Inspection on 21/04/05 for The Elizabethan Care Home

This inspection was carried out on 21st April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Elizabethan Care Home 29/08/08

The Elizabethan Care Home 14/04/08

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 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 Leonorah Milton Announced 21 April 2005 st 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. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 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 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 01582 720010 Heritage Care Homes Ltd Miss Erin Bermingham Care Home 21 Category(ies) of OP Old Age - 25, 10 of whom may also registration, with number dementia DE(E) of places The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No one falling within the category of DE(E) may be admitted to the home where 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. Date of last inspection 28.10.04 Brief Description of the Service: The Elizabethan was registered to provide for twenty-one older people, ten of whom who may also have dementia. Mr S Hussain had been the proprietor a number of years. He had changed the registered status to a company, Heritage Care Homes, two years ago. The company also operates two other care homes in the vicinity. The manager Miss Bermingham had been appointed several months ago. The service had improved significantly under her direction. The home was located in a pleasant residentail suburb of Luton with convenient access to the towns amenities and transport links. The accommodation was distributed over three floors that were accessible via a staircase and a shaft lift. Each bedroom was for single occupancy although a few rooms were large enough to accomodate two persons who wished to share. A lounge and dining room were located on the ground floor. Toilet and bathing facilities were located on each of the floors. However, only two of the bathing facilities was in use. The garden to the front of the property was not accessible as it had a steep slope. The front entrance to the building was similarly restricted. Service users and visitors to the home therefore mostly used the door that led directly into the laundry from the side of the property. Service users could also use the patio doors that lead out from the rear lounge onto a paved area. The majority of the rear of the property was given over to a large parking area. Beyond this was a further large grassed area that was not in use. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over 7.15 hours. Miss Bermingham, the manager, was present throughout and received feedback as the inspection progressed. Included in the methods of inspection were discussions with five service users, three members of staff, the manager, a district nurse and a brief conversation with the proprietor Mr Hussain; a partial tour of the building; case tracking in relation to three service users; assessment of various documents and taking the mid-day meal with service users. What the service does well: What has improved since the last inspection? It was evident that effective management and supervision of the staff had resulted in an improvement in individual practice and the overall performance of the team. Staff were observed to go about their business in a professional and confident manner. Documentation required to evidence and underpin the operation had continued to improve. Records had been well maintained and were readily accessible. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 6 Redecoration of some bedrooms and corridors and the dining room had improved the décor. The replacement of chairs in the dining room was a considerable improvement on the worn chairs seen at previous inspections. 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. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 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 The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 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) 1,2,3,3,4. Sufficient information was available to service users to enable them to make an informed choice about the home before admission. Sufficient information about service users’ needs had been sought prior to their admission to ensure that the home was able to properly care for them. EVIDENCE: A conversation with one service user demonstrated that she and her family had visited the home prior to her admission and that she had been provided with written information about the service. She stated that the service was as had been explained to her and met her expectations. Case files assessed at this inspection demonstrated that personal information about individual’s needs had been obtained prior to admission. This process had continued after admission via a family history where further information about past lives that might be relevant to current care needs had been sought where possible. Contractual arrangements in the case files where satisfactory. It was positive to note that the requirement for bedrooms with obscured glass to be agreed for occupation by contract with service users had been actioned. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 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) 7,8,9,10,11 Care planning systems were of good standard with only a few omissions and provided staff with detailed information to enable them to meet service users’ needs. EVIDENCE: Records assessed indicated that a detailed plan of care was compiled shortly after admission and reviewed in a simpler format by key workers on a monthly basis. The monthly review recorded the service user’s progress; any problems encountered and identified goals for the following month. Plans mostly recorded service users’ wishes in relation to last rites and similar. Preferences for social activities were a little brief as were service users’ abilities to manage keys to their rooms and personal monies. Care planning processes must take factors other than the environmental hazards and manual handling risks into account. There were no written strategies in place for a service user with dementia who smoked and occasionally used oxygen therapy. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 10 Medication procedures were not assessed in full but there had been some confusion about the changes to one prescription. The manager was advised to ensure that all changes to prescriptions have been authorised by service users’ doctors in writing. There was evidence that service users had been referred to their general practitioners and other health care professionals for routine appointments and as need be. One service user however was concerned about the service that she had received from her general practitioner who had had prescribed additional medications without consulting with the service user in the home. The manager was advised to discuss this concern with the service user to seek an appropriate solution that would meet her health care needs and expectations. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 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) 12,13,14,15. An increase in the performance of the team had resulted in an improvement in the arrangements to ensure that service users achieved a fulfilling lifestyle. However there were instances where the service users had not received a service that matched their assessed need. EVIDENCE: Staff had strived to support service users to achieve a fulfilling lifestyle within the constraints of the service users’ declining abilities, those that come about when living amongst a large group of people and reduced staffing arrangements. A reduction in care staffing arrangements in the afternoons meant that care staff were occupied in meeting physical care needs and had insufficient time to engage in conversation with service users and provide activities for stimulation. It was also apparent that some inflexibility had developed in the catering arrangements. A reluctance to serve breakfast later in the morning was reported. Service users praised other aspects of the catering provision. Meals were plentiful. Menus showed a nutritious choice. Special diets could be met. Unrestricted visiting arrangements were in place. Several visitors including those with young children came and went as the inspection proceeded. A The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 12 service user commented that she frequently went out with members of her family and that her visitors were welcomed into the home. The service user also confirmed that she managed her personal finances and had a lockable facility for safe storage of valuables. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 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) 16,17,18 Appropriate action had been taken in relation to complaints and to ensure the protection of service users. EVIDENCE: Records of concerns and arising investigation and actions had been maintained. The manager had promoted professional conduct and had taken disciplinary action where need be. There was a discernable increase in the awareness of the team about adult protection issues as a result of external training and the gradual change in the culture of the home. It was evident that the home’s whistle blowing policy had been promoted and was effective. Service users confirmed that they had been informed about the recent national election debate and intended to use postal voting procedures. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 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) 19,20,21,23,24,25. The home, with some few exceptions, provided a clean, comfortable and homely environment that was suitable to service users’ needs. EVIDENCE: The areas of the building seen at this inspection were all clean and orderly. Service users’ personal belongings created a unique and individual appearance to each room. One service user had been supported to choose colour schemes and co-ordinating linen. Standards of furniture varied considerably. A few bedrooms still contained furniture that was worn and that would need to be replaced in the near future. Replacement of furniture in other bedrooms had achieved an appearance of comfort and quality. Information provided prior to this inspection demonstrated that equipment and similar had been maintained to required safety standards through regular maintenance and servicing visits by approved contractors. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 15 Redecoration in some areas had resulted in an improvement in the overall appearance of the building. Rearrangement of furniture in long narrow bedrooms had improved but access and space in these rooms was still restricted. Only two bathrooms were suitable for the use of frail elders. An identified maintenance programme showed that there had been an improvement in the organisation to deal with minor maintenance issues without undue delay. It was therefore most frustrating to note that one wardrobe door that had been without a fastening and held fast with another piece of furniture, had still not been repaired for more than three years. The proprietor was personally asked to action this without delay. Similarly there had been no action to provide a ramp to access the building from the front of the building or to provide universal access to the rear that could also accommodate disabled persons. Access for frailer service users and visitors via the laundry continued to compromise hygiene standards. Access to the large garden to the rear of the premises was limited for service users to a small walled off area. The larger grassed area beyond the car park remained unused. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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) 27,29,30 Whilst staff had the necessary skills and knowledge to understand and meet service users’ needs, inadequate staffing arrangements in the afternoons had prevented them from providing a satisfactory service. EVIDENCE: Systems to inform staff and guide staff had been further developed with positive results for team working. The training provision had progressed under the organisation of the manager. Further training had been planned. Some had been already arranged for the forthcoming year. Recruitment practices were satisfactory with the exception of those for a member of staff transferred from another home part owned by Mr Hussain. The manager was advised that where previous employment was not within the company, usual recruitment procedures must be followed in relation to references and checks via the Criminal Records Bureau. It was positive to note the improvement in staff conduct and morale. Staff spoken to at this inspection were enthusiastic about the support they had received and demonstrated an awareness of their responsibilities and a regard for service users’ welfare. They were concerned about the reduction in staffing levels and anxious about some deterioration in the service. It was a great pity that the improvements in the staff performance and morale that had been noted at the previous two inspections after several years of poor performance had been compromised by the proprietor’s decision to reduce staffing levels. Given the rise in the operation of the home and its occupancy The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 17 levels it was difficult to understand why this development of the service had been put at risk. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 31,32,33,34,35,36,37,38. The home was well managed. It had reviewed aspects of its performance through consultation with service users and their relatives. EVIDENCE: Miss Bermingham had ably demonstrated her management skills and commitment to the home that was reflected in the development of the service noted at the last three inspections. Systems to consult with service users and their families were in place via regular service user meetings and an overall quality audit process. Minutes of two previous service user meetings and the agenda for the next had been advertised in a large print format for information. Staff meetings were recorded and covered topics of performance, safety and other relevant issues. Supervision for staff had been evidenced by a planned The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 19 schedule. Staff were positive about the support and guidance they had received through supervision and meetings. Records demonstrated that financial transactions made on service users’ behalf were appropriate and had been properly recorded and substantiated by receipt. The arrangements to monitor safety aspects of the home had also improved significantly. Staff had received statutory training. Records indicated a methodical approach to routine safety checks had ensured that equipment and systems had been checked on a regular basis in house and by contractors as required. The manager had actioned a previous requirement to compile a business and financial plan for the operation of the home. She unfortunately had been unable to complete the process because an audit of accounts had not been made available to her. It was a pity, given the considerable overall improvement in the service delivery, occupancy levels and staff turnover that the proprietor had failed to take note of comments from the previous report about the manager’s level of pay that was not commensurate with her responsibility and legal accountability as a registered person. Employment and retention of a skilled manager had been a problem in the past. It is to be hoped that this will not reoccur in the future. The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 3 2 x 3 2 x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 2 3 3 3 2 The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 21 yes 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 7 Regulation 13(4)(b), 15(1)(2) Requirement Care plans must take account of risks assessments in relation to smoking and the use of oxygen. Care plans must detail service users abilities including the ability to manage keys, personal monies and detail why they do not take their meals at a dining table. Changes to prescriptions must be authorised by a doctor in writing. There must be sufficient time in the staffing arrangements for staff to provide stimulating activities including one to one conersation. Meals must be served at times to suit service users needs and expectations. Mealtimes must not be governed by the staffing roster. Provide a suitable ramp to the entrance door to the home and to the access via the front garden.(Previous timescale of 30.04.05 had not been met). Provide the maintenance person with sufficient time to carry out the maintenance of the Timescale for action 30.06.05. 2. 3. 9 12 13(2) 16(2)(i) 30.05.05. 30.05.05 4. 15 16(2)(m) 30.05.05 5. 19 23(2)(n) 31.07.05 6. 19 18(1)(a), 23(2)(C) 30.06.05 The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 22 7. 24 16(2) 8. 27 18(1)(a) 9. 38 13(4)(b) home.(Previous timescale of 30.11.04 had bot been met). Repair furniture in various sites where it is chipped and worn (Previous timescales of 31.07.04 and 31.12.04 had not been met in full) Provide sufficient staff to meet service users assessed needs including recreational and social needs and and meals served at times required. In this instance roster care staff on duty during the day at a minimum ratio of 1:6 or part thereof. Carry out a risk assessment on the safe storage and use of oxygen. 31.07.05. 21.05.05. 30.05.05. 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 22 Good Practice Recommendations Arrange for the home to be assessed with regard to environmental changes and the provision of adaptations that may be required to meet service users’ assessed needs. Enable service users to have access to a greater area of the garden. Review the terms and conditions of the manager to ensure the retention of a competent manager(Previous timescale of 30.11.04 had not been taken ingto account.) 2. 3. 20 31 The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF 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. Extracts may not be used or reproduced without the express permission of CSCI The Elizabethan Care Home I51 S45208 Elizabethan V212925 AI 210405 Stage 4.doc Version 1.30 Page 24 - 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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