Care Home: Elizabeth House

What the care home does well People who will be staying at the Home have their needs assessed before agreement is reached to move in. People are encouraged to visit the Home and information is given to help people decide whether Elizabeth House is the right place for them. One person said "I have only been here a few weeks and I have settled really well, there are no problems at all". Care plans are in place for every identified need. Detailed information tells staff the action to take to meet people`s needs, and those people spoken to were happy with the care and the way in which care is provided. People have access to advice from health professionals where they need it, so their health needs can be met. One person said "I see the Dr when I need to, I have had new glasses as well recently. Staff provide my care in a way that I like". People are treated with respect, moving and handling was completed in a way that maintained dignity and put people at their ease. A choice of meal is provided on a daily basis and discussions are held with people to find out their likes and dislikes. Assistance to eat meals is provided in a sensitive way. Two people living at the Home said "there is a choice at breakfast, a choice at tea time and a choice of pudding at lunch, you can have an alternative at lunch if you want", "the food is good, there is plenty of it". The home`s complaints policy is on display for all to see. People living in the home were confident that their concerns would be listened to and acted upon. Systems are in place to ensure that any concerns received are acted upon and action taken to address issues identified is recorded. Staff attend training to give them knowledge of the appropriate action to take if abuse is suspected. Fixtures and fittings are in a good state of repair The Home is well decorated and clean and provides a welcoming, relaxing atmosphere. People said "My room is always tidy, they come in every morning and vacuum and dust", "I like to go in the garden they are really nice". There are sufficient numbers of trained staff on duty to meet the needs of people living in the home. One person said "Staff are all lovely. Everyone here is really kind and friendly. I am sticking here and not moving anywhere else, I can`t imagine being anywhere else". Quality assurance systems take into account the views and needs of those that live in the Home and their advocates. Systems ensure that people are able to have their say. Health and safety systems and practices are maintained to ensure that people live and staff work in a safe environment. What has improved since the last inspection? Evidence was available in those care files seen to demonstrate that care planning is now discussed with people, who have the option of signing care plan documentation if they wish. Care plans seen had been reviewed on a monthly basis and updated as necessary. The adult protection policy has been reviewed and updated to include the fact that disciplinary action will be taken if abuse is substantiated. Details of who should be contacted if abuse is suspected, for example, social services and the police is now recorded on the policy. Alarms have now been put on entry/exit doors to alert staff of people entering or leaving the building. The main entrance door was locked on the day of inspection therefore ensuring that unwanted visitors are not able to enter the building through an open door. Improvements have been made to quality assurance systems, the views of the people who use the service are obtained twice per year and audits of working practices and systems take place regularly. Fire training was up to date for all long term staff. Newly employed staff are booked on to a fire training course. These staff have watched a training video which gives some guidance until they are able to attend their training course. What the care home could do better: The manager and her staff have addressed a majority of the recommendations for improvements identified at the last inspection. One recommendation remained outstanding. The manager confirmed that she spoke to staff following the last inspection and improvements were made. However, it was noted at this inspection that the information recorded in daily entries was insufficient to demonstrate that staff are taking appropriate action to meet people`s care needs. Daily entries did not demonstrate that staff are monitoring people`s changing health and welfare needs. Night entries did not demonstrate that they are checking on people throughout the night. Key inspection report Care homes for older people Name: Address: Elizabeth House Elizabeth Grove Union Road Shirley Solihull B90 3BX     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: Deborah Shelton     Date: 2 0 0 7 2 0 0 9 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 31 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Elizabeth House Elizabeth Grove Union Road Shirley Solihull B90 3BX 01217442753 F/P01217442753 ann.baker@unicombox.co.uk www.elizabethhousecare.org.uk Shirley Old People`s Welfare Committee care home 19 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 19 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: Old age, not falling within any other category (OP) 19 Date of last inspection Brief description of the care home Elizabeth House is a registered care home catering for 19 older men and women aged 65 and over. A committee of a voluntary organisation is responsible for the home. The main criterion for admission is that