Care Home: Eldon House

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What the care home does well Staff were cooperative and helpful throughout the inspection. People were complimentary about the quality and choice of meals provided. The cook appeared to have a clear insight into peoples choices and preferences. People using the service told us that if they called for assistance in the night staff arrived promptly. The Registered Manager has implemented her own timescales for review of all care plans. What the care home could do better: People using the service who were able, told us that they could rise and retire at times of their choice. We looked at records kept by night staff to identify their tasks undertaken. We found that over the most recent two days prior to the inspection, three people were helped to get up at 05:00 and a further three the previous day at 05:20 . We looked at the care plans for those people got up at this time, to identify if this was their choice. In each persons care plan it was identified that the people liked to be woken between 07:00 and 08:00. Daily records maintained for each of the people did not state that on the days identified they had requested or chosen to get up before the stated preferred time of rising. We looked at staff rotas and found that overnight for the seventeen people at the home there is one waking and one sleeping staff. During the day there are two staff on duty to assist the remaining people with their personal care needs. We have been advised by the manager/provider that there are 3 care staff on duty at peak times, these include between 8-9am and 5-8 pm. There are also a cook and cleaner on duty. The homes Statement of Purpose and service User Guide tells prospective people using the service that Eldon House is ` A service where individuality is emphasised`. We discussed our concerns with the Registered Manager that peoples choices and preferences were not being met. The registered manager told us that the care plans were not updated and so some of the care plan content was not accurate and that this processwas currently being undertaken by herself, with a completion timescale for all care plans within the forthcoming week. The provider/manager has since advised us that people do experience choices of meals and where they eat their meals. The Commission made a previous requirement with a timescale of 23/11/2009 which stated that `The registered manager is required to ensure that all areas of identified need have a care plan in place. This care plan must be reviewed regularly and all changes documented as they occur. This is required to ensure that the person receives the care they need`. This timescale has not been met. The registered manager told us that the care plans she had reviewed were not as detailed as she would have done. We looked at the homes Statement of Purpose and Service User Guide. This document provides people with information about the home. Section 6 of this document told us that `Care plans and risk assessments are updated as soon as the changes to the needs of the service users have been identified, and if there are no changes at least monthly`. This has been identified to not be the case. The Statement of Purpose also told us that there is a `Monthly audit of care plans by the management`. These audits were seen but did not reflect that people were being assisted to rise so early and not in accordance with their care plan. We are advised by the provider/manager that she has undertaken a review of all care plans. We asked to look at one of the already completed care plans. We identified that this care plan was for one of the people assisted to rise at 05:00. The new care plan was also not clear on this issue and stated the person liked to wake around 07:00. The care plan did not identify that should the person choose to rise earlier that was their choice and that this choice should be recorded to ensure a clear audit trail of the decision made. Care plans must be an accurate reflection of peoples choices and preferences and people must be supported to rise and retire at the times of their choosing. We looked at several care plans which were inaccurate in their content and contradictory in their statements. One care plan identified the person as having `Self neglect signs of mental impairment`. Later records stated that the person has no mental impairment. This inaccuracy is confusing for staff and may place people using the service at risk. We saw that one persons care plan had clearly identified needs to support adequate nutrition and fluid intake. The person is in need of monitoring to ensure that enough food an drink had been taken each day. The person is directed to be weighed weekly. We looked at the records of care given. There is no record of how much diet and fluid the person takes daily. There is a total of fluids taken for each morning and afternoon but there is no auditable means to identify how this total was achieved. Staff told us that they know how much fluid is held in the cups used and they know when people are given a drink and this formulates the information. This is not an accurate method to ensure that the person had enough to drink as there is no record of if a drink was only partially taken or refused. There is no record of how much food was consumed to enable staff to know if it was adequate or indicates further action to support nutrition if needed. The care plan identifies this risk and requires that the person is weighed weekly. This Random inspection report Care homes for older people Name: Address: Eldon House Eldon House Downgate Upton Cross Liskeard Cornwall PL14 5AJ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gail Richardson Date: 2 1 0 9 2 0 1 0 Information about the care home Name of care home: Address: Eldon House Eldon House Downgate Upton Cross Liskeard Cornwall PL14 5AJ 01579362686 01579362686 s_hancock@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sharob Care Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 20 Number of places (if applicable): Under 65 Over 65 0 10 20 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 10 0 0 The maximum number of service users who can be accommodated is 20. The registered person may provide the following category of service only: Care Home providing personal care only - CodePC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (Code OP) - Maximum 20 places Dementia - (Code DE) - Maximum 10 places Mental disorder, excluding learning disability or dementia Care Homes for Older People Page 2 of 13 (Code MD) - Maximum 10 places Date of last inspection Brief description of the care home Eldon House is an older property that has been restored and extended to provide care and accommodation for older people. It is situated in a rural area approximately five miles from Liskeard. Accommodation is provided on three floors and comprises 18 single rooms and one double. Four of these rooms are en suite. Access to first and second floor is aided by stair lifts. Communal space is provided on ground floor in a sitting room and a dining room. An additional lounge is available on the first floor. There is level access to the exterior with its extensive grounds. Car parking is available off road next to the home. Sharob Care Homes Ltd also runs a domiciliary care service. 