Care Home: Edenside

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What the care home does well All residents are fully assessed prior to admission to ensure all needs can be identified and met. Family members are invited to be part of the assessment process providing the resident is in agreement. People living in this home are encouraged to exercise choice and control over their own lives. Social, health and personal needs are outlined in each resident`s care plan. The information contained gives the care staff the ability to provide a high standard of care. Although there have been staff shortages in recent months steps are now being taken to address this problem. Some comments made about the staff team included, "you won`t find better carers anywhere" and " they are lovely girls, and very kind" What has improved since the last inspection? Some internal decoration has been completed and work has been carried out to provide an improved garden area for the residents to enjoy. The manager has improved the protocol for recording and handling medications that are taken, "as and when required". This will further ensure safety for those using this service. What the care home could do better: The service could improve the information recorded on the care plans particularly that relating to the residents` lives before they moved into the home. Some work has been started on the care plans in this area and this needs to be continued. This would help to make the care plans more personcentred and individual to each resident. There has been little remedial work on the environment due to financial constraints within the organisation and the manager was unsure when this situation would be rectified. Parts of the home are now looking in need of some redecoration and this would certainly improve the environmental standards. CARE HOMES FOR OLDER PEOPLE Edenside Holme Street Appleby in Westmorland Cumbria CA16 6QU Lead Inspector Mrs Margaret Drury Unannounced Inspection 26th November 2007 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Edenside Address Holme Street Appleby in Westmorland Cumbria CA16 6QU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 017683 51163 017683 53877 edenside@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care Ms Deborah Wendy Byrne Care Home 26 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (26) of places Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 26 service users to include: *up to 26 service users in the category OP (Old age, not falling within any other category). *up to 3 service users in the category of DE(E) (Dementia over 65 years of age). 5th October 2006 Date of last inspection Brief Description of the Service: Edenside is a care home registered to provide personal care and accommodation for up to twenty-six people. The home is owned by Cumbria County Council and operated by Cumbria Care, an internal business unit of the County Council. Ms Debbie Byrne is employed as the manager of the home. Edenside is located near the centre of Appleby and has level access to the local shops, Health Centre, library and local churches. The property consists of a purpose built two storey building and is equipped with a passenger lift to assist residents to access accommodation on the first floor. There are twenty-four single bedrooms and one double room which two people can choose to share if they wish. Three bedrooms have en-suite toilet facilities and there are accessible toilet and bathing facilities close to all the accommodation used by residents. Shared space is provided in the form of one smoke free sitting room, a separate smoking lounge and three lounges with dining and kitchen areas. The home is set in pleasant gardens with seating for residents. The fees charged at this home range from £373.00 to £396.00, as at the date of the visit, with extra charges for hairdressing, newspapers, magazines, personal toiletries hairdressing, private chiropody and some outings. There is also a charge for any meals taken by those visiting the home. This home does not provide intermediate care. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit that forms part of a key inspection took place over one day and we (The Commission for Social Care Inspection) were in the home for five and a half hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager • The service history • Interviews with residents, visitors and staff on the day of the visit. • Completed questionnaire survey forms We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and a tour of the building to inspect the environmental standards was undertaken. Staff personnel files were examined. What the service does well: All residents are fully assessed prior to admission to ensure all needs can be identified and met. Family members are invited to be part of the assessment process providing the resident is in agreement. People living in this home are encouraged to exercise choice and control over their own lives. Social, health and personal needs are outlined in each resident’s care plan. The information contained gives the care staff the ability to provide a high standard of care. Although there have been staff shortages in recent months steps are now being taken to address this problem. Some comments made about the staff team included, “you won’t find better carers anywhere” and “ they are lovely girls, and very kind” Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are fully assessed prior to moving in and are confident that all their needs will be met. EVIDENCE: Admissions are not made to this service until a full needs assessment has been completed. The registered manager normally carries this out and it can be in the local hospital or the prospective resident’s own home. Where appropriate a family member or advocate is invited to be present during the assessment. No resident is admitted unless the manager is confident that the service can meet the assessed needs. