Care Home: Eldon House

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What the care home does well There is a relaxed, homely atmosphere. Visitors are warmly received and they confirmed they can visit at any time and staff involve them in decision making about their relatives. A person recently admitted into first time to care at the age of 95 had some reservations initially, wishing to retain her independence. She said that she had settled well with support and assistance from staff. She was able to choose her preferred lifestyle, spending time in her bedroom, receiving visitors and keeping in contact with her friends by installation of a telephone in her room. There are a range of activities to meet the needs of all people in the home, ranging from the usual indoor activities to external events, fund raising and trips to local venues. This was borne out in discussions with people and visitors and the large collection of photographs recording the various events. The new care planning system introduced provides detailed information about the individual needs of people using the service. Health care needs are well assessed and defined. Referrals are made to health care professionals if there are any concerns about health matters. A visiting health care professional spoke highly about the cooperation between the District Nursing Service and staff in the home and the fact that staff were pro-active about early referral of health concerns. No complaints have been received by this service or by us over a long period of time. The complaints procedure is readily available in the home for everyone. There is a good standard environment that is well maintained providing a pleasant, comfortable homely place for people to live. There is an ongoing redecoration and refurbishment programme. Our impression on this visit was the the whole of the interior and the exterior of the building had been redecorated and presented extremely well. Many staff have worked for several years in the home, staff turnover is low. This provides continuity of care for people and allows well-established relationships between staff and people living at Eldon House. What has improved since the last inspection? We had some serious concerns about the safety of medication administration in the home at the time of the last key inspection. We made requirements and have found that all have been satisfactorily addressed. A new supplier of medication has been commissioned, new storage equipment provided and the recording of receipt, storage, administration and disposal of medicines have improved considerably. Due to the concerns we had at the time of the last key inspection the quality rating was changed from 2 Stars Good to 1 Star Adequate. The improvements made and checked at this inspection mean that the service will return to the 2 Stars Good rating. CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks are now carried out prior to employment of staff. This means that people at Eldon House are more protected. Three bathrooms have been refurbished including electric baths and hoists improving bathing choices and facilities The Statement of Purpose/Service Users Guide have been updated. People are now informed in writing following assessment that the home can meet their needs and all people self-funding now have contracts. There has been some staff training in dementia care needs, although some staff still require this training. Records are now maintained recording routine maintenance of equipment. This promotes safety for people using the service. What the care home could do better: People should be weighed regularly and where there are concerns about weight loss more regular weighing is required. Weight loss must be referred to the GP for possible dietary supplements/referral to dietitian. Moving & Handling training must be provided urgently for all staff. The practice of under arm lifting must cease, the moving and handling risk assessment must be reviewed and where necessary an appropriate hoist used in consultation with an Occupational Therapist. We recommend that the home consider providing a hot dish alternative a lunch time, ensuring people have a choice at all times. Eye drops should be dated when opened to ensure effective treatment for people. Medication must be administered as prescribed to ensure people have the treatment they are prescribed and need. This relates to monthly prescribed medication that was missed. It is important that DNAR (Do Not Attempt Resuscitation) forms are reviewed by the GP within prescribed timescales (5 working days) when the election is made by a hospital doctor. This will ensure the DNAR pro forma remains in force. Where moving and handling assessments stipulate pressure relieving cushions are required, these must be in place at all times to prevent possible pressure damage. Staff training is needed in relation to dementia awareness, Health and Safety and Safeguarding Training. Mental Capacity Act assessments must be provided by staff as a means of determining whether people have capacity. The TV picture quality in the main lounge area was very poor and could not be easily viewed from across the room. The home should consider repair or replacement. This will reduce possible eye-strain, particularly for people with sight impairments. Key inspection report Care homes for older people Name: Address: Eldon House 69 Ricardo Street Dresden Stoke-on-trent Staffordshire ST3 4EX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter Dawson     Date: 1 3 0 5 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 32 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Eldon House 69 Ricardo Street Dresden Stoke-on-trent Staffordshire ST3 4EX 01782326620 01782313633 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Eldon