Care Home: Ebberly House

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What the care home does well People thinking of living at Ebberly House have an assessment done to make sure the home can meet their needs. People tell us that good information is shared with them and their family or representatives so that they are able to make a decision about whether to move in or not. People are encouraged to bring personal and sentimental items in with them to make their private rooms homely. Families and friends tell us that they are encouraged to visit regularly and take a part in the care of their loved ones. People enjoy good food and meals are served to them in a comfortable dining room. The home has good procedures in place to deal with complaints, concerns and comments. People are confident that they could raise any concerns with the staff of the home and these would be dealt with properly. Staffing levels are good and meet the needs of people living in the home. Staff receive a training and regular updates in health and safety related topics and also subjects relevant to the health and care needs of older people living in the home. Staff and people living in the home tell us they have complete confidence in the manager and the owner. What has improved since the last inspection? The application form for potential resident`s has been updated to make sure that all people moving to the home receive the same level of assessment regardless of who is paying for their care. People`s health and social care needs have been identified in their care plan, although further improvement is needed to ensure people have their assessed needs met in full. Records demonstrate when communication has taken place with other health and social care professionals ane ensure that people using the service are given correct consistent information. A record of controlled drugs that may be used by people using the service has been kept and the provider has applied to the pharmacist for a proper register. This has ensured that there is a clear and appropriate audit trail of how these medicines are used that is in line with recognised guidelines. Staff that have had appropriate training give medicines out and records of their qualifications are now kept in their file. This has ensured that people are cared for by appropriately qualified and experienced staff. An appropriate refrigerator has been purchased in which to store medication. This has ensured that medicines are stored safely at the correct temperature and are not contaminated or contaminate food. Recreation, fitness and training opportunities have been made available and people are involved in making decisions about the programme of activities arranged by or on behalf of the care home. This has ensured that some people using the service haveenjoyable and fulfilling days. Further improvements are needed to ensure that these meet the diverse needs of people living in the service. The Complaints Procedure is easily accessible to all and demonstrates the homes openness and willingness to improve the service. All fire exits at the home were safe to use at all times and are regularly checked. This ensures that everyone living, working or visiting the home are able to make a quick safe exit from the home in the event of a fire. A programme of routine maintenance and renewal of the fabric and decoration has been put into place and ensures that people live in well a maintained home. Radiators and pipe work in the building have been covered since the last inspection and have eliminated the risks to people from hot surfaces. The home has been kept free of offensive odours, ensuring that the environment is pleasant for people using the service. There are facilities in place for staff to wash and dry their hands and the laundry was kept in an orderly manner. This has reduced the risk of cross infection to people using the service. People are cared for in a timely unhurried manner and sufficient staff are on duty to ensure that this is maintained at all times. Similarly, the manager has sourced training for staff that has increased their skills and knowledge of caring for people using the service who have dementia type illnesses as this will benefit those people and increase staff confidence in how they work with people. People`s views have been better accounted for through the quality assurance processes in the home. Staff have had regular supervision and have received feedback about their performance and development. This has ensured that people are cared for by suitably qualified and experienced staff. Routine essential fire safety checks are carried out correctly and any identified hazards reported and acted upon immediately. This is has insured that the risk of injury from fire to people using the service is minimised. Electrical testing has been completed and ensures that the health and safety of people using the service is maintained. What the care home could do better: Some of the people living in the home have complex nutritional needs. The home does not use a recognised tool to assess this to ensure that people get the right foods to keep them healthy.People should have their care plan in a format that meets their individual needs, for example in a total communication format such as pictures or symbols with simple words and sentences. People`s needs should be assessed in terms of occupation, interest and capabilities using an evidence based tool such as the `Pool Activity level instrument`. This will ensure that activities are person centred and appropriate for the individual. Future decoration and refurbishment should be done to best practice to ensure that the needs of people with dementia are taken account of and gives them the best chance of orientation to the environment they live in. The recruitment procedure has not been consistently followed. Ensuring that appropriate pre-employment checks are done before staff are allowed to work must protect people living at the home. We made a legal requirement about this. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ebberly House 17/18 Ebberly Lawn Bear Street Barnstaple Devon EX32 7DJ     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: Susan Taylor     Date: 1 1 1 2 2 0 0 8 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 30 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 30 Information about the care home Name of care home: Address: Ebberly House 17/18 Ebberly Lawn Bear Street Barnstaple Devon EX32 7DJ 01271345684 01271345684 ebberly@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Peter Frederick George Allen Name of registered manager (if applicable) Mrs Beverly Judith Watton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Ebberly House is a large, adapted Victorian property, situated in a residential area close to the centre of Barnstaple. The home is sited on the corner of a private residential square, which provides an attractive outlook from the homes lounge. There is dedicated parking for visitors to Ebberly House in the square. Access to the house is on several levels, the main entrance being approached from Ebberly Lawn. Other entrances have ramped access for wheelchairs. There are stair lifts to facilitate access inside the home. Ebberly House provides long-term accommodation for up to 19 elderly people. There are 17 single bedrooms are of varying sizes and outlook and one double room, all are Care Homes for Older People Page 4 of 30 care home 19 Over 65 0 16 3 0 Brief description of the care home furnished individually. The communal rooms on the ground floor are spacious and comfortably furnished; the atmosphere is homely and relaxed. The current level of fees range from £356.82 to £447.31. A copy of the last inspection report is available on request. Care Homes for Older People Page 5 of 30 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 Two star. This means the people who use this service experience GOOD quality outcomes. This was a key inspection of Ebberly House under the Inspecting for better lives arrangements. We were at the home with people for 8.5 hours over two days. The purpose for the inspection was to look at key standards covering: choice of home, individual needs and choices, lifestyle, personal and healthcare support, concerns, complaints and protection, environment, staffing and conduct and management of the home. Care Homes for Older People Page 6 of 30 We looked at records, policies and procedures in the office. A tour of the home took place. We sent surveys to all the staff and received none back. We tracked the care of 3 people and met some of their relatives. We also looked at the care plans, medical records and daily notes for these 3 people. We spoke with those we could speak with and observed others. We did this using a method partly devised and fully accredited by Bradford University. This method is called a Short Observational Framework for Inspection (SOFI). This gives us information about peoples well being, their interactions with other people and staff and about how they are engaged over a period of time. Several weeks before this inspection took place an Annual Quality Assurance Assessment (AQAA) document, which contains general information about the home and the people living there, was completed by the registered manager of the home and returned to the CSCI. We sent surveys to 10 people living in the home and received 6 back. The comments of these people and our observations are in the report. The current level of fees range from £356.82 to £447.31. A copy of the last inspection report is available on request. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. People funded have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk People describe Ebberly as being a lovely place to live. Staff are said to be excellent and caring. What the care home does well: What has improved since the last inspection? The application form for potential residents has been updated to make sure that all people moving to the home receive the same level of assessment regardless of who is paying for their care. Peoples health and social care needs have been identified in their care plan, although further improvement is needed to ensure people have their assessed needs met in full. Records demonstrate when communication has taken place with other health and social care professionals ane ensure that people using the service are given correct consistent information. A record of controlled drugs that may be used by people using the service has been kept and the provider has applied to the pharmacist for a proper register. This has ensured that there is a clear and appropriate audit trail of how these medicines are used that is in line with recognised guidelines. Staff that have had appropriate training give medicines out and records of their qualifications are now kept in their file. This has ensured that people are cared for by appropriately qualified and experienced staff. An appropriate refrigerator has been purchased in which to store medication. This has ensured that medicines are stored safely at the correct temperature and are not contaminated or contaminate food. Recreation, fitness and training opportunities have been made available and people are involved in making decisions about the programme of activities arranged by or on behalf of the care home. This has ensured that some people using the service have Care Homes for Older People Page 8 of 30 enjoyable and