Care Home: Eastbrook House

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What the care home does well There has been some progress with regard to the requirements made at the last inspection. The people live in a homely environment. They have access to a well maintained garden. What the care home could do better: The service needs to ensure that risk assessments are detailed and that they are effective in meeting peoples` needs. Manual handling assessments need to clearly identify the support required and specify identified risks to people and staff. To fully promote the safety and wellbeing of people living in the home. The service needs to ensure that the policy used when a person has fallen is being used consistently and staff have training in relation to its use. The recording, administration and auditing of medication needs to be effective. To ensure that peoples` wellbeing is promoted and protected. Care plans need to be reviewed to ensure they are detailed and include all identified areas. To ensure that peoples` needs can be fully met. There needs to be an improvement in relation to recording to clearly evidence that peoples` personal care needs are being met. Improvements need to be made with regard to effective recording and staff need to be trained to ensure that recording is effective. The recruitment process needs to be more robust to fully safeguard the people living in the home. Supervision records need to be detailed and take place on a consistent basis to ensure that staff working in the home are operating n a professional consistent manner. Random inspection report Care homes for older people Name: Address: Eastbrook House 16 Eastbrook Avenue London N9 8DA two star good service 17/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Wendy Heal Date: 1 0 0 9 2 0 1 0 Information about the care home Name of care home: Address: Eastbrook House 16 Eastbrook Avenue London N9 8DA 02088056632 02088056637 Eastbrookhouse@UK2.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Johnathan Beacham Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Roland Jenkins Beacham,Mrs Janet Beacham care home 43 Number of places (if applicable): Under 65 Over 65 0 43 dementia old age, not falling within any other category Conditions of registration: 43 0 The registered person may provide the following categories of service only: Care Home only-- Code PC To service users of the following gender--Both Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category-Code OP and Dementia Code DE Date of last inspection 1 7 1 1 2 0 0 9 Care Homes for Older People Page 2 of 14 Brief description of the care home The home is owned by Mr & Mrs Roland Beacham and managed by their sons Jonathan and Richard, the former being the registered manager. The Beacham family has run Eastbrook House for over twenty years. The home is registered to provide care for forty three older people. The number of double rooms had been decreased so that there is now only one room used as a double room. The communal space includes three lounges and a dining room. There is a passenger lift and the garden is to the rear of the property. The registered manager stated that the current cost of the service is £400 per week. The home displays the latest CSCI inspection report in the entrance hall of the home for the information of all. Eastbrook House is situated in a quiet part of Edmonton at the end of a short residential road. The home is accessible by public transport and within ten minutes walking distance of the local amenities. The home aims to provide a safe and caring environment for service users. Care Homes for Older People Page 3 of 14 What we found: The purpose of this random inspection was to check compliance with the statutory requirements identified in the last key inspection report, which was carried out on the 17th of November 2009. The inspection was carried out by Ms W Heal and Ms J Schofield. We arrived at the home unannounced at 9:30am and we were met on arrival by the Deputy Manager, who contacted the Registered Manager to inform him that we had arrived. On entering the entrance hall we noted that information about the home was on display for people, and for their representatives, to read and for reference. The information included the Care Quality Commission Registration certificate for the home and the Employers Liability Insurance certificate, which was valid until the 4th of November 2010. We saw the NVQ certificate level 4 (RMA) for the Registered Manager of the home and a City and Guilds Advanced Management of Care certificate for the Deputy Manager of the home. Additional information included the statement of purpose, the complaints procedure and a copy of the last key inspection report. There was information regarding staff training and the Mental Capacity Act. People were also made aware of hairdressing services, chiropody services, library facilities and advocacy support available. We carried out a site visit to check compliance with the environmental requirements and noted that these had been met. Compliance promotes the health and safety of people who use the service and staff. The home has replaced the broken handle on the cuboard storing cleaning materials. The corridors of the home were clear of trip hazards. The two identified doors within bathrooms, leading into void spaces, are now locked. We looked at the training records for two members of staff to check compliance with a statutory requirement in respect of updating and refreshing training in key topics and concluded that this had been partialy met. The manager provided a training matrix that recorded the date on which members of staff had completed a specific training topic. On the first staff