Care Home: Elcombe House

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What has improved since the last inspection? We did not make any requirements at our last inspection. However the new manager has introduced several improvements including person centred planning. This is where the focus of a persons care considers all aspects of their life, ensuring the person is treated as an individual. What the care home could do better: The environmental health office undertook an inspection of the kitchen at the home in November 2008, they made recommendations for changes. It was not clear if the actions had been carried out and the staff had not yet responded to them. This is needed so that it shows that the home will listen and respond to regulators to ensure all standards are maintained. Key inspection report CARE HOMES FOR OLDER PEOPLE Elcombe House 61 De Parys Avenue Bedford Bedfordshire MK40 2TR Lead Inspector Katrina Derbyshire Unannounced Inspection 27th April 2009 07:55 DS0000072783.V375189.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elcombe House Address 61 De Parys Avenue Bedford Bedfordshire MK40 2TR 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) 01234 266010 01234 217760 St Andrews Care Homes Ltd Manager post vacant Care Home 22 Category(ies) of Dementia (22), Old age, not falling within any registration, with number other category (22), Physical disability (22) of places Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Physical Disability - Code PD Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 22 Not applicable 2. Date of last inspection Brief Description of the Service: Elcombe House is situated in a pleasant residential area of Bedford within easy walking distance of Bedford Park and the town centre. The home is privately owned and is one of a group. The accommodation is over 3 floors served by a passenger lift. Several bedrooms have en-suite facilities and some others have wash basins. There is a large open plan living and dining space on the ground floor. Following recent refurbishment the home also has a new laundry, hairdressing room and training room. There is a small rear garden that is landscaped and overlooks the playing fields of a nearby school. The following information about fees was confirmed on 27/04/09:Weekly fees £600.00. These items are not included in the fees: Chiropody; toiletries; newspapers; hairdressing. A contribution to the cost of special excursions is sometimes requested. Further information can be obtained by visiting the homes website. Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service submitted an application to the Commission for Social Care Inspection in 2008 to change an element of its registration to reflect a change in its ownership to a Limited company. As a result of this in accordance with our registration guidance the service from 31st October 2008, was considered a new service. However it should be noted that the home had previously been inspected and its staff and systems remain the same. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. This was an unannounced key inspection carried out on the 27th April 2009. The care of three people was looked at in detail and this is known as case tracking. Tracking people’s care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The management’s submission of documentation was also considered prior to the site visit. The focus of this inspection was to look at the key standards. What the service does well: The manager at the home had previously been employed as the manager of another home within the group prior to her starting at Elcombe House in June 2008. Her contributions to improving standards since that time are commendable. The manager has and continues to undertake a planned improvement to the standards of care offered to people living at the home. One person who has lived at the home for several years said, “I think she is marvellous”. Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 6 The standard of accommodation is good. People living at the home feel that it meets their needs and provides a pleasant environment in which to live. Many people commented on ‘how clean the home is kept’ and feel that it is always tidy and well presented. The management at this home have ensured that all staff had received the training and updates that they need to carryout their roles. Even though a training manager had been employed by the company and commenced on the day of this inspection, the manager of the home had ensured records and updates were up to date and this helps to ensure staff have the knowledge needed to meet the needs of the people living at the home. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. Elcombe House DS0000072783.V375189.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 Elcombe House DS0000072783.V375189.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6. People using the 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 feel that they have sufficient knowledge and information to assist them in making an informed decision on whether they wish to move into the home. EVIDENCE: The statement of purpose available in the home. The document provided information on the staffing, accommodation and services available at the home including how you could complain. On speaking with people they advised that they had been given sufficient information about the home prior to moving in. Additionally they had been able to visit before deciding and that their initial Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 9 residence had a trail period and that they had a formal review following this so that they could feedback their views on the care that they had received. Assessment documentation was in place for people that had moved into the home recently. Although for one person the document had not been signed, dated or completed in full. The documentation showed that an assessment had always taken place prior to the person’s admission. Information from other agencies had also been secured and also showed the assessment of the persons needs by a representative from Social Services for example. Information that was contained within these were then linked to the persons plan of care. Intermediate care is not provided at the home. Elcombe House DS0000072783.V375189.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning is sufficient to provide staff with the information that they need to ensure people receive the care that they need. EVIDENCE: Since the homes previous inspection there had been significant changes to care planning in the home. The new manager had been working with staff to introduce person centred planning. The documents viewed showed that the standard of entries were improving and staff were now being more objective in their description of a change in a person’s circumstance for example. A history had been secured of the person’s childhood, and stages throughout their life where possible to build a full picture of the person and the life that they had led. Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 11 Risk assessments were in place in regards to nutrition, falls, moving and handling and other areas identified as possible risks to the person. These had been evaluated on a regular basis and measures were in place to reduce a risk if one had been identified. Observations of care during the visit showed staff to approach people in a supportive manner and address them as the person wished. Only one member of staff was overheard calling one person a ‘good lad’ on two occasions, this is not appropriate and was feedback at the end of the inspection. Medication systems in the home were examined on this visit. Records maintained by the home relating to medication were seen to be sufficient to undertake an audit to ascertain if people had received their prescribed medication. The stocks of medication were recorded and any continued usage of medicines between medication cycles had been carried forward so that a clear audit trail is in place. The balances audited were correct. An observation of the early medication round should that the person followed safe practice in this area. On speaking with people in the home they confirmed that Doctors and nurses would visit them when they required it. Documentation seen supported this as recordings were made of any healthcare intervention and guidance given to staff. Elcombe House DS0000072783.V375189.