fulfilling days. Further improvements are needed to ensure that these meet the diverse needs of people living in the service. The Complaints Procedure is easily accessible to all and demonstrates the homes openness and willingness to improve the service. All fire exits at the home were safe to use at all times and are regularly checked. This ensures that everyone living, working or visiting the home are able to make a quick safe exit from the home in the event of a fire. A programme of routine maintenance and renewal of the fabric and decoration has been put into place and ensures that people live in well a maintained home. Radiators and pipe work in the building have been covered since the last inspection and have eliminated the risks to people from hot surfaces. The home has been kept free of offensive odours, ensuring that the environment is pleasant for people using the service. There are facilities in place for staff to wash and dry their hands and the laundry was kept in an orderly manner. This has reduced the risk of cross infection to people using the service. People are cared for in a timely unhurried manner and sufficient staff are on duty to ensure that this is maintained at all times. Similarly, the manager has sourced training for staff that has increased their skills and knowledge of caring for people using the service who have dementia type illnesses as this will benefit those people and increase staff confidence in how they work with people. Peoples views have been better accounted for through the quality assurance processes in the home. Staff have had regular supervision and have received feedback about their performance and development. This has ensured that people are cared for by suitably qualified and experienced staff. Routine essential fire safety checks are carried out correctly and any identified hazards reported and acted upon immediately. This is has insured that the risk of injury from fire to people using the service is minimised. Electrical testing has been completed and ensures that the health and safety of people using the service is maintained. What they could do better: Some of the people living in the home have complex nutritional needs. The home does not use a recognised tool to assess this to ensure that people get the right foods to keep them healthy. Care Homes for Older People Page 9 of 30 People should have their care plan in a format that meets their individual needs, for example in a total communication format such as pictures or symbols with simple words and sentences. Peoples needs should be assessed in terms of occupation, interest and capabilities using an evidence based tool such as the Pool Activity level instrument. This will ensure that activities are person centred and appropriate for the individual. Future decoration and refurbishment should be done to best practice to ensure that the needs of people with dementia are taken account of and gives them the best chance of orientation to the environment they live in. The recruitment procedure has not been consistently followed. Ensuring that appropriate pre-employment checks are done before staff are allowed to work must protect people living at the home. We made a legal requirement about this. 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 10 of 30 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 11 of 30 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 have their needs assessed before moving in, so can be sure that the home can meet those needs. However, further improvements are needed in the assessment of peoples dietary and physical needs to ensure these can be met. Evidence: 100 percent of people living in the home verified in a survey that the home provides sufficient information for them to make decisions about whether to live at the home or not. People who told us that they had a copy of the service users guide in their room. 100 percent of people in a survey had received a contract. We looked at three care files to establish whether the care delivered was based on detailed assessment of peoples needs. Information that the provider had sent us verified that the manager assesses people prior to admission to ensure that their needs can be met at the home. Assessments were person centred and reflected what Care Homes for Older People Page 12 of 30 Evidence: the individuals themselves told us their needs were. Information about individuals had also been obtained from social services where the care package had been commissioned by them. This demonstrates the peoples needs are established at the point of admission to the home and the team are clear about them. We looked at how assessments are reviewed with people and in particular focussed on the needs of two people. The first person was bedridden and receiving palliative care. We discussed this persons care with the manager and a member of staff caring for the person. Records demonstrated that the person was on a pressure relieving mattress and being visited regularly by district nurses and hospice staff and the person verified this themselves. A tissue viability assessment had not been done, which would have highlighted the level of risk of potential pressure damage for the individual and ensured continued monitoring. Measures had, however been put in place to minimise the risk of further damage to that person. We discussed this with the manager who was familiar with the medley scoring tool and recommended that this is used and reviewed regularly so that there is a clear baseline upon which to measure changes to the persons needs. Similarly, we observed a person with dementia who was choking whilst finger feed themselves from a plate of food at lunchtime. Staff responded appropriately after being alerted to this, however were unaware that there is a high risk of choking for people with dementia. We read the information about the persons nutritional needs, which provided basic information about their likes and dislikes. We discussed this with the manager and highlighted that a more indepth assessment of the persons nutritional needs was necessary. This will ensure that staff were aware of the risk of potential choking and that measures to prevent this are put in place for the persons safety. 