file we noted that they had completed their NVQ level 3 in September 2009. There were certificates for food hygiene training August 09) and for infection control training (April 09), which were valid for three years. Medication training was completed in July 2010 and a further medication training module is to be undertaken in September 2010. Certificates were available for safguarding (November 09), health and safety training (October 09), dementia care training (January 09) and supporting people with challenging behaviour (June 09). There was evidence on the second staff file that the member of staff had successfully completed their NVQ level 2 training. There were certifcates for Manual Handling Training (March 10), First Aid at Work (October 09), infection control (October 09), food hygiene on (August 09), First Aid Training (September 09), safeguarding (July 10), understanding dementia (December 09), and fire safety (October 08). Advanced dementia care training has been booked for the 12th of January 2011 and further medication training for November 2010. A discussion with the manager has taken place since the inspection and he has told us that he will provide dates for further fire safety training. The staff training matrix Care Homes for Older People Page 4 of 14 provided identified that six members of staff had not refreshed their manual handling training at the recommended yearly interval. The manager has now provided dates for each of these staff members to attend training. Within the care home there are people at risk of developing pressure sores or who have in the past developed a pressure sore. We have since discussed the need for staff to receive training in respect of pressure care needs and that the training programme needs to be reviewed to include this topic. The manager told us that at present pressure care training is not provided but he has contacted the local authority about himself attending training and then cascading this information to members of staff. We looked at the case files belonging to two people to check compliance with the statutory requirements in respect of risk assessments. The requirements were in respect of a risk assessment when cot sides were fitted to peoples beds and the need for a manual handling risk assessment. We concluded that although risk assessments were present on file the assessments lacked sufficient detail. Therefore the requirements had been partially met. We saw that one person was supported by the use of cot sides. The following information was recorded on the front of the risk assessment page Bed guards fitted to stop her from falling out. Permission from family. We have clear concerns regarding the format for recording the actual assessment, which consisted of a one line entry. This is too brief and lacked sufficient detail. Under the heading measures taken to minimise risks identified there was a statement bed guards have been put in place on bed to protect her falling out of bed. The assessment lacked identification of the risks to the person if this measure was not in place or of the risks that might be involved if the measure was put in place. A more detailed risk assessment would promote the health and safety of people living in the home. When we looked at the manual handling risk assessments we noted that these also lacked sufficient detail and failed to record all factors relevant when supporting the service user. Although in the case file there was a record of a standing hoist being used in an entry which said that from time to time we have to use the standing hoist not continuous there was no mention of this in the risk assessment. We were concerned that the format of risk assessments identifies what the person is able to do but does not give details in relation to what support is required, how this support is given and the risks to the person and staff that may be involved. When looking at the manual handling risk assessment we also noted that there was guidance in the event of a person being found on the floor which read if safe to do so and the injury is not serious or does not involve a suspected broken limb then the person should be hoisted to the nearest seat and emergency services are to be called. The manager was advised that this guidance needs to be reviewed to ensure that the safety and wellbeing of the person is maintained at all times. We understand that the home is going to follow Enfields Social Services policy guidance regarding this matter. They must ensure they can understand and follow this guidance. We inspected the medication administration records to check compliance with the statutory requirement in respect of recording the use of creams and concluded that it was now partially met. The record of creams administered are kept separatly in a book, which is kept in the staff room. When looking at the record sheets we were concerned that they are not always given or applied as often as prescribed. The head of care explained that certain people refuse to have the creams applied more than once a day although the Care Homes for Older People Page 5 of 14 refusals are not recorded on the sheets. We looked at the medication records with the head of care after bringing to the attention of the deputy manger the gaps in recording that we had noted. One person takes a certain medication once a week on a specific day. However, althougth there were crosses in the boxes where the member of staff enters their initials to confirm that medication is given to remind the member of staff that this medication is not taken on a daily basis the crosses were entered for more than seven continuous days. Therefore there was no record that it had been given during the week prior to the