2 6 0 5 2 0 1 0 Care Homes for Older People Page 3 of 13 What we found: This was an unannounced inspection, which took place over 3 hours on the 21st September 2010 by Compliance Inspector Gail Richardson. We worked in conjunction with the Adult Care and Support Safeguarding Lead person. The purpose of the inspection was to gather information and ensure that peoples needs are properly met and people are not placed at risk, in accordance with good care practices and the laws regulating care homes. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. We spent time talking to people using the service, some of whom were not able to share their opinion of the care provided with us due to health issues. We spoke with the staff on duty and the registered manager and we looked at care records and staff documents including staff rotas. What the care home does well: What they could do better: People using the service who were able, told us that they could rise and retire at times of their choice. We looked at records kept by night staff to identify their tasks undertaken. We found that over the most recent two days prior to the inspection, three people were helped to get up at 05:00 and a further three the previous day at 05:20 . We looked at the care plans for those people got up at this time, to identify if this was their choice. In each persons care plan it was identified that the people liked to be woken between 07:00 and 08:00. Daily records maintained for each of the people did not state that on the days identified they had requested or chosen to get up before the stated preferred time of rising. We looked at staff rotas and found that overnight for the seventeen people at the home there is one waking and one sleeping staff. During the day there are two staff on duty to assist the remaining people with their personal care needs. We have been advised by the manager/provider that there are 3 care staff on duty at peak times, these include between 8-9am and 5-8 pm. There are also a cook and cleaner on duty. The homes Statement of Purpose and service User Guide tells prospective people using the service that Eldon House is A service where individuality is emphasised. We discussed our concerns with the Registered Manager that peoples choices and preferences were not being met. The registered manager told us that the care plans were not updated and so some of the care plan content was not accurate and that this process Care Homes for Older People Page 4 of 13 was currently being undertaken by herself, with a completion timescale for all care plans within the forthcoming week. The provider/manager has since advised us that people do experience choices of meals and where they eat their meals. The Commission made a previous requirement with a timescale of 23/11/2009 which stated that The registered manager is required to ensure that all areas of identified need have a care plan in place. This care plan must be reviewed regularly and all changes documented as they occur. This is required to ensure that the person receives the care they need. This timescale has not been met. The registered manager told us that the care plans she had reviewed were not as detailed as she would have done. We looked at the homes Statement of Purpose and Service User Guide. This document provides people with information about the home. Section 6 of this document told us that Care plans and risk assessments are updated as soon as the changes to the needs of the service users have been identified, and if there are no changes at least monthly. This has been identified to not be the case. The Statement of Purpose also told us that there is a Monthly audit of care plans by the management. These audits were seen but did not reflect that people were being assisted to rise so early and not in accordance with their care plan. We are advised by the provider/manager that she has undertaken a review of all care plans. We asked to look at one of the already completed care plans. We identified that this care plan was for one of the people assisted to rise at 05:00. The new care plan was also not clear on this issue and stated the person liked to wake around 07:00. The care plan did not identify that should the person choose to rise earlier that was their choice and that this choice should be recorded to ensure a clear audit trail of the decision made. Care plans must be an accurate reflection of peoples choices and preferences and people must be supported to rise and retire at the times of their choosing. We looked at several care plans which were inaccurate in their content and contradictory in their statements. One care plan identified the person as having Self neglect signs of mental impairment. Later records stated that the person has no mental impairment. This inaccuracy is confusing for staff and may place people using the service at risk. We saw that one persons care plan had clearly identified needs to support adequate nutrition and fluid intake. The person is in need of monitoring to ensure that enough food an drink had been taken each day. The person is directed to be weighed weekly. We looked at the records of care given. There is no record of how much diet and fluid the person takes daily. There is a total of fluids taken for each morning and afternoon but there is no auditable means to identify how this total was achieved. Staff told us that they know how much fluid is held in the cups used and they know when people are given a drink and this formulates the information. This is not an accurate method to ensure that the person had enough to drink as there is no record of if a drink was only partially taken or refused. There is no record of how much food was consumed to enable staff to know if it was adequate or indicates further action to support nutrition if needed. The care plan identifies this risk and requires that the person is weighed weekly. This person has not been weighed weekly. We were told by the manager/provider that the person has capacity to make decisions about how much food is taken. However the registered manager has a responsibility and duty of care to ensure that appropriate monitoring and support is provided. Care Homes for Older People Page 5 of 13 The homes Statement of Purpose told us that For those service users who are unable to communicate, we consult with relatives, carers and other health care professionals so we can determine the service users likely wises. We looked at five care plans for people who could and could not express their wishes clearly, we saw no evidence of consultation with the relatives or representatives. We were advised that on the previous day