100 percent of the people responding in a survey verified that their care needs were always met. Relatives responding on behalf of their relations in a survey wrote comments like I cannot imagine my mother being anywhere else. Responses such as Im phoned regularly about any changes in care however small demonstrated that the team communicates well and keeps advocates informed about issues affecting their relation when they have dementia, for example, and therefore lack capacity to make decisions for themselves. The provider verified that intermediate care is currently not provided at Ebberly House. Care Homes for Older People Page 13 of 30 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 receive good personal and healthcare support. Medication systems have improved and are safe. Evidence: 6 people living in the home returned surveys verified they always receive the care and support they need. A relative wrote I cannot imagine my mother being anywhere else. In surveys people also verified that they always receive the medical support they need. We looked at 3 care plans for people whose care we tracked. Assessments had established what risks there were for individuals receiving care. However, when we tracked the outcomes for people we found that these were incomplete. Records highlighted that a person was at risk of choking and therefore had specific nutritional needs. We discussed this with the manager and suggested that a tool such as the Malnutrition Universal Screening Tool be used. This will ensure that staff are prompted to look into all aspects of a persons needs and so that individuals are Care Homes for Older People Page 14 of 30 Evidence: confident that their care plan gives a full picture of how these will be met. All the care plans seen had been regularly reviewed. The plans were person centred. One person with physical and learning disabilities told us that they find big words difficult. This persons care plan was not in a format that made it accessible to them. We discussed this with the manager and suggested that advice about this matter could be sought from the Community Learning Disability Team. Total communication formats can include pictures or symbols with simple words and short sentences and would ensure that the individual is fully involved in planning their care and will be able to refer to this themselves at reviews. In terms of privacy and dignity, a relative responding on behalf of their relation wrote that they always arrive unannounced when they visit and find their mother always well dressed and clean. Similarly, we observed that people were treated with respect and that staff always knocked on doors before entering peoples bedrooms. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and we tracked how medication is managed for 3 people. Records accurately reflected medication having been given as prescribed by the GP. All medication was kept in a secure place. We observed medication being given to individuals concerned after lunch. This was done safely and records were completed appropriately after each person had taken their medication. Other care staff we spoke to said that medicines are only given by staff trained to do this. We examined a random selection of 4 staff files, 1 of which was of a long serving employee that had a certificate demonstrating this. Particular aspects of the management of medicines had improved since the last inspection. A new refrigerator, specifically for medicines had been purchase and we looked at records, which demonstrated that the temperature was regularly checked. The home has obtained a proper register to make sure that there is a record of receipt, administration, stock level and disposal of any controlled drugs. Therefore, the management of medicines has improved and ensures that people are given the correct medication, at the right time. Care Homes for Older People Page 15 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are consulted and listened to regarding the choice of daily activity, but this process could be improved further for people with dementia or communication difficulties. Evidence: In surveys 100 percent of people told us that there are usually activities which they can participate in if they wish to. Information sent to us verified that an activity of choice is arranged every day, which tends to be a group activity. Additionally, records are now kept of each activity and the names of people that have taken part. 3 care plans that we looked at provided information about each persons life history and their social interests. They also contained information about a persons preferred daily routine, such as what time they get up and what time they go to bed. We spoke to each individual to find out how much choice they had about their life at the home. A person who was frail and in bed was listening to the radio and told us that they had always enjoyed programmes on the radio. Additionally, they said that it was their wish to only have a certain visitors and that this was respected. This information was detailed in the persons care plan and therefore demonstrated that their wishes were known and followed. Care Homes for Older People Page 16 of 30 Evidence: Another person said