the prospective resident should be able to walk with or without a walking aid but without the need for physical assistance from another person. Care Homes for Older People Page 4 of 31 Over 65 19 0 3 1 0 7 2 0 0 7 Brief description of the care home The home has three lounges, a dining room and gardens at the front and rear of the building. Bedrooms are located on the ground and first floors. The kitchen, laundry and office are located on the ground floor. It is located in a pleasant cul-de-sac in Shirley, Solihull, which is conveniently close to the main Shirley shopping centre, with amenities such as places of worship, places for socialising and public transport. The current range of fees at the home is 489 to 521 per week. Additional charges are made for chiropody, hairdressing, toiletries and newspapers/magazines 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. The visit took place on Monday 20 July 2009 between 11.00am and 5.05pm. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the Care Homes for Older People Page 6 of 31 past and how it has improved. An Annual Quality Assurance Audit (AQAA) was completed by the manager and returned to us within the timescale required. This document gives information on how the Home thinks it is performing, changes made during the last twelve months, how it can improve and statistical information about staffing and residents. During this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Discussions were held with people who use the service and staff. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Two people living in the home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service, this helps us to see whether the service meets individual needs. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Evidence was available in those care files seen to demonstrate that care planning is Care Homes for Older People Page 8 of 31 now discussed with people, who have the option of signing care plan documentation if they wish. Care plans seen had been reviewed on a monthly basis and updated as necessary. The adult protection policy has been reviewed and updated to include the fact that disciplinary action will be taken if abuse is substantiated. Details of who should be contacted if abuse is suspected, for example, social services and the police is now recorded on the policy. Alarms have now been put on entry/exit doors to alert staff of people entering or leaving the building. The main entrance door was locked on the day of inspection therefore ensuring that unwanted visitors are not able to enter the building through an open door. Improvements have been made to quality assurance systems, the views of the people who use the service are obtained twice per year and audits of working practices and systems take place regularly. Fire training was up to date for all long term staff. Newly employed staff are booked on to a fire training course. These staff have watched a training video which gives some guidance until they are able to attend their training course. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. 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. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs in a way that suits them. Evidence: The care file of the last person to move into Elizabeth House was reviewed. Discussions were held with this person, the manager and staff to identify whether preadmission processes at the Home are sufficient. The manager confirmed that it is usually herself or the deputy manager who complete pre-admission assessments. These can be completed at the persons current place of residence including hospitals or other Care Homes. However, it was noted that people usually come in to Elizabeth House to have a look around, they are able to stay for the day, have a meal and are introduced to other people that live at the Home. The manager said that often pre-admission assessments are undertaken at this time. Care Homes for Older People Page 11 of 31 Evidence: People are given information about the Home in the form of a brochure. A copy of the last inspection report is available to look at and the manager informs people where they are able to get a copy of this report from if needed. The Service Users Guide is available if required. People are given a copy of this document when they move in to the Home. The pre-admission assessment is used to find out information about the persons needs so that the Home can ensure that they have the staffing, equipment and correct facilities to meet these needs. People are given information about the Home and are able to have a look around to ensure that they have enough information before they decide that they would like to move in. Once agreement has been reached, people are able to stay for a two month trial period. A conversation was held with the person whose care file was seen. This person said that they had settled very well and that staff were all kind and friendly. A member of staff spoken to said that when this person first moved in to the Home they had spent extra time chatting to them and introducing them to other people that live at Elizabeth House to try and make them feel at ease. From records seen, discussions with staff and management it was noted that the preadmission processes at Elizabeth House are satisfactory and provide both the Home and the person who wishes to move in to the Home with sufficient information to enable them to make an informed choice about moving into the Home. 