Care Home: Elizabeth Court Care Centre

What the care home does well Before anyone moves into Elizabeth Court staff meet with them and their representatives and obtain information about their support needs and choices. They also invite people to visit the home. This helps everyone to decide if Elizabeth Court is the right place for the person to live. It also helps staff to plan how they can meet the persons needs. Elizabeth Court provides people with a warm, safe and comfortable home to live in. Staff have a good understanding of the people who live at Elizabeth Court and of their support needs and choices. Good support is provided to people with their personal and health care and staff liaise with other health care professionals to meet peoples health care needs. Staff take time to sit and talk with people and to offer explanations and obtain their opinion about the support and care they receive. Visitors told us that they are always made welcome at the home and commented on the calm atmosphere there. Information about how to raise any concerns or complaints people have about the service is made readily available and people we spoke with were aware of this. This open approach helps to ensure that any issues are quickly dealt with and that people can feel safe living there. The manager at Elizabeth Court is experienced in both care and management and is clear about her role and about working to continually improve the service they provide. What has improved since the last inspection? Since our last big inspection of Elizabeth Court in March 2008 there have been several improvements made to the service provided for the people who live there. Training for staff in supporting people who have dementia is improving. This includes basic training in understanding dementia and more specialist training such as supporting people with pain relief and with nutrition. This training will enable staff to have a good understanding of how to successfully support people who have dementia. During this inspection we found that there are sufficient staff working in the home to meet the needs of the people living there. Staff had time to interact with people and to build relationships with them, as well as to meet their basic health and personal care needs. Before anyone is appointed to work at Elizabeth Court a series of checks are carried out on them, including obtaining written references. These checks help to ensure that staff are suitable to work with people who may be vulnerable. Improvements have been made to the environment at Elizabeth Court, with firm plans in place for future improvements. The environment is being adapted in a way that is adult but helps the people living there to understand and find their way around their home more easily. For example corridors are themed with seating areas and bathroom doors are colour coded. Several systems have been put into place at Elizabeth Court for checking the quality ofthe service they provide. These include regular checks by the manager as well as seeking the views of the people who live there and their representatives. This helps to ensure that any minor issues can be quickly noted and dealt with. It also provided a clear way to plan future improvements to the service provided. What the care home could do better: Some of the care plans written for the people living at Elizabeth Court should be more detailed with regards to their preferences. As many of the people living there may not be able to communicate their views, detailed plans will help to inform staff of how to meet both the persons preferences and their needs. Information recorded about people social interests and religious interests is mixed. Some people receive very good support with their chosen lifestyles. However records of the support offered to other people with their religious beliefs and activities did not evidence that they are consistently offered support in these areas. A written record of responses to complaints should be maintained in the home. This would provide clear records to refer to, if needed in the future. It would also provide a clear way to establish if complaints have been dealt with effectively. More frequent auditing of medication within the home would help to ensure that it is managed safely at all times and that any issues are quickly noted and acted upon. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elizabeth Court Care Centre New Street Sutton St Helens Merseyside WA9 3XE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lorraine Farrar     Date: 0 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Elizabeth Court Care Centre New Street Sutton St Helens Merseyside WA9 3XE 01744821700 01744821701 ec@keyhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Key Healthcare (St Helens) Ltd. Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 43 Number of places (if applicable): Under 65 Over 65 43 dementia Additional conditions: 0 The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Elizabeth Court is a purpose built care home situated in a residential area of St Helens, not far from the town centre. The home is registered to provide accommodation and support for people who have dementia. Support for people who have dementia and also require nursing care is provided downstairs on Bluebell unit, support for people who have dementia but do not require nursing care is provided upstairs on Primrose unit. Everyone living at Elizabeth Court has their own bedroom, in addition there are several shared spaces including lounges and dining rooms and an enclosed back garden. Aids and adaptations are provided throughout the home to support people with their Care Homes for Older People Page 4 of 31 Brief description of the care home mobility and personal care. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use this service experience good outcomes. We gathered information for this inspection in a number of different ways. Before we visited we sent survey forms to the home. Seven staff completed and returned these to us. We also sent a self assessment form to the manager of Elizabeth Court. This provided us with information about records in the home, the support provided and staff. It also provided us with information about where the manager thinks the home has improved, the areas that could be further improved and their plans for the future. We reviewed all of the information we have received about Elizabeth Court since our last big inspection. All of the above information helped us to plan our visit to the home Care Homes for Older People Page 6 of 31 and in writing this report. We carried out an unannounced site visit to Elizabeth Court on 4th March 2009 , which took place over eight hours. During our visit we spent time looking at the support the people living at Elizabeth Court receive. This included the support they get with their daily lives, health and personal care, money and medication. We spoke with nine visitors and nine members of staff including the manager. We also met with many of the people living there and observed daily life in the home. Fees for living at Elizabeth Court range from five to six hundred pounds per week, depending on the persons level of need and their room. What the care home does well: What has improved since the last inspection? Since our last big inspection of Elizabeth Court in March 2008 there have been several improvements made to the service provided for the people who live there. Training for staff in supporting people who have dementia is improving. This includes basic training in understanding dementia and more specialist training such as supporting people with pain relief and with nutrition. This training will enable staff to have a good understanding of how to successfully support people who have dementia. During this inspection we found that there are sufficient staff working in the home to meet the needs of the people living there. Staff had time to interact with people and to build relationships with them, as well as to meet their basic health and personal care needs. Before anyone is appointed to work at Elizabeth Court a series of checks are carried out on them, including obtaining written references. These checks help to ensure that staff are suitable to work with people who may be vulnerable. Improvements have been made to the environment at Elizabeth Court, with firm plans in place for future improvements. The environment is being adapted in a way that is adult but helps the people living there to understand and find their way around their home more easily. For example corridors are themed with seating areas and bathroom doors are colour coded. Several systems have been put into place at Elizabeth Court for checking the quality of Care Homes for Older People Page 8 of 31 the service they provide. These include regular checks by the manager as well as seeking the views of the people who live there and their representatives. This helps to ensure that any minor issues can be quickly noted and dealt with. It also provided a clear way to plan future improvements to the service provided. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 10 of 31 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. Sufficient information is obtained about and given to prospective residents, before they move into the home. This ensures that people can make a decision as to whether Elizabeth Court can meet the persons needs and choices and is the right place for them to live. Evidence: Elizabeth Courts statement of purpose says that admissions usually follow a visit from the home manager and or visit to the home by the residents themselves. This was confirmed in discussions with relatives of some of the people who live at Elizabeth Court, who told us that they had the opportunity to look around the home before the person moved in. One relative expressed the opinion that, it is one of the best places whilst another told us that they choose Elizabeth Court as they liked the calm atmosphere. Care Homes for Older People Page 11 of 31 Evidence: Information about the home including staff, management, how to raise concerns, meals and costs is displayed in the foyer where it can be easily accessed by anyone visiting. Visitors we spoke with confirmed that they received information about the services provided at Elizabeth Court before their relative moved in. In addition relatives also told us that senior staff from the home visited the person and carried out an assessment of their needs before offering them a place to live. We looked at care records for two people who had moved into Elizabeth Court recently and found that the manager had visited them and carried out a detailed assessment of their needs and choices. The information gained from the assessment process along with the information given to prospective residents and their relatives helps everyone to decide if Elizabeth Court is the right place for the person to live. It also helps staff to plan how they can successfully support the person. Elizabeth Court does not provide an intermediate care service. Care Homes for Older People Page 12 of 31 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. The people living at Elizabeth Court receive dignified support to meet their health and personal care needs and choices. More detailed records would enhance this further. Evidence: A relative of