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 9 All residents have a contract with the home or the Social services Department and this together with the service user guide outlines the residents’ rights. Residents who spoke to the inspector said they were able to visit the home to look around prior to moving in. If they were not able to do so, a family member or friend visited on their behalf. They agreed that this gave opportunity to meet the staff and others who live at Edenside. Some of them had spent time at the home during the day and so were comfortable moving in as they already knew the staff and some of those already living there. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8. 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. Privacy and dignity are respected at all times. EVIDENCE: All residents have an individual plan of care that is prepared from information gathered during the care needs assessment. Care plans were detailed and individualised and included aims to help residents maintain their independence. These documents are reviewed each month but the “tick box” system that is used may not always show a true reflection of any changes in the level of care required. Cumbria Care is in the process of changing the format of the care plans in order to introduce a more “person- centred” approach. This new format has been used for some recently admitted residents and the manager is hoping all care plans will be transferred over in the near future. The new plans will take into account the social, health, spiritual and cultural needs of the Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 11 residents and provide more details of the life of the resident before they moved in. The plans will also show the resident and/ or their family’s involvement, where appropriate, in the preparation of the plan. Daily and supervisor notes are kept in respect of each resident showing the details of significant events and occurrences. Records are kept of G.P and other healthcare professional visits. Nutritional screening is in place and weights are checked regularly. We discussed, with one of the supervisors, the service received from the local doctors’ surgeries and she confirmed that both the doctors and district nurses gave excellent support and were also available for advice. The home has designated staff that are responsible for the administration of medication and work to the corporate practice of having a second member of staff to act as a “checker”. All the staff involved have completed training to ensure they carry out this duty competently and safely. Records were checked and found to be in order and completed correctly. Medication is correctly stored and there is provision for the safe storage and recording of controlled drugs. The manager has worked hard in preparing a new protocol for the administration of medication that is taken “when required”. The documentation provides information regarding the actual medication prescribed, any side effects that may occur, the administration procedure and any other relevant information. This protocol, together with the organisation’s policy should ensure that there are no errors. Staff were seen to speak to residents in a polite manner and assist them in a way that ensured dignity and privacy were maintained. Residents told the inspector that “the girls are lovely” and “ the staff are always polite and kind”. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to make choices about their life style and are supported as far as possible to maintain their independence. Dietary needs are well catered for. EVIDENCE: The routines within this service are flexible to meet the needs of those living there. As there is currently no activities organiser the support workers are currently doing what they can to provide activities for the residents. Due to staff shortages there is no daily activities programme but special events, such as Halloween, bonfire night and birthdays are always celebrated. There is a programme of events and entertainment organised for the Christmas period. Four ladies meet on a daily basis to enjoy a game of dominoes and we were able to speak to them whilst they were playing. Whenever possible those residents who are able, go in Appleby to do some personal shopping or for a walk close to the home during the Summer months. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 13 The local Anglican and Methodist churches conduct regular services and there are three residents who are able to attend the church of their choice. Holy communion is provided for all denominations. Families and friends can visit at any time and are always made welcome. Visits can be taken in the communal areas or in the privacy of the resident’s own room. During the visit we were able to spend some time speaking with the cook and inspecting the kitchen areas. The full time cook was retiring the week of the visit after over thirty years at the home. Residents and staff told us she will be sadly missed and a party for her was being organised. The kitchen areas were clean and well kept, with all records kept up to date. We examined the menus and found them to be varied and nutritious with special diets catered for. All food store areas were well stocked. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to express their concerns and have access to a suitable complaints procedure. Policies and procedures ensure residents are protected from abuse and have their rights protected. EVIDENCE: The home has policies and procedures in place in relation to complaints and concerns, with details on display in the hall. The complaints procedure is also contained in the resident’s guide that is given to all new residents. Those who spoke to the inspector all said they would speak to the manager or one of the supervisors if they had any concerns to discuss. They did also say that they “had no complaints anyway”. There is a complaints log in place although there have been none to record and The Commission for Social Care Inspection have not received any either. We discussed with the manager the fact that concerns or “niggles” are not recorded. It is good practice to record all concerns and the way in which even the smallest query is dealt with. There are residents’ meetings held every quarter when the residents are able to make their concerns known or raise any issues they want to. The minutes of the latest meeting were on the board in the hall for anybody to read. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 15 We discusses adult protection with the manager and she confirmed that, apart from the staff induction programme, there is very limited training available in this subject. It is discussed in staff supervision and staff meetings and there have been no issues to raise. It would be beneficial for external training in this subject to be accessed for the staff even though those we spoke knew what the procedure was if necessary. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The design and layout of the home enables the residents to live in a safe, warm and comfortable environment. EVIDENCE: We conducted a tour of the building looking at the environmental standards and fabric of the building. The home is built over two floors with access to the upper floor via a passenger lift. Because of recent financial constraints within the organisation there has been very little improvement to the internal decoration of the home and parts now look in need of some attention. However this situation will slightly improve in the near future as some refurbishment is planned. New curtains have been purchased for three lounges and ten of the bedrooms. Two bedrooms have been re-carpeted and another two are to be Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 17 completed in the near future. The kitchen area in one of the units has had new flooring laid and new worktops fitted. We inspected several of the bedrooms and found them to clean and sweet smelling. They were all personal to the individual residents with pictures, photographs and ornaments. Although some of the rooms are small and only three have en-suite facilities all the residents we spoke to all said that they were happy with their accommodation. Two of the current staff vacancies are for domestic staff, which means the home currently does not employ any cleaners but uses some agency cleaners for a few hours each week. However, on the day of the visit the home was very clean and hygienic, thanks mainly to the care staff that are working hard to ensure the home stays as clean as possible. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service are generally satisfied that the care they receive meets their needs but, due to staff numbers, there are times when they may have to wait for support and attention. EVIDENCE: The home follows the corporate recruitment procedure that meets the regulations and National Minimum Standards. There is accurate recording at all stages of the process and no member of staff starts work before all the legal checks ( Protection of Vulnerable Adults and Criminal Records Bureau) are completed. The home currently has staff vacancies both in care and domestic duties, which necessitates the use of agency staff mainly covering night duty and cleaning hours. When we talked with the staff it was obvious that they knew the residents well and were, on the whole, able to meet the assessed needs. The management team works with the care staff to ensure they work as a team and support each other. We looked at the staff files and recruitment process for 3 members Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 19 of staff. These were very well maintained and contained all the necessary checks including Criminal Records Bureau (CRB) checks and references. Comments from residents about the staff included, “they are grand girls” and “the staff are so kind and will do anything for you”. There is a good training programme with each member of staff being responsible for keeping their own continuous professional development files up to date. Training recently completed includes, moving and handling updates, emergency action, safe handling of medication, dementia care and infection control, which is also included in the induction programme. There is now a link member of staff dealing with infection control and the home works to the Department of Health documentation “Essential steps to a safe and clean home”. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service live in a home that is safe, well managed and run in their best interests. EVIDENCE: The manager has many years experience in residential care and is now registered with The Commission for Social Care Inspection (CSCI). She has completed the Registered Manager’s Award and is waiting to start her National Vocational Qualification level 4 in care. We discussed the running of the home, during which she demonstrated her knowledge of care issues and her ability to Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 21 ensure the home is run in the best interests of the residents. She has an open management style and works with the members of the senior team to support the other staff. The service takes care of a small amount of personal allowance on behalf of some residents. This is used for toiletries, hairdressing, newspapers and magazine. Records of the individual amounts spent are kept and show that 2 members of staff record and check all transactions. This helps to ensure that residents’ personal finances are protected and managed safely. Quality assurance survey forms are sent to residents and their families annually and regular meetings are held with residents to ask for their opinions about the running of the home. The manager also ensures that she is always available to speak with residents and visitors. The home was recently inspected by the Food Standards Agency and received 4 stars for food safety. Regular fire training takes place and all risk assessments are up to date. Cumbria Care’s health & Safety manager completes an annual health and safety check and makes any recommendations known to the home manager. All equipment is serviced under annual service level agreements. Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Edenside DS0000035019.V351679.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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