that they like going out shopping and did so sometimes. They also told us that they would really like to be taken out on a trip to Westward Ho when the weather is better. Information sent to us verified that an extra member of staff had been employed to accompany people on outings such as shopping and trips to local areas of interest. The manager told us that this will ensure that people have 1 to 1 time available for such outings, which will give people more choice about how they spend their time. We spent time in the communal areas of the home to help us make a judgment about peoples sense of well being. At various times a television was on, although it was rare to see anyone actively watching it. We asked one person how she spent her day. She said I just seem to sit. Then I go in for meals. We said to another person that it seemed very quiet in the lounge. She said You sit here and relax. The main distraction for people seemed to be the coming and going of staff as they passed through the lounge to other parts of the home. We saw staff engaging with people, which individuals seemed to enjoy and responded well to. The majority of people dozed in armchairs. In the afternoon, the hairdresser arrived and the atmosphere in the lounge became more lively as people were engaged in conversations whilst having their hair done. Some people living at Ebberly who are frail cannot take part in these activities. The activities records shows that these people sometimes have hand massages given by staff. However, their care plans do not include instructions for staff or a plan of care on how their needs, other than physical needs, might be met. In addition, some people living here have very short attention spans and for that reason cannot join in with activities. The home have not yet explored options available which might help these people to engage with their surroundings. We discussed specific tools that might be useful to gain in depth information about individual capability and interest such as the Pool Activity level instrument with the manager. This would also ensure that activities are person centred and pitched at the right level for people. We observed the experiences of 3 people at lunch. Staff assisted people to eat by sitting with each person,attending to them and by supporting them at a pace that suited each person in an unrushed manner. Food was served plated to people. They said there was no choice. However, assessment information about the 3 people whose needs we tracked did include individual likes and dislikes. A pureed meal did not have sections separated but others meals were nicely presented. No eating aids seen, which would promote independence for people living in the home that have physical disabilities. We observed that two people used pudding dishes for their meal. One person had a plate but no plate guard and some food did fall off the plate. The same person also finger fed themselves at one point. We also heard other people make positive comments about the lunch such as The food is excellent and I really enjoyed my lunch. The record of meals provided Care Homes for Older People Page 17 of 30 Evidence: demonstrated that meals are varied. Care Homes for Older People Page 18 of 30 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. Arrangements ensure that people are protected and able to voice their concerns, safe in the knowledge that this will be dealt with. Evidence: Information that the provider sent to the Commission verified that no complaints had been received in the previous 12 months. Similarly, the Commission has not received any complaints about the service since April 2008. 100 percent of people responding in a survey verified that staff listened to them. Additionally, people knew who to complain to and how to make a complaint. We read the complaint procedure in the service users guide. The contact information for the Commission is out of date and needs to be amended. We saw a copy of the Alerters guide. The home also had a whistleblowing policy, which all of the staff we spoke to understood. Kind and caring interactions were observed throughout the day between staff and people living in the home. Staff engaged positively with people who had dementia and demonstrated good skills in engaging those individuals. A relative in a survey wrote told us that the staff have a special way of handling the residents which is so very kind and affectionate. Information sent by the provider told us that 80 percent of staff hold an NVQ in care, which ensures that staff have knowledge about safeguarding people. Additionally, staff Care Homes for Older People Page 19 of 30 Evidence: told us that policies and procedures are discussed with them. The provider verified that no safeguarding or POVA referrals had been made in the last 12 months. This demonstrates that people are protected and safeguarded from abuse. Care Homes for Older People Page 20 of 30 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. Improvements have ensured that the home is clean, well maintained and safe and that furniture provided for people is of an acceptable standard. Evidence: Information sent to the Commission verified that equipment is regularly serviced, that staff strive to keep the home clean, tidy and odour free and that each time a new resident moves in if appropriate the bedroom to be occupied is decorated. We carried out a tour of the home and visited almost every persons individual room. We also looked at maintenance records spoke with 4 people using the service, the Registered Manager, Provider and staff. We also considered the results contained in the surveys we received and read 3 peoples care records. 