one of the people living at Elizabeth Court told us that they are happy with the care provided, whilst another relative told us the person they visit, looks well cared for. It was clear when we met the people living at Elizabeth Court that they had received support from staff to maintain their appearance and their personal care. Individual care plans are in place for all of the people living at Elizabeth Court and we looked at a sample of these along with daily records for the person. We found the majority of care plans were up to date and provided clear guidance for staff to follow in supporting the person with their personal care and their health. One plan we looked at contained clear information to support the person at night, explaining that they liked the light dimmed, a cup of tea and the windows closed. This level of detail is particularly useful as the people living at Elizabeth Court have dementia and may not Care Homes for Older People Page 13 of 31 Evidence: always be able to express their choices. However the same plan stated that the person needed support to have a bath but did not give details of the type of support they needed, this could lead to unfamiliar staff not supporting the person as successfully as possible. Care plans also contained a series of assessments for the persons health, these included assessment of their pressure areas, nutrition, weight and manual handling needs. The assessments had been updated regularly to reflect any changes. For example one plan we looked at was clear as to why the persons weight changed from monthly monitoring to weekly and back to monthly. This clear recording and reviewing helps to ensure staff can quickly respond to peoples changing needs. One of the people living at Elizabeth Court had recently returned from hospital and remained poorly. No care plan had been put into place for meeting their current health needs, although an entry had been made in the staff diary to do so. Several staff we spoke with were clear about the persons needs and the support they were currently providing. However a lack of a short term care plan could lead to some staff not being aware of, and therefore meeting the persons current needs. We discussed this with the manager who advised that she would ensure a plan was put into place as soon as possible. Daily records showed that staff monitor peoples health needs and liaise with other health care professionals when needed. This includes regular health appointments such as the Optician, Dentist and Dietician. Records showed that staff note any changes to peoples health and take appropriate action, such as referring them to a Doctor or sending them to hospital. Staff we spoke with had a good understanding of peoples health and personal care needs and choices and were able to explain how they meet these. We noted throughout our visit that staff spoke politely and respectfully to people and offered discreet support to them with their personal care. We observed medication being given to people during the evening meal. The member of staff was polite and discreet and offered the person the choice to take their medication at that time. When asked she gave the person a very clear explanation of what the medication was for and also gave them the time to make a decision about taking it. This is very good practice as it ensures peoples rights are protected and that they are as involved as possible in decisions about the care and support they receive. We looked at a sample of records and storage of medication in the home. We found that controlled drugs were well managed with clear records kept. We checked a sample of these and found that they tallied with records held. A fridge is provided for storage of some medications, we found that this was correctly used and that the temperature of the fridge is checked regularly to ensure it is remains suitable. The Care Homes for Older People Page 14 of 31 Evidence: majority of medication recording sheets we looked at had been signed to stated that the person had received the medication. However one sheet recorded a medication that had not been signed for. A member of staff explained that this was no longer used by the person and no stocks were held in the home. This needs to be clearly recorded on the record sheet so that all staff are aware of the persons current medication. We checked another persons medication stock against the records of medication received into the home and given, and found that there was one less tablet than records indicated. The manager does carry out audits of medication. We looked at the last audit in January 2009 and found that this was detailed with good records of any issues noted and actions needed. More regular auditing may help to pick up on any minor errors that could impact on the persons health. The medication room felt warm however no record was maintained of the temperature in there. A daily record of the room temperature taken at different times of the day would establish whether the room is at the correct temperature for medication storage. Staff who support the people living at Elizabeth Court with their medication have had training in the receiving, administration and recording keeping of medications. This helps to lessen the risk of errors which could impact on peoples health, occurring. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support offered to people to maintain their beliefs and interests and live a lifestyle of their choice is varied. Once plans to improve the services currently offered are fully implemented this will help to ensure people are supported to live as fulfilling and interesting a life as possible. Evidence: During our site visit we observed that the people living at Elizabeth Court spent time in various areas of the home as they chose. Some made use of the small seating areas in corridors whilst others spent time chatting with staff or visitors. Staff have an awarness of how people spent their lives before moving to Elizabeth Court and have begun integrating this into their life now. For example one person who used to work in an office was observed spending time with staff and the manager in the office. A relative of another person explained that they used to work in the building trade and staff had supplied them with a hard hat and tape measure and spent time going around the building with them, measuring up. This is good practice as it enables people to maintain their interests and keep their minds as active as possible. A notice board advertises monthly religious services. In the service user guide the Care Homes for Older People Page 16 of 31 Evidence: home state that they hold, a denominational communion service once a month. It also states that they will arrange for a representative of their religion to visit of they wish. Relatives of one person explained that they know their relative received communion in the home but were unsure if he was asked if he wanted to attend the service. We looked at files for some of the people living at Elizabeth Court. One recorded that the person had attended the service, another file recorded that the person had been a regular church attender prior to moving to the home, however it was not recorded whether they had been asked if they wished to attend the in house service. Elizabeth Court employs an activity coordinator to support people with their daily hobbies and lifestyles. In discussions with her she was motivated and enthusiastic in her role and had several plans to improve the service offered to people. This included liaising with the local Alzheimers society to gain information on providing activities for people and looking into arranging outings for the people living at Elizabeth Court. No budget for activities is available, however the activity coordinator advised she has arranged for a family and friends meeting and intends to discuss fund raising that can be used to support residents hobbies and interests. The activity coordinator also explained that she has spent the past couple of months getting the games room ready and observing the types of activities people enjoy. She now intends to use this knowledge to provide a new activity plan for the home and hopes to spend half her time providing group activities and half providing individual support. Records of the support people are offered with activities varied. One person had attended several group activities including art, beauty, baking and a visiting entertainer. However another persons records showed they liked horse racing, snooker and reading a named daily paper, no records were available to evidence if support to continue with some of these interests had been offered. We did observe throughout our visit that staff took time to engage people in conversation, which the residents appeared to enjoy. The service user guide for Elizabeth Court states, your family and friends are welcome to visit at any time. Throughout the day we observed many visitors to the home and the people living there are able to see them in private or in communal areas as they prefer. All of the relatives we spoke with told us that they can visit whenever they want and are made welcome. Elizabeth Court does not act as appointee for anybodys benefit money. Where people do not have the capacity to manage their own money then their relative or representatives are encouraged to do so. Information about the law, advocates and societies that can support people with their rights is made freely available to people Care Homes for Older People Page 17 of 31 Evidence: via the notice board in the foyer. This all helps to protect people rights and choices. The service user guide explains that, special diets can be catered for and that the home have carried out a nutritional analysis of the menu, details of which are displayed in the foyer. In discussions with the chef he was able to explain that he is always advised if anyone is on a special diet and knows where to get information or supplies for anyone who requires a specialist diet due to their beliefs, culture or religion. He was also able to explain the changes they make to the menu for people who have diabetes and we observed that staff ensure people receive suitable drinks and meals. Elizabeth Court provides a four week menu with two choices at each meal time, meals are homemade including soups and cakes. Visitors told us that the meals they have observed are good and look nice and that people get the support they need. We observed part of the evening meal and noted that staff sat with people and provided discreet support where needed. However one lady was eating her meal, independently from a bowl that was sliding around the table causing her some difficulty, no sticky mat was provided to prevent this. The menu records a variety of meals for the main lunch time meal and lighter evening meal. However the tea time choices during our visit were beans on toast or beans and fish cake. The choice of meal on this occasion was limited and a more wide ranging choice would offer people better options. Care Homes for Older People Page 18 of 31 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. The people living at Elizabeth Court and their relatives are confident that any concerns they may have will be listened to and acted upon. This helps people to feel safe whilst living there. Evidence: Information