Care Home: Eastholme Nursing Home

What the care home does well People told us that they are satisfied with the care they receive at the home and are happy living there. Their comments included, `it`s great here, `I am looked after very well`, `the staff are 100%` and `it couldn`t be better`. They told us that they generally have enough activities to do, although, two people said they would like to go out on more outings. They said they can make their own decisions and choices about their daily lives and are encouraged to give their views about the care they receive. Staff told us they have opportunities to access relevant training to help them carry out their role and they feel supported by the management team. What has improved since the last inspection? A new manager has been employed and she has worked hard to make changes to improve the care for people living in the home. This has included setting up resident and relative surgeries to encourage discussion and raise any issues about the day to day running of the home. At the last inspection we said that care plans must be person centred and written in more detail to make sure staff know what to do to meet people`s needs and we found that this has now been done. We also said that appropriate activities and leisure opportunities for people must be provided and we found that the provider has employed an activity worker and a wider range of activities is now being offered. We also said that staff preparing and cooking food must make sure satisfactory standards of hygiene were maintained in the kitchen and we saw that this has been done. A new chef has been employed and we saw a clean and tidy kitchen, records are kept of cleaning schedules and a new cooker has been fitted. Staff are now completing a thorough in-house induction programme before going on to a nationally recognised programme. Staffing levels are regularly reviewed and staff told us the manager will always rota extra staff when needed. The Statement of Purpose and Service User guide have been updated and includes information about the current rate of charges and tells people how they can access our reports. What the care home could do better: We made some good practice suggestions that may help to further improve the standard of care for people living in the home. We said that pre-admission assessments should tell people who provided the information and their level of involvement. Care plans should include more detail of how the person`s privacy and dignity is to be respected and should show that people are given the opportunity to be involved in their reviews. These things would mean that there is better information to help staff care for people. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Eastholme Nursing Home 74 - 75 South Park Lincoln Lincolnshire LN5 8ES     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elisabeth Pinder     Date: 1 9 1 0 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Eastholme Nursing Home 74 - 75 South Park Lincoln Lincolnshire LN5 8ES 01522521956 01522537371 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Kanagasooriam Ravivaruman care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: People whose needs come within the category PD will be accommodated as single occupants in any one of the following identified bedrooms :- 1, 2, 7, 9, 12a, 14, 15, 16, 17 and 18 The maximum number of people who can be accommodated is 24 The registered person may provide the following category of service only: Care home with Nursing - Code N to people of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Physical Disability - Code PD of the following age range: over 55 years - Maximum number of places 4 Date of last inspection 1 5 0 9 2 0 0 8 0 4 Over 65 24 0 Care Homes for Older People Page 4 of 27 Brief description of the care home Eastholme Care Home is a large, detached, three-storey, Victorian building with a ground floor, purpose built extension. It is situated in a cul-de-sac in a residential area to the south of the city of Lincoln, overlooking the common. It is one of four homes in Lincolnshire owned by Mr. Ravivaruman. The accommodation has been substantially altered and refurbished to provide improved standards with some rooms now providing en-suite facilities. First floor rooms are accessible via stairs or a shaft lift. There is a small garden area to the rear of the property with car parking space and there is also car parking opposite the home next to the common. It is registered to provide personal and nursing care for a total of twenty-four people of both sexes over 65 years of age, up to four who may have a physical disability and who are aged over 55 years of age. On the day of our visit sixteen people were living in the home. The current scale of charges at this home range from £360.00 to £463.00. Additional costs are made for hairdressing, chiropdy, newspapers and personal toiletries. This information together with a copy of the last inspection report is included in the Statement of Purpose and Service User Guide which are available from the manager. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that people who use the service receive good quality outcomes. This was an unannounced visit and it formed part of a key inspection. It focused on key standards which have the potential to affect the health, safety and welfare of people who use the service. The visit lasted approximately five hours and took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since our last visit in 2008. Before we made our visit the manager had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. The main method used to carry out the inspection is called case tracking, this includes Care Homes for Older People Page 6 of 27 following the care of a sample of people through their care records and assessing their care. We spoke to people who use the service, two members of staff, the area manager, the homes manager and two visitors. Before our visit questionnaires had been sent to 5 people using the service and to 4 staff, those returned to us will be mentioned throughout this report. What the care home does well: What has improved since the last inspection? What they could do better: We made some good practice suggestions that may help to further improve the standard of care for people living in the home. We said that pre-admission assessments should tell people who provided the information and their level of involvement. Care plans should include more detail of how the persons privacy and dignity is to be respected and should show that people are given the opportunity to be involved in their reviews. These things would mean that there is better information to help staff care for people. Care Homes for Older People Page 8 of 27 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that the home can meet their needs by way of a clear assessment process. Evidence: We looked at the records of two people who had recently been admitted and these showed information had been