examined. These were found to be in St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 22 good order. All 9 staff spoken with stated that they had had their CRB checks completed. All 9 staff members spoken to confirmed that normally they receive one to one formal supervision, once every two months. Supervision records are maintained. Delegated members of the management team with supervision responsibilities have received training and coaching on this subject. Staff expressed a great deal of satisfaction with the quality and management support they receive. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 and 42. A skilful, knowledgeable and experienced Manager supported by an able management team, ensures that the establishment is managed well; this evidently benefits service users and staff as well. All staff members must however participate in a fire drill annually, at minimum. EVIDENCE: The effective implementation of a number of systems including assessment and admission process, care planning and review, consultation and communication, recruitment, induction, training, supervision and appraisal of staff ensures that the home operates in an efficient manner; this clearly benefits service users and the staff teams. The risk assessment systems are thorough and tailored to the needs/requirements of the individual resident, and the Organisation linked to with a clear root-cause analysis, which enables the management team to learn and develop from events. The Registered Manager is known as the Director of Care. She has the overall management responsibility and accountability for the home. A team of senior Managers including 2 Assistant Directors very ably support the Manager. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 24 Consistent with the findings of the last inspection report dated 24.01.06, there continues to be excellent evidence to indicate that the Director of Care is well qualified and experienced, and competently manages this large establishment to meet its stated purpose, aims and objectives. Staff members have received mandatory training to ensure safe working practices. Fire extinguishers and the alarm system had been serviced and portable electrical appliances checked and tagged as appropriate. Fire drills and weekly test of break glass points have been carried out within the required frequency and a record maintained. Hot water temperature is monitored regularly; this ensures a safe limit of 43 degrees Centigrade at the point of outlet. Windows have been fitted with restrictors for the safety of service users and security of the building. The only shortfall identified is that 2 of the 9 staff members spoken to stated that they had not participated in any fire drill in the previous 12 to 18 months. The Registered Person is aware that all staff members must participate in at least one fire drill annually, at minimum. Remedial action is required. Rigorous record keeping practices are followed that demonstrate a disciplined approach to health and safety; this protects and promotes the interests of service users. St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 x 3 4 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 x 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x x 2 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 4 15 X 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 3 4 4 4 x x x 2 x St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 26 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 YA42 Regulation 23 (4) (d) & (e) Requirement The Registered Person must ensure that all staff members participate in at least one fire drill annually, at minimum. Timescale for action 19/07/06 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 YA5 Good Practice Recommendations The draft placement contract/terms and conditions should be updated, finalised and used for new service users. (A previous recommendation). It would be good practice for the care plan to reflect the signature of the service user and next of kin where appropriate, in order to demonstrate their participation in the care planning process. A system should be instituted, in order to demonstrate more clearly that the service user is being informed about their rights to confidentiality and access to records retained about them. 2 YA6 3 YA10 St Elizabeths Care Home with Nursing DS0000019542.V291472.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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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