about how to raise any concerns or complaints is made available to the people living at Elizabeth Court and their visitors via a notice board in the foyer. In addition a suggestions box is available that people can use to put forward any suggestions they may have with regards to improving the service provided. We spoke to several peoples visitors and they all told us that they know how to raise any concerns or complaints that they have, with one relative telling us they always find the manager helpful if they approach her about anything. Records of complaints made to the home are maintained and these showed that the manager seeks advice appropriately and acts on concerns raised. However no actual record was available of the outcome of a complaint made by a relative. The manager was able to give a clear verbal explanation and explain that she had given verbal feedback to the relatives. A written record of the outcome would provide a clear record that could be referred to in future if required. Each month the manager does an audit of the home which includes any complaints that have been received, in addition a weekly report is put together for the owner which includes details of any complaints Care Homes for Older People Page 19 of 31 Evidence: received. This all helps to ensure that complaints are dealt with efficiently and effectively. It also provides a clear way to monitor complaints and note if any patterns emerge or if any general actions need to be taken to improve the service offered. Staff told us in their comment cards that they know what action to take if anyone raises concerns with them about the home. This was further evidenced in our discussions with them during our visit. They displayed an awareness of how to note and deal with any potential concerns or adult protection issues that arose and the actions they should take. However records of staff training we looked at showed that only four staff had undertaken training in this area in the last year, although several staff we spoke with told us they had received this training in the past. The manager explained that she is in the process of updating staff training and we saw a training plan, which listed planned training for staff in this area. Regular staff training in this area would help to ensure that are up to date and fully aware of how to deal with any issues that may arise. Elizabeth Court does not act as appointee for the benefit money of any of the people living there. However they do have a clear computer system to list any expenditure people make. We checked samples of this and found it to be in order with receipts kept. This helps to ensure that peoples money is managed openly and safely. Care Homes for Older People Page 20 of 31 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. Elizabeth Court provides a warm, safe home for people to live in. Ongoing decoration and refurbishment of the home is providing an environment that supports people who have dementia to understand and use their home more easily. Evidence: Elizabeth Court is a two story building that provides single, en-suite bedrooms for the people living there. Accommodation is based over two floors, people who require support with nursing care live on the ground floor known as Bluebell unit, whilst people who require support without nursing, live on the first floor known as Primrose unit. Each unit has a living room, dining room, staff office and sufficient adapted bathrooms and shower rooms to meet peoples needs. A passenger lift is available to the first floor. Outside the home has off street parking and a large enclosed back garden. Although seating is available we noted that some of the flagstones were uneven which may be a trip hazard. The manager informed us that they intend to re-design the garden by the end of September 2009, with money from the company and fund raising. Clear plans for this re-design are in place and include a sensory garden, vegetable plot and three hole golf course. In addition flags will be flattered and paths joined up so people can go for a short walk. Once completed this will provide a good facility for the people Care Homes for Older People Page 21 of 31 Evidence: living at Elizabeth Court to use and enjoy. Relatives we spoke with told us that the home is, always clean and tidy and during our visit we observed all areas of the building to be warm, comfortable, clean and tidy. In the past year work has commenced at Elizabeth Court to upgrade the environment to make it more suitable for people who have dementia. For example all toilet doors have been painted blue with a picture on them, this helps people to easily identify the room. Corridors have been colour coded and are being themed. This work is more advanced on Primrose unit and includes a garden corridor. This has relevant pictures on the walls, a small settee at the end and a large roll of wallpaper themed as a garden view next to the settee. This helps both to give people a sense of destination, as they can sit and look at the view and also may help them to orientate themselves as to where they are in the home. Similarly a corridor junction has a small table, chair and lamp and was awaiting a woodland picture to go on the wall which the manager advised they intended to frame as a window. The manager also explained that they have an appointment with the local Alzheimers Society to visit and advise on further adaptations to the home as well as plans to involve the local college in creating interactive art on some corridor walls. Upstairs a games room has been created, this has been thoughtfully completed to a good standard, with a pool table, safety dart board, half papered