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. People have good access to a wide range of health professionals which results in their health care needs being met. People can be sure that their medication will be given to them as prescribed and that they will be treated with respect and their rights to privacy and dignity maintained. Evidence: Two people were chosen to case track during this inspection. This involved looking at their care file, talking to the person (were possible) and to the staff who care for them, looking at their living accommodation and any other records relating to the care of these people. Care files seen contained sufficiently detailed information to enable staff to meet identified care needs. They included information on the task to be completed, the number of staff required to provide assistance, any equipment needed, individualised requirements regarding how to provide the care and preferences regarding independence or timings, for example the time and day that the person prefers to Care Homes for Older People Page 13 of 31 Evidence: have a bath, times for getting up in the morning, going to bed at night. Care plans also recorded ways in which staff are to assist people whilst maintaining privacy and dignity. All three people spoken to confirmed that their care needs were met by staff in the way in which they prefer. They said that staff were kind, caring and patient. Risk assessments were in place regarding the risk of developing a pressure area, malnutrition, moving and handling and other activities that people undertake on a daily basis such as use of a key to lock their bedroom, washing and dressing, mobilising inside and outside of the Home, self administration of medication. Where a high risk was identified a care plan had been developed by the Home which gave staff instructions of the action to take to reduce the risk. Records were available to demonstrate that people have access to external professionals such as GP, optician, dentist and chiropodist. Records also showed that people were able to refuse the services of these people if they wished, for example one care plan recorded that the person had refused to see the dentist when he visited the Home. This takes into consideration peoples choice and independence. There was also other documentary evidence to show that people have access to hospital services and information received from hospitals was readily available in care files. The key worker system is in place. This means that staff will have extra responsibilities for two or three people living at the Home. The key worker for one of the people being case tracked was knowledgeable about the needs of the person under her care. She was able to discuss tasks that are to be completed on a daily basis which help to ensure that this persons health and wellbeing is maintained. This staff member was aware of the persons likes and dislikes and of the instances when further advice should be sought from senior staff or the persons GP. Care plans seen were up to date and information recorded was easy to find and clearly written. From discussions with staff, the people that live at the Home and review of documentation it was evident that care plans contain all of the information needed to enable staff to meet the needs of those that live at Elizabeth House. Medication records, storage and administration practices were reviewed to ensure that systems in place are robust and protect people from risk of harm. Care Homes for Older People Page 14 of 31 Evidence: Medication is stored appropriately in a locked medication cabinet and controlled drugs cabinet. Two medication trolleys, which are secured to the wall when not in use, are used to transport medication when administering it to people in various places in the Home. A lockable medication fridge is available to store any medication that requires refrigeration. Key custody practices were discussed and found to be satisfactory. The storage of medication, including that which is to be returned to the pharmacy was also satisfactory. Controlled drugs were checked and stocks of controlled drugs balanced with records held. Records of controlled drugs were available and clearly written. A copy of the care plan regarding pain relief was available with the medication administration records for the person taking controlled drugs. This reminds staff of the reasons for taking the medication and the correct timings and dosage. The medication and records for the two people being case tracked were reviewed and found to be correct. The manager or deputy audit medication and records on a monthly basis and evidence was available to demonstrate that appropriate action is taken when errors are identified. Appropriate equipment is available to monitor individual blood sugar levels. Records were kept and the manager confirmed the blood sugar level that staff should call the GP, however this was not recorded on documentation seen. Copies of prescriptions are kept for each person, these are checked against medication administration records and medications received into the Home. This helps to ensure that the medication received is correct. All staff have undertaken basic medication administration training. However only those staff who administer medication have also undertaken a level two safe handling and administration of medications course. A list of sample staff signatures is available. This is useful when auditing medication as it helps to easily identify who has given medication on each day. All of the people spoken to during the inspection and those people seen in the lounge were appropriately dressed for the time of year. Ladies nails were manicured and Care Homes for Older People Page 15 of 31 Evidence: some had their nails polished. Hair was nicely brushed and people were wearing clean clothing. Throughout the inspection staff treated people with respect and maintained privacy and dignity. Staff were seen assisting people to move from lounge chair to wheelchair using moving and handling equipment whilst maintaining peoples dignity. Staff were also seen assisting people to drink and were kind and patient. All people spoken to praised staff saying that they were kind and caring and always respected their privacy and dignity. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to keep in contact with family and friends and visiting is flexible. Activities take place to ensure that the lifestyle experience in terms of social and leisure activities meets the needs of those that live at the Home and enhances their quality of life. Meals are wholesome and nutritious. Evidence: Discussions were held with the manager and three people living at Elizabeth House regarding daily life, activities and meals. All three people said that there are things going on in the Home every afternoon if you want to join in. One person said that he likes to spend some time in the lounge chatting to the ladies and some time in his room relaxing. He also mentioned an art class, quizzes and prize bingo. The manager confirmed that once per week an external entertainer provides either a show, singers, guitarist or pianist. The activity list on display recorded various activities such as Monday - art classes, Tuesday dominoes school, Wednesday live show, Thursday quiz etc. The manager said that as well as this there are film afternoons, colouring/drawing sessions and prize bingo. The activity list is on display on the noticeboard by the office and this informs people Care Homes for Older People Page 17 of 31 Evidence: of the suggested activities for the following week. Records are kept in peoples care plans to show what activities they have joined in and whether they enjoyed them or not. The two care files seen showed that these people had joined in several varied activities during the month of July. It was noted that a hairdresser visits the Home on a weekly basis and there is a designated hairdressing room which people visit to have their hair washed and cut etc. On the day of the inspection four people were seen in the dining room joining in an art class. The television was on in the large lounge and people were watching the television or chatting amongst themselves. In the afternoon a member of staff sat with those in the lounge and cut and filed nails whilst chatting to people. The atmosphere was relaxed and friendly. The radio was playing classical music in the small lounge and the manager said that a few people like to sit in this area and listen to music. Other people were seen in their bedrooms reading or watching the television. A Church of England Vicar visits the Home once per month and provides holy communion. The manager said that the Vicar is very friendly and will call in to see people on request. It was noted that all of those currently living at Elizabeth House are either Church of England or do not wish to practice religion. The manager confirmed that they have contact details for a local Catholic Priest who would visit the Home as required. Care plans recorded details of peoples preferences regarding times for rising and retiring and bathing or showering. Details of the tasks the people are able to do without staff assistance, details of where people require prompts and those that they require greater assistance are recorded. The manager confirmed that they try to ensure people remain as independent as possible and have choices in everything that they do. People spoken to said that staff help them out when needed but also let them do things for themselves. Meals were discussed with three people that live at Elizabeth House. All said that the food was OK and confirmed that there was a choice at breakfast and for the evening meal. There is also a choice of hot or cold desert at lunchtime. One person said that although there was no recorded choice of the main lunchtime meal you were able to ask for an alternative if you did not like what was on offer. People said the food is OK, there is sometimes something that you are not keen on but it is generally OK. There is always plenty of food, the food is OK, you have plenty to eat. 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. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. Evidence: We have received one complaint about this service since the last inspection. This was forwarded to the Home for them to investigate. Documentary evidence was available to demonstrate that satisfactory action had been taken to resolve the concerns raised. Complaints forms are available for people to complete if they have any worries and the complaints policy is on display in the Home. The manager said that she has an open door policy and makes herself available to people if they want to speak to her or if they need anything sorting out. Any complaints received are recorded in a log book which also contains details of the action taken to resolve any issues. Care staff were knowledgeable about the action to take if any complaints were raised with them. People spoken to on the day of inspection said that they had no worries or concerns. One person said if you have any problems they are sorted out