gathered prior to their admission either by the manager or their care manager. Assessments generally contained lots of information about needs and preferences such as moving and handling, nutrition and pressure care. They also contained details of personal life history, family and friends and whether the person was able to make decisions about how they wished to be treated. However, they did not tell us who gave them the information and the manager told us they are developing new forms which will include this. Care Homes for Older People Page 11 of 27 Evidence: A letter confirming that after their assessment the home could/could not meet their needs was in one persons record and we were told that one had not been been sent out to the other. A member of staff told us that she is given information about people before their admission and their specific care needs. Surveys received prior to our visit told us that most people felt they received enough information about the home to help them decide if it was the right place for them and most said they had been given a contract/terms and conditions of residency. One person had not but had since read the information. Staff surveys returned all confirmed that they are given up to date information about the needs of the people they support and care for. People and their relatives told us that the manager had visited them before they moved in and they were very satisfied with the care being provided. One relative said I never want my mother to move from here, its great. Information about the service is written in the Statement of Purpose and Service User Guide, both documents give the current charges and tell people how they can access our reports and include our web address and the manager said these could be written in a different format should this be needed. The service does not cater for people with intermediate care needs. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that their care needs will be met by the way of clear care plans. Evidence: We continued to case track two other people and looked at their care plans and risk assessments. These had been written in the first person and detailed needs such as communication, personal care and preferences, nutrition, decision making and safety. There were also short term care plans in place for things like pressure care. The care plans had been signed by the person or their representative to show that they were in agreement with them, however, they did not show that people continued to be involved in their care planning as any subsequent reviews/evaluations had only been signed by staff. This was discussed with the manager who agreed to address this. The care plans gave staff clear guidance about the action they should take to meet needs and staff were able to tell us how individual people make their wishes and choices known. Not all care plans gave enough detail about how peoples privacy and dignity were to be met and this was also discussed with the manager who agreed to Care Homes for Older People Page 13 of 27 Evidence: make sure this was expanded. Risk assessments were in place for things like the use of bed rails, mobility and the use of alcohol and these cross referenced clearly with care plans. Records of visiting professionals were written in the daily notes showing people have access to other healthcare services when necessary. Medication record sheets were completed correctly and staff confirmed that medication is only given by trained nurses. Five surveys were received prior to our visit from people living at the home and four told us they always received the right care and support and one usually. All felt they always or usually received the medical support needed. Staff surveys told us they feel they provide a high standard of care, it is a friendly caring home but has a high professional standard. People spoken to during our visit told us they felt they were looked after very well, the staff are 100 and it couldnt be better. Relatives told us that staff keep them up to date with everything they need to know and they had a lot of confidence in the manager. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of social and cultural opportunities ensures that peoples needs are met and people benefit from a well balanced diet that suits their needs and preferences. requirements. Evidence: Information taken from the AQAA told us that improvements within the last twelve months have included a wider choice of activities being offered to reflect peoples choices. The home now employs an activity co-ordinator working five days each week and this person told us she is soon to go on a training course to learn more about art. She has introduced new activities like reminiscence, crafts and pamper days and regularly talks to people to find out if there is anything else they would like to do. Activity programmes are displayed on the notice board in the main hallway and these showed that a range of activities/entertainment is offered. During our visit a reminiscence group was being held and a video was being shown about life in Lincolnshire during the war. We saw people interacting with each other and talking about their own memories of this time. Records showed that people had an assessment of their nutritional needs when they moved into the home and their diet preferences are recorded. People told us the food Care Homes for Older People Page 15 of 27 Evidence: is very nice, they are always asked what they would like to eat and if possible the chef will always try and cook them what they want. Since our last visit a new chef has been appointed and he told us that the management are extremely good, everything he has requested to help him be more efficient has been provided. Surveys received prior to our visit told us people always or usually like the meals. During our visit people were observed having their lunch in the dining room and were chatting to each other and to staff whilst they ate. We saw that alternatives and specialist diets, such as a diabetic diet were also being given to people and there were good stocks of foods and drinks, freshly baked cakes and home made desserts. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by robust procedures in place for handling complaints and allegations of abuse. Staff have received training in these subjects to help them protect the people they support. Evidence: Information taken from the AQAA tells us that a clear complaints procedure is available and is included in the service user guide and this was confirmed during our visit. It was also on display in the reception area of the home. During our visit people told us they feel able to raise issues with their relatives, the manager or staff and felt these would be taken seriously, however, only two of the five surveys received prior to the visit indicated people knew how to make a complaint. This was discussed with the manager who agreed to develop and distribute a simple version of the complaints procedure. Regular relative/resident surgeries are held and records looked at showed that people were able to raise any complaints or issues of concern and at the last surgery on 23th June 2009 no issues were raised. There are policies and procedures in place to make sure that people are protected from harm and these include the Local Authority guidance on keeping people safe. Staff were able to tell us how they would identify abuse and what they would do about it. Training records verified staff had undertaken training relating to safeguarding adults and equality and diversity. Care Homes for Older People Page 17 of 27 Evidence: Within the last twelve months no complaints have been received and no referrals made to Lincolnshires Safeguarding Adults team. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well-maintained, clean, comfortable home which meets their needs. Evidence: We looked at the lounge, dining room and three bedrooms and these were clean and tidy and people told us they were comfortable and they liked their bedrooms. They told us they were able to arrange them to their liking with personal items and those we saw showed this.Communal areas were bright and nicely decorated and there were no unpleasant odours in the home. Surveys received prior to our visit from people living at the home all told us the home is always fresh and clean. Information taken from the AQAA told us that regular checks are carried out to ensure people have the right facilities and equipment. Environmental risk assessments are written and regular audits are completed throughout the year to make sure that the home remains a safe place to live and any identified problems are addressed. Within the last twelve months some furnishings and the cooker have been replaced. Plans to further improve include an extension to the home which will include an enclosed garden area. We were told that a member of staff has been designated as a link person for infection control and we saw staff using appropriate hand washing techniques and using gloves and aprons where necessary. Care Homes for Older People Page 19 of 27 Evidence: The Environmental Health Officer last visited on the 28th July 2009 and gave the service a three star rating. Some recommendations were made and the manager told us they had all been addressed. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by robust recruitment and training systems for staff. Evidence: During our visit people and their representatives told us that the staff are 100 , the girls are lovely and most of them are okay. Surveys we received showed that people feel there there are enough staff on duty to look after them and staff told us they generally feel there is enough of them on duty to meet the needs of people at the moment. They told us that the manager will always recruit extra staff if needed and she works with them three shifts a week as the nurse in charge. Surveys from people living at the home told us that staff are always or usually available when needed, no specific comments were written and during our visit we saw that the staff were busy but they responded to peoples requests for help and support in a timely way. Staff told us they have good access to training courses and they had a good induction to the home when they started working there. Records showed that a nationally recognised induction programme is used and the manager showed us new documentation of the homes programme which staff will commence within the first two days of employment and complete within four weeks before progressing to the national programme. Staff told us they had completed training in subjects such as dementia, health and Care Homes for Older People Page 21 of 27 Evidence: safety, fire, infection control and the new laws about protecting peoples rights and freedoms. Many of the staff have also completed, or are working towards, a nationally recognised care qualification. The manager told us that she is looking into training for qualified staff regarding immunisation to make sure they are up to date with current guidelines. Staff files contained all of the information needed to show that they have been recruited safety. We saw records of application forms, written references and identification and criminal record bureau checks. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from clear leadership and management arrangements within the home. Evidence: Since the last inspection there has been a new manager employed and she is currently applying to be registered with us. An area manager oversees the four homes owned by the provider and is based at Eastholme. People who live at the home told us that the manager is lovely, she is approachable and supportive. During our visit there was a good atmosphere in the home and no one raised any concerns about the management. Staff told us they have regular supervision with the manager and records looked at were up to date. Systems are in place to monitor the quality of the service being provided and this includes seeking the views of people living at the home, their representatives and other healthcare professionals. Recent surveys were dated January 2009 and the results of these had been collated and a report written identifying any issues. Peoples comments have also been included in the homes Care Homes for Older People Page 23 of 27 Evidence: Service User Guide. A comment/suggestion box is also available and the manager told us that the provider is the only person with a key to this. The area manager carries out monthly evaluations to see how the home is running and writes a report for the provider and copies of these are kept in the home. Regular resident and staff meetings are held and records of these were available for us to look at. The area manager also told us that a business contingency plan for emergency situations has recently been written. Information provided in the AQAA told us that there are a range of policies and procedures in place and the majority of these had been reviewed in 2009. We were told of equipment maintenance and service dates and building risk assessments are in place together with regular health and safety audits. The Department of Health Essential steps is used to assess infection control and records showed staff receive health and safety training. A link person has been designated to monitor tissue viability and our records show that we are told about anything that happens in the home that may affect the health, safety or welfare of the people who live there. Systems are in place to help keep peoples personal money safe, this includes records to show when money has been deposited with the home, how much has been spent and what the money was spent on. Care Homes for Older People Page 24 of 27 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 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, Care Homes 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 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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