inspection taking place. The head of care confirmed that she had given the medication this week and that there were no tablets remaining in the box as the last of the four tablets had been given. However the empty box had been placed in the large industrial waste bins outside the home and we were unable to verify for ourselves whether the medication had been given. Another person took prescribed medication one day per week and again there were no initials entered for the previous week. The box that contained this medication was available and we were able to confirm that it had not been given during the previous week. A gel which was used for pain relief had finished three days before the end of the four week cycle and we were told that no additional supply had been requested or obtained for the remaining days of the cycle. It was noted on the record sheet for another person that there was none of a particular medication in the blister pack for one week of the cycle. The head of care stated that the hospital had advised the home to discontinue administering this medication to the person. We were unable to verify whether tablets were missing from the blister pack as we were informed that the blister pack cassettes had already been collected. An identified person who receives a food supplement was being given the supplement three times per day and not four times a day, as perscribed. The head of care explained that the person went to bed quite early and they were not able to administer the four supplements. The head of care was advised to speak with the general practioner to confirm if the times when the supplement was given could be changed to ensure the four supplements could be administered in the one day as prescribed. In response to the errors identified a review of the assessment of competence of a member of staff to administer medication is needed. The assessment should be reviewed on a regular basis with a record being kept. We discussed our concerns with the deputy manager and manager of the home during the inspection. The management team expressed concerns with regard to the auditing of the medication stating that they sometimes identified errors, which have not been identified in the planned audit of medication by the head of care. We checked compliance with the statutory requirement in respect of reviewing and updating the Fire Risk Assessment and noted compliance. The Fire Risk Assessment had been reviewed on the 22/2/10. The assessment included identified risks and an action plan and information of when, and by whom, the work was going to be undertaken. We inspected two care plans that contained information regarding peoples needs and which dentified areas such as personal cleaning, dressing, emotional wellbeing, eating and drinking, social aims and objectives and sleep routines. One care plan noted on the records shouts out when gets restless but did indicate on the file the agreed process to support this person to minimise their distress. Care plans specified when the person was admitted and there was also a photograph of the person. We noted that care plans Care Homes for Older People Page 6 of 14 concentrated on personal and physical needs but lacked detail regarding their social care needs. Information in respect of cultural and religious needs was limited and brief e.g. statement that cultural needs in place. There was a record of when the person was bathed, shaved, showered or had their hair washed. There were minimal entries made for the months of July and August and it was unclear in the recording whether SH referred to a shower and hairwash or to a shave. There were records of visits by health care professionals. The recording in relation to weight charts raised concerns. Information recorded included comments e.g. lost a bit of weight lost 1kg gained a bit of weight. The actual recorded weights were found in another part of the file. We noted that this person had lost 5.5 kgs over a 12 week period. There was no record that this weight loss had resulted in a referal being made to the General Practioner. Another persons records indicated that their weight had reduced from 45.7 kg to 23.3 kilo grammes and a staff member had recorded the need for the person to see the General Practioner. This recorded comment was not dated and although signed the staff member had not entered their full name. The records did not indicate that a General Practioner had been called or visited to see the person. There were no records of monitoring the persons weight on a weekly rather than a monthly basis in response to the comment recorded on the document. Our concerns were raised with the management team during the inspection and we were informed that the deputy manager had identified this issue the week before and asked the staff member to re -weigh the identified person as he believed the recorded weight to be incorrect. The manager explained that they had checked the weighing machine and were satisfied that the machine was working correctly but that members of staff were making errors in the weighing and/or recording in peoples files. The manager did email after the inspection to confirm that the staff member had entered the information in the care plan section called Moving and Handling Assessments. Clear guidelines for staff on when to contact the doctor when noticing that a person is losing weight needs to be in place to ensure that their health and wellbeing is promoted and protected. One person seen and spoken with on the day of the visit spends most of the time in their room and we were informed that this had been her wish for the last six years. This person, who was frail and needed assistance with personal care, had a pressure mat on