House Care Services Ltd Name of registered manager (if applicable) Mrs Susan Ibbs Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category 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: Physical disability (PD) 16 Dementia (DE) 6 Old age, not falling within any other category (OP) 34 Date of last inspection Brief description of the care home Eldon House is registered to provide personal care and support for up to thirty four elderly people. Of these six may have dementia care needs and twelve may have a physical disability. The home is located in a quiet residential area in Dresden and close Care Homes for Older People Page 4 of 32 6 0 16 Over 65 0 34 0 Brief description of the care home to Longton town centre. There is easy access by public transport. There are local shops and amenities close by. There is parking to the rear of the property. The home comprises a large detached Victorian property, and a single storey extension added some years ago. Accommodation is on three floors with access by passenger lift, stair chair lift or stairs. The lower ground floor has 9 bedrooms. The ground floor, where there are four lounge areas, dining room, kitchen and offices, has 15 bedrooms. The first floor provides a further 10 bedrooms. With the exception of one, all bedrooms are for single occupancy. There are eight en-suite bedrooms. Assisted bathrooms and toilets, including a shower room are located conveniently throughout the home on each of the three floors. The laundry is located in a Porto Cabin to the rear of the property and has good facilities. There is a well-kept garden to the front of the home which has attractive garden furniture and seating. A large garden shelter is provided for the use of residents who wish to smoke. This structure has exterior specification lighting so that it may be used after dark, if needed. The fees are not outlined in the homes brochures and therefore the reader may wish to contact the service directly for this information. Care Homes for Older People Page 5 of 32 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: This key unannounced inspection was carried out by one inspector on one day from 08:30 - 19:00. The home did not know we were coming. Our last key inspection of this service was on 14/07/09 when we made 4 requirements relating to medication. We had serious concerns about the system of medication in the home. This was followed up by our Pharmacist who has made 2 random inspection visits and also made 2 further requirements, although most of the original requirements had been addressed. The focus of this unannounced inspection was, therefore to ensure continued compliance under regulations and to meet the required standards of the National Minimum Standards for Older People. Before visiting the home we sent out and directly received 9 surveys from people living Care Homes for Older People Page 6 of 32 at the home and 8 from staff working at the home. Comments received are included in this report. The service also completed an Annual Quality Assurance Assessment (AQAA) - a legally required self-assessment by the service outlining the standards of care being provided. This focuses upon what the service does, how they evidence this and any areas in need of improvement. This document was returned to us on time and provided adequate information, some of which is included in this report. There were 33 people in residence at the time of the inspection and we spoke with many of them. We also spoke with 4 visitors and members of staff on duty. We were able to observe interactions between people living in the home, staff and visitors. We looked at care plans, risk assessments, medication records, accident reports, staff records and other documents relating to the inspection process. We inspected the communal areas of the home and a sample of bedrooms. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? We had some serious concerns about the safety of medication administration in the home at the time of the last key inspection. We made requirements and have found that all have been satisfactorily addressed. A new supplier of medication has been commissioned, new storage equipment provided and the recording of receipt, storage, administration and disposal of medicines have improved considerably. Due to the concerns we had at the time of the last key inspection the quality rating was changed from 2 Stars Good to 1 Star Adequate. The improvements made and checked at this inspection mean that the service will return to the 2 Stars Good rating. CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks are now carried out prior to employment of staff. This means that people at Eldon House Care Homes for Older People Page 8 of 32 are more protected. Three bathrooms have been refurbished including electric baths and hoists improving bathing choices and facilities The Statement of Purpose/Service Users Guide have been updated. People are now informed in writing following assessment that the home can meet their needs and all people self-funding now have contracts. There has been some staff training in dementia care needs, although some staff still require this training. Records are now maintained recording routine maintenance of equipment. This promotes safety for people using the service. What they could do better: People should be weighed regularly and where there are concerns about weight loss more regular weighing is required. Weight loss must be referred to the GP for possible dietary supplements/referral to dietitian. Moving & Handling training must be provided urgently for all staff. The practice of under arm lifting must cease, the moving and handling risk assessment must be reviewed and where necessary an appropriate hoist used in consultation with an Occupational Therapist. We