100 percent of people in a survey commented that the home is always clean. Information sent to the Commission verified that a cleaning rota was put in place after the last inspection. We found that all areas of the home were clean and odour free. We found that the communal areas are well furnished and provide a homely environment for people to enjoy. Since the last inspection, all of the issues highlighted to the manager and provider had been dealt with. Fire exits were safe and had nonCare Homes for Older People Page 21 of 30 Evidence: slip surfaces. A maintenance book demonstrated that routine maintenance and renewal of the fabric and decoration of the home is done. We read contractors certificates that showed equipment is regularly maintained. We found that call bells are accessible in every room and that there are stair lifts to assist people when needed, in addition we saw grab rails and other equipment to assist people. We observed that a hoist is used by staff when moving the position of a person that is currently bedridden. From our discussion, no other people living in the home had an assessed need that required a hoist to be used to move them safely. However, the provider and manager verified that if this situation changed another hoist would be purchased. Since the last inspection, furniture has been replaced, rooms have been decorated and radiator guards fitted throughout the home. Therefore, people we spoke to felt that their surroundings were much improved and provide a comfortable place for them to live in. We did an indepth observation of the suitability of the environment for people with dementia. Much of the paintwork was cream and hand rails were cream. We did not see any specialist adaptations that would enable people with dementia orientate them to particular rooms like the bathroom, their own bedroom or to discourage entry to unsafe areas. We observed 1 person wandering in and out of the lounge. We discussed this with the manager and recommended that further research about this should be done to ensure that environmental changes also take account of the needs of people with dementia. The home has guidance on infection control that is accessible to staff. Protective clothing is accessible for staff to use and we observed staff regularly washing their hands after caring for people. This demonstrates good practice and protects people living in the home from the risk of infection. Information sent to the Commission verified that 8 staff has done infection control training and further in house sessions are planned. We looked at the laundry, which has external access only. We met the member of staff who was doing the laundry and saw that there is a good system in place that ensures clothes and linen and washed separately for infection control purposes. Similarly, we observed that linen and clothes are taken to the laundry in receptacles and clean clothing is returned to people the same day after being washed, dried and ironed. People looked well turned out in their own clothes, which were clean. Care Homes for Older People Page 22 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices are not robust and fail to protect residents. The training and development programme ensures that knowledgeable staff cares for people. Evidence: 6 people living in the home returned surveys, 5 stated that they always received the care and support they needed. 1 verified that this was usually the case. Their comments included cannot fault any of the staff as we feel they are first-class. At the home, we asked people whether staff were available when they needed help, and they told us that staff are very attentive to them. We observed this to be the case for people that had difficulty communicating their needs. Therefore, we established that there are sufficient numbers of staff to meet the needs of people living in the home. We spoke to the manager about recruitment and they told us that they had appointed 3 new staff since we last inspected. We examined the files for these individuals to establish whether the recruitment procedure was robust and had been followed. CRB and POVA checks had been obtained for all new staff. However, these and pre employment checks such as references had been obtained after the individual had been employed. In the first file we read an undated hand written testimonial. The person had previously worked in a care service and no reference had been requested or obtained from that provider. The member of staff had commenced employment on Care Homes for Older People Page 23 of 30 Evidence: 26/6/08 (verified by the manager and duty rosters). A POVA check for this individual was dated 16/7/08. In the second file, a testimonial had been obtained (dated 22/9/08) for the individual after the start date of employment on 17/8/08. We looked at duty rosters and established that the individual had worked on 17/8/08. The POVA check for this individual was dated 28/8/09. Finally, a third file contained a record of a verbal reference and a written reference that was dated 14/11/09. The employment date for the individual was confirmed by the manager as being 22/10/08. A POVA check had been obtained and was dated 11/11/08. Therefore recruitment procedures are not robust and people living in the home are unprotected because of this. We discussed our findings with the manager and made them aware of the Commissions publication Safe and sound? Checking the Suitability of new care staff in regulated social care services [available at http:/www.cqc.org.uk]. We also clarified best practice in relation to recruitment procedures. New staff had completed equal opportunities and health monitoring forms prior to employment. Information sent to us by the manager tells us that 80 percent of staff hold NVQ level 2 in