there had been a re organisation of the lounge. As a result two people using the service were now seated in the upper floor lounge because this was easier to access their rooms to assist them back to bed. We visited those people and spent time talking with them and we looked at their care records. One person is immobile and needs support with diet and fluids and changes of position to ensure there is no risk of pressure sores. This person is recorded as liking company and the banter of the lounge. The other person was recorded as being able to mobilise, but is at risk of falls and had a walking aid with them in the lounge. This person is recorded as at risk of isolation and needs stimulation and one to one contact. We were told by the registered manager that this person is immobile. This error in record keeping is confusing for staff and may place the person and staff at risk. There are no instructions for staff in the care plans to inform them of how the people are to be supported with their risks and identified needs in the change of lounge. We observed that there is no access to a call bell and no supervising record of how often these people are monitored and supported with all of their needs. We noted that in the upper lounge there is a window that is unrestricted and may pose a risk of falls injury. This window restrictor must be put in place immediately. We observed that another person in their room was trying to attract the attention of staff, we noted that the call bell was fastened to the wall on the wall furthest away from the person using the service. We were told that the person had the ability to mobilise independently, however we witnessed the person to be distressed and unable to alert staff. People must have access to a means of alerting staff at any time. We noted that two staff not seen previously, accessed the home freely to undertake maintenance work . We asked to view their recruitment files to establish that the appropriate checks are in place to protect the people using the service from harm. We asked on five occasions for the records to be produced. The registered manager advised that they had been requested by the acting manager but were not currently available. We advised that all recruitment checks must be in place prior to people accessing the home. We observed that there are holes in the stair carpets where fittings for the old stair lift did not match. These may present a trip hazard and must be risk assessed and the appropriate action taken to ensure there are no risks. We also noted that two out of the three wheelchairs stored by the stairs did not have footplates in place. Using wheelchairs without the footplates fitted presents a risk of injury to the person being transported and this poor practice must be discontinued. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered manager 29/09/2010 must ensure that all people planned to be admitted to the home are assessed by a suitably qualified and trained person. It is also required that as part of this assessment the input of associated health professionals is sought. This is required to ensure that the registered manager can ensure that the service can meet the persons needs prior to admission. 2 7 12 The registered person must ensure that all areas of identified need, including management of personal money where this is appropriate, have an agreed care plan in place. This care plan must be reviewed and updated regularly. This will ensure that staff are clear about the persons choices and preferences and those care needs can be met. 30/06/2010 3 7 15 The registered manager is 26/10/2010 required to ensure that all areas of identified need have a care plan in place. This Page 7 of 13 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action care plan must be reviewed regularly and all changes documented as they occur. This is required to ensure that the person recieves the care they need. 4 9 13 Hand written entries to the 01/07/2008 MAR sheets should be witnessed by two signatories. 5 9 13 The management of the 29/09/2010 home must ensure that all prescribed medications are recorded and provide a clear audit trail of prescription, procurement and administration. This is required to ensure that there is a clear audit trail and reduce any risk of error in administration. 6 35 17 The registered person must 14/07/2010 ensure that staff receive appropriate training to ensure they follow the homes policy for the management of personal monies. This will ensure that both people using the service and staff are safe. 7 35 17 The registered person must 14/07/2010 ensure that records of all transactions are accurately maintained and receipts provided to both the person using the service and a copy Page 8 of 13 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action maintained at the home. This is required so that there is a clear and sufficiently detailed audit trail of all management ofp ersonal monies. Care Homes for Older People Page 9 of 13 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, 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 8 12 The registered manager must ensure that identified areas of need are met. This is with reference to people who need support to maintain adequate diet and fluid intake. Where a need for monitoring is identified , this monitoring and supporting action must be undertaken and recorded. 15/10/2010 2 8 12 The registered manager 01/10/2010 must ensure that people being transported in wheelchairs and do so safely. Wheelchairs must not be used without footplates fitted as this poses a risk of injury to people using the service. 3 8 12 The registered manager 01/10/2010 must ensure that people using the service have appropriate access to a means to summon assistance when needed. Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 There must be in place for all people using the service means to attract staff attention and appropriate monitoring arrangements to ensure that people are safe. 4 8 12 The registered manager 15/10/2010 must enable people using the service to make decisions with respect to the care they are to recieve and their health and welfare. People must be supported to rise and retire at the time of their choosing and any changes to this must be documented to provide a clear audit trail of why this has changed. 5 29 19 The registered manager 01/10/2010 must ensure that recruitment checks are in place and available for all staff who have unsupervised access to the home. These checks must be in place and the registered manager must be able to locate them should they be needed. 6 37 12 The registered manager 30/09/2010 must ensure that upper floor windows are suitably restricted. This si required to ensur ethat there is no risk of injury or falls for epople using the service. Care Homes for Older People Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: 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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