the floor and was sitting on a cushion on a chair. However, there was a monitoring form on the bedroom door to monitor the contact made with this person to evidence that this person was not isolated and was being suported by staff. We looked and this and were concerned to note that on a specific day there was no information recorded between 11.45am and 15.45pm. It appeared that staff had difficulty understanding how to record the times that the person had been seen. The form was developed using the twenty four hour clock but staff had recorded for 17.45 as 7.45. We brought this to the attention of the deputy manager at the time of the inspection and the matter was discussed with the management team. We viewed two staff files when checking compliance with the requirement in respect of training. We looked at the documentation in relation to the homes recruitment procedures and noted that on one of the files not all of the required documentation was in place to demonstrate that the home had a procedure that included robust recruitment checks. One file lacked proof of ID and after discussion with the manager we confirmed that it also lacked confirmation of the right of the member of staff to reside or to work in Care Homes for Older People Page 7 of 14 the United Kingdom. Since the inspection passport details and the right to work in the United Kingdom have been provided. We also noted on this file that although a reference had been taken from the member of staffs previous employment, which was at another care home, the reference had been completed by an administrative worker as a colleague. We checked whether there was evidence of regular individual supervision sessions with individual carers. Records demonstrated that this was not taking place on a regular basis as one file contained the minutes of two sessions for 2010. We were concerned that a lack of regular staff supervision and support could hinder staff working in a consistent and professional manner. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 14 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The Registered Provider must 15/10/2010 review the care plans of people with pressure sores or at risk of developing pessure sores and ensure that appropriate intervention is included in the plan of care. This will assure that people who use the service receive appropriate intervention. 2 7 12 The Registered Provider must 14/10/2010 ensure that care plans are detailed and this must include areas in relation to cultural and religious needs. This will ensure that peoples individual needs are fully met. 3 7 13 The Registered Provider must 14/10/2010 ensure that Manual Handling Assessments are detailed and identifiy the risks to people and staff. This will ensure that the health and safety of people living in the home and staff Care Homes for Older People Page 10 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action is fully promoted. 4 7 13 The Registered Provider must 15/10/2010 ensure that risk assessments are completed in sufficient detail to meet the needs of people. This will ensure that the risks to people are minimised. 5 9 13 The Registered Provider must 14/10/2010 make arrangements to ensure that all medication is administered as directed by the General Practioner. This is to maintain the health and well being of people. 6 9 13 The Registered Provider must 14/10/2010 ensure that a review of the assessment of staff competence is undertaken and reviewed on a regular basis and a record is kept. This will ensure that staff have been assessed to administer medication and assist to further safeguard people. 7 9 13 The Registered Person must ensure that a system is put in place to ensure that medication administration records (MAR) charts accurately reflect whether any medication was taken refused, or refused and destroyed. This will ensure there is Care Homes for Older People Page 11 of 14 15/10/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action evidence of accurate administration of medication which protects the wellbeing of people. 8 29 19 The Registered Provider must 16/10/2010 ensure that full employment checks that include reference checks evidence of identity and the right to work in the UK are completed satisfactorily and are on file before people come to work in the home. This will ensure that people are fully protected. 9 30 18 The Registered Provider must 17/10/2010 ensure that staff receive training to follow Enfields falls policy. This will ensure that staff are fully trained and informed in relation to the falls policy and guidance as documented in risk assessments. 10 30 18 The Registered Provider must 17/10/2010 ensure that staff undertake training in relation to effective recording. This will ensure that clear and accurate information is documented. 11 30 18 The Registered Provider must 17/10/2010 ensure that all staff complete refresher training as required. This will ensure that staff Care Homes for Older People Page 12 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action have the knowledge and skills to ensure that peoples needs can be fully met. 12 36 18 The Registered Provider must 13/10/2010 ensure staff receive supervision sessions which are recorded, detailed and take place a minimum of six times per year. This will ensure that people living in the home and staff members are supported and their work is monitored and kept under review. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 We strongly advise that the information in relation to bathing and shaving is more explicit. Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 14 of 14 - 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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