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The choice of meals is excellent alongside the attention to detail which means peoples tastes, preferences and nutritional needs are met. EVIDENCE: Activities in the home were noted to have improved in recent months. Several people commented on the activities that they had enjoyed and ones planned for the future. Activities available in the home are on display so that people are kept informed of all events. One of the people living at the home is also involved in updating the menu board, they confirmed that they are encouraged to participate in aspects of running the home. Feedback from people living at the home indicate that staff are supportive to them in maintaining contact, and involving families in their care. There are no restrictions on visiting within waking hours as advised by staff. Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 13 Information seen within the care records contained entries and information to show that residents continued to make decisions in their lives examples included personal financial matters and voting. Menus available in the home show that a choice of food at mealtimes is offered that includes fruit and vegetables. A new a la carte menu has been introduced offering a very good amount of choice. During the inspection it was noted that the chef made breakfast to order. He was seen to speak to every person when they got up in the morning and ask what they wanted. Some had cereal, others fried egg on toast and other a full English breakfast. The stock of food seen was sufficient to provide a balanced diet at the home. Nutritional risk assessments were in place and featured greatly within the care records of the people living at the home. The combination of choice, menus, standard of nutritional documentation and the chef commitment results in the home exceeding this standard. Elcombe House DS0000072783.V375189.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The training and knowledge of staff in safeguarding is good and helps protect the people living at the home. EVIDENCE: As with the other homes in the group within the statement of purpose there was information on whom to contact if you wished to make a complaint. There had been one complaint received when the previous manager had been in post, all the details and repose was not available at the time of this visit. However the new manager views complaints and concerns to be important to the management of the service as they felt it was another way that they could improve the service. The home had in place a policy on abuse and a copy of the most recent guidance for the Safeguarding of Vulnerable Adults that contained the correct reporting of any alleged abuse. Training records showed staff had received training in this area. During the interviewing of staff they were able to demonstrate that they knew how to report any concerns. In addition the owner represents the independent sector on the Bedfordshire Safeguarding Adults Board. Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 15 Information supplied by the service showed that people can be provided with advocacy service information and that people use the postal voting system. Elcombe House DS0000072783.V375189.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Accommodation standards are good and provide a comfortable home for people to live in. EVIDENCE: All communal areas seen at this visit were clean and tidy. The quality of fittings and furnishings in the living space was very good, and with numerous windows in this area there was also a very good amount of natural light. Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 17 The front of the home and rear garden was immaculate. One of the bedrooms on the ground floor needed the carpet replacing due to an odour, the manager assured us that this was going to be replaced. Cleaning schedules were in place. Clinical waste contracts were also in place and equipment was seen to be used by staff for the purposes of managing cross infection. Elcombe House DS0000072783.V375189.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the 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 living at the home feel confident in the abilities of staff to meet their individual needs. EVIDENCE: Access to training records showed that the manager had maintained an up to date record of staff training. When she had identified any shortfalls in training she had made arrangements for these to be rectified. Copies of certificates were also seen. In addition the company had employed a training manager who commenced her employment on the day of this inspection and they are introducing a new computerised system for record keeping. Staff files examined contained documentation to show that the home had received and documented all required information prior to the appointment of staff. References, applications, identification had been checked and Criminal Record checks were in place. Staff through discussion confirmed that prior to their appointment they had attended interview and all held contracts of employment. Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 19 The manager and Deputy manager had been working with staff to make changes to the way care was provided in the home. Information showed that there had been staff meetings and supervision. Where standards were not acceptable management had taken appropriate action. Everyone spoken to only had praise for most of the staff at the home. With the exception of one person calling a resident ‘good lad’, all other staff were courteous and respectful in their approach. In addition a student from a local college was seen to be undertaking a work placement at the home, showing a commitment to the training of future professionals and links with the community. Elcombe House DS0000072783.V375189.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home is excellent in cascading her vision to staff to provide a good standard of care to the people living at the home. EVIDENCE: Feedback received from people indicated that they felt satisfied with the management of the home. The changes to the ethos since the last inspection is commendable and this has been driven by the current manager. The improvements that she has made have been significant in improving standards of care and addressing any poor practice with staff. The manager in addition Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 21 acknowledges that further improvements are still needed and has made plans for these for example activities, this shows a willingness to continually develop and improve. The deputy manager stated that the amount of changes for the better had been “enormous”. The home had undertaken a review in which they had sought the views of residents and relatives on the standard of care at the home this was in November 2009. No monies were being held on behalf of any resident at the time of this visit. Health and Safety information provided by the home showed contracts with approved contractors are in place for the maintenance and servicing of equipment. The most recent inspections undertaken by Environmental Health had not yet been responded to, however the manager gave assurances that this would be done. Other areas of health and safety were noted to meet all the standard. Elcombe House DS0000072783.V375189.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 3 X 3 X X 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 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X N/A X X 3 Elcombe House DS0000072783.V375189.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 Elcombe House DS0000072783.V375189.R01.S.doc Version 5.2 Page 24 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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