walls and murals of dominos and playing cards. The room has the appearance of a social club and is both adult in decor and completed in a way that can support people who have dementia to find their way around and identity where they are. In discussions with the manager she was clear about how they intend to continue this work in line with good practice guidance on supporting people who have dementia to understand their environment. For example she advised they are looking into providing memory boxes for bedrooms so people can have a photo or memento outside to help them recognise their room. It was noted at our last inspection of Elizabeth Court that some of the windows has lost their seal and had condensation. During this visit the windows had not been repaired or replaced, however the manager advised us that they have now obtained quotes and intend to carry out this work. Systems and equipment such as disposable gloves and bags are provided to help prevent or deal with any outbreak of infection. Care Homes for Older People Page 22 of 31 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. There are sufficient competent staff working at Elizebeth Court to meet the needs of the people living there. Once planned training is completed, the staff team will be well equipped with the skills and knowledge to provide support in line with current good practice in supporting people who have dementia. Evidence: Relatives of the people living at Elizabeth Court were complementary about the staff team. Their comments included, staff are very friendly, very good and positive and pleasant. The majority of the relatives we spoke with told us that there are always enough staff to support people with one telling us, you always find staff sitting with people here. The manager explained that she uses a dependency tool to ensure there enough staff to meet peoples needs, she also confirmed that she can arrange for extra staff if peoples needs change. We observed during our visit that there were sufficient staff to support the people living at Elizabeth Court and that they were able to spend time interacting with people as well as meeting their support needs. Staff we spoke with displayed a good understanding of the people they support. They were able to explain peoples different support needs and choices as well as the effect that their dementia has upon them and how to provide effective support with this. We observed throughout the day that staff took time to talk with people, appeared Care Homes for Older People Page 23 of 31 Evidence: unrushed and were pleasant and polite with the people living there. The self assessment form, completed by the manager shows that out of twenty seven care staff, eight hold a nationally recognised care qualification (NVQ level 2) and another fourteen are working towards this. In discussions with staff they confirmed that they are supported to undertake this qualification and also receive support to undertake an NVQ at levels 3 or 4. Once the staff undertaking the NVQ 2 have completed this, the home will have exceeded national standards for fifty percent of staff to be qualified at this level. This qualification helps to ensure staff are aware of and up to date with current good practice in supporting people safely and well. In their survey cards staff told us that before they commenced work at Elizabeth Court a series of pre employment checks were carried out. We looked at a sample of staff files for people who hold different roles within the home. These all had a checklist in place to ensure that all required information had been obtained. The files confirmed that before anyone is appointed the home obtain identification and written references, they also carry out a Criminal Records Bureau (CRB) check and a check of the protection of vulnerable adults register. This all helps to ensure that staff are suitable to work with people who may be vulnerable. Staff told us in their survey cards that they receive training which helps kept them up to date and meet peoples individual needs. Computer records of staff training have been compiled, we noted that several staff we spoke with told us they had completed some training that was not listed on this record. However the records did show that not all staff are up to date with basic areas of care, such as moving and handling people and health and safety. The manager was aware of this, she explained that they now provide six hours of training per week and also access external training for staff. We saw a list of planned training until the end of April 2009 which included regular sessions on the above subjects as well as updates in fire and the protection of vulnerable adults. In addition we saw more specialist training booked for staff in, nutrition, decision making, capacity and consent, supporting people with their behavior and diabetes. The manager also explained that two staff have completed a training course so that they will be able to train other staff in supporting people who have dementia. Computer records showed that some, but not all staff have undertaken courses in caring for people with dementia. We saw bookings for staff to undertake training in pain assessment for clients with communication difficulties, activities for people who have dementia and feeding, swallowing and nutrition for people who have dementia. One member of staff also explained that she is now attending local meetings of the Alzheimers society and that they have invited a representative of the society to visit Care Homes for Older People Page 24 of 31 Evidence: the home and offer advice. The training staff have undertaken and that is planned will help to ensure that all staff have a thorough understanding of how to support people who have dementia successfully and in line with current good practice. Records showed that some staff have undertaken a company inducton day. We spoke with a member of staff who explained that when they started work they had an inducton day and spent a week working with more experienced staff, who could explain the routines of the home and the support residents needed. However we saw no records that staff currently undertake national induction standards and a member of staff confirmed that she had not undertaken these. These standards help to provide staff with a good basic knowledge of current good practice in the field of care. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems and practices at Elizabeth Court ensure that the home is safely and well run to benefit the people living there. Evidence: Mrs Norma Sherwin is the appointed manager at Elizabeth Court. Mrs Sherwin is a registered nurse who is experienced in working with people who have dementia and who holds a management qualification. She attends regular training courses to ensure she keeps up to date with current good practice in managing care services safely and well. Throughout our site visit Mrs Sherwin was motivated and enthusiastic in her role and had clear plans and views in place to further improved the service offered to the people who live at Elizabeth Court. Relatives and staff who we spoke with told us that they find Mrs Sherwin supportive and effective. One relative told us they find her, nice, obliging whilst a member of staff explained, she gets things done. At the time of our site visit Mrs Sherwin stated that she intended to apply to register with ourselves as the manager of Elizabeth Court. This process helps to ensure that Care Homes for Older People Page 26 of 31 Evidence: managers are suitably qualified and experienced people to manage a care service. There are several systems in place at Elizabeth Court to check on the quality of the service they provide and plan for improvements. This includes a yearly questionnaire sent to relatives of the people living at the home. The last questionnaire was carried out in August 2008 and the results of this are on display in the foyer. This includes the percentages of people who responded with their views, along with comments made and note of the actions the home have taken in response. In addition there is a comments box available in that anyone can use. These systems are good practice as they enable people to formally give their view on how the home operates and influence future improvements. In addition a series of in-house audits are carried out regularly. These include monthly audits of the kitchen and a weekly audits of complaints, staff, health and safety and the environment. These audits help to quickly identify any issues that may arise and plan how to address them. Elizabeth Court does not act as appointee for any of the residents benefit money. They do however provide safe storage for smaller amounts of money people wish to leave in the home, a record of which is held on computer. We checked samples of this along with receipts and the weekly total and found them to be in order. A series of internal and external checks are carried out on the safety of the building and equipment. We checked a sample of these and found them to be up to date and in order. This includes fire checks and drills, small electrical appliances and checks of the water temperatures and bed rails people use. In addition staff we spoke with were clear about the actions to take in the event of a fire and receive training in this area. This all helps to ensure that Elizebeth Court is a safe place for people to live and work. Care Homes for Older People Page 27 of 31 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 28 of 31 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 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 7 Care plans should be audited to ensure they all contain sufficient, detailed information to guide staff in how to meet the persons needs in the way they prefer. Medication audits should be carried out more frequently. This will help to quickly identify any issues that may impact on the persons health. A check of the temperature in the medication room should be implemented. This will help to ensure it remains at a suitable temperature for medication storage. 2 9 3 12 Peoples previous social interests and religious beliefs should be clearly recorded and this information used to plan the support they are offered. This should include recording when an activity is no longer suited to the person or when it is offered and they do not wish to participate. This will help to ensure people receive support to meet their religious beliefs and also to maintain any interests or hobbies that they had prior to moving to the home. The choices offered at mealtimes should be reviewed to ensure they are varied for that meal. This will offer people a more wide ranging choice of meals. A record should be kept of all actions taken regarding Page 29 of 31 4 15 5 16 Care Homes for Older People concerns or complaints that are made to the home, this includes the outcome and action taken as a result. This will help to provide a clear audit trail that can be referred to in the future. 6 31 The manager should apply to the Commission for Social Care Inspection or replacement body, the Care Quality Commission to register as the manager of Elizabeth Court. This will help to ensure the home has a suitably qualified experienced manager. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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