straight away, I would definitely speak to someone if I had any concerns another person said If I had any worries I would speak to the manager, she is really nice. Care Homes for Older People Page 19 of 31 Evidence: The protection of vulnerable adults was discussed with the manager and with a member of care staff on duty. The carer was aware of the action to take if she witnessed an act of abuse. The manager said that staff have undertaken training regarding the protection of vulnerable adults and this was confirmed by the member of staff spoken to. There have been no issues relating to the protection of vulnerable adults since the last inspection of this Home. Policies and procedures are in place to guide staff of the action to take if abuse is suspected. The manager, deputy and a team leader have undertaken training recently regarding deprivation of liberty safeguarding. The manager confirmed that information will be cascaded to all staff. Staff were seen assisting people to move from lounge chair to wheelchair using appropriate moving and handling equipment. People were moved in wheelchairs safely with footplates in place to enable them to rest their feet whilst being moved. Staff spent time telling a person what they were doing and why when they used specialist equipment to help her get out of the lounge chair. Staff were patient and reassured the person whilst she was being assisted to move. Moving and handling seen on the day of inspection protected people from risk of injury. 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. People benefit from living in a safe, clean and well maintained environment. Evidence: Elizabeth House is a Care Home which has facilities and equipment to meet the needs of the people currently living there. The Home is in a quiet location in Shirley, Solihull, close to shops, public houses and bus services. On the day of inspection the Home was clean and hygienic and no unpleasant odours were noted. Furnishings, fittings and decor were in a good state of repair. Communal areas consist of two lounges and a dining room. The television was on in the main lounge and some people were occupying themselves watching programmes during the morning. The lounge had an organ, television and provision to play music i.e. radio, CD player. Large windows let in a lot of natural light. The manager confirmed that the smaller lounge is used by those people who do not wish to watch television. On the morning of the inspection classical music was playing and people were seen wandering in and out of this lounge as they wished. Both lounges had pictures on the walls and ornaments which give a homely feel. The dining room was also clean and hygienic. Tables were nicely laid at lunchtime, the Care Homes for Older People Page 21 of 31 Evidence: manager said that most people chose to eat their meals in the dining room. People were also seen enjoying an art class in the dining room in the afternoon. Ramps are available to the entrance of the building and to the garden via the lounge. Exit doors to the garden are alarmed to make staff aware if anyone is leaving the building. Gardens were well kept and had lots of brightly coloured flowers, hanging baskets and pots which provide visually attractive displays. A water fountain provides a focal point for the attractive gardens and seating and shades are available to enable people to sit outside if they wish. Bedrooms seen had personalised with pictures and ornaments and were all clean with no unpleasant odours. Call bells were easily accessible to people whilst in bed to enable them to get assistance from staff when needed. There are two assisted bathrooms and a shower room which enables people to have the choice of having a bath or shower to suit their preferences. A hairdressing room is also available and the hairdresser visits every week. The laundry was clean and hygienic. All equipment in the laundry was in good working order. The washing machine has a sluice cycle and can wash clothing at appropriate temperatures to meet infection control standards. Laundry processes were discussed with the manager and found to be satisfactory. Disposable gloves and aprons area available throughout the Home and are used by staff when undertaking laundry duties. A separate hand wash sink is available in the laundry. The Home has machinery to dispose of soiled continence pads and a bed pan washer to clean commodes. The manager confirmed that commodes are cleaned every day whilst people are in the lounges and are replaced in the rooms in the evening. Liquid soap and disposable hand towels are available in bathrooms and toilets. Adaptations such as raised toilet seats and grab rails are available to meet peoples assessed needs. The Home has hoists to assist those with mobility difficulties. The Home are involved with the Infection Control Improvement Foundation and attend three monthly workshops regarding infection control. Infection control issues are monitored within the Home with the aim of making improvements. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of competent staff on duty to meet the needs of people living in the home. Each person can be assured that they are cared for by staff who are suitably employed and trained to carry out their job. Evidence: The number of staff on duty each day is as detailed below: 7.30am - 5.00pm Manager or Deputy 7.30am - 2.00pm Senior or Team Leader 3 care staff 2.00pm - 9.00pm Senior or Team Leader 2 Care Staff 5.00pm - 9.00pm 1 Care Staff (in addition to care staff working 2.00pm - 9.00pm) 8.45pm - 8.00am 2 waking care staff From discussions with staff, review of duty rotas and observation on the day of inspection it was evident that appropriate numbers of staff are on duty each day. All Care Homes for Older People Page 23 of 31 Evidence: people spoken to during the inspection were complimentary about staff saying staff do what you want them to do, you only have to ask, nothing is too much trouble, staff come quickly when they are called, they are all friendly with a good sense of humour, staff help when needed, the staff are all really friendly and kind, they come in every morning and help me choose what to wear and to get dressed, the staff are wonderful. The Home also employ catering and domestic staff and a gardener. Care staff complete laundry duties on two days, Monday and Friday when there is only one member of domestic staff on duty, the rest of the week the domestic staff undertake laundry and domestic duties. A majority of staff at Elizabeth House have been in post for a number of years. Agency staff are currently being used to cover shifts due to two staff vacancies. The manager confirmed that they try to ensure that the agency send the same staff each time so that the people that live at Elizabeth House are familiar with the staff that care for them. The manager is also working some care shifts to help provide cover until new staff are employed. The personnel files of the two staff employed since last inspection were reviewed. Both files contained sufficient information to demonstrate that recruitment practices are robust. Information to ensure that suitable people are employed to work with vulnerable adults is available. Files contained two written references, application forms, criminal records bureau checks (CRB), Protection of Vulnerable Adults (POVA) checks, statements of terms and conditions of employment amongst other things. The manager confirmed that criminal records bureau checks are undertaken for all staff before employment, staff do not work shifts in the Home until this information has been obtained. Staff files contained certificates to demonstrate training undertaken. Those files seen showed that staff had undertaken moving and handling, protection of vulnerable adults and infection control training. A discussion took place with the manager regarding staff induction and training. It was noted that all staff have undertaken induction training in line with the requirements of the Common Induction Standards. Induction records were available in the staff files seen. In-house induction training also takes place and this covers staff responsibilities as recorded on their job description, important policies and procedures such as protection of vulnerable adults, disciplinary etc, watching videos re food hygiene, health and safety, fire etc. It was also noted that newly employed staff must shadow Care Homes for Older People Page 24 of 31 Evidence: or work alongside another member of staff for at least two weeks before they are able to work without supervision. Training records are kept in individual staff files. A training matrix also records training undertaken. From discussions with the manager and deputy and records seen it was noted that two newly employed staff have not undertaken in depth fire or moving and handling training. These subjects are discussed during induction training and staff must watch a video regarding both subjects. The manager confirmed that the in depth training has been booked and staff will attend in the near future. Recent training undertaken by staff includes dementia, protection of vulnerable adults, first aid, fire, health and safety, moving and handling, infection control, continence medication training and control of substances hazardous to health. The manager, deputy and five other staff are currently undertaking a distance learning course regarding palliative care. The annual quality assurance assessment completed by the Home records that seventeen of the twenty care staff currently employed have achieved a National Vocational Qualification (NVQ) in Care at level two. One recently employed staff member spoken to during the inspection confirmed that she is undertaking this training currently. This should mean that people living in the home are cared for by competent staff. Staff spoken to during the inspection said that they do a lot of training such as infection control, first aid and dementia. Staff said that they would ask the manager if they could attend any training course that they felt necessary to help them care for the people that live at Elizabeth House. 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. The home is well managed and has systems in place to ensure that the safety and well being of the people who live in the Home, visitors and staff are promoted and protected Each person can be confident that the running of this services involves all those who are involved and considers what is best for those who live there. Evidence: Management systems and practices were discussed. There have been no change in management arrangements since last inspection. The manager has worked at the Home for fourteen years. The manager is supported by a deputy and team leaders. Lines of accountability were discussed and staff were aware of who to report to if they had any concerns or issues. Arrangements for providing support to staff whilst the manager or deputy were not on duty have not changed since the last inspection. The manager, deputy or team leaders provide on call support to staff on