care and 100 percent have completed the induction training. Additionally, staff in a survey verified there are regular training sessions about dementia, manual handling, first aid. New staff said that their induction was thorough. Care Homes for Older People Page 24 of 30 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. Management arrangements are meeting the needs of the people living in the home, and the quality of the service has improved. Evidence: The Registered Provider have many years experience of managing Ebberly. Additionally, there is a registered manager who has obtained the Registered Managers Award and NVQ level 4 in care management. The provider gave the Commission a reasonable picture of the current situation in the service, in a document entitled AQAA (Annual Quality Assurance Assessment). However, there were areas when more supporting evidence would have been useful to illustrate what the service has done in the last year, and/or explicitly how it is planning to improve. Information within the AQAA verified that the home has a business plan. As discussed under the staffing section, our main concern is that the recruitment procedures are not robust and therefore do not protect people living in the home. We are confident, however that this matter will be rectified quickly by the manager. Care Homes for Older People Page 25 of 30 Evidence: Throughout the inspection and the information provided demonstrated that the provider and managers aim to constantly improve the service for people living in the home. The Commission had received a letter from the provider outlining what action they had taken to address all of the legal requirements we made at the last inspection. These have all been met. We observed that people are consulted about changes and asked for feedback. People we spoke to had been asked to complete a survey. In surveys we sent, all of the people responding told us that they are always listened to and that staff act on this. A relative wrote they have a special way of handling the residents which is so very kind and affectionate and I cannot imagine my mother being anywhere else. Another wrote, overall my mother appears to be more than happy with the care and support she receives. People living in the home made comments like I have been looked after excellent they are so kind to me. Therefore, the provider and manager actively seek feedback and people are satisfied with the service they receive. We looked at records showing how money is managed on behalf of 2 people that live in the home. All were accurate when crosschecked with the balance kept for safekeeping. Entries had been signed for. We concluded that peoples money is well managed and their financial interests are protected. We toured the building and observed that cleaning materials were stored securely. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. We observed hand sanitizer being used by staff to minimise the risk of cross infection. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, relatives and staff told us that the alarm was regularly checked and sounded. Certificates verified that an engineer had checked the hoists. First aid equipment was clearly labelled. Three staff on duty verified that they held a current first aid qualification. Good manual handling practice was observed as carers transferred a person from wheelchair to chair at lunchtime. Maintenance certificates were seen for the fire alarm system. The provider had verified in information sent to the Commission that a local electrician had inspected both the electrical system and appliances. Therefore, the health and safety of people living in the home is maintained. Care Homes for Older People Page 26 of 30 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 27 of 30 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 1 29 19 The provider must ensure 29/05/2009 that no member of staff is employed to work at the home without first obtaining all the necessary information required, in this case two satisfactory written references. This will ensure that people are not put at unnecessary risk of harm. To ensure that people are not put at unnecessary risk of being cared for by staff that have not been properly vetted. 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 2 The nutritional needs of people living in the home should be known by being properly assessed with a tool such as the Malnutrition Universal Screening Tool (available at www.bapen.org.uk). Similarly, the likelehood of pressure damage should be assessed so that the risks can be Page 28 of 30 Care Homes for Older People reduced for people living in the home. 2 7 People should have their care plan in a format that meets their individual needs, for example in a total communication format such as pictures or symbols with simple words and sentences. The recreational needs of people, particularly those with dementia or communication difficulties, should be assessed using a tool such as the Pool Activity level instrument. Activities would then be person centred and pitched at a level that is suitable for the individual. The home needs to be able to demonstrate that individual preferences have been accounted for by keeping a record of meals provided to them. Future decoration and refurbishment should be done to best practice to ensure that the needs of people with dementia are taken account of. Resources such as Designing Interiors for People with Dementia ISBN 1-85769-179-2, University of Sterling. Tel:(01786) 467740 E mail: m.t.marshall@stir.ac.uk/dsdc should be used. 3 12 4 15 5 19 Care Homes for Older People Page 29 of 30 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. 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