recommend that the home consider providing a hot dish alternative a lunch time, ensuring people have a choice at all times. Eye drops should be dated when opened to ensure effective treatment for people. Medication must be administered as prescribed to ensure people have the treatment they are prescribed and need. This relates to monthly prescribed medication that was missed. It is important that DNAR (Do Not Attempt Resuscitation) forms are reviewed by the GP within prescribed timescales (5 working days) when the election is made by a hospital doctor. This will ensure the DNAR pro forma remains in force. Where moving and handling assessments stipulate pressure relieving cushions are required, these must be in place at all times to prevent possible pressure damage. Staff training is needed in relation to dementia awareness, Health and Safety and Safeguarding Training. Mental Capacity Act assessments must be provided by staff as a means of determining whether people have capacity. The TV picture quality in the main lounge area was very poor and could not be easily viewed from across the room. The home should consider repair or replacement. This Care Homes for Older People Page 9 of 32 will reduce possible eye-strain, particularly for people with sight impairments. 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. Care Homes for Older People Page 10 of 32 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 32 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. Detailed information assists people in making a choice about the suitability of the home for them. Pre admission assessments and written confirmation mean that needs are assessed and can be met, leading to successful placements. Evidence: At the last key inspection on 14.7.09 we made 3 recommendations relating to this outcome area as follows: Include more detail about staffing in the Statement of Purpose. Issue a contract to people who fund their own care and confirm in writing to prospective residents that their needs can be met by the home. The recommendations have all been actioned. The Statement of Purpose containes more information about the number the qualifications of staff. We saw contracts issued to people recently admitted who were funding their own care and following assessment prior to admission we saw letters sent confirming in writing the the home could meet peoples assessed needs. Care Homes for Older People Page 12 of 32 Evidence: We saw pre admission assessment comprehensively completed identifying all areas of need prior to the persons admission. Care Homes for Older People Page 13 of 32 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. Care plans provide sufficient information to enable staff to deliver a person-centered service. Practice and procedures in relation to medication have improved ensuring the home has a safe system of medication to protect people using the service. Evidence: The home introduced a new care planning format in January 2010. This provides detail of all areas of need including personal, health and social care needs. All care plans have been transferred to the new system which has been a major task. Neverthelss this has been completed and has vastly improved both the information and presentation of care plans, identifying needs and stating what action staff need to take to meet those needs. We sampled 5 care plans and were pleased with the improved presentation of information. The plans had also been signed by the person or their relative throughout ensuring people were aware of the information held and detailing the actions needed to met those needs. Care plans included detailed information and Risk assessments relating to nutrition, risk of pressure damage, moving and handling needs and risk Care Homes for Older People Page 14 of 32 Evidence: assessments, health care needs and medication plans. Involvement of health care professionals were listed with outcomes of visits and any required action. We saw good social histories Life Story personalising peoples experiences and social and emotional care needs. We also saw that care plans are reviewed monthly within the home as part of the new care plan format. Other statutory reviews with social workers were also identified. Arising from the information we saw and discussed with Managers we identified the following points: We saw a DNAR (Do Not Attempt Resuscitation) election completed on the required form, but the entry was completed by a hospital doctor prior to discharge and return to the home. This must be further reviewed by the GP within 5 working days of discharge, by the GP, otherwise the DNAR arrangements lapse. This had not been done and the person was being re-admitted to hospital on the day of this inspection. The home will monitor these in future. We saw that a person with low weight had only been weighed twice since January. The last recorded weight was 5 stones, with a 2lb loss. We recommend that this person should be referred to the GP and dietitian for further action/ advice. It is important that where there are concerns about weight,and there is further loss, people must be weighed weekly and referred to the GP. We saw in a care plan that a person should have a pressure relieving cushion on his chair. He did not have one on this wheelchair or the lounge chair he was transferred to. The Manager will ensure that clear instructions are given in the care plan for staff to follow and a re-assessment carried out. We saw a Health Care Support Worker from the GP practice in the home taking routine blood samples and applying dressings. We asked her for a view about the service. She told us that she has been visiting the home in a professional capacity for 6 years. She has been extremely impressed with the standards of care and more recently arranged the