Inspection on 14/04/08 for The Elizabethan Care Home

This inspection was carried out on 14th April 2008.

CSCI found this care home to be providing an Poor 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

The Elizabethan Care Home 29/08/08

The Elizabethan Care Home 18/05/07

The Elizabethan Care Home 07/06/06

The Elizabethan Care Home 30/11/05

The Elizabethan Care Home 21/04/05

The Elizabethan Care Home 28/10/04

The Elizabethan Care Home 22/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Elizabethan Care Home 220 Old Bedford Road Luton LU2 7HB Lead Inspector Sally Snelson Unannounced Inspection 14th April 2008 07:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elizabethan Care Home Address 220 Old Bedford Road Luton LU2 7HB 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) 01582 720010 No email 3/7/2007 Heritage Care Homes Ltd vacant post Care Home 21 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (23) of places The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users over the age of 65 years, not falling within any other category 21(OP), 10 of whom may have dementia DE(E) (10). No one falling within the category of DE(E) may be admitted to the home when there are 10 persons in category DE(E) already accommodated in the home. The home can accommodate a maximum of 21 service users of either sex. 18th May 2007 Date of last inspection Brief Description of the Service: The Elizabethan is registered to provide services for twenty-one older people, ten of whom may also have dementia. Mr S Hussain is the proprietor. The company, Heritage Care Ltd, also operates two other care homes in the vicinity. The registered managers post is currently vacant. The home is located in a pleasant residential suburb of Luton with convenient access to the towns amenities and transport links. The accommodation is distributed over three floors that are accessible via a staircase and a shaft lift. Each bedroom is for single occupancy although a few rooms are large enough to accommodate two persons who wish to share. There is a lounge and dining room on the ground floor and toilet and bathing facilities on each of the floors. The garden to the front of the property is not accessible as it had a steep slope. The front entrance to the building is similarly restricted. Service users and visitors to the home therefore mostly use the door that leads directly into the communal areas. The majority of the rear of the property is given over to a large parking area. Beyond this was a further large grassed area that was not in use. The acting manager reported that the minimum fee at the time of the inspection was £418 per week and the maximum £450. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which requires review of the key standards for the provision of a care home for older people that takes account of residents’ views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Two inspectors, Sally Snelson and Louise Trainor, undertook the inspection of the Elizabethan. It was a key inspection, was unannounced and took place from 07.30am on the 14th April 2008. Because of the number of concerns identified, and the need to triangulate the evidence, 15 hours was spent on this inspection, and not all of the key standards were assessed. The acting manager, Ru Ziyenge, was present from 9.30 am. Feedback was given throughout the inspection, and at the end. During the inspection the care of three people who used the service (residents) was case tracked in detail. This involved reading their records and comparing what was documented to what was provided. Information about other people was also read. In addition to sampling files, people who lived at the home, and staff were spoken to and their opinions sought. Any comments received from staff or residents about their views of the home, plus all the information gathered on the day was used to form a judgement about the service. Prior to the inspection nine service users, six staff and three relative quality surveys had been received. The inspector would like to thank all those involved in the inspection for their input and support. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There were a number of things that needed to improve to ensure that the people living at the home received a good standard of care. These included:The care plans and risk assessments had not been written in sufficient detail to ensure that the care needs of the people at the home would be met in a consistent and safe way. Also, medication procedures were unsafe and put service users at risk of receiving the wrong medication at the wrong time, or not receiving any medication. People were assessed for suitability before they were admitted to the home, however the information that was available to people using the service and their families, had not been updated, so was inaccurate. Staff arranged some outings and trips but there was very little available to stimulate the people living at the home each day. It was apparent from the information gained during the inspection that staff did not always report issues that adversely affected the people living at the home as safeguarding concerns to the Local Authority. The complaints procedure was not robust and was not followed. The environment was unsuitable for many of the people living at the home and did not offer them a homely environment in which to live. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 7 There was no evidence to indicate that the staff team had the necessary, training, qualifications and experience to care for the people living at the home. This could mean that people did not receive the correct care. 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. The summary of this inspection report can be made available in other formats on request. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6, Quality in this outcome area is poor. Although people were assessed before they entered the home, staff did not have the necessary understanding to ensure that their was protected or promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager informed us that she had altered the Statement of Purpose, however the document available suggested that it needed further reviewing and updating, to be a true indication of what the home offers. We tracked the care of three people using the service, and looked at the file of the newest person to be admitted. It was apparent that the acting manager The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 10 assessed people before they were admitted to the home. The acting manager told us that she would seek advice from the community nursing service if she believed a person had additional needs that would need their support. Care files included social service contracts, but these were out of date and unsigned. Of the three people we tracked one had a learning disability and two a mental health diagnosis. There was nothing to suggest that the staff had the necessary skills, experience and qualifications to provide care for people with these diagnoses. For example, the person with a learning disability, was supported by a carer, to get ready to go out to a day centre. She was wearing a skirt and jumper with an outdoor coat over it, and short white socks and lace up shoes. When we asked the carer why she was dressed like this we were told because she has a learning disability. At the time of the inspection we were not made aware that any of the people living at the Elizabethan were receiving intermediate (rehabilitation) care, although the Annual Quality Assurance Assessment (AQAA) did refer to those admitted for rehabilitation. One relative also told us that she believed her mother had been admitted to the home for rehabilitation, but this had not happened. In the AQAA the manager made reference to requesting physiotherapy from the PCT. If a person has been admitted with rehabilitation as a perceived need it is for the home to provide. People should only be admitted to a care home for rehabilitation if a dedicated area is provided and the staff have been trained to support the rehabilitation programme. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. The care plans and risk assessments had not been written in sufficient detail to ensure that the care needs of the people at the home would be met in a consistent and safe way. Also, medication procedures were unsafe and put service users at risk of receiving the wrong medication at the wrong time, or not receiving any medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the people living at the home had a care file with a plan of care. However the plans had not all been reviewed monthly, although there was an up-to-date six monthly review form in all of the files sampled. As it is a requirement that care plans for older people are reviewed every month this is The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 12 additional paperwork for staff that did not appear to be serving a purpose. There was an absence of plans for some activities and conditions. For example, one of the people case tracked had a diagnosis of type-two diabetes. None of her care plans made reference to this, or how the condition should be managed. All of the people living at the home had been nutritionally assessed, but the scoring was not explained, and we could not identify how these assessments were used to provide better care. All three files sampled suggested, that since the start of 2008, (three months) each of the resident’s weights had remained completely static. The acting manager confirmed that it was sometimes necessary to fill in gaps where staff had ‘forgotten’ to make an entry. It was noted that these entries had not been signed. We also noted that some entries in the care files had not been signed; others had not been dated or had been dated incorrectly. For example, one risk assessment had been written with a date that had yet to be reached. A risk assessment for ‘tends to wander off’ described how a person could wander, and why they should not, but not how to prevent it, or what to do if it happened. Poor recoding, as described above, means these documents are of little, or no, use and do not serve the purpose for which they are intended. While checking medication procedures in the home, we were shown a policy that had not been reviewed since 1997. The policy included out of date information. At the start of the inspection the padlock used to chain the medication trolley to the wall was open, so the trolley was not locked to the wall. A service user, whose medication sheet detailed that she should have a certain medication ½ an hour before her meal, was given breakfast at 08.40am and her medication after 10.00am. Our pharmacist confirmed that this practice could be detrimental to health. It was noted that many service users regularly refused their prescribed medication. Staff were not following up and recording when service users were consistently refusing medication, and did not ensure that the GP was informed, or what they had done to ensure, that the decision of the service user to refuse, was an informed one. When medication was refused, or not given, staff had to code the reason why on the Medication Administration Record (MAR). Codes were not always being written, or incorrect codes were used. If codes were used it was expected that additional information, as to why a medication was not given was recorded on the back of the MAR chart; this was not happening. Because it was not possible to know if the drug had been given, refused, or forgotten, it was not possible to reconcile the medications in the home. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 13 Very few of the residents had received the first dose of this month’s cycle, as the new month’s medication did not arrive into the home until lunchtime. This was unacceptable, and although the fault of the pharmacy, there should be documentation in the home to provide evidence of what staff had done to try to rectify this as soon as possible. This delay in medication arriving at the home had resulted in one service user not being given at least 3 days supply of MST (a morphine based pain killer). This was not sent to us as a Regulation 37 incident, or as a safeguarding issue, but following this inspection we made the appropriate referral. The controlled drug cabinet was a combination safe; it was not bolted to the floor or the wall and was stored in a cupboard that was unlocked at the time of the inspection. This contravenes the medicine Act. This unlocked cupboard also held the medications of a service user who was no longer a resident at the home. The recording of controlled drug usage was a poor, it was not apparent how much medication was received into the home, or returned to the pharmacy. For example comments such as one bottle had been recorded as returned. There was nothing to indicate how much was in the bottle and if it had been opened and some used. The controlled drug book was not always filled in when controlled drugs came into the home and as a result it was not possible to audit this medication, particularly the Oromorph. Entries in the controlled drug book were sometimes in blue pen, sometimes not dated and had been altered without signatures. There was no index at the front of the book, so it was difficult to tell where the next entry was made after a page was completed. The staff delegated to administer medication were senior staff, but there was no evidence that they had had any accredited medication training. We asked the manager for the evidence that the four senior staff, who were responsible for the administration of medication, had had the appropriate training. She was unaware of any specific training. She told us that it was a part of the senior carers role, and one senior carer would show another what to do. She confirmed that a manager from another of the heritage homes, who had recently supported training within the company, had done some training with staff. She also told us that the supplying pharmacy had given staff some training about different medicines. There was no evidence provided to support this. The manager did not regularly audit the administration of medication. The practice of administering medication at 09.30, 13.00, 17.00 and 20.00 hrs did not ensure that medication was regularly spaced out during a 24 hr period. This could mean that people had a period of 13 and a half hours without pain relief over night. Throughout the visit we saw creams and lotions belonging to other people in bedrooms and bathrooms. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 14 At times the privacy and dignity of the people living at the home was compromised. For example staff had to carry laundry through communal areas of the home to access the laundry. The pay phone no longer accepted money, so could not be used by residents; this phone had the same number as the home so did not provide privacy. Also, as already discussed, one service users clothes were not suitable for them. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. Staff arranged some outings and trips but there was very little available to stimulate the people living at the home each day. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection we did not see any activities taking place. We spoke to one person about how she spent her day. She told us, ‘we mostly watch TV, we used to do bingo and a lady comes once a month to play music’. The manager and a visitor told us that theatre trips to Luton and Dunstable were occasionally organised, but since the mini-bus has been taken out of use, in November 2007, this can become very expensive as there was a reliance on taxi’s. A relative told us that she had chosen the home because it advertised the mini-bus and being able to take people out, but this had not been The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 16 happening for the last six months. People at the home would benefit from a variety of activities that would stimulate them both mentally and physically. Visitors were welcomed into the home at anytime and could meet with their loved ones in the communal areas of the home, or in the person’s bedroom. The acting manager told us that she was trying to change the four-week rolling menu plan and introduce a wider variety of foods, but was finding it difficult to persuade those preparing the meals to come on board. On the day of the inspection the cook, who had been off over the weekend was unsure what she was preparing for the main meal. She eventually told us she was making a shepherds pie and requested that the handyman should go and buy the meat. There was chicken defrosting, which we were told was for the next day’s meal. These meal options did not appear to follow the planned menu for the week. Basic foods were stored in the home, and a greengrocery order was delivered during the inspection. We were concerned at the way food was stored. For example salad cream with a use within 4 weeks instruction did not have a date indicating when it had been opened. We also found opened bottles of tartar sauce and pickle, with use by dates of August 2006 and October 2006, respectively. The cook came on duty at 8am served breakfast to people as they came into the communal areas. At 08.30hrs, a resident was looking for drink and becoming quiet agitated. She confirmed to us that she had a hot drink and a biscuit at 8pm the night before, but nothing since. Hot and cold drinks were available, at times, throughout the day. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. It was apparent from the information gained during the inspection that staff did not always report issues that adversely affected the people living at the home as safeguarding concerns to the Local Authority. The complaints procedure was not robust and was not followed. EVIDENCE: A relative reported that he/she had made an official complaint to the owner of the home and requested a response, but had not had one. We were not aware of how the complaints procedure was followed or how any complaint investigation took place, because complaints were not centrally stored. In the AQAA the acting manager stated that four of the five complaints made since the last inspection had been dealt with in the suggested timescale. When we looked at the published timescale for dealing with complaints we felt that a 48-hour response would not always be possible and the policy should be reviewed. We also expected the homes policy to offer more independent investigation before we were asked to intervene. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 18 As already detailed staff were not always identifying when service users were at risk of abuse; such as when medication did not arrive into the home on time, and were consequently not reporting safeguarding issues correctly. However, over the last few months, when staff discovered bruises and injuries that could not be accounted for, they had referred them to the SOVA team and co-operated with any investigation. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 Quality in this outcome area is poor. The environment was unsuitable for many of the people living at the home and did not offer them a homely environment in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During a tour of the premises it was apparent that many areas of the home were unsuitable for people with any kind of mobility problems. Many of the bedrooms were off very narrow corridors. Stairs or a lift accessed the three floors of the home. However, at the bottom of the stairs a pushbike belonging to a staff member was stored and posed a real hazard. We were also concerned that a number of areas could be The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 20 dangerous, but all residents could access them. For example, the generator room had a notice that stated ‘DANGER access forbidden to all unauthorised person’, but despite this the door was unlocked. We also noted a cupboard with two steps down into it unlocked. The people who lived in the home could choose to use one of the two communal areas. Both were used as lounge/diners. However the throughway from the front door was via the front lounge. We witnessed a carer bringing a service user into the communal area. The carer was wearing the gloves she had used to provide the personal care and had the persons soiled laundry under one arm against her body; the soiled laundry had not been bagged. Staff did not appear to be aware of laundry bags. There was a very strong smell of urine from one area of the home and the smell permeated into at least four bedrooms. The manager was asked about the smell and we were told it was because one of the people living in that area was incontinent of urine, and consequently the carpet was soiled. No explanation was given of how, or if, the problem was to be addressed. One person living at the home also complained of ‘an odour’ In the laundry room we noted that there were six plastic black and yellow waste bags, and a washing basket, filled with dirty washing. The washing machine and the tumble drier were filled with absorbent sheets from the beds. There is usually an instructions that these sheets should not be tumble dried, as it effects their absorbency. We believed that the amount in the machines would make it difficult for the machines to operate effectively. Some areas of the home were not very homely. For example there was a toilet roll on the mantle shelf in the lounge and boxes of plastic gloves in the hall. Plastic gloves can be harmful if misused by a person without capacity. The floor in the bathroom was very sticky and the threshold uneven. In one residents room we noted that the ‘sit-on’ weighing machine were stored. There were also two call bell wires coiled up on the windowsill. In another room that was not being used we found an old banana. This was particularly concerning as we had read that in order to avoid a possible allergic reaction to bananas for one person, the kitchen should be kept locked at all times. While touring the premises we had access to the managers office. The office was untidy; there were used gloves on the desk. We were able to look in a box file and discover how much each staff member had been paid for the last few months. It was therefore fair to say that this information could also be accessible to staff and visitors. Also in the office was a key cabinet, which was unlocked and might provide access to other private areas. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. There was no evidence to indicate that the staff team had the necessary, training, qualifications and experience to care for the people living at the home. This could mean that people did not receive the correct care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived at the home at 07.30hrs we were told that there were three staff on shift. However, we noted that the third person did not arrive until 08.10hrs. We were concerned that the two staff on duty were working in individual’s bedrooms, assisting people to get up and dressed, and no one was observing what was happening in the communal areas. In addition to care duties care staff were responsible for laundry, and for cleaning at weekends. In addition to the care staff the home employed cooks, a handyman and cleaners. The acting manager confirmed that there had been a high turnover of staff recently, including the moving on of the manager. She admitted that it was The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 22 therefore difficult to ensure that the staff team had the necessary training and qualifications required. Staff were encouraged to attend and to keep updated mandatory training but there was little evidence that specialist training was provided. Of the 12 staff employed 11 had NVQ level 2. We were disappointed to learn that after level 2 the company expected the employee to pay for this training themselves. As already mentioned those staff administering medication had not been specifically trained to do so and we were concerned that the staff did not have the skills to care for the diverse needs of the people at the home such as mental health, dementia and learning disability. The staff files of three staff members were sampled. It was clear that the manager had done the necessary checks on the latest person to be appointed and had documented her reason for employing a persons whose references suggested that there might be some problems. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,37 Quality in this outcome area is poor. The manager did not have the training, experience or support to be responsible for managing the home, but showed a lot of care and compassion for the people she was caring for and managing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager informed us that she had been in post for seven months and believed that the owner of the home was processing her application to The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 24 become the registered manager. However she told us that she had not completed a Criminal Record Bureau check for the role so it was apparent to us that this was not happening. The acting manager did not have the required NVQ level4 or Registered Managers Award. She told us the company would not pay for this, and at over £1,000.00 it was large expense to her. The owner had been advised that the quality of the reports made after visits to the home to check quality was not good enough. It was expected that he was to delegate the responsibility to an ex-manager who was working for him in an administrative role. We were told that she was visiting the day of the inspection, but postponed because of our visit. The regulation states that these visits should be unannounced. Currently there was no programme for holding regular staff, relative and resident meetings. The acting manager was not receiving any supervision. Recently the home had moved away from task supervision and offered staff the opportunity to discuss issues that were affecting them. We believed that all involved would benefit from a more structured process that looked at training needs and the philosophy of the care in the home. As detailed documentation in the home was of a poor standard and senior staff were not aware of the National Minimum standards and the Care Homes Regulations, and their duty to comply with them. We did not look at health and safety checks in detail at this inspection. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 X X X X X 1 1 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 1 1 X The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 4,5 Requirement The people who use this service must have access to information that accurately reflects the services provided by the home. It should be kept under review and altered as circumstances change. People who use this service should not be admitted to the home without a thorough preadmission assessment that clearly details how the staff team can meet their needs. Care plans must be thoroughly written for all areas of care provided to a resident to ensure that all staff are aware of the care needs, and these plans must be kept under review. Staff must identify any risks to the people who use this service, and assess and document these risks. All medication procedures must be clearly recorded to ensure people receive the correct medication in a safe way and medication practices can be audited. DS0000045208.V359896.R01.S.doc Timescale for action 01/07/08 2 OP3 14(1)(a) 01/06/08 3 OP7 15 01/06/08 4. OP8 13(4) 01/06/08 5 OP9 13(2) 12(1)(a) 21/04/08 The Elizabethan Care Home Version 5.2 Page 27 6 OP12 16(2)(n) 7 OP15 16(2) 8 OP16 22 9 10 11 OP18 OP19 OP26 13(6) 23(1), 13(4) 12(1),23( d),16(1), 13(3) 18(1)(a) 12 OP30 13. OP36 18 (2) An immediate requirement was left that the registered person shall make arrangements for the recording, handling, safekeeping, and safe administration of medicines received into the care home. People who use this service must be offered, and encouraged to participate in, activities that are suitable for their specialist needs. Staff must ensure that people are provided with adequate, wholesome and nutritious food throughout the day. The interval between a bedtime snack and breakfast should not exceed 12 hours. People who use the service must be protected by a robust complaints policy that is followed whenever a concern is raised. People who use this service must be protected from any risk of harm and abuse. People who use the service must have a safe place to live that is free from hazards. The home must be kept clean and free of offensive odours and care must be taken to prevent the spread of infection. The people who live in this home must be cared for by staff that are suitably qualified and competent to do their jobs. The home must ensure that the care staffs receive formal supervision at least 6 times a year. This would include recording the supervision and judgement making about an individual’s performance in a descriptive way. Some work had been done DS0000045208.V359896.R01.S.doc 01/07/08 01/06/08 01/06/08 01/06/08 01/06/08 01/06/08 01/06/08 01/07/08 The Elizabethan Care Home Version 5.2 Page 28 towards addressing this requirement, so the date is extended. 14 OP37 17 Staff must make sure that all records in the home are accurately written, dated and signed, as they are legal documents. An immediate requirement was left in respect of the documentation associated with the medication. 21/04/08 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 2. 3. Refer to Standard OP2 OP10 OP31 Good Practice Recommendations Contracts with the placing authority should be current. The home must operate in a way that people’s privacy and dignity is respected. The proprietor must support a member of the staff team to become the registered manager. The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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 © 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 The Elizabethan Care Home DS0000045208.V359896.R01.S.doc Version 5.2 Page 30 - 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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