a rotational basis. This ensures that staff on duty have access to help and support twenty four hours per day. Care Homes for Older People Page 26 of 31 Evidence: From review of documentation and discussions with staff it was noted that management systems and practices in this Home are good. However, the annual quality assurance assessment (AQAA) document completed by the Home and sent to us before this inspection contained sparse information about life at the Home, what the Home does well, what could be improved and planned future improvements. During discussions the manager mentioned various areas of improvement that the Home has made since the last inspection that were not mentioned in the AQAA. Quality assurance systems and practices were discussed and records were reviewed. A six monthly satisfaction survey is sent to all who live at Elizabeth House. Some of the surveys for April 2009 were seen, these contained positive comments about life at Elizabeth House. Elizabeth House is owned by the Shirley Old Peoples Welfare Committee. A member of the committee visit on a monthly basis to talk to staff and the people that live at Elizabeth House to find out their opinions of the Home. Each person is spoken to at least once within a twelve month period. Any issues for action identified are reported and forwarded to the manager who undertakes the appropriate action to ensure issues are addressed. The Home have developed a quality assurance file which contains copies of the quality assurance procedures, statement of purpose and service users guide. Various audits are undertaken as part of quality assurance practices. Audits of peoples spending money are undertaken monthly. This is to ensure that funds held balance with records. All policies and procedures are reviewed and amended if necessary every twelve months. The Homes fire risk assessment is reviewed annually, care plans, accident records and medication is audited monthly. Room checks are also completed monthly. These are used to ensure that all equipment in bedrooms is in good working order and that the room is tidy and clean. Meetings take place twice per year to enable those that live at Elizabeth House to have their say about daily life at the Home. Minutes of meetings are taken and action to address any issues raised is recorded on the minutes. There are no separate relatives meetings but relatives are invited to the main bi-annual meeting. Fund raising events take place such as a cheese and wine evening which is held once per year and two coffee mornings are held per year to fund raise for the Home. The manager confirmed that she attends these events and makes herself available to speak with people if they wish. Care Homes for Older People Page 27 of 31 Evidence: The minutes of the last residents meeting held April 2009 were seen. The minutes demonstrate that at this meeting discussions were held regarding food, rooms, entertainment and decor. People were able to have their say and make suggestions for improvements. The systems and practices regarding storage and issuing peoples spending money was discussed. There have been no changes since the last inspection. Funds are stored securely and records are audited by the manager and a different member of care staff each month. Receipts showing details of any expenditure are available. Information is kept separately for each person. The spending money log book is signed by two people each time money is received or withdrawn. Signatures are required from either two members of staff or one staff member and either the person whose money is being withdrawn or their relative. Records were not checked on this occasion. Records held in staff personnel files seen demonstrated that staff receive regular supervision. Detailed information was recorded regarding training undertaken, policies and procedures of the Home etc. Staff spoken to confirmed that they receive supervision and are able to air their views at these meetings and discuss any areas of concern or other issues. A selection of records were examined to see if the Home have adopted appropriate systems and practices regarding health and safety. Records seen were up to date and demonstrated that servicing and maintenance of systems and equipment is carried out. For example, fire extinguishers were last checked on 10 October 08, portable appliance tests were undertaken July 09. A Legionella risk assessment was undertaken in April 09, a contract is in place with an external professional who undertake risk assessments and complete all required works. Other records reviewed related to call alarm systems, fire detection and alarm, emergency lighting and lifting equipment. All had been serviced as required within appropriate timescales. The last Landlords Gas safety certificate issued was dated January 2009 and records show that fire alarms are checked on a weekly basis to ensure they are in good working order. Risk assessments were seen regarding activities that staff undertake, i.e. making beds, vacuuming, using sling and hoist use of electrical beds, use of dishwasher etc. The manager said that every activity undertaken is risk assessed. These are reviewed on an annual basis or sooner if things change or new equipment purchased. Care Homes for Older People Page 28 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 29 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 Care Homes for Older People Page 30 of 31 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. 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