admission of a close relative. She said that staff ere astounding and felt that the home was gold star. She said that staff care about patients, are very caring and loving. she said there was a Warm feel to the home and nothing is too much trouble. Professionally staff always follow procedures and advice about health care matters and she said the home is outstanding. We were not able to speak with a visiting GP who was arranging re-admission to hospital for a person but we saw recent written feedback from a GP stating Excellent staff members. Work together as a team. Staff identify patients needs and call appropriately. Care Homes for Older People Page 15 of 32 Evidence: At the time of the last Key inspection on 14.7.09 we made 4 requirements and were seriously concerned about the safety of the medication system in the home. We arrange for our Pharmacist to carry out a more detailed inspection of medication. This was done involving 2 Random Inspections by the Pharmacist. Concerns included: Inadequate storage/security of medication. Poor recording of receipt, administration and disposal of medication. Staff required training in the application of prescribed reams and drops. All as required medication must be administered only to the individual it was prescribed for. Medication must be stored at the correct temperature. There was evidence on interim visits that the majority of requirements had been actioned. During this inspection we looked at the medication system in detail to ensure that all requirements made at the Key and subsequent 2 Random inspections had been met as identified in the improvement plan supplied by the home. We found that a new supplier had been commissioned for mediation. New medication trolleys were in place with a new fridge to monitor the daily temperature for stored items. These were found to be within required limits. Staff have received medication training with assessed competencies to administer prescribed creams/drops. As required medication was being stored individually. We found that medication in stock at the start of the medication cycle was not recorded and added to medication received - allowing an audit of the system. Medication audits by senior staff are carried out regularly. We found that records relating to anti-coagulant medication had improved where there were changing/variable doses being administered. We found that the 6 requirements made at previous inspections over the past year have all been satisfactorily addressed. On this visits we found that medication given only once each week had not been given on one occasion. Investigation showed that the introduction of this medication halfway through the cycle had been misunderstood because of a changed start-date on the MAR sheet. This will be brought to the attention of all staff. Where handwritten additions are made to MAR charts during the medication cycle it is good practice to ensure entries are checked and countersigned to further increase safety. We saw that eye-drops in the fridge had not been dated when opened. This must be done to ensure medication is administered within effective time limits. Care Homes for Older People Page 16 of 32 Evidence: In relation to death and dying - we found that a person had died in the week prior to the inspection and the funeral the following day was being attended by several staff. The family had sent a Thank you card to the home detailing the excellent care and support the person and the family had received during a difficult time stating that staff at Eldon House were very special people. Care Homes for Older People Page 17 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities are provided to meet peoples social and recreational needs. There is high level of satisfaction with the level of service. Evidence: A range of activities are provided to meet the daily social and recreational needs of people using the service. The AQAA summarises activities as follows: We have a wide range of games and quizzes, memory teasers nd nostalgia prompts which are suitable and adaptable for all levels of suitability. We have an activities room where clients can join in a variety of pastimes. We have very successful fundraising events which have enabled us to enjoy many days out and events throughout the year. Relatives are invited too and many take up the offer. We also have excellent outdoor amenities where people can enjoy the nice weather and we can hold summer fetes and barbeques. This is supported in discussions with people using the service and in photographs around the home capturing the events described. For the future the AQAA states: We intend to organise the home and staffing levels Care Homes for Older People Page 18 of 32 Evidence: so that we can spend more time with service users to expand our programme of activities and daily living. During the summer months we would like t have more time to spend in activities such as taking more of our residents to the local park more often. Many visitors were seen in the home during the inspection day, those spoken with confirmed that they were encouraged to visit at any time, were welcomed and felt comfortable moving around the home. Daily living choices were evident. Some people spending time in their bedrooms as they wished throughout the day. Some meals were delivered to bedrooms also. We were concerned when we arrived at 8.30 a.m. that 15 people were up, many having had breakfast. In the main lounge we saw 7 people who had had breakfast, many quite high dependency and 3 were asleep. We wondered why they were still not in bed. We were told that people got up from bed as they wished, some from 6.00 a.m. We saw some preferred rising times in care plans and people able to express a view said that they had risen at the time they wished. We discussed this with Managers who assured us that people were never woken. We accepted the explanation. We looked at menus and found a 3 weekly rotating menu providing a varied and wholesome diet. People we spoke with said that they enjoyed the food. The home prides itself on providing good home-cooking. Our only concern was that there was not a choice of main hot dish at lunchtimes. The dish for the day was pork and everyone apparently liked pork. We were told that people could ask for an alternative if they wished. We were concerned that many people would not ask and recommended the home consider providing a choice of hot dish for the mid-day meal. Visitors we spoke with said that they were very pleased with the care provided at Eldon House. Prior to the inspection we received written feedback directly to us from 9 people living at the home who all expressed their satisfaction with the service. Comments included: Eldon House offers an excellent, professional service, the staff are the homes best asset. They are very committed and take great pride in the way they care for residents This person also expressed the view that more day trips, especially in summer would be good. Staff are extremely polite and welcoming. I feel that my father is in very capable and safe hands Care Homes for Older People Page 19 of 32 Evidence: Staff care about me and will do almost anything to make things happen for me. My stay here has been, since day one, fabulous. I was made to feel like a family member and always feel at home. In answer to the question What does the home do well? - 3 people said Everything In answer to the question What could the home do better? - 3 people said Nothing. Care Homes for Older People Page 20 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to and their safety is protected. Some further staff training will further safeguard peoples interests. Evidence: There is a complaints procedure in place, all people using the service and visitors have access to a copy. No complaints have been received by the service or by us since the last key inspection. We recommended at the last key inspection that the service obtained a copy of the Safeguarding procedures from the local authority. This has been done. No safeguarding referrals have been made or received by the safeguarding team since the last key inspection. Some staff have not received training in safeguarding vulnerable adults and this is recommended. It is stated in the AQAA that the home intend to book further training in relation to safeguarding. We found in care plans that the Mental Capacity Act assessments had not been completed. Some senior staff have had training in this area of work, some have not Care Homes for Older People Page 21 of 32 Evidence: and we recommend this is provided for all staff. It is important to establish if people have capacity so that their interests are protected. We were told that at the recent general election some people had postal votes, others were taken to the polling station. Care Homes for Older People Page 22 of 32 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. A well presented and well maintained environment provides a pleasant, bright homely and comfortable place for people to live. Evidence: We inspected the communal areas and a sample of the 34 bedrooms. We found that most areas of the environment had been redecorated, providing a pleasant, bright, comfortable setting. Ongoing replacement of furniture and carpets ensures a well presented interior. The exterior of the home had also been recently redecorated and is maintained to a high standard. Many original features to the original part of the building have been retained giving a very homely feel to the Victorian architecture. The large floor to ceiling wooden cupboards and fittings in the dining area have been renovated/re-polished and are excellent, providing a unique pleasant traditional Victorian setting that people enjoy. We noticed that the TV in the large lounge area was poor quality and could not be seen from accross the room even by people with good eyesight. We recommend repair or replacement of this item. The home has continuously been upgraded. Since the last inspection 3 bathrooms have been upgraded at considerable cost. One has a new electric-rising bath and Care Homes for Older People Page 23 of 32 Evidence: electric hoist, another had new electric hoist and a walk in shower area has been upgraded. These areas provide a choice of excellent bathing facilities for people. Ongoing maintenance and presentation of the home is good. The provider states that planning permission to build on the adjoining land is presently being considered by the Local Authority. Care Homes for Older People Page 24 of 32 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. Improved staff recruitment procedures and ongoing training will ensure peoples interests are protected. Evidence: A requirement was made at the Key inspection on 14.7.09 that CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks must be carried out for all staff prior to employment. We were unable to check this on the random inspections as no new staff had been appointed. We inspected staff records on this visit including staff recently appointed. We were able to confirm that POVA and CRB checks had been carried out prior to employment, references obtained together with other documents required. Managers informed us that they were presently awaiting two written references for each of three people who had been interviewed and were to commence work when 2 written references had been obtained. To assist in this we advised Managers that if letters had been sent for references, it was acceptable to obtain references by telephone pending receipt of written references. In these circumstances a record must be kept of the name of person spoken with, details of the reference, dated and signed by staff. New employees could then commence duties. Care Homes for Older People Page 25 of 32 Evidence: We looked at staffing rotas and found that 7.30 - 2.30 there was one senior carer on duty and 4 care assistants. From 2.30 - 10.00pm there was one senior carer and 3 care assistants on duty. Additionally either the Manager or Deputy are on duty each day, 7 days per week. At night time there are 2 waking night staff on duty and one person on call. The person on call is not resident in the building (will be one of 3 Managers) but live in close proximity to the home. The numbers are for 34 people. We questioned whether 2 waking night staff was sufficient. We were told that on-call staff would respond within minutes and that if anyone needed hospital admission in the night the on-call senior would respond. It is important for the Manager to continually review the levels of night staffing taking account of the dependency levels of people using the service and the availability of on-call staff. Additional support staff are available throughout the day including catering, domestic and laundry staff. We looked at staff training information and agreed that training in the following areas is needed to update or provide first-time training for staff: Moving and Handling, safeguarding, Mental Capacity Act, First Aid and Health and Safety. Some training is already booked other courses must be secured. Care Homes for Older People Page 26 of 32 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. A well run home, managed in the interests of the people using the service. Evidence: At the time of the last key inspection we made 4 recommendations: Hoists must be tested and maintained. Food Hygiene training for staff required. Routine maintenance required for equipment. Hazardous materials (COSHH) must be securely stored. All recommendations have been satisfactorily addressed. The Registered Manager has been employed at the home for several years and has the required training and experience to run the home. The provider visits the home daily and is known to all people living at Eldon House, staff and visitors. There is a relaxed atmosphere and people have ready daily access to owner and manager. Care Homes for Older People Page 27 of 32 Evidence: The issues surrounding medication that were identified in the last key inspection report have now been satisfactorily addressed by Management with new medication systems in place and regular checks by managers to ensure the system continues to be safe. Supervision of staff is in place with regular 2 monthly supervision of all staff. In an anonymous survey received from a member of staff it stated Since the last inspection there has been much improvement, although the home was always run well, management have pulled out all stops to make sure everything is spot on. The home now have a system of quality assurance that seeks views of the service by sending out questionnaires to people living at Eldon House, visitors and external professionals. We saw a sample of returned questionnaires indicating a high level of satisfaction of people using the service and positive comments from other professionals. In relation to safe working practices, we saw a man being transferred from a wheelchair to a lounge chair by two staff members. He was grabbed under each arm for the transfer. This is not acceptable moving and handling practice and presents potential safety hazards for both person and staff. We checked moving and handling training records to find that moving and handling training had been carried out by staff in the home who were not approved trainers. Moving and Handling training must be provided urgently for all staff by approved moving and handling trainers. A professional assessment from Occupational Therapist regarding the possible use of a hoist is needed in the instance cited above. Care Homes for Older People Page 28 of 32 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 29 of 32 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 38 13 The registered person shall 27/05/2010 make suitable arrangements to provide a safe system for moving and handling service users. This will ensure the safety of people when being moved in the home. 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 8 Pressure relieving equipment must be in place following assessment and risk assessment. Any changes must be recorded in the care plan. It is important to monitor DNAR elections to ensure they are reviewed as required by the GP. This will ensure appropriate action is taken in an emergency in accordance with the persons wishes. People must be weighed regularly. Where there are concerns about weight loss this should be referred to the GP and dietician. This will ensure people have oversight from health care professionals to secure good health. 2 8 3 8 Care Homes for Older People Page 30 of 32 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 4 9 Medication must be given a the times defined by the presriber. This relates to monthly medication missed for one month. People must have the prescribed medication to sustain good health. Eye drops should be dated when opened. This will ensure medication remains effective. We recommend that an alternative hot dish choice is considered for the mid-day meal. This will ensure people have maximum choices without having to ask for an alternative. Further training in Safeguarding and in the operation of the Mental Capacity Act will ensure people are fully protected. Training must be provide for all staff in Health and safety, Mental Capacity Act, Safeguarding